In his presentation on Nov. 5 to attendees participating in the Health IT Summit in Beverly Hills, Scott Weingarten, M.D., M.P.H., senior vice president and chief clinical transformation officer at Cedars-Sinai Health System in Los Angeles, shared with his audience the results of his hospital organization’s participation in a nationwide program to improve patient care outcomes and control cost, one that holds broad implications for the entire U.S. healthcare system.
Weingarten, in his presentation, which was the closing keynote address at the Summit, sponsored by the Institute for Health Technology Transformation (iHT2; a sister organization with Healthcare Informatics under the corporate umbrella of the Vendome Group), and being held at the Sofitel Los Angeles at Beverly Hills, spoke of the gains being made through participation in the Choosing Widely® initiative.
Scott Weingarten, M.D., M.P.H.
An initiative of the ABIM Foundation, the research arm of the American Board of Internal Medicine, Choosing Widely, as its website explains, “is working to spark conversations between providers and patients to ensure the right care is delivered at the right time. Participating organizations have created lists of “Things Providers and Patients Should Question” which include evidence-based recommendations that should be discussed to help make wise decisions about the most appropriate care based on a patients’ individual situation.”
What’s more, since more than 60 medical specialty societies have joined the Choosing Widely campaign since its inception in 2012, the initiate has very broad support across the U.S. medical world.
As the initiative’s website further explains, “Choosing Widely® is part of a multi-year effort of the ABIM Foundation, along with its partners, to help physicians be better stewards of finite health care resources. It continues the principles and commitments of promoting justice in the health care system through a fair distribution of resources set forth in Medical Professionalism in the New Millennium: A Physician Charter, which states: ‘While meeting the needs of individual patients, physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources.’ Since 1999,” the website goes on to state, “the ABIM Foundation has worked toward its mission of advancing medical professionalism into clinical policy and practice. Our work is an ongoing, collaborative process, engaging the health care community—including physicians and physician leaders, medical trainees, consumer organizations and patients, delivery system leaders, payers and policy makers—to build a shared understanding of professionalism and actively advance the tenets of professionalism in practice.”
At its essence, the initiative, originally conceived by the National Physicians Alliance seeks to support physicians in avoiding making medical orders, particularly of diagnostic tests, that are not supported by evidence; that are duplicative of other tests or procedures already performed; could cause patients harm; or are clinically unnecessary.
For Weingarten, leading the implementation of Choosing Widely-facilitated order sets at Cedars-Sinai Health System is the culmination of work he has been involved in for years. He served as director of health services research at what was then called Cedars-Sinai Medical Center, from July 1991 through January 2009. During the period of July 1996 through December 2012, overlapping with that tenure, he became co-founder and CEO of Zynx Health, the Los Angeles-based provider of evidence-based order sets. And then he returned full-time to Cedars-Sinai in January 2013.
As Weingarten told his audience on Wednesday, referring to physician order sets generally, “Order sets are checklists, and they’re wonderful checklists, and they remind you of things that are important to do; and they may or may not reduce cost and improve care. But many of our patients in our hospitals today are pretty sick, and have a lot of conditions and situations. So order sets and care plans can be helpful, but may not be able to create plans that account for all the co-morbid conditions,” he noted. “And many patients are outpatients. And what type of information can we provide clinicians in the workflow, to keep these patients as healthy as possible?”
Helping physicians optimize their ordering has become more and more crucial over time, Weingarten said. In that context, he said, “Choosing Widely, I think, is one of the most important physician-led initiatives of the last 20-30 years. Initiated by the American Board of Internal Medicine, the initiative has gathered support and involvement from 60 of the nation’s subspecialist groups, representing 500,000 practicing physicians nationwide.”