Q and A With HealthCare Partners

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HealthCare Partners Medical Group

Three executives describe the challenges and rewards expected of electronichealth records.

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 organization’s 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.

HCP’s 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 health plans.

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 clinical guidelines.
• 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 organization’s 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 company’s 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 don’t use it, if it isn’t 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.” It’s working more collaboratively, a “let’s 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 user.

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 addressed.

HCT: Healthcare Technology: What’s 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 you’ll 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 you’ll 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 rates.

WC: Everything I see is that there’s 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.