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Even though the hospital is waiting till 2012 to apply for Stage 1 meaningful use, at this point, it is compliant with most, if not all, of the Stage 1 measures. The hospital is currently looking at Stage 2 requirements across the board and performing a readiness assessment to focus on problem list usage.
Beyond meaningful use, TMC is engaged in many ACO preparation activities like information exchange, which happens rather seamlessly, says Marini, in the OneChart program which operates on a common patient database. TMC's employed physician group, Saguaro Physicians, also uses it and is able to see all inpatient information. TMC intends to connect the hospital to a number of practices, specialty and primary care physicians (PCPs), and ancillary services like laboratory and radiology using the Axolotl exchange technology. TMC has also agreed to participate in the recently announced statewide exchange Health Information Network of Arizona (HINAZ) linking all payers and providers.
THE REAL OBJECTIVE IS TO UTILIZE THIS DATA AND GET IT INTO THE HANDS OF PHYSICIANS IN THE COMMUNITY CARING FOR THESE PATIENTS, SO AS AN ORGANIZATION WE CAN PROVIDE THE MOST COST-EFFECTIVE, HIGH QUALITY CARE TO EVERYONE IN THE COMMUNITY. -BRIAN CAMMARATA, M.D.
The second core element to TMC's ACO foundation is a robust analytics engine (provided by the Eden Prairie, Minn.-based OptumInsight) that will allow clinicians to analyze clinical data, with future advanced capabilities to support clinical activities over the continuum of care and transitional care services. “The real objective is to utilize this data and get it into the hands of physicians in the community caring for these patients, so as an organization we can provide the most cost-effective, high quality care to everyone in the community,” says Cammarata.
Beyond moving forward on its ACO initiative and meaningful use, TMC is focused on its transition to ICD-10. Like its OneChart implementation, it will encompass the whole hospital, but fortunately for this single-platform organization, IT challenges will be mitigated moving forward.
Reaching Stage 7 is not easy, and involves much change management, says Marini. “For something as big, expensive, and risky as an electronic medical record implementation you absolutely need to have your executive team and your CEO on board, fully engaged and committed for the long haul,” he says. “Getting the organization to understand that an initiative like this is not an IT project [is key]. The minute it is looked at as an IT project, you know you're headed in the wrong direction. This is really an organizational initiative; it needs to have leadership from the medical staff, as well as the nursing and operational staff.” Hoyt was impressed by the scope of TMC's IT team, which includes about 100 IT personnel and 20 informatics professionals. “It's clearly a multi-disciplinary effort,” says Hoyt.
WE BELIEVE THAT ALL INFORMATION THAT IS NEEDED FOR PROVISION OF PATIENT CARE IS BEST TO BE IN ONE ENVIRONMENT, SO THAT CARE PROVIDERS DON'T HAVE TO GO TO MULTIPLE DIFFERENT AREAS TO GET THAT INFORMATION. -ED BABAKANIAN
Marini acknowledges the importance of Stage 7 achievement, but says it's really a byproduct of what TMC is trying to pursue. “We didn't think about Stage 6 or Stage 7 when we set out to do this. It was really about the realization that patient care requires better tools; our clinicians require better tools, and that's really what we pursued,” he says. “It was gratifying and validating to use HIMSS Analytics as a benchmark to see that we are on the right track.”
UCSD HEALTH SYSTEM
The story of the University of California, San Diego Health System (UCSD) is one of iterative change, says its CMIO, Josh Lee, M.D. The health system has made many early important decisions that helped it reach Stage 7. The organization, which is comprised of a few specialty centers and two hospitals, UC San Diego Medical Center and Thornton Hospital, operates under one license, with a combined licensed capacity of 552 beds. UCSD has been focused on increasing patient care quality and patient safety through health IT for the last 12 years.
Recently, the system has been transitioning its hybrid systems into a more streamlined, enterprise approach. “We believe that all information that is needed for provision of patient care is best to be in one environment, so that care providers don't have to go to multiple, different areas to get that information,” says Ed Babakanian, who has a team of more than 200 people and has been the system's CIO for 16 years. “That system is supported by these specialized systems like labs, pharmacy, cardiology, imaging, but you have to deploy those in a way like a human body, in that they are integrated and transparent in what they need to do-so a pharmacy system can't be an island of automation all by itself.”
