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Calculated Risks Pay Off

February 1, 2006
by Mark Hagland
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Mitchell Adams, executive director of the Massachusetts Technology Collaborative (MTC) since 2001, doesn't have a typical background for a healthcare IT leader. Rather than having a conventional technology background, Adams' main experience is in finance. After receiving a bachelor's degree from Harvard College, cum laude, in 1966, and an MBA from the Harvard Graduate School of Business Administration in 1969, Adams worked in a variety of financial management positions, including stints as budget director at what is now Boston's Beth Israel Deaconess Medical Center and vice-chancellor for finance and administration at the University of Massachusetts Medical Center in Worcester. Although in the 1990s he was best known as Massachusetts' top tax man as the state's commissioner of revenue, Adams is no numbers-crunching bureaucrat.

These days, Adams' passion for a good challenge is steering the helm of Massachusetts' most ambitious healthcare IT project: A drive to implement computerized physician order entry (CPOE) systems in every hospital in the state.

"I'm absolutely a can-do person," Adams says. "I thrive on the possibilities for success. And I've always been that way. I'm not, however, a gun-slinger." Instead, Adams says he takes calculated risks, pointing out that one of his most important innovations as commissioner of revenue was to invent a program for telephone-based tax filing, now standard across the United States. "It had been tried by Illinois and Mississippi in little test pilots," he says. "We looked at it in Massachusetts and decided not to do a pilot; we just did it. And in our first year, we had a potential of 1 million taxpayers who could have used the telefile system. In year one, 400,000 did it."

The rollout was carefully planned, with live testing in advance and armies of coordinated test-users. Still, Adams says he was more than willing to take the controlled risk.

It all began when MTC released a study two years ago that estimated 300-400 patient lives could be saved every year through CPOE implementation statewide. That's "almost a person a day," Adams emphasizes. The state's governor publicly released the study, with its top-line conclusion that it would cost $210 million for the state's hospitals to implement CPOE, but that doing so could save $305 million annually.

To Adams, the impetus is obvious, as he cites the exorbitant cost of healthcare services in Massachusetts compared to other regions. "If you look at the data, you'd be hard-pressed to find anywhere else where a unit of healthcare costs more," he says.

The initiative, which is also supported by the Cambridge, Mass.-based New England Healthcare Institute-an organization that is partnering with the MTC on this and other projects-will have spent $1.7 million on consultants, studies and support for the project by summer.

This kind of intensely collaborative work toward a common goal is an activity that Adams says he's naturally well suited to guide. "In preparing the initial report, we had brought together a working group of over 30 leaders from stakeholder organizations, including insurers, providers" and local civic leaders, he recalls.

After brainstorming together on what the initiative's first goals should be, they settled on inpatient CPOE as a key goal for EMRs for several reasons, Adams recalls.

"One [reason] was the obvious one, which is that it appears there's more dollar savings here than with the other technologies. And that's important, because if you can make a compelling dollar case for ROI [return on investment], you grease the skids and improve the case for change. But the other reason we went for inpatient CPOE is that the data demonstrating the savings is more readily available than with other technologies-there was reason to believe you'd have a promising outcome."

Adams' crusade for statewide CPOE implementation has gotten attention in places where it counts: The state legislature has dedicated $500,000 to support the initiative, while the MTC was able to augment that with an additional $700,000 from the organization's own funds, for a current total operating budget of $1.2 million. "This has really caught fire," Adams says. The first 12 hospitals, with MTC's guidance, are on track to begin their rollouts sometime this year. Preparatory work is under way for the next group of hospitals to roll out in the following two years.

As if all this activity weren't enough, in November Adams also signed on as the new chairman of the Massachusetts e-Health Collaborative, a Waltham, Mass.-based consortium that is spending $50 million (supported by funding from the Boston-based Blue Cross Blue Shield of Massachusetts) to universalize EMR adoption among physicians across the state. The initial focus is on wireless connectivity among all the physicians' offices and hospitals in each of three communities-North Adams (western Massachusetts), Newberryport (northern Boston), and Brockton (southern Boston).

The e-Health Collaborative initiative, he says, should be viewed as a "sibling" to the Massachusetts CPOE Initiative. "[The two projects] are done in complete sync," he adds.

On a personal level, Adams reflects, "I've always been an entrepreneurial spirit, even in large organizations. For example, during the eight years I spent as commissioner of revenue, the politics of the situation was such that I could be extremely innovative with IT, and I was so."