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At Cleveland Clinic, Leveraging IT for Systemic Transformation

February 3, 2015
by Mark Hagland
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As he prepares to deliver a keynote address at the Health IT Summit in Miami, Cleveland Clinic CIO C. Martin Harris, M.D. shares his perspectives on the leveraging of IT for fundamental transformation

Exciting things are always happening at Cleveland Clinic, the multi-hospital integrated health system based in Cleveland. The 10-hospital integrated health system has long been on the leading edge in terms of clinical quality improvement, clinical integration, and IT innovation. C. Martin Harris, M.D., Cleveland Clinic’s CIO and the chairman of the organization’s Information Technology Division, will speak of the organization’s work when he presents a keynote speech, titled “The Role of Integrated Technologies in the Innovation of Medical Practice,” at the Health IT Summit in Miami, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC), on Feb. 10 at the Ritz-Carlton Coconut Grove Miami Hotel, in Miami, Fla.

As the conference’s description states, “During his talk, C. Martin Harris, M.D. reviews several real-world examples that illustrate how technology professionals and clinical practitioners are working together to create services that will fundamentally transform the 21st century’s model of healthcare delivery.

In anticipation of his presentation, Dr. Harris recently gave an interview about his keynote address to HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

What are some of the latest developments these days at Cleveland Clinic?

We’re transitioning out of what I call the transactional phase of information management, and are really moving into what most people call the analytics phase. And my view is that there’s a third phase, the knowledge management phase. In the analytics phase we really are focused on driving the combination of strategic and tactical goals, and the practical implementation of information technology. So we’re spending far less time on the technology, because most of the big systems, at least at CC, are already in. so put the network in, put in your EMR, build the data center, put your processes in, put in an enterprise supply chain and HR system, consolidate your systems, and so forth. That’s all been done.

Now, all of those systems generate a wealth of data, and we’ve been using that data in a tactical way: the blood tested high, that kind of thing—alerts. Very simple transactional kinds of activity, and simple reporting. So the analytics phase to me says, now that we have all those systems in and all those caregivers using the systems, and they’re used to the alerting, to change their focus. We will always be caring for patients one by one; what we need to add to that is the ability to think about subpopulations and entire populations of patients, whether or not they’re sitting right in front of us.

So if you go to industry meetings, you will see hundreds of conversations in this space. But what is top of mind for us is actually translating those ideas into practice. So the big models of operations for us are care paths—that’s a model that is really quite individual right now… You can’t buy a fully developed care path from a single vendor in the marketplace. And if you went to 10 different healthcare organizations and asked for a care path, you’d be looking at 10 different things. So we’ve put a significant amount of investment into figuring this out, and to summarize, it’s about purpose, people, process, and technology.

So we’ve really been focused on creating these teams that are interdisciplinary, with shared outcome and process goals, to reach the value equation. An example is hip and knee replacements. We now have an operational care path, what this should look like, for hip and knee replacements.

Are you and your colleagues essentially creating templates for care delivery, then?

Yes, though it’s broader than that.  Let’s save that we’ve got maybe 100,000 patients in our system—and I’m just making that number up—who have osteoarthritis of the hip and knee, now most of those can be managed. And the patients start out in the medical management part of that care path. And ideally, the patient can remain in the medically managed portion of the care path. And we don’t want all 100,000 people to end up getting a joint replacement. So everyone’s getting medical management, getting therapy, and are being trained to do range-of-motion exercises. And we’re collecting data on their functional status on a regular basis. And those with osteoarthritis who remain stable remain on the medical management portion of the care path. Now, for those whose functional status declines over time, we will move those patients into the surgical portion of the care path. So we have appropriateness tools that say, have you done everything prior to sending this patient to surgery, that you can? And is their functional status appropriately low.

It’s basically evidence-based medicine, correct?

Yes, but it’s applied evidence-based medicine. In a review article in the clinical literature, you can define evidence-based medicine, but it doesn’t translate to what’s actually delivered. So we call this the applied care path, and use it to measure outcomes and processes. So we can see the patient on the care path, and everything from 30 days before the surgery to 90 days afterwards, is built into the care path. And the process measures—did you get your medication on time? Did you get to rehab? What was the outcome of your rehab? And what we want is that your lowest level of functioning will be the day after surgery—the valley in the middle—and we want to see a steady improvement in your functional status.

So demonstrating the value is what’s top-of-mind for us, getting that done in a way that we can represent it to all of our constituents, our patients first, and payers as well in the process, and our other stakeholders.