Making Healthcare Work
Healthcare systems worldwide are seeking ways to encourage physicians to adopt digital medicine. In the U.S., the provisions in the American Recovery and Reinvestment Tax Act are designed to encourage adoption by providing financial incentives for physicians and healthcare organizations to use EHRs and penalties for not doing so. As Potter notes, “With the state of our current EHR, we had a high adoption rate among our physicians. But although many embrace EHR innovation, it is a proven fact that some will resist improvements such as CPOE [computerized provider order entry].” As Deloitte’s Keckley puts it, “Implementing EHR is like telling someone they need to drive a car within the speed limit. It should be required.”
At TOH, Potter managed to get broad physician buy-in by having two of the hospital’s well-respected physicians report directly to him. “Having two physicians reporting to a CIO—you should have seen the reaction when I suggested that to senior management,” he says. “They’re like, ‘My God, doctors only report to doctors!’ So it’s a bit of a culture shift.” Fortunately for Potter, his chief clinical information officer, Dr. Glen Geiger, was an electrical engineer before going to medical school, and epidemiologist Dr. Allan Forster, scientific director, Clinical Quality and Performance Management, studied patient safety and quality of care at Harvard. Thus, both recognized the importance of technology. In Potter’s words, both “wanted in” once they understood that Potter was not just implementing technology for technology’s sake.
“It’s all about enabling better patient care,” says Potter. “A lot of adverse events that occur would not occur if patients were more aware.” Potter has established awareness as a theme to promote better-informed patients and doctors. He even intends to print “Awareness” on coffee mugs and T-shirts.
To advance awareness, Potter aims to create a unified portal interface to harmonize the “several hundred clinical systems” that TOH inherited and interacts with through the CLHIN. He intends to use a SOA to allow real-time access with a single sign-on to all the distributed systems. He cites online banking as a model: “When you do online banking, you interact with between 12 and 15 systems to do things like pay bills or transfer funds. But you don’t know that, because the complexity has been abstracted away from you, the consumer, through the SOA.”
Some of Potter’s goals are yet to be achieved, but TOH has already reaped huge benefits using Oracle Warehouse Management, Oracle iProcurement, Oracle Daily Business Intelligence, and mobile supply chain applications. And it will soon implement Oracle’s PeopleSoft Enterprise applications for recruitment, payroll, and workforce administration. In particular the warehouse management solution is “enabling us to be the regional warehouse for the entire CLHIN—20 hospitals or healthcare institutions in the region,” says Potter. “So if a small hospital in Alexandria buys a bed, it’s going to arrive at our campus. We’ll manage the logistics of getting it to where it’s supposed to be. And the supply chain and warehouse management applications are the backbone enabling that functionality. As we speak, we’re constructing a new warehouse at one of our campuses, and the warehouse management system does all of the picking and shipping and gives us a single view of inventory.”
The key to improving both processes and patient care is information management through data warehouse and other technologies. “The trick is integrating information so it flows,” says Potter. “I want information to follow a patient from admitting to transfer to discharge. And then, on their next encounter [with TOH], we would know who they are. We have that information today, but it’s all disaggregated in various clinical systems.” Essentially, he adds, TOH is prepared to enable all the region’s healthcare institutions to “use advanced technologies that they couldn’t justify given their size, such as the portal. It’s about scale.”
US Oncology: Rethinking Cancer Care
Unless you’re in the community oncology field, you’ve probably never heard of US Oncology, acknowledges senior vice president and CIO Todd Schonherz. But although it may not yet be a household name, the company, headquartered 30 miles north of Houston, Texas, supports a network of more than 1,200 physicians operating in 468 locations in 39 states that treats more than 640,000 patients a year. (According to the American Cancer Society’s 2009 Cancer Facts & Figures, there will be 1,479,350 million new cancer cases in 2009.) And, says Schonherz, his company’s goal is to use that scale to improve both cancer care and the patient experience while bringing down costs to patients and payers.
As is the case with TOH, the key is using technology to leverage scale—aggregating the information that US Oncology retrieves from all those thousands of cases to advance the physicians’ practice of evidence-based medicine. At the center of US Oncology’s technology is its iKnowMed application, an oncology-specific EHR that US Oncology recently fully migrated from a Smalltalk and GemStone environment to a Java and Oracle Database environment, and took to enterprise-class speed and scalability through Oracle Coherence, part of Oracle Fusion Middleware. The application is fully integrated with US Oncology’s practice management system for patient registration and scheduling. When a patient enters the US Oncology system, a nurse inputs the patient’s history, vital signs, and medications into the EHR. But what distinguishes iKnowMed from other EHR applications is the rich oncology-specific content that supports the clinician’s treatment decisions. US Oncology preloads the EHR with treatment regimens on specific cancers, including research trials, to present the physician with clinical pathways. Designed by US Oncology’s 1,200-strong network of physicians, these are treatment choices based on outcomes evidence from peer-reviewed journals and relative cost factors. In this way, the physician can design an evidence-based, optimal course of treatment tailored to the individual patient.