11 May Marshfield Clinic delivers on clinical transformation
Editor’s Note: Dr. Robert Carlson and Carl Christensen spoke at WTN Media’s Digital Healthcare Conference on the topic of “Clinical Transformation and the Future of Health IT: A Case Study of Marshfield Clinic”. Click here to view his presentation.
MADISON – While the Marshfield Clinic operates on the cutting edge of health care, with physicians using portable electronic tablets since 2003 as part of a complete paperless system that was deployed there two year ago, evidently one patient is not impressed.
A terse e-mail from the patient to a clinic physician said: “You make a better data clerk than a doctor,” which strongly suggests that consumers are less impressed by technology and still want good old-fashioned medical attention, a la “Marcus Welby, M .D.,” said Robert Carlson, M.D., CIO for the clinic that provides health care through 45 centers in central, western and northern Wisconsin.
While the caring, all-knowing family doctor played by Robert Young in the early 1970s television series has largely become a thing of the past due to the realities of administering modern-day medicine, the enduring question for health care providers is how to maintain the efficient practice of medicine that lets doctors be doctors, Carlson said last week during a presentation at the Digital Healthcare Conference 2009 in Madison.
“People are looking for the Marcus Welby of old,” Carlson said. “We have gone from being a repair shop to an air traffic control system in terms of proactively managing populations of patients.”
While the complexities of present-day health care have multiplied exponentially since the simpler days of Dr. Welby, technology-driven changes coming in the next five years could dwarf what has taken place over the last 40, Carlson said.
Using data to treat patient populations
Within the Marshfield Clinic’s primarily rural service territory of northern Wisconsin, the elderly population age 85 and over has doubled in the last 10 years. This aging demographic has created a sense of urgency among clinic officials to implement a home medical model that uses a wealth of data to help manage care, Carlson said.
“For us to successfully implement a medical home model, we have to determine what is the appropriate way – it’s a matter of how well we operationalize everything into a very complex system,” Carlson said.
So, while the Marshfield Clinic has received recognition for converting to a system where all of its physicians are tethered to portable electronic tablets, and where paper medical charts are a thing of the past, electronic heath records are not the end-all, cautions Chief Technology Officer Carl Christensen.
“EMRs and EHRs are only the beginning,” Christensen said. “The value is in doing something useful with the data.”
The next step for the Marshfield Clinic is to expand into knowledge management versus simply collecting the data, as officials there re-think the role of information systems, Carlson said.
“With the avalanche of data, who is going to sort through the noise and get the relevant information at the right time, and what is the role of IT in delivering it?” Carlson said.
Inverting the EMR model
When it comes to electronic medical records, the clinic has traditionally been provider/physician centric in terms of how the system has been set up and managed, Christensen said. The approach has been bottom-up, operationally focused, with heavy IT ownership.
Going forward, the future direction of EMRs and EHRs needs to be inverted and become population centric, or constructed from the top down, Christensen said.
“You start with determining the outcome,” he said. “How we are going to measure it, define process changes, then define the type of system changes necessary?”
The Marshfield Clinic is just getting started down this road, as it is only starting its third year of converting to electronic records.
“What we are getting into is developing a comparative list of patients that ranks the patients who are most at-risk,” Carlson said. “This is a very different model than waiting for the patients to present [with symptoms or illness] before you take action.”
There are simple things that can be done that that will have an impact on the bottom line, Carlson said, advising the health care audience to pick something simple that can be measured, like remembering to do foot exams with diabetic patients – something that, when repeated, has saved the Marshfield Clinic an appreciable sum.
Carlson says clinic officials need to develop the proper tools to help them manage the delivery of healthcare to the elderly and other at-risk populations. This effort is part of an intended move toward a more highly evolved, value-based model of continuous health care described in an earlier conference presentation by Gartner Inc. research director Thomas Handler, Carlson said.
As part of this future scenario, patients will play a role in managing their health, as they are referred to information portals that guide them to make proper healthcare decisions.
“The emphasis is shifting from purely technology, and more to knowledge management and analytics,” Carlson said. “How are we going to manage all of this knowledge? This is bigger than any one health care organization or vendor. It’s going to be interesting to see how this all unfolds, and how it integrates in the future.”
Tracking physician performance
Now that the Marshfield Clinic has built a database, it can also determine which of its physicians are more productive by mining various audit, transaction and system availability logs.
When officials there decided to track productivity versus quality of care, the somewhat surprising finding was that the most productive physicians – those that treat a higher number of patients – also graded out at the top for providing the best quality of care, Christensen said, adding:
“We don’t know why yet, but we are going to find out.”
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