At the Cleveland Clinic, technology-based tools have helped transform the healthcare delivery model from provider-driven to consumer-driven, according to C. Martin Harris, M.D., Cleveland Clinic’s CIO, and the chairman of the organization’s IT division.
On Feb. 10, Dr. Harris presented a keynote speech, titled “The Role of Integrated Technologies in the Innovation of Medical Practice,” at the Health IT Summit in Miami, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC), at the Ritz-Carlton Coconut Grove Miami Hotel, in Miami, Fla. (Last week, HCI's Editor-in-Chief Mark Hagland spoke with Harris in advance of his presentation at the Health IT Summit).
To begin his keynote, Harris said that as the healthcare system brings in 40 million new patients, four things will be critical to establish: quality, safety, care coordination, and cost effectiveness. "We cannot bring in more people and let quality erode. You need to be a reliable and reputable system. We cannot produce enough physicians and nurses to meet this consumer demand. And we have to reduce costs," said Harris. "What will that transformed delivery system look like?" he continued. "If we are going to deliver on these four factors, we have to imagine that care can occur at a different location than it does today. One of those prime locations is a patient's home," he said.
In order to bring this four-pronged vision alive, IT would be necessary, noted Harris. As such, Cleveland Clinic became an early electronic medical record (EMR) adopter, with the goal to create a single tool so all of the organization's caregivers could use it in caring for the patient. "This is our core tool, and it's present everywhere," Harris said. "We have 7,600 physicians who use this tool, and the transition is from thinking about internal to care divisions across the region."
Harris noted that clinical documentation has been the great journey for Cleveland Clinic, and while it started with just typing whatever you can to get the note in, it quickly moved towards getting it structured. "Voice has a role, but outcomes will be the stronger driver over time," Harris said. "Directly relating documentation to whats happening to the patient will drive the value," he said.
What's more, for the Cleveland Clinic, a parallel strategy to the EMR is imaging, and this is something that will become much more important, Harris acknowledged. "Imaging is increasing in its value for both diagnoses and treatment. We think about imaging as part of EMR, not separate from it," said Harris.
Another tool is the Clinic's personal health record, MyChart. Harris said the organization knew this was a tool that patients would need. Cleveland Clinic put this tool up more than a decade ago, and Harris said he had to turn his phone off for the first year as patients said it was the worst singular idea that they ever heard. Three years later, there was alignment between patients and physicians, noted Harris. " Patients are out in front now compared to the caregivers," he said. "We have an open medical records policy, and when the physician writes a note and signs it, it's instantly available to the patient. Certain things such as the first cancer diagnosis would obviously not be available, but we believe engaging patients and giving them knowledge through this tool is necessary. We wanted to create a virtual relationship rather than only what happens in the doctor's office," Harris said.
Further, Harris said that Cleveland Clinic also wanted to get its patients used to idea of driving their own healthcare team, rather than being constrained by organizational relationships going forward. As such, MyConsult is a tool designed as a simple second opinion program, he said. To use this tool, you must have the primary diagnosis, which is from your physician somewhere in your town. Then, you look for confirmation and any alternative treatments online, Harris explained. "We cover 6,000 diagnoses in medicine, and there about 250 in this system, so your diagnosis has to be one of those," Harris said. "You pick one and you get very specific questions related to that. It tells you exactly what needs to be collected in order to have that second opinion given," he said.
Additional tools at Cleveland Clinic include DrConnect, an online service that provides community physicians real-time EMR information about their patients' treatment at Cleveland Clinic. Harris said this service is based on the idea that a physician who refers a patient to Cleveland Clinic should become part of that patient's care team forever. And then there is HealthVault, a patient-data storage and sharing platform where patients upload the data that is then shared on Cleveland Clinic's EMR. This is a tool that Harris hopes can lead to "true interoperability" rather than be Cleveland Clinic-centric.
Concluding his keynote with a story of how all of these tools could be used together to the advantage of the patient, Harris spoke about a patient who had a heart condition and got the first diagnosis that he needed a repair of his valve rather than a replacement. In this case, Harris noted, the patient said he wanted a second opinion, which happened via MyConsult, meaning the patient never left his home to get a second opinion. "We want you to sign up your doctor who will care for you in your hometown for the long run," Harris said, referencing the DrConnect tool. "We also want as much information as possible up front in digital form. The patient chooses to do just that through the HealthVault service, and what's nice is that the patient manages it and control it. That gets rid of a lot of the HIPAA questions, since the patient is entering information, not a computer. And post-surgery, we had the patient sign up for MyChart, so our caregivers could be a part of the care team forever," Harris said.
These type of e-health services allow the healthcare delivery model to change from provider-driven to patient-driven, Harris noted. "With enhanced and convenient access to their health information, patients become more empowered," he said. "And that creates a whole new way of requesting and receiving a variety of health-related services any time, anywhere."