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Pushing Ahead on Quality and Performance Improvement at Piedmont Healthcare

March 29, 2014
by Mark Hagland
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Mark Cohen, M.D. shares his perspectives on quality improvement in a multi-hospital system in Atlanta

Mark Cohen, M.D., Ph.D., is vice president of medical affairs and chief quality officer at Piedmont Atlanta Hospital, the flagship facility within Piedmont Healthcare, a five-hospital integrated health system. The system encompasses, Piedmont Atlanta Hospital, a 488-bed tertiary care facility, as well as four community hospitals, 500 employed physicians, and 700 affiliated physicians.

Dr. Cohen, who continues to spend about 20 percent of his work hours in clinical practice, as a a clinical cardiac electrophysiologist, has spent seven years in executive leadership at the health system—two years in his current position, and five years prior to that as chief of quality, informatics, and IT for the Piedmont Heart Institute.

Dr. Cohen will be joining several other industry leaders on for a panel discussion, “Driving Improved Outcomes with Electronic Health Records,” as part of the Health IT Summit in Atlanta, to be held April 15-16 at the Historic Academy of Medicine at Georgia Tech.

The event is sponsored by the Institute for Health Technology Transformation (iHT2). Since December 2013, the Institute has been in partnership with the Vendome Group, LLC, the parent company of Healthcare Informatics.

Dr. Cohen spoke recently with HCI Editor-in-Chief Mark Hagland regarding some of the challenges and opportunities Piedmont Healthcare is facing as it moves forward to create an outcomes-driven care delivery system. Below are excerpts from that interview.

Looking at all the opportunities available for clinical quality improvement work available, how have you and your colleagues prioritized your agenda for such work?

There are two paths involved; one is an IT-based path, and we’re working very hard to make certain that our hospital is fully integrated into the structure of the larger parent system. We’re about half the size of the healthcare system, so we get a prominent vote, but we’re not all of it. And the healthcare system has recently converted to Epic for its electronic health record; so all the employed physicians and all the hospitals; and we now have one Epic for Piedmont Healthcare, so we’re utilizing Epic for all this work—pathways, guidelines, order sets, clinical alerts, information integration, and systems integration.

Mark Cohen, M.D., Ph.D.

How far has that initiative gotten so far?

The EHR install just completed, so the very last hospital just went up three months ago. So we’re still in the stabilization phase, but for our Piedmont Healthcare patients, we have fully integration of all information, and that by itself has been a big improvement.

What are the  biggest areas of quality improvement that you and your colleagues are currently taking on?

We’re focusing on publicly reported measures: value-based purchasing and core measures; Joint Commission and Medicare outcomes reporting; and large buckets, such as mortality and serious safety event rates. And running in parallel is a significant effort on patient satisfaction, physician satisfaction, and staff satisfaction.

Has your organization had any involvement yet in the development of a patient-centered medical home program or accountable care organization?

Not directly. We sometimes have to deliver results to some of those, so if there are specific metrics that an insurance company might need, or a social work agency working with a PMCH, we’ll provide data, but I’m not personally involved in setting those up.

What have been the biggest challenges, and lessons learned, so far, in this overall initiative?

We’re not special; I think our challenges are very typical here. And our two biggest challenges are on the IT side and on the user/people side. On the IT side, the systems have just massive complexity; and the ability to effect change in the system is very limited. We have to be very, very careful of unintended consequences. An example came up today; we have recently implemented an inpatient hospice program; these are virtual hospice beds from which patients can receive hospice care in their hospital beds. That provides a tremendous clinical advantage. We try to physically cohort the beds, but that’s not possible all the time. We enrolled a patient yesterday, and we discharged the patient administratively from the hospital, admitted the patient to hospice, while she was still in the bed; but I got a message saying that that particular unit had not been set up to administer this, but the patient is so sick and fragile that she can’t be moved. So we’re going to sequester the patient’s encounter and handle the financial and administrative aspects of that manually. It was some technical thing. So we look at the information systems and functionality, and everyone has a slightly different vision of what the technology can and cannot do. And in that instance, I inadvertently generated a huge number of hours of work for a significant number of people, just by doing what I thought we should do.