A dozen years before the term meaningful use entered the healthcare lexicon in relation to electronic health records, Southeast Texas Medical Associates (SETMA), a Beaumont-based 22-physician multi-specialty medical group, acquired its electronic health record (EHR) system. It was the organization's first baby step in an ongoing journey that has led its physicians to embrace the intensive use of outcome measures as an integral part of providing care to their patients. In a rapid succession of innovations, SETMA has essentially exploded the traditional black box of clinical care by introducing the concepts of audits, performance tracking, and-not least-public reporting of physician performance, as a way to drive constant improvement in the quality of patient care.
IT WAS A TRANSFORMATIVE THING, A EUREKA MOMENT, BECAUSE WE SUDDENLY REALIZED WE COULD DO THINGS THAT OTHERWISE COULD NOT BE DONE.-JAMES L. HOLLY, M.D.
That goal was the vision of James L. Holly, M.D., CEO and one of four founding partners of SETMA. In 1997, Holly and a colleague attended a strategic planning session at a meeting of the Denver-based Medical Group Management Association. Following the session, the two compared notes, and discovered they both had the same objective: to lead, guide, and direct healthcare in Southeast Texas through excellence. That, says Holly, planted the seed of the organization's strategy.
In March 1998, three years after SETMA opened the doors of its practice, the group acquired its EHR system from the Horsham, Pa.-based NextGen Healthcare Information Systems. By the following January, all of the patients in the clinic were on the system.
But the partners wanted more than an electronic method of documenting patient visits. Holly realized that the system could be used to gain treatment leverage. He envisioned that SETMA's EHR system would eventually provide the organization with a way to audit, analyze, and compare what its providers were doing and share that information electronically across its network. “It was a transformative thing, a Eureka moment, because we suddenly realized we could do things that otherwise could not be done,” he says.
To that end, SETMA set about customizing the EHR system with a set of disease management tools, in the form of electronic templates that would allow its physicians to gain treatment leverage with their patients. Holly estimates that it took about a year for SETMA to devise its first set of templates to track various disease groups, which were, and continue to be, developed in-house.
SETMA has developed a series of templates in major disease areas, including hypertension, lipids, diabetes, asthma, and weight management, explains Jonathan Owens, the clinical systems engineer at SETMA who designed the electronic tools. In addition, SETMA has designed sets of templates for various practice specialties, such as physiotherapy, pediatrics, and rheumatology, as well as specific templates geared to nursing home care.
Each template contains itemized measures on specific health conditions, such as care for diabetic patients. If the text is gray, it doesn't apply to the patient; if it is black, it does apply, and the physician's care is in compliance with desired parameters; and if it is red, one or more measures are out of compliance.
Using its customized EHR as a foundation, SETMA has moved rapidly on refining its vision, divided into two major initiatives: the Patient Centered Medical Home; and real-time data access, auditing and reporting, which can broadly be defined as SETMA's Model of Care.
Holly believes that, ultimately, three things can transform healthcare for the better: an IT foundation; an evidence-based foundation for the IT; and a performance-based payment structure that offers some possibility of recovery for improved care or the decreased cost of care.
In his view, reliance on quality metrics is the key to improving patient outcomes. SETMA employs a “cluster” of seven or more quality metrics for a single condition; “galaxies,” or multiple clusters of conditions, are tracked for patients with multiple health conditions. Holly maintains that the group has achieved significant results.
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