Cleveland Clinic's e-tools enable coordinated care

Health information technology will be the "fundamental enabler" of new care delivery models and disease management, Cleveland Clinic CIO Martin Harris, M.D., said yesterday at the opening keynote of the Institute for Health Technology Transformation (iHT2) summit in Ft. Lauderdale.

He walked the audience through a suite of patient- and physician-facing platforms that he said keeps the Cleveland Clinic's patients and their physicians--whether the latter are affiliated with the Clinic or not--connected, setting the organization up for accountable care, pay for performance and other initiatives to improve care and reduce costs.

The e|Cleveland Clinic suite is helping to dissolve the distinction between clinical practice and technology, he said.

The MyPractice EMR is designed not only for doctors and nurses, but also for non-clinical staff, and is used as a training, education and research tool, as well. The electronic medical record system has some of the typical functions, such as decision support, messaging and scheduling. The inpatient version has census, medication reconciliation, and digital documentation of vitals and other data, with specific alerts based on a patient's age and gender, for example.

The Clinic's EMR also has an integrated imaging program--docs can view images from within the EMR without opening a separate program. That's key, Harris, told the audience.

Imaging is going to become increasingly more important, he said--not just X-rays of bones but images that will show whether organs are functioning properly. Having not only the result but also the actual image right in the record will be "critical," he said.

The patient-facing MyChart tool bears some similarities to the clinical ones. The organization's personal health record contains the same lab results, for example, that the doctor gets, although they are "consumerized" so that the patient can better understand them. Instead of decision support, the patient gets reminders and other engagement tools. It includes messages, appointments, preventive care tips medications, allergies, and so on.

MyChart is also available as an iPhone app.

The third piece of the puzzle is getting all this information to the patients' other providers. Roughly half of all Cleveland Clinic patients have a provider who is not affiliated with the organization. Coordinated care demands that those physicians have access to their patients' data, as well, Harris said.

The web-based DrConnect is the Clinic's fastest-growing program, Harris said. Physicians who sign up get daily messages about their patients, such as orders and notes and results--including imaging--in near real-time. "They can literally see everything the Cleveland Clinic doctor can see," he said.

Newer tools in the suite include MyMonitoring and MyConsult.

In the monitoring program, patients can choose whether they have traditional monitoring through follow-up appointments or what Cleveland Clinic docs have taken to calling the "OnStar" model. It allows a patient with a pacemaker, for example, to send information about the device from home at set intervals.

The next generation of smart pacemakers, he said, will send information not only about the device but about the patient and will deliver the data directly to the medical record.

MyConsult is a virtual second opinion program for "high-end" diagnosis such as cancer—those for which there is enough data from imaging and pathology reports, for example, to make a diagnosis without seeing the patient in-person.

Patients sign up online and the program runs them through a series of steps, giving them a list of information they'll need to provide and suggesting where they can get it, for example. A doctor reviews the information, renders the opinion over the Internet, and then follows up with a phone call. Going from online to on-the-phone helps the patient prepare for the conversation, Harris said. The patient is educated and prepared for that phone call, making it much more productive.

Guiding the patient through the process makes them feel empowered, he added.

The second opinion program is reimbursed at standard virtual consult rates, but because patients come from all over, there's no way the organization can contract with every payer. Typically, patients pay up front and the organization helps them submit a reimbursement claim.  

One by one, none of Cleveland Clinic's virtual tools or medical records systems is particularly groundbreaking. But combined, they clearly support the Clinic's strategy of providing integrated services, patient-centered and coordinated care--and of pushing its market potential beyond the boundaries of its geographic locations. 

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