Keeping Healthcare Healthy

C. Martin Harris, CIO, Cleveland Clinic, truly believes that electronic medical records are the key to the long-term health of the healthcare delivery system. “As I look around the world, whether you have government sponsored delivery systems or privately sponsored systems, the real goal is to make healthcare more valuable,” stresses Harris.

The Cleveland Clinic is a physician group practice, employing 1800 physicians and scientists. In 1921, the practice operated out of a single building, and was able to make sure that patient information was in front of the physician whenever they saw the patient. Today, at over 10 million square feet spread across 70 miles it is impossible to do this using a paper model. The answer is the electronic healthcare record.

By delivering quantifiable improvements in quality, while managing cost effectively, the value of healthcare will soar. Introducing information technology directly into the practice of medicine is important in order that practitioners – doctors, nurses and other allied health professionals – can use those tools efficiently and continuously.

Beginning on the ambulatory side of the organization, which is the largest daily portion of the operation, Cleveland Clinic looked at how the ambulatory practice worked, and made a decision to implement electronic medical records in this area first. This was in contrast to many other organizations who focused on the hospital side first. Today, in all of the clinic’s facilities the physicians use the electronic medical record in the examination room while the patient is there, to document the care, to assist them in making medical decisions, and to set up services that can be delivered to patients virtually, when they leave the office.

“The average 65-year-old in the US is on six to seven different medications. The average internist sees somewhere between 20 and 30 patients a day. If you do the math there are far too many adverse drug interactions that could occur, or that an individual physician could really remember,” says Harris. “So, a key function of our computerized medical record system is to provide decision support to our physicians, as they see patients every day.”

Over the past two years, Cleveland Clinic has implemented electronic medical records on the hospital side of the practice also. “We’ve installed the exact same electronic medical records with a single system,” comments Harris. “Our patients can be reassured that when they’re seen by one of our ambulatory physicians, and they have to be admitted to the hospital, all of their information is immediately available to the physicians who will be seeing them on the hospital side.”

Challenges and opportunity

For Harris the implementation of electronic medical records has been both a challenge and an opportunity. The challenge involved fundamentally rethinking how the care process would be delivered once the tools were in place. “We had to create a vision of how the tools would be used to enhance the relationship between patients and physicians,” explains Harris. “Once we were able to do that it enabled us the opportunity to be a leader in bringing consumers and patients directly into the healthcare decision making process.”

Cleveland Clinic has been able to implement some innovative tools off the back of their electronic healthcare records. “We envisioned the use of information technology and saw it as an expression of the Cleveland Clinic, and a mechanism for fundamentally redesigning how we deliver care.” The initiative was called eCleveland Clinic. As Executive Director of the project, Harris cites the primary mission is introducing health information technology at the point of care and to deliver clinical services to patients and physicians.

The initiative now contains a portfolio of services that are focused on patients and providers. One of which is MyChart, which makes a patient’s record available to them online 24 hours a day, seven days a week, providing a service directly to the patient. They can see their medication list and the test results that their physician has released to them. MyChart is the single largest service provided by Cleveland Clinic, with over 115,000 patients using the service today.

The opportunity for innovative technology is being able to enhance the way services are delivered to patients. “In banking, the ATM is the business transaction, in healthcare it is the personal delivery services that are ultimately what we have to offer patients and consumers,” believes Harris. “Technology is the supporting tool but if it is done in the appropriate way it can enhance the kinds of services that health professional can provide to patients.”

Patient/physician relationship

Electronic medical records have made a tremendous difference in the way that patients have been able to interact with physicians. For Harris this means that he has been able to increase patient satisfaction scores, by thinking about delivering healthcare services from the patient’s perspective. Providing information online to a patient when they are ready to absorb it has become a very important part of effective communication with a patient.

In the traditional paper world, a patient would come into the office and was given certain information. They remembered on average, around 25 to 50 percent of what they were told. They went home, and would come back after three or four months and the exercise was repeated. “The new online technology has allowed us to extend the patient/physician relationship right into the home, so that using the technology our physicians can send messages to patients directly in real time. And we know that the patient has information that they can continually refer to,” notes Harris.

The records have also allowed Cleveland Clinic to measure how well they are doing in caring for not just an individual patient, but an entire population of patients. As an example Harris looks at diabetic patients: “We now have the ability to look at every diabetic patient being cared for in our system, look at some specific measures, make a decision about whether we have done an optimal job, and then use the tool to actually improve their scores in a regular and consistent fashion. It’s really helping to drive the quality paradigm as we move forward.”

In addition, the electronic medical records have produced some operational efficiencies that have become essential to the long-term economic health of Cleveland Clinic. Less time is spent registering patients when they show up at the front desk and paper expenses associated with handwriting and copying documentation have decreased.

Finally because the tools have some fundamental safety features, Harris believes that the clinic has been able to dramatically reduce the number of adverse events that can occur in a complex healthcare delivery system.

One such tool has been the introduction of ePrescribing. Prescription writing is probably the most common function that all physicians perform. At the Cleveland Clinic last year alone just under three million prescriptions were handed out. In a typical organization that means three million slips of paper that have to be interpreted by a pharmacist – hopefully accurately – and entered into a computer before the prescription is administered. Using ePrescription the physicians at Cleveland Clinic do not have to handwrite their medication but rather select medications from a computerized list, that only has appropriate doses on it. This lowers the amount of adverse events that could happen and ultimately makes the prescribing process easier, faster and safer.

Future

Over the next 20 years it has been predicted that 77 million Americans will retire, which is the largest single cohort of Americans to retire in a 20-year period. “If you assume that they will have roughly the same sets of diseases that the current Medicare population has, we literally do not have the physical facilities for all of those individuals,” remarks Harris.

For Harris, this means the most exciting new technology is the potential of home-based technology. “For many chronic diseases, if we have the right technology in the home – blood pressure cuffs, intelligent scales, personal health records such as MyChart – then we will be well positioned to care for a number of patients in a very high quality way, literally from their home.”

Harris also believes that the integration of medical technology with information technology will become more common in the future. As the medical device industry makes ever more intelligent devices that are being implanted in patients, that have the ability to relay the physiologic state of the patient at a given moment technology can only advance. “Tomorrow will actually be a vehicle for intervening in a patient’s health,” predicts Harris. “The ability to use information technology offers a huge advantage in our ability to care for chronic diseases like diabetes and keep us healthy.”

The eCleveland Clinic portfolio of services

DrConnect – For independent physicians. If you have a computer and a browser in the office you are able to virtually follow the care that is being delivered to your patient on a daily basis while they are at Cleveland Clinic. The most important function of this service is that when the clinic are finished caring for the patient, the referring physician will know exactly what has happened to the patient so they can continue to deliver the best possible care.

MyMonitoring – This is an innovative service that allows a patient to make a decision about they would like to receive the chronic care of implanted medical devices. The most common example is a pacemaker. Through MyMonitoring, the clinic can offer the convenience of having their pacemaker checked from the comfort of their own home three times a year. They have a 30-day window to connect their device to the electronic medical record over the Internet and deliver the information.

MyConsult – An online medical second opinion service available to any patient who may have suddenly been given a new medical diagnosis that is life altering of threatening. In this situation 80 percent of people will seek a second opinion. Accessing the website, the patient can enter their primary diagnosis and follow a six-step process that guides them through the information that they need to input. At Cleveland Clinic a sub-specialist reviews the information and contacts the patient with recommendations and reference material to make sure they are maximally informed about everything to do with their condition. This service is provided to patients in 49 different countries, the vast majority of who never arrive at the clinic’s campus.

MyChart – This makes a patient’s record available to them online 24 hours a day, seven days a week, providing a service directly to the patient.

About C. Martin Harris

C. Martin Harris, MD, MBA, is the Chief Information Officer and Chairman of the Information Technology Division of Cleveland Clinic in Cleveland, Ohio. Additionally, Harris is Executive Director of eCleveland Clinic, a series of eHealth clinical programs offered over the Internet.

Harris received his undergraduate and medical degrees from the University of Pennsylvania in Philadelphia. His residency training in general internal medicine was completed at The Hospital of the University of Pennsylvania. He completed a Robert Wood Johnson Clinical Scholar fellowship in General Internal Medicine at The University of Pennsylvania School of Medicine and holds a Masters in Business Administration in Healthcare Management from The Wharton School of the University of Pennsylvania.