Community-wide Clinical Information Infrastructure in Whatcom County, WA

1. Community-wideClinical InformationInfrastructureinWhatcom County, WA Marc Pierson, MD PeaceHealth

2. It Takes a Community

3. "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has."- Margaret Mead

4. Whatcom County, WA • NW Washington • 170,000 people • Community vision, 1990--present • Seamless care for patients • Goal—county with best care WA by 2000 • IOM • Computerized Patient Medical Record • “Community Health Record” 1993--present • To support quality for patients • “Right info, right place, right time”

5. PURPOSE • EVERYONE has the • INFORMATION they need • WHEN and • WHERE they need it. • PATIENTS are at the center.

6. Physician's Office Physician Hospital Home OP Surg. Radiation Pharmacy etc.. ED & SNF EMS Patient's Home Health Home Payer PATIENTS AT THE CENTER Patient Patient

7. Current State of Connected IT • Private self sustaining Health Information Intranet serving community • 170 K citizens (450 with Shared Care Plan) • 1 hospital • 300 physicians (99%) • 8 of 9 Skilled nursing facilities • 90 locations • Over 1700 pcs • 1800 network users • Plus a similar number in the hospital

8. Current State of IT • Hospital on line with robust installation of IDX LastWord EMR • Accessible to all physicians, office and home • Accessible to all staff--with need to know appropriate to job • Labs and images online • Several specialty practices importing notes • Vascular, GI, Cardiac Echo, Nephrology, Surgery Centers, Senior Center, RT group, Path, Registries, 1 OB, others considering • e-mail - internet access – antivirus protection • helpdesk phone and onsite service • LAN consulting and implementation

9. Current State of IT, cont. • Medical reference resources on line • Up To Date • Micromedex • MD Consult • Medical Journals, databases, etc in electronic library • 40 doc family practice implementing Logician EMR • 50 doc multi-specialty group implementing Better Health Record EMR • 450 Shared Care Plans in use, rollout to broader community planned for late this fall • Pilot e-prescribing project beginning • PSI integrated display of Patient Safety Data from disparate systems in contracting phase

10. Chronic Disease Registries and Decision Support Infrastructure • Community Health Record as front end • IDX LastWord (CareCast) • Analytical databases as back end • Web query & presentation layer • Conditions • Diabetes • Asthma • Anticoagulation • Congestive heartfailure

11. Most Important Learnings • The technology is easy • Constancy of shared purpose is THE KEY • The challenge is in relationships, timing, and support for the process change necessary to implement the technology • Neutrality is also key • Involve the patients--directly

12. Focus on Chronic Illnesses • Most of the disability and cost are here • This the costs will sink healthcare, communities, and the economy if not addressed • Just encouraging EMRs will not help this much. • There is no system for chronic care except in a few HMOs. Need a new way of working, and complex information systems are required • Must intend to work across organizational lines • Must include the patient and their family and friends

14. Learning with others at the edge of knowledge.

15. What is Pursuing Perfection [P2] ? We are building a patient-centeredcommunity wide chronic care management system in Whatcom County (I try to separate acute and chronic care as systems—however, they do use many of the same resources.)

16. How Are We Doing This? We are supporting each patient and their virtual care team with: • A secured electronic shared care plan • A shared, single, accurate medication list • Access to clinical information at all times • Idealized design of clinical office practice (IDCOP), including group visits and telephone/ e-mail visits and alignment of hospital to support this system and patient self-management • Evidence-based guidelines • A clinical care specialist when needed We will promote cost-effective screening, preventive education, and risk management Together and across our diverse community we are building safety, timeliness, effectiveness, efficiency, and equality into our health care system.

17. Involving Patients in the Process

18. Inviting PatientsAs Partners • On all teams: as designers, on governance As Motivators • Re-establishes meaning in health care • Provides hope and dampens cynicism/skepticism • Perhaps the most important learning • Their compassion for us will heal us.

19. Virtual Care Teams • Patients with multiple conditions are often left at the center by default • Resources surrounding and supporting are necessary

20. Secured Shared Care Plan

21. Community and Relationships- We each know it • In some deep sense none of this is news, we all know it somewhere. The opportunity is to bring more of ourselves to the work. • To take the risk of being fully human in the workplace. Spirituality, loving, risking, embarrassment, failing in full view--everything that being a member entails. • How large do we want our “WE”? Can it be our community?

22. Summary Slide • Next Scope of Work

23. Implementation Hopes • 3 medical records and 1 patient health record connected • 100% of physicians prescribing electronically within three years • All individuals in Whatcom County who want a Shared Care Plan have one • Quality reporting available across community