Anyone who would want to make the assumption that the data analytics revolution is only occurring in large integrated health systems in large metropolitan areas in the U.S. needs to rethink, and consider what’s happening in little Hutchinson, Kansas (population: 45,000), in the south-central part of that sprawling state. There, leaders at the Hutchinson Clinic, a multispecialty clinic with 67 physicians in 22 specialties—not only primary care, but also obstetrics/gynecology, orthopedics, dermatology, and otolaryngology—are busy innovating around data analytics in fascinating ways.
What’s more, according to Robert (Bob) Davidson, the organization’s CIO, some aspects of the clinic’s demographics and operations might surprise some people. For one thing, Hutchinson Clinic physicians have 262,000 active patients, and their patients come from 103 of the 105 counties in the state of Kansas. One reason for that, he explains, is that, in addition to the two core clinic sites in the town of Hutchinson itself, as well as three other physical sites, in the nearby towns of Great Bend and Macpherson and including a walk-in care clinic in South Hutchinson, Hutchinson Clinic physicians regularly travel longer distances to spend individual days taking care of patients farther afield.
With regard to information systems, the organization’s core electronic health record (EHR) is Allscripts Touchworks, from the Chicago-based Allscripts; and its PACS (picture archiving and communications system), from Philips, and RIS (radiology information system) from Swearingen, are fully integrated with its Allscripts EHR. The organization also uses the practice management solution from Allscripts.
What’s more, the physicians at Hutchinson Clinic are currently finishing their testing period for Stage 2 attestation in 2014. They attested to Stage 1, and attested to Stage 2 for the full year of 2013. Their current attestation period will end on Dec. 31. That’s a lot going on for an IT staff of just 12, in a total staff of 700.
Davidson spoke earlier this fall with HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.
You and your colleagues have been very active on a number of fronts. What would you say your organization’s biggest accomplishments and challenges have been recently?
We are a physician-owned clinic that’s fee-for-service today. Their production is their livelihood, they eat what they kill. And with 250,000 patients, our doctors are very busy. And our family practice doctors will see in excess of 30 patients each a day, and they fully use the functionality of the EHR. Allscripts calls their more advanced notes ‘structured notes,’ and our family practice docs use structured notes in all their encounters, so we’ve been very successful in utilizing discrete data.
Physicians are very analytic people, and it’s amazing how in the paper-chart days, they had to hunt everything down; now they have all the information available to them statistically. The biggest challenge is that, with very, very busy doctors, we’ve been able to incorporate all the technology needed to support discrete data. Some doctors have had a bit more of a problem transitioning to the computer world, but more often, in many cases, the doctors are essentially documenting as they go, and are all done when they’re done seeing patients for the day. And for example, that Dodge City patient might see two different doctors here in one day.
In the old days, in the paper world, the first doctor would keep the paper chart, and the second doctor had to go blind. Now, with the first doctor, the note is signed, the lab results are in the system, the radiology might have been read, and the second doctor has up-to-date information, and it helps that they didn’t have to call doctor number one. It all happens much more easily. And the interoperability between the systems is fantastic. And if there’s a critical radiological finding, it all happens automatically that the referring doctor is contacted.
You’re not yet part of an accountable care organization, correct?
We are not yet. We have filed for level 3 patient-centered medical home status from NCQA [National Committee for Quality Assurance]. And every one of our doctors is NCQA-certified for diabetes care.
What kind of insurance do most patients have?
Per the demographics of Kansas, we’re about 50 percent Medicare, 20 percent Blue Cross, and we probably don’t have as high a Medicaid population as some areas might have—it’s in about the 7-percent range. Everything else is commercial, mostly PPO. Blue Cross is mostly PPO. Blue Cross of Kansas has been very supportive, with incentive programs, that would… we’re participating in several value-based purchasing programs with BCBSKS. That includes patient-centered medical home program. Like our clinical quality program, which is highly coordinated with theirs.
Are you doing any data analytics or population health work?
Tons. The really great thing about the EHR and the way we’ve utilized it—we’ve been collecting discrete data on our patients for years now and that has enabled us to really look at our population. For instance, when we were certified for the diabetes recognition program for NCQA, every one of our primary care doctors qualified for DRP certification on the first run, just because of the data available and the fact that they had been using the data to manage the diabetes population very well. That was all 23 of our primary care doctors. And they were half of the certified docs in the state. That happened in 2012.
And you’re engaged in data analytics around chronic care, correct?
Yes, we use a third-party product that we acquired through Allscripts, called Precision BI.
How long have you and your colleagues been doing some analytics work?
We’ve been doing something in that area for about five years. We went live in 2008, and in 2009, started to see the value and completeness of the discrete data that we could query.
What kinds of learnings have you and your colleagues, both physicians and IT professionals, been gleaning, from that work?
I’m a data person; I love data, and always have. But in terms of the value that the doctors are deriving from all this, now, they get reminders, warning signs, that a particular patient is due for their hemoglobin a1c, for example; and more broadly, the doctors can look across their patient population for whatever chronic disease program they have, and they can see how they’re doing. And they’re very competitive, and the data helps them do a better job. I’ve been involved with many implementations of software across a few different industries; and it’s very typical that the implementation of a system like an EHR is painful for doctors, because it slows them down and makes them do things that haven’t been in their workflow. But six months later, they’ve worked through that, and they can start to look at data and see the value of it. And in most cases, it’s the doctors who have asked to see more data.
Our doctors have to do their own rounds with the hospital across the street, and take turns covering their call, and so on. And since we implemented the EHR system, and it’s available for them everywhere, and it helps the doctor to do more than just stabilize a patient over the weekend; they have enough information that they can start treatment. And consequently, the hospital stay moves them closer to recovery.
The hospital must have an EHR, correct?
We work closely with the hospital across the street, and they do have an EHR, but they mostly use ours, because it’s so complete.
What will you be working on in the next couple of years?
I think the programs we’ve been working on, with our patient portal, for example, we use Allscripts FollowMyHealth, and we’ve been live with that since early 2012. And 62 percent of the patients who have FollowMyHealth accounts are over 50 years old. The really amazing thing to me is the extent to which seniors have shown interest. For instance, my mother’s 81, and she has a FollowMyHealth account, and she has access to it on her smartphone, and uses it. And we’ve made visits to senior citizen facilities and have helped to sign people up for the patient portal. And it’s amazing to me that you take the 70-to-79-year-old age group, and you wouldn’t think they’d be very techno—and they’re our fourth-largest population group using the patient portal. And we have more people from 70 to 79 than we do from under 30.
And we have our nursing staff, when they meet with the patients, they talk with the patients about it. And we actually promote it through contests, where we have a prize for the person who recruits the most people to sign up for the portal. But we have appointment requests, available-refill requests, through secure messaging, and we make that available to them, and we actually are over the 5-percent requirement, and have been for some time. The patients who use the portal, they actually ask us if there’s a way they can communicate with the clinical staff. So having the portal opens up communications more easily. We’re trying to work it out now where they can request a specific appointment time.
We’re also working with Allscripts on their Achieve product, a goal-oriented, task-oriented engagement tool. If a doctor wants a patient to check their blood glucose three times a day, there are tasks for the patient to complete through FollowMyHealth. So if you have a patient from Dodge City who might be diabetic, and if there’s a significant change, the doctor can contact the patient, to bring them in to be seen, and that will encourage that communication process. The toughest part is just getting them to sign up. Once they’ve signed up, it’s not that hard to get them to use it. I myself am a big fan of it as a patient.
Do you have any advice for fellow medical group CIOs, with regard to engaging in innovative activities like these?
I’ll refer back to the availability of discrete data, where we can analyze it through the analytics programs, examine the health of our population; once doctors start using it, they love that they can get alerts, that a particular patient is due for a colonoscopy, for example… or that we need to step up the frequency for alerts or something. When you have a patient coming in with four different chronic disease states, it’s difficult to manage that. And that’s the biggest advance that helped us, which was getting the staff to collect that information discretely rather than in just freetext. Once you can generate reports off that type of information, then buy-in and adoption are whole a lot easier.