The 2012 Healthcare Informatics/AMDIS IT Innovation Advocate Award

For the second year in a row, Healthcare Informatics and the Association of Medical Directors of Information Systems (AMDIS) are proud to sponsor the Healthcare Informatics/AMDIS IT Innovation Advocate Award program, which recognizes teams of clinical informaticists, clinicians, and other healthcare leaders in hospitals, medical groups, and health systems whose innovative initiatives are moving healthcare forward.This year, our organizations are delighted to announce the first-, second-, and third-place winning teams here. The three teams are:First Place: The health informatics team at the St. Paul, Minn.-based HealthEast Care System, led by HealthEast CMIO Brian Patty, M.D., for that team’s broad leveraging of clinical IT in the pursuit of the organization’s quality improvement goals.Second Place: The short-cycle measure dashboard team at Cleveland Clinic (Cleveland, Ohio), led by Andrew W. Proctor, senior director, business intelligence, for that team’s work on a real-time quality dashboard mechanism and process.Third Place: Edward Rippel, M.D., of Quinnipiac Internal Medicine, a solo internal medicine practice in Hamden, Conn., which was the first solo medical practice in the state of Connecticut to receive formal patient-centered medical home recognition by the National Committee on Quality Assurance (NCQA).We at Healthcare Informatics recognized representatives of all three top teams with awards at the Healthcare Informatics Executive Summit in Orlando in May, and will share interviews with the team leads from each of those teams in the coming months.In that regard, the first interview to be presented is with Brian Patty, M.D., who leads the health informatics team at HealthEast, a 684-bed, four-hospital integrated health system. At HealthEast, Brian Patty leads a team of about 45 informaticists, 90 percent of them clinician informaticists, who have been involved in an impressive array of initiatives across the organization.Among the team’s accomplishments have been:• Facilitation of several comprehensive implementations, including a full-replacement computerized physician order entry (CPOE) system, broadly interoperable clinical documentation system, bedside barcoded medication administration system (eMAR), pharmacy management system, and comprehensive physician portal.• Development of an advanced clinical decision support (CDS) system that incorporates innovative web-based physician order sets called iForms.• Advanced applications, including an enterprise-wide longitudinal health summary and an advanced provider notes application with capabilities expanded beyond the usual physical and discharge summary documentation capabilities.• Implementation of a data warehouse in an online analytical processing (OLAP) environment, to facilitate financial, operational, and quality retrospective analytics.

Patty, who reports to HealthEast’s CEO and is a peer of the organization’s CIO, works collaboratively with HealthEast’s CIO, and credits the organization’s culture of cooperation and innovation with the success of his health informatics team in making inroads in all these important areas. He spoke recently with HCI Editor-in-Chief Mark Hagland about all this; below are excerpts from that interview.

Focus on Decision Support

Healthcare Informatics: What are the top-line things you’re accomplishing?Brian Patty, M.D.: Our primary focus is to work closely with our quality department, and really find out what their priorities are. And we focus the decision support tools that we deploy based on what we feel will best help us focus our quality work. So where are the pain points in some of our quality initiatives, and what can we do with our EHR and with some of our CDS tools, to help out? Some areas that are naturally included are the management of falls and pressure ulcers, and so on; but we’re really focusing on how we can help the organization.

Brian Patty, M.D.HCI: What have you found to be the biggest process-oriented challenges in what you do to support care improvement?Patty: I think it’s in designing solutions that allow more efficient workflow for end-users, yet also let us meet our quality goals. For example, take our VTE [venous thromboembolism] prophylaxis order set: we had a lot of challenges in designing that set so that it would feed clinicians with some risk-based scenarios to help them select the right treatment, but also to allow them, if they chose not to use the recommended treatment, to use a reason that would be acceptable to CMS [the federal Centers for Medicare and Medicaid services], and not to slow them down too much. In other words, our biggest process-oriented challenges have been balancing the need to meet quality and regulatory requirements through embedding specific tasks into clinicians’ workflows while not slowing them down so that they feel as though that’s all they’re doing.HCI: In what areas do you think your team’s work has stood out the most?Patty: Our vendor has a tool called iForms, which are basically HTML-based order sets, so they look like little mini-web pages. We actually brought in some designers to work on these, with workflow in mind, and they are in great demand among our clinicians. We’ve got about 160 out there now; each order set takes the team about 40-60 hours to create, so they’re very labor-intensive to create, but they’re very easy for the clinicians to use, so we can pull in things like decision scenarios. That means that we can present clinicians with a decision tree; can do weight-based dosing on medications, specifically on our pediatric population; and we can pull information in from the rest of the EHR, like labs or other patient values, right at the time a physician is making the decision, so they don’t have to go outside the order set to look things up; so it really improves the workflow of the ordering process.Getting Physicians on BoardHCI: How do you achieve consensus on order sets with your physicians?Patty: Rather than creating a new committee for that, we built the design and approval for order sets into the clinical councils, which are essentially departmental meetings. So our team goes to the surgery department clinical council, the cardiology department clinical council, and so on, and talks with the physicians, so that they understand what the challenges are for the providers, but also engage with them on the design and upkeep on the order sets around what is pertinent for them.HCI: What are the issues around the interoperability and integration of all these clinical systems, for optimized end-user integration?Patty: Obviously, if we can get a system to integrate with our core EHR, that’s the best; but if not, we try to use our physician portal to help the physicians navigate, so they can have a one-stop shop for getting their work done.HCI: So they use the portal to access everything?Patty: Exactly; and the portal is fairly facile about being able to link to other systems that don’t necessarily integrate fully with the EHR, yet in a way that makes it look seamless to the physicians.Lessons Learned

HCI: What are the key lessons you’ve learned to date around creating process change?

Patty: One of the things I’ve encouraged my team to do has been not just to train on the technical tools, but to engage on the workflow. We involve end-users in designing our training, so that we can make sure that we understand current workflow, and design and train the new workflow based on the best integration of that new tool into the work of the clinician—whether physician, nurse, etc., so that we’re not just training the technical aspects of the tool. In other words, we try not to layer a technical solution on top of a bad workflow; instead, we try to redesign the workflow at the same time, so that we now have an improved workflow for the clinician as well.

HCI: What have been your particular lessons learned as a CMIO directing a team of informaticists?

Patty: I think it’s all about engaging stakeholders early in any process, and getting my team to really involve stakeholders in all aspects of a project from start to finish, so that we understand the challenges that we’re going to face as we roll something out.

HCI: It inevitably ends up being about people and process, right?

Patty: Absolutely. I really reiterate that to my team that it’s less about the technology we’re introducing, and more about the workflow and process around that technology.