Editor’s note: This is Part II of our Visions interview with Frank Byrne of St. Mary’s Hospital in Madison, one in a series of healthcare IT articles that will be published in advance of WTN Media’s annual Digital Healthcare Conference. The conference will be held May 7 and 8 in the Fluno Center on the University of Wisconsin-Madison campus.
Madison, Wis. – Dr. Frank Byrne, a former practicing physician, still remembers his mother’s reaction when he informed her of his interest in hospital administration.
“So you went to medical school for nothing,” she said, as only a mother can.
Byrne, president of St. Mary’s Hospital in Madison, instantly tried to reassure his mother that he could still make an impact in medical circles. He jokingly introduces himself as either a pulmonary critical-care physician working undercover as a hospital administrator, or as a “recovering” pulmonary critical-care physician, but thanks in part to health technology and the opportunity for process improvement it presents, Byrne has never been more certain that he’s making a difference.
In fairness to his mother, “my son the doctor” sounds better than “my son the administrator,” but Byrne insists that he did not walk away from a career as a physician. “I embraced an alternative role in healthcare where I thought I could use the knowledge I’d gained as a caregiver, as a patient, and as a nursing assistant on behalf of the patients who entrust their care to us,” he said.
His role in advancing the adoption of healthcare information technology is part of that certitude, but not all of it. Byrne said the healthcare industry gradually has come to realize that variation to established workflow is the enemy of quality. While healthcare was “late to the party” in acknowledging that its service is a process like other industrial processes, Byrne said if new technology deployments are linked with process improvements, consumers should expect investments in healthcare IT to make a difference in health outcomes.
“As physicians, as caregivers, we derided things like care pathways if you go back 15 or 20 years,” he said. “We derided care pathways and protocols as cookbook medicine when we should have embraced them as opportunities.”
In a tip of the hat to Sister Mary Jean Ryan, president and CEO of SSM Healthcare, who was one of the first healthcare leaders to embrace the concept of continuous improvement, Byrne said this call for consistency is not in conflict with the drive toward continuous improvement. Once new workflows are developed, they should be adhered to, but that should not prevent healthcare organizations from continually seeking better ways to deliver care.
Fortunately, healthcare is catching up and using techniques like Continuous Quality Improvement (CQI), a blend of Six Sigma and lean methods employed by St. Mary’s. Byrne said the healthcare industry had functioned almost as a guild, where a separate function was crafted for each patient. While each patient is unique, all heart angioplasty patients benefit from compressed door-to-balloon time – now an average of 50.9 minutes at St. Mary’s, whereas the industry gold standard is an average is 90 minutes.
That’s due to a process that actually starts with first responders in the field – one that recognizes that time is heart muscle for everyone. St. Mary’s collaborated with other Madison hospitals to invest roughly $30,000 per facility in communication equipment needed to transmit EKGs from the field to the ER, which helps initiate a treatment plan ahead of the patient’s arrival.
“The quicker you get them from when they get in the door to the time the cardiologist has got that balloon in their artery and restores flow across that blockage, that directly correlates with their outcome, with their quality of life, with their activity levels,” he said.
In a sense, the hospital’s inpatient EMR implementation already has been jump-started. While the inpatient environment is not yet electronic, the hospital has provided some space on its desktops so that physicians can practice in an electronic environment when delivering ambulatory services. Paraphrasing Lou Gerig, Byrne said he considers himself to be the luckiest guy on Earth because St. Mary’s physicians already are using the EMR in the ambulatory setting.
The hospital, with the help of physicians Larry Elfman and Bob Gilbert, is taking what it has learned in the ambulatory area and applying it to the inpatient implementation. In contrast to some hospital situations, where the facility feels like it’s dragging doctors into the electronic age, St. Mary’s physicians are “actually pulling us forward,” Byrne said.
“We’ve provided real estate on the desktops here and we allow them to pull ambulatory records into the hospital environment,” Bryne stated. “Back when I was a practicing critical-care physician, the process was very inefficient and sometimes not as accurate as you would like.”
Back “in the day” as a practicing physician, when Byrne admitted a patient to the hospital, he would call his office and they would fax over the patient’s records. He had to take whatever they sent him, and invariably he would call back and request additional reports or images that could be stored in various places.
Now that the electronic age has been jump-started, a portal has been provided to bring ambulatory records into the hospital environment, which provides for greater accuracy and timeliness. Both medical records (thanks to EMRs) and medical images (thanks to picture archiving and communications systems or PACS) “will always be where you are,” Byrne said.
“Having a health record where you are, when you need care, is tremendously important to providing the best care, the right care, the safest care,” he stated. “It’s the most effective resource utilization.”
St. Mary’s and other Madison hospitals are not only implementing Epic Systems’ EMR, but also Epic’s Care Everywhere product to share patient data with other facilities. Byrne said there is a commitment to sharing patient data, in part because Madison is in a unique position to lead the way.
“We have a unique and refreshing level of collaboration in this community that may be underappreciated,” he said.
When St. Mary’s Hospital’s new electronic medical record goes live on May 31, it will be but one step in the sharing of patient data between Madison hospitals and clinics. The project, which also was aided by the recent passage of legislation to remove statutory barriers, should deliver efficiency and outcome benefits for caregivers and patients, according to Byrne.
The other “secret sauce,” he said, is that the state is very committed to patient data exchange. He noted that Health and Family Services Secretary Kevin Hayden, former chief executive of Dean Health System, is a big proponent of EMRs. In addition, Gov. Jim Doyle’s eHealth Board is focused on the all-important issue of interoperability between computer systems in different healthcare organizations.
The human interface
Byrne would be the first to tout what he calls the “fabulous advances in technology,” but he said some perspective is in order. Just because a facility can implement a new technology doesn’t mean it should, so the healthcare industry must be cognizant of the appropriate use of technology and its limitations, and combine that with the necessary human interface and communication.
Case in point: Byrne loves checking his lab results on MyChart, another Epic product, but for complex decisions about treatment options, e-mail alerts and other online services are not an alternative to face time with his doctor. It goes back to the folly of automating a bad process and ignoring the human factors that impact technology adoption. He views communication as the cornerstone of any health intervention, but part of that communication is change management for the sake of end users.
“Technology is a tool that can help us achieve the outcomes we want,” Byrne said. “The EMR will help us, if we implement it properly, make healthcare safer. It will help us eliminate waste in healthcare, but it won’t do it by itself if the human interface – us, the caregivers – is not properly positioned to use it.”