Founded in 1837, Cleveland’s MetroHealth System is an integrated health system operating three hospitals, one of which, MetroHealth Medical Center, serves as Cuyahoga County’s public safety-net hospital. Annually, the health system handles more than one million patient visits, including more than 100,000 in the emergency department, one of the busiest in the country.
In many ways, MetroHealth is at the forefront of health IT and the use of technology to enhance clinical care. In 2014, the health system was designated as Stage 7 on the ambulatory electronic medical record adoption model (A-EMRAM) by HIMSS Analytics, the research arm of the Chicago-based Healthcare Information and Management Systems Society (HIMSS). Stage 7 represents the highest level of EMR adoption and indicates a health system’s advanced electronic patient record environment. MetroHealth was among the first safety-net health systems in the country to reach Stage 7 status, and the first to do so using the Verona, Wis.-based Epic Systems. In addition, the health system continues to move forward into population health management and value-based care and payment models.
David Kaelber, M.D., Ph.D., is the chief medical informatics officer (CMIO) at MetroHealth System, a position he has held for the past nine years, and is leading or involved in a number health IT initiatives at the organization. Dr. Kaelber, who also has a Master of Public Health degree, is slated to be a speaker at Healthcare Informatics’ Cleveland Health IT Summit at the Hilton Cleveland Downtown on March 27 to 28. Among other topics, Dr. Kaelber will share MetroHealth’s road to success with regard to the health system’s MetroHealth Care Partners Accountable Care Organization, one of 30 successful Medicare Shared Savings Program (MSSP) ACOs. Healthcare Informatics’ Associate Editor Heather Landi caught up with Dr. Kaelber to discuss his top priorities right now as it relates to IT initiatives at MetroHealth, as well as the healthcare technology developments that are on his radar in 2018. Below are excerpts of that interview.
What are your top priorities right now?
The MetroHealth System is trying to move very quickly into value-based care instead of fee-for-service, and accelerate our move into more pay for performance. Within the MetroHealth system, we see that there is a huge technology catalyst that needs to occur to make that happen. So, it’s a big chunk around analytics, and within analytics, I’d put predictive analytics into that. We’re really trying to get our data processes better, as well as reporting and those predictive tools. The best data set or analytics or predictive tool is only as good as whether people can use that to make some change that otherwise wouldn’t be possible. So, analytics is not the end, it’s the end of the beginning. It’s necessary but not sufficient.
One hallmark that demonstrates our competence in that is, last year, we were one of a relatively small number of organizations that succeeded in our Medicare Shared Savings Program ACO (accountable care organization) contract. My view of that is it was informatics or health IT-enabled success. I think if I pulled out the informatics rug from underneath what the population health team was doing, I don’t think we would have been successful because most of what they did was enabled by both the analytics and the workflow tools that we put into our system, and these are the tools that all the providers as well as care coordinators and the population health team used to enable us to achieve that success. That has been a major push, and I think it continues to be a major push. We’re not doing the same population health that we were doing last year. Every year, not only is the bar being risen by the payers, but we’re also trying to get new contracts with more and more payers. So, I think that’s huge.
Another area I’d point to is patient engagement. We’re trying to be very aggressive with our personal health record. I think it’s particularly of note that we have a very diverse patient population, both socio-economically and educationally diverse patient population. Traditionally, you would expect that a personal health record for patient engagement might not be quite as high on the strategy. But, for us, we see that as a significant tool for the future.
We’ve implemented this thing called fast pass. Patients can already self-schedule most of their appointments, and many of their procedures, online. What the fast pass does is if another patient cancels an appointment for a time slot much earlier than your appointment, the system would automatically send you an email or text to let you know that the doctor has an opening, and if you want the earlier appointment, it will then automatically reschedule you. We’ve been live almost a year now. At this point we have almost 100 appointments being automatically re-self-scheduled per week. The average is about 23 days earlier that the appointment gets moved up. It’s a win-win for everybody. Patients like it because they get to see their doctor earlier. As a system, we like it, because it fills our schedules and it does it in an automated way.
You mentioned patient engagement efforts as it relates to the personal health record and the socio-economic diversity of your patient population. Why is that a challenge?