HealthCare Partners Medical Group (HCP) and its affiliated independent physician
associations (IPAs) serve over 500,000 managed care and fee-for-service patients
in Southern California. The organizations group model division provides medical
services in 30 offices and four urgent care centers throughout greater Los Angeles.
Its IPAs provide care through hundreds of other offices around Los Angeles and
Orange County. It is the second-largest medical group in California.
HCPs business model provides medical services funded by capitation from the
health plans. The model supports a variety of clinician, hospital and ancillary
contracts, as well as the agreements, partnerships and relationships with various
Driven by its vision Dedicated to the well-being and respectful compassionate
healing of our patients and communities HealthCare Partners has long been
involved in strategic process improvement initiatives to improve patient care.
The most recent, and most exciting, undertaking is a multiyear process improvement
program: the Clinical Information System (CIS) project. The goals of CIS include:
- Enabling clinicians to improve the outcomes for chronic diseases, to achieve
preventative care goals and to increase safety for their patients through
decision support, disease management programs and safety programs.
- Empowering patients by improving communications between patient and physician,
and providing access to their medical record, laboratory results, medication
lists and other clinically important information.
- Expanding clinical trials programs by linking the patient base of data.
- Leveraging technology to enhance relationships with contracted physicians,
hospitals and other vendors.
- Creating and identifying highly efficient outpatient care processes and
- Prescribing medications more effectively and safely.
- Improving communications between primary care clinicians and specialists
to reduce inappropriate referrals, and provide better satisfaction and efficiency.
- Improving communications between primary care clinicians and hospitalists/
specialists to reduce admission and re-admission rates.
- Improving the organizations ICD-9 and CPT coding.
A key component of CIS is the implementation of the Allscripts TouchWorks
product, a Web-based electronic medical record system. Here three of HealthCare
Partners senior executive team discuss the companys motivation, the challenges
and expected rewards of electronic health records (EHRs).
HCT: What are the goals and objectives of EHRs?
William Chin, M.D., Executive Medical Director: I think everyone who
has used an EHR will stand by the statement that this will improve the quality
of care. Some of the reasons for that statement are that there are fewer lost
records, there are reminders built into the system to prompt the physician and
the healthcare team to know what needs to be done for a given patient, for a
given disease. From the physicians point of view, it is a real benefit to have
a tool that will allow them to provide better care, reduce frustration and improve
satisfaction with the process.
Zan Calhoun, Chief Information Officer: In addition, another of the
major goals of EHRs is more standardization of the data. So that what we have
is more consistent data throughout the entire healthcare system, so that data
can be more easily aggregated, so that data can be more easily shared. It all
supports what Bill just talked about in terms of improving the quality of care.
More standardization of data will support interoperability between systems and
healthcare information users.
Melayne Yocum, Chief Operating Officer: A word that I many times hear
associated with the EHR is enabling, because it does enable physicians to
have more data at their fingertips; it enables sharing of that information across
a wide range of healthcare entities and providers. And it enables patients to
be more participative in their healthcare, to take on more decision making and
be a true partner with their clinician and their care team.
HCT: What is the role of physicians in making EHRs happen?
WC: The physician plays a key role in that if they dont use it, if
it isnt intuitive for them, then the system is not valuable. So the physician
must play a leadership role in this whole process.
ZC: There are several roles that a physician might play. The first one
is as a thought leader, providing the visionary leadership in terms of where
we want to go with our use of the product. The second one is to be a champion,
which is perhaps less about vision, but more about enthusiasm and attitude:
Yes, we can make it happen. Yes, we can figure out how to do it. The third
is as a team leader. Its working more collaboratively, a lets work things
through attitude. The fourth is a trainer: I, as a physician, am going to
train other physicians. Lastly, the physician role is just as an individual
HCT: What do you think are some of the implementation challenges?
MY: One of the challenges that our industry has in implementing EHRs
is the lack of standardization in our processes. Healthcare is more of a craft
industry with many individuals who have developed their own processes to accomplish
their goals in delivering care. This lack of standardized processes can make
the implementation of an EHR very challenging.
ZC: Other challenges are the technical and security components of rolling
out such a large system. Clearly the networks need to be enhanced to deal with
the additional traffic and security needs to be a high priority issue to be
HCT: Healthcare Technology: Whats on the horizon? Do you think there
will be widespread adoption in the next five years?
MY: Yes. As we see physician organizations installing and improving
their EHRs, we will then continue to reap the benefits of these systems in improved
care for patients. This will lead to improved functionality and added benefits
for patients and physicians alike.
ZC: I agree with that. Other issues on the horizon include significantly
more focus on security. HIPAA is a first step in that process, but in the intervening
few years, there will be more issues around unanticipated or unexpected divulging
of health information, which will lead to much more focus around security. This
will, I think, break down some of these walls that might have been keeping some
out of this market. I also believe youll see more portability of the information,
where I as an individual have more control over my health information. The P
in HIPAA stands for portability, and yet very few people are talking about portability.
So I do think youll see more and more discussion and action surrounding how
to make our records more portable. And as we see the adoption rates climb, there
will be more integration of data from more sources, and that will inherently
make the value of these systems even greater, causing yet more growth in adoption
WC: Everything I see is that theres going to be more adoption of the
EHR, and as more and more folks are using it the hospitals, the physicians,
etc. that in itself will drive integration. As more and more users have systems,
then they want to talk to each other.