Lessons from a HIT leader
At Marshfield Clinic, we see health information technology not as a solution, but as a powerful tool to help develop solutions to the challenging, dynamic health care environment. Our experience may be helpful to other health care organizations and national leaders, including President Obama, interested using electronic health records to reduce health care costs and improve the health and well being of the American people.
Information is Changing Medicine
Like many industries, medicine has entered a new information age. The last two decades have seen a knowledge explosion – new diagnoses, treatments, medications, clinical trials, laboratory codes, scientific advances and a wealth of information about the human genome.
The information requires tremendous change to the way medicine is practiced and how chronic disease, such as diabetes and heart failure, is managed. It also holds great potential for controlling health care costs, improving care, personalizing medical treatment to individuals and advancing research. Managing these changes and realizing the potential means the information must be organized, stored, analyzed and easily retrieved by physicians’ as they are treating patients. New tools – powerful health information systems – were needed.
Marshfield Clinic is a leader in Health Information Technology (HIT)
Marshfield Clinic is a large group practice in Wisconsin with a long history of using computers and information to improve patient care. We have a personalized medicine (genomics) project, the largest bio bank in the country and one of two or three bioinformatics research centers. We have been using electronic medical records since the early 1980s and developed our own EMR system, Cattails, which is available commercially. We eliminated paper charts in 2007.
All 750 physicians plus their care teams in the Marshfield Clinic system use tablet computers, allowing immediate access to patient health records, test results, X-ray images procedures and more. This improves efficiency, reduces time spent searching for information and avoids costly duplicate testing.
Our significant investment in HIT and care management systems has helped provide effective and efficient care while enhancing patient safety and improving quality. The efforts have been noticed. Steve Lohr wrote in the New York Times recently, “To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.”
As an HIT laboratory, Marshfield Clinic has demonstrated several advantages:
- Managing Chronic Disease
Chronic, or long-term, diseases become more common with age. The most common are diabetes, arthritis, cancer, pulmonary conditions and heart disease.
Spending on chronic disease is growing exponentially. By 2020, a projected 157 million Americans will have one or more chronic conditions, accounting for 80 percent of health care spending. This is estimated at more than $4.64 trillion, according to national health expenditure projections from the Centers for Medicare and Medicaid Services (CMS).
Marshfield Clinic invested in HIT systems that identify patients with chronic disease and track their blood pressure, blood sugar, cholesterol and other so-called quality measures. Patients with diabetes, for example, have hemoglobin A1c and fasting lipid profiles monitored, eye and foot exams and kidney function tests conducted annually, steps that will control the disease.
- Lowering Costs
Managing care through these efforts could mean avoiding hospitalizations. As the percentage of Clinic patients with diabetes whose cholesterol and blood pressure reached recommended levels from mid-2004 to the fall of 2008, hospital admissions fell. The number of Marshfield Clinic patients admitted to hospitals during the period declined from 360 to 311 per 1,000 patients annually. A hospital stay for a diabetes patient ranges from $8,000 to $22,500, according to national statistics cited in the New Times article, so the results translate into an annual cost saving of $7.3 million to $20.5 million.
Avoiding hospitalization saves patients and payers higher costs. Equally important, it enhances patients’ quality of life. Complications of diabetes can include kidney failure, blindness and amputation.
- Transforming Health Care Delivery
Our electronic medical record allows health information from thousands of Marshfield Clinic patients to be collected and analyzed. Each patient’s records, while private and secure, become part of a database of evidence showing what treatments are effective for populations with the same chronic disease. The information is analyzed and returned to physicians as evidence-based recommendations for treating and preventing disease.
This is transforming the way health care is delivered. Marshfield Clinic’s HIT systems allow the health care team to move from reactive treatment of disease toward proactively preventing and intervening before complications arise. Clinic systems are in place to alert physicians and nurse practitioners when screenings for cancer or heart disease, immunizations or diabetes monitoring and other routine preventive care are due. This seemingly simple step allows medicine to move from a traditional reactive mode to one that proactively identifies patients at risk and provides the opportunity to intervene before more costly care is required.
“The Marshfield experience suggests that the digital record becomes truly useful only when patient information is mined to find patterns and answer questions: What treatments work best for particular categories of patients? What practices or procedures yield the best outcome?”
The New York Times noted that Marshfield Clinic “understands that it’s a system of improvement that technology makes possible that really matters, and the electronic health record itself is no silver bullet,” said Dr. Carolyn M. Clancy, director of the federal Agency for Healthcare Research and Quality.
- Improving Quality Care
These questions are continually being raised and answered by mining information from the Marshfield Clinic EMR and analyzing patients in our data warehouse. The goal is better quality of care, higher quality of life and reduced costs.
As President Obama and Congress consider an economic stimulus package, we encourage them to consider a suggestion from Tom Still, president of the Wisconsin Technology Council, to broaden the definition of “shovel-ready” projects that include tools of the 21st century. In Wisconsin Technology Network News, Still suggests modernizing America’s health information technology, and cites the national attention that Marshfield Clinic’s electronic health records system has drawn. “Washington need not reinvent this particular wheel, but invest in what’s already working and save money and lives while creating jobs.”