On Friday, May 17, at the Healthcare Informatics Executive Summit, being held at the Sir Francis Drake Hotel in San Francisco, Mark Hagland, Editor-in-Chief of HCI, and Howard Landa, M.D., CMIO of Alameda County Medical Center in Oakland, Calif., and a member of the board of the Association of Medical Directors of Information Systems (AMDIS), co-presented the 2013 Healthcare Informatics/AMDIS IT Innovation Advocate Award, to recognize healthcare IT leaders who have helped moved the healthcare industry forward through their innovations.
HCI’s Hagland also announced that the name of the award will be modified going forward, in order to honor James. E. Levin, M.D., Ph.D., the CMIO of Children’s Hospital of Pittsburgh, who died unexpectedly in February of this year, and who was a nationally recognized leader in clinical informatics. Henceforth, the award will be known as the James E. Levin Memorial IT Innovation Award, to honor Dr. Levin.
The three recipients of the award are Neal Patel, M.D., CMIO of Vanderbilt University Medical Center, Nashville (first place); John Mattison, M.D., assistant medical director and CMIO of Kaiser Permanente-Southern California, Pasadena (second place); and Michael Zaroukian, M.D., Ph.D., vice president and CMIO, Sparrow Health, Lansing, Mich. (third place). As the news article announcing the awards on May 16, noted, each of these CMIOs has shown exceptional leadership in their work with colleagues in their organizations, and beyond.
Vanderbilt’s Patel has been in clinical practice as a pediatric critical care physician since 1997, and has been involved in clinical informatics in some way for years before that. Five years ago, Patel became CMIO at the 1,000-bed Vanderbilt University Medical Center, where he works with other medical and clinical informatics as part of a larger IT team of over 400 IT professionals. Vanderbilt has been live with computerized physician order entry (CPOE) since the mid-1990s; clinicians there use a self-developed system that was later commercialized by the Alpharetta, Ga.-based McKesson Corporation as McKesson Horizon Order Entry.
At Vanderbilt, Patel has been a driving force in clinical transformation work. Among his achievements there to date has been the creation of what he and his colleagues call the “team summary” concept, which is working no turn simple standardized templates into advanced documentation tools that incorporate data analysis modules and modular capture of clinical content, allowing physicians to document more efficiently, and to share patient record information more efficiently with each other, through an aggregate-view solution. He has also helped lead his colleagues in an initiative around what they are calling “integrated presence”—a real-time patient risk monitoring solution that allows clinicians to quickly assess the clinical situation of any patient. That solution is currently being piloted in the burn unit at the hospital, and is expected to be expanded onto other units during the current calendar year.
In April, all three recipients spoke with HCI’s Hagland regarding their accomplishments and their perspectives on healthcare IT innovation. The interviews with Drs. Mattison and Zaroukian will appear in this space in the coming weeks. Below are excerpts from Hagland’s interview with Dr. Patel.
What areas are you responsible for as CMIO at Vanderbilt?
I have the hospital side under my portfolio; but we also have Jack Stormer, M.D., and Jim Jirjis, M.D., on the outpatient side.
Neal Patel, M.D.
Can you share with us about a couple of recent things you’ve been involved with?
Well, several things. Number one, as an institution, we’ve been focused on visualizing our clinical data in an aggregate view. One of the big complaints about computerized systems is that they lose the patient story. And one of the things I’ve helped to lead is that we’ve created a kind of virtual cloud or cache that decouples portions of the patient’s story from individual documents, in order to make them living and dynamic, so that data and information can be visualized by the team and handled. It’s a modular documentation process, whereby certain aspects of the module can be operated bi-directionally, so you don’t copy and paste the whole document. That has allowed us to make sure that a patient’s treatment can be updated as the patient condition changes, rather than at each note-writing event, which tends to focus on a daily or billing cycle. We’ve had a good success in streamlining documentation, but also in promoting the relevance of the documentation.
So this module is carrying the capsule of the patient?
Exactly. And the capsule can be updated independently of the rest of the documentation.
So this is like a little space ship that comes out of the big space ship, with its own agency?
Exactly. And because we have a homegrown electronic health record [EHR] system, we’re able to aggregate information from proprietary systems as well as from our homegrown system, so that you can be in an analysis phase in your documentation, but actually, it will streamline the viewing process for the physician. It’s been neat, because as some concepts such as handovers and team communication—especially in an academic environment, where we have resident work hours, etc., now we can abstract the data in different ways and come up with different views of the patient, instead of having to go to each patient’s individual chart and full note, which becomes cumbersome.
So that’s one area. We are currently working with RedCap, a research tool created here at Vanderbilt that is being used everywhere now to do clinical research data capture, where individuals can manage their own clinical data. Paul Harris is the genius behind it. And it has been supported by the federal government. It’s part of our CTSA [Clinical and Translational Science Award], our clinical research arm. It’s completely outside healthcare informatics, but it can function to manage large, multi-center studies, and handle database questions for the novice. And we’ve been working on how to embed information and transition to data in the RedCap from the clinical record. It used to be that it was a separate act; it’s like you closing down your Word document and opening up a separate Excel document and entering your data. If you want to transition with your front-line clinical teams, that’s hard. So we recently embedded access to the RedCap form within our clinical documentation tool so that you don’t have to change out of the clinical documentation process. We piloted that in January. And what Vanderbilt is very good at is taking the best of the applications out there, and integrating them. So with our underlying architecture, we’re able to better integrate underlying concepts than how each individual system can do by itself.
What is the biggest project that you’re personally involved in right now?
The biggest thing right now is that we’re beginning to work on Stage 2 of meaningful use. We attested to Stage 1 back in October 2011. And we’ve had our year mark this past year. So we’re beginning to work on Stage 2. The second big project we’re involved in is a concept called integrated presence, where we’re utilizing our ability to aggregate key pieces of information, as well as real-time monitoring, and putting it into a view, for real-time monitoring for at-risk patients.
What they call conditional or situation monitoring?
Yes. Because our EHR allows us to aggregate key pieces of information through that “team summary” function into a capsule, as I mentioned, we can get you a four-panel screen with the patient’s vital signs, etc.
You personally created the “team summary”?
Yes, it was my creation; I led the development. We’re also working forward on a concept around monitoring at-risk patients in real-time, called “integrated presence.” It’s still in a pilot in the burn unit; it went live there in August, but we’re developing it forward for broader implementation. Over the next two months, we’re hoping to expand it into our surgical and pediatric ICUs, and also to get better framing for graphical trends out of our EHR data.
What are your mission and vision around the work you’re doing?
My mission and vision are to help clinicians deliver the best patient care they can, to as many patients as they can in a streamlined manner, and to use those tools optimally. So I want clinicians to be able to be most effective. I’m loath to use technology for technology’s sake; it only works if the masses can use it seamlessly. So more often than not, I’m the biggest skeptic about new tools.