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- Phil Loftus has a huge task as chief information officer and vice president of information systems for Aurora Health Care
He's in charge of defining and implementing the information services component of Aurora's strategic goal - to provide an integrated approach to the delivery of care.
At Aurora, a not-for-profit healthcare organization, that integration must take into account 3.5 million patients, the vast majority of whom have electronic medical records, 25,000 employees (including 3,400 physicians), plus 13 hospitals, more than 100 clinics, and about 120 community pharmacies.
The system, which has a presence in 90 communities in eastern Wisconsin stretching from the Wisconsin-Illinois border to counties that border the Upper Peninsula of Michigan, may be best known for its Sports Medicine Institute and Vince Lombardi Cancer Clinics.
Yet Loftus has handled big projects before. He developed one of the major systems that supports the new Medicare prescription drug benefit, and did so without a great deal of time - 12 months - before the Jan. 1, 2006 go-live date. The rules for adjudication were complicated and the functionality standards, set by the Center for Medicare and Medicaid Services
, kept evolving right up until the go-live date, but he was able to design a system that could handle transactions in real time while consumers wait in the pharmacy.
I was up until midnight that night watching the system go live, he said, noting that others were ushering in the New Year. Strategic access
Singing Auld Lang Syne to antiquated systems, not to mention paper charts, has come with the turf during a 25-year technology career that includes stints with GlaxoSmithKline
, and what is now AstraZeneca
Loftus has implemented major strategic systems in research and development, manufacturing, and finance. As senior vice president and CIO at Caremark
, a provider of prescription drug management programs, he implemented the move to a paperless mail-order pharmacy system based on the electronic documentation of workflow.
He's been around long enough to know that when major or transformational information technology implementations fail, it's often due to a lack of clarity. If it's not clear what the benefit it, it's very hard to keep the scope under control, Loftus said. You have no good compass to understand which steps you should take and which ones you shouldn't.
One step Aurora has taken is its commitment to a 10-year strategic plan that will be heavily dependent on information technology and the system's electronic medical record, which will serve as the foundation for IT upgrades to come. The EMR already has paid dividends in terms of real-time access to patient medical histories, preventing duplicate or inappropriate tests, and streamlining surgical scheduling and physician order entry.
Next, the EMRs will enable Aurora to complete the key component in its strategic plan - the improvement of patient access across a series of traditional healthcare transactions.
From the patient's point of view, there are four key transactions: registration, scheduling appointments, viewing medical results, and paying bills. In healthcare, these key transactions are not managed in a consistent way, but a potential framework dubbed One Aurora is being explored to address that. One Aurora
One Aurora would essentially mean that a patient could go online to make an appointment, register for the appointment, view key components of their electronic medical record, and view and pay for all clinical and medical bills online.
For single parents or working patents that need to schedule an appointment after hours, on weekends, or during a rare Monday through Friday opening, online access to Aurora's entire network of clinics and available times could be the difference in getting their child a timely vaccination.
That's where all other industries have gone, Loftus said of such online services. These are four transactions that someday will be done online. Healthcare traditionally just hasn't thought of things that way.
With an established electronic medical record, Aurora is steadily introducing wireless technology in hospitals and clinics. More and more, nurses are using the wireless capabilities as part of a more buttoned-down process for administering medications (with the help of a computer on wheels or COW apparatus), and physicians are using laptops not only to access patient records from anywhere, but execute new processes like computerized physician order entry to order prescriptions at pharmacies.
Wireless capabilities mean there are no more multiple log-ins to access the system. By entering just one password, the patient's record pops up in the office or the exam room. It required a dramatic upgrade to the wireless infrastructure of Aurora clinics, but it's an investment that could pay for itself in timesavings alone.
People have to agree to work in a common way, but then they can move much faster, Loftus noted. Why WHIE?
Aurora also is playing a prominent role in the Wisconsin Health Information Exchange
, an effort to share patient data among eastern Wisconsin healthcare facilities. That kind of exchange requires a high level of trust between institutions, the establishment of common standards and formats among institutions with different technology systems and clinical processes, and consensus about access to patient data in light of state and federal standards.
Three Milwaukee hospitals will go on line to test the system, with Aurora providing the basic data feeds. Loftus believes the basic data exchange is very achievable, even though metropolitan Milwaukee healthcare institutions use varying electronic medical records software. A big fan of keeping things simple, especially at first, Loftus said there is no technological reason why a pilot program could not be put in place in the near future, with incremental expansions in the use of data at various points down the road.
However, the broader aspiration of using patient data for research purposes is more of a gray area and requires legal access requirements to be resolved. The simpler we can keep requirements pertaining to data access, Loftus said, the easier it will be to get the necessary agreements to implement the systems.Scholarly advice
Loftus, who has a bachelor's degree and a Ph.D. from the University of Liverpool
, also was a Fulbright Hays Fellow at CalTech
It doesn't take a Fulbright scholar to know that electronic medical records and IT implementations are about more than technology. In fact, Loftus openly wonders how much technology has to do with it.
It's not about the technology, he said. It's about understanding the processes the business wants to put in place and the benefits the business expects to derive from them.