Last year, Healthcare Informatics received many submissions as part of our annual Healthcare Informatics Innovator Awards Program, which recognizes leadership teams from patient care organizations—hospitals, medical groups, and health systems—that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance. While three organizational projects won and received honors at last year’s HIMSS conference in Orlando, Fla., plenty of other laudable submissions impressed us as well. Here’s a look at one of last year’s finalists, an enterprise chart project from John Muir Medical Group based out of Walnut Creek, Calif.

For the folks at John Muir Medical Group (MMG), an independent practice association (IPA) with more than 700 physicians that cover 25 specialties spread across three counties in Northern California, there is a clear cut advantage to having an enterprise data chart, which was implemented in 2009, that makes single-patient data chart electronically accessible electronically to all MMG providers. MMG has implemented the core electronic health record (EHR) from the Horsham, Pa.-based NextGen Healthcare.

“Being able to recognize the true value of enterprise chart has been phenomenal,” Tina Buop, MMG’s CIO, says. “The true value of the enterprise chart is similar to an HIE (health information exchange): you’re able to make point-of-care decisions holistically about a patient. You’re able to see contra indications that may prevent potential medical issues with the patient.”

Buop says having a holistic record is not only better for the patient, but the physician and IPA itself as well, resulting in significant time and cost savings.

For example, recently a patient’s primary care physician (PCP) submitted an image requisition for their knee. The request was completed the same day of the patient’s visit, with the image entered into the EHR and made available to various specialists. The PCP was able to call the patient at the end of the day, give them the best care, and allowed the patient to avoid a trip to the emergency room or another specialist, according to Buop.

Buop recently spoke with Gabe Perna, assistant editor at Healthcare Informatics, about the enterprise chart project.


Tina Buop

What is the history behind the enterprise chart project?

When Muir started our clinical integration team, the goal was to have an enterprise chart and connect the physicians to the larger community. When we first started, every practice in our NextGen [NextGen Healthcare, Horsham, Pa.] system was listed as a single practice. However, from the onset we left open an opportunity to go with an enterprise chart. The technology was relatively easy. We had to make minor changes to our user group names. Those names allowed us to implement the appropriate security levels for each user group. Believe it or not, there was one button inside NextGen that said “select enterprise chart,” which allowed for the implementation. It did, however take us upwards of nine months from the project’s start to the selection of the enterprise chart. This was because we had to get our physicians in agreement and ensure we were following best practices for security.

What resources did you use to launch the enterprise chart?

There were pioneers that had done this before, so we leveraged some knowledge from them. We also wouldn’t have been able to complete the enterprise chart if it wasn’t for our other vendor partners such as InteHealth [Malvern, Pa.]. They were our broker of multiple data interfaces. As a portal and a data broker, they were able to understand the difference in a single data stream for one practice as opposed to multiple data streams across an enterprise.

What were some of the challenges that you faced in getting this project off the ground?

The biggest challenge, and I think it’s still echoed today, is fear-based behavior (from the physicians). They are fearful that someone will see their chart; they’re fearful that their open and vulnerable to others seeing the information that they are documenting on the patient. Really, it’s pre-go-live jitters.

How were you able to overcome that and get everyone on board?

In order to help with physicians’ apprehensions, we took four different work processes into play. One was contractual to make sure we were meeting all of our legal obligations. The other was in training and socializing very early on that we would be adopting an enterprise chart. From the very first sell of the contract of our services, we would talk about enterprise chart. We hosted a community physician dinner and brought all of the physicians together, so they could voice their concerns collectively and hear each other’s questions and answers to that. We also followed up aggressively after we implemented the enterprise chart. And we also made some mistakes.

What were some of those mistakes?

The one that comes most frequently to mind is the fact that some of our smaller practices have a front-desk person who is also the medical assistant, the biller, etc. Because we set our security rules so rigid, we didn’t take into account these multi-faceted practices that have those people float throughout their practice. Our traditional roles didn’t always fit for those smaller practices. This was a small mistake and we addressed it quickly.

How has the project progressed over the past year?

We’ve added new specialties since last year. Where it has progressed now is more forward thinking, and towards advancing patient care across specialties. Imagine wanting to know how many patients are of a certain age. This is a normal question all IPAs ask. That’s a tradition question. With an enterprise chart, you can not only find out how old the patients are and how many patients the primary care physician sees, but you can also find out how often the PCP sees them, and how often do they do everything but see them. By that, we mean you can find out when he has a phone call with the patient, or when he processes the patient’s lab results. You can look at the member touch point. Instead of the traditional, ‘I have 10 Medicare patients and I’ve seen them six times each,’ you get ‘I have 10 Medicare patients and I’ve seen them six times each, but I’ve helped them 23 times total.” It’s real work volume. It also allows us to implement evidence based clinical guidelines. With that, we can see if the patient is being cared for across the continuum.