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Clinical Transformation

February 1, 2009
by Mark Hagland
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Under pressure to alter the cost/quality paradigm, hospital organizations are turning to IT

By every measure—intensifying reimbursement changes, legislative and regulatory mandates, and media coverage—the demand on the part of purchasers and payers for a fundamental transformation in healthcare quality and patient safety will be agenda item number one for hospital organizations in the years to come. And, increasingly, C-suite executives and boards are realizing that clinical transformation is not truly possible without IT.

That puts CIOs in a position which is both enviable and daunting. More and more, they are becoming vital strategists in their organizations' clinical transformations. Put simply, those paying the bills for healthcare are putting a collective foot down and demanding that patient care be of far more consistent clinical quality going forward, while at the same time less expensive. CIOs not up to the task might as well go elsewhere, because experts say this trend is only going to accelerate.

What's at stake? Survival. The Baltimore-based Centers for Medicare and Medicaid Services (CMS), through the Medicare program and a host of private insurers, is already pushing more aggressively on pay-for-performance programs, and demanding documentation of quality-of-care outcomes. And, looked at from an industrial-model perspective, many agree it will be impossible for hospitals to become more cost-effective without tackling care delivery issues. And once again, IT, strategically deployed, will be a key facilitator.

At the 20-hospital, 4,200-bed UPMC Health System in Pittsburgh, Senior Vice President and CIO Dan Drawbaugh and Chief Medical Information Officer Dan Martich, M.D. agree that clinical transformation is among the top goals of their organization.
(From left) dan martich, m.d. and dan drawbaugh

(From left) Dan Martich, M.D. and Dan Drawbaugh

What's more, in the current economic climate, Drawbaugh says, “It's become extremely important to ensure in any clinical transformation initiative that we can track the return on investment and can validate the return on investment. From an operational and clinical perspective, the physician leadership and operational leadership take complete ownership for the investment and the return that we're seeking on that initiative.”

Adds Martich, “Clinical transformation is, in large, predicated on bringing to the doctor or nurse the technologies that will enable transformation. Those technologies include wireless capabilities, access from home, complete access to the electronic record, and complete redundancy and backup. And all those things are predicated on being able to finance them.”

So, like senior executives at hospital organizations across the United States, Drawbaugh, Martich, and their colleagues are pursuing care quality, safety, and workflow transformation in the context of an increasingly economically challenging environment.

The solution

For organizations leading the charge towards clinical transformation, there are numerous paths forward. At UPMC, Drawbaugh and Martich are emphasizing their push towards CPOE as an effort that encapsulates all the clinical IT changes. At UPMC, among the hospitals that have implemented CPOE so far, 85 to 90 percent of physician orders are now created electronically. As a result, those hospitals have seen a 20 percent increase in the prescribing of generic drugs, while the implementation of clinical decision support rules has increased blood pressure control among patients treated in the ambulatory setting by 32 percent.
Tim zoph

Tim Zoph

At Northwestern Memorial Hospital in Chicago, where a host of clinical innovation is taking place, Vice President and CIO Tim Zoph sees strategic IT and clinical transformation as inextricably linked. Clinicians at the 897-bed academic medical center are engaged in a wide variety of initiatives, including medication reconciliation analysis, organ transplant identification management, shoulder dystocia care optimization, and smart pump implementation.
Ron paulus, m.d.

Ron Paulus, M.D.

Naturally, CIOs in such innovative organizations are assuming ever-higher profiles as they become change agents as well as technology experts. “It's important that the CIO feel ownership and true partnership with the operating organization in terms of transforming quality and safety,” Zoph says.

At Geisinger Health—the Danville, Pa.-based integrated health system that serves 2.5 million people in 40 counties across central Pennsylvania—Ronald Paulus, M.D., the organization's chief technology and innovation officer, cites the concept of “paired responsibility” as a critical success factor in his organization's clinical transformation efforts. The pairing of IT and clinical and executive leaders has helped make Geisinger's groundbreaking ProvenCare program effective, he says. The program has established innovative clinical pathways and guaranteed prices for a range of procedures, beginning with coronary artery bypass graft surgery.

In the program, each service line is led by a pair of clinical and executive leaders, each mutually accountable for the budget, clinical outcomes, and patient and employee satisfaction in their area. And, Paulus adds, in addition to the implementation of the paired-responsibility concept, the creation of a culture of innovation, which is making intensive use of IT analytical tools, has been the other most important success factor in Geisinger's clinical transformation breakthroughs.