Corporate News and Events

Clinicians Better Equipped With Evidence-based Medicine in Real-Time

Standard Terms, Inpatient Pay–for-Performance Necessary to Build Momentum of Health IT

Novi, Michigan (June 11, 2007) – Early results from Trinity Health’s nation-wide electronic health record initiative shows that clinical decision support systems are successfully linking clinicians with large amounts of health information and evidence-based knowledge in ways that enhance patient care, Trinity Health’s chief informatics officer told the American Health Information Community (AHIC) Quality Workgroup.

To continue maximizing the effectiveness of health information technology, J. Michael Kramer, MD, Trinity Health chief medical informatics officer, said federal health agencies must do two things:  Adopt standardized terms for defining quality, and align physician quality measures with hospital measures in order to enhance interventions and reduce the burden of reporting of quality data in both inpatient and outpatient care.

“In order for Trinity Health — and other health systems involved in using health IT — to continue our journey, it is critically important that we achieve further alignment of terminology and pay-for-performance goals between physicians and hospitals,” Kramer told the AHIC Quality Workgroup, which is co-chaired by Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ).  The workgroup’s membership includes officials from hospitals, hospital associations, health plans, industry, consumers and federal agencies.

AHIC’s Quality Workgroup is considering how health information technology (IT) can be used for the development of real-time quality measures that will benefit patient care. AHIC has identified health system IT as an important tool for data collection that can support performance improvement on those quality measures. 

Trinity Health, a national Catholic health system of 46 community hospitals, is engaged in a $315-million “Genesis” initiative to create a common platform for not only clinical information systems but also revenue-cycle and supply-chain management. All Trinity Health hospitals have adverse drug event (ADE) alert systems in place, and 10 hospitals in Michigan and Iowa have launched computerized physician order entry (CPOE) with a new pharmacy system, online nursing documentation and EHR, and a new revenue management system. 

Trinity Health maintains a database of more than five million patient records, making it the third-largest clinical repository in the nation.  Data is contained in a single location and includes clinical, financial and administrative information across all facilities. Two facilities are able to manage both inpatient and outpatient care in the same system.

Both within and outside of the hospital, wired and wirelessly, clinicians now have access to evidence-based recommendations to support their patient decisions at the point of care.  “The primary goal of Genesis is to provide clinicians with the best information to meet the needs of a particular patient at the time of patient care,” Kramer said.

Accomplishments to date on Trinity Health’s paperless clinical platform:

• Entry of orders into computers directly by the authorized prescriber or physician occurs 60 percent of the time across deployed facilities and is as high as 84 percent in the most recently deployed hospital system – St. Joseph Mercy Oakland, Pontiac, Michigan. 
• Up to 80 percent of the former paper medical record is now electronic.
• More than 1,500 caregivers use the system simultaneously during peak hours, with more than 180,000 chart openings per day.
• Inpatient nursing care, pharmacy and medication administration are documented directly by providers in the same electronic system.  Lab and Radiology data also feed from regional and hospital-based systems.
• Over 300,000 orders are placed, processed, and completed per day electronically from order to administration, in the same system.
• More than 700 physicians place orders every day.

Trinity Health is increasingly leveraging electronic patient data to encourage evidence-based quality care.  But despite its early successes, Kramer said Trinity Health’s record system has a long way to go before evidence-based care is achieved at the point of care. The process remains a retrospective and a manual effort.  For example, the electronic record captures less than half of the information necessary to report on the 26 JCAHO/CMS quality indicators for heart attacks and heart failure, surgical care infection prevention and community acquired pneumonia.  The challenge, he said, is to turn “after the fact” quality data into real-time patient care.

“Forty percent of the data needed to assess quality in inpatient care is generated by physicians who may not have access or incentive to contribute to quality data,” Kramer said.

Recent government actions will help incentivize physicians, such as the Physician Quality Reporting Initiative (PQRI), which on July 1 will provide a financial incentive of up to 1.5 percent of allowed Medicare payments to report data on a designated set of quality measures.  In order to qualify for this incentive, physicians must report satisfactorily using one or more of 74 quality measures. 

“Trinity Health’s ongoing investment in Genesis, incentives like PQRI, and other opportunities for collaboration will allow not-for-profit organizations to support the efforts of our associated physicians in driving and reporting quality,” Kramer said.  “Given the complexity of patient care and these quality measures, individual physician practices and health systems like Trinity Health must continue to collaborate in managing an increasingly complex data set that spans the communities we serve.”

About Trinity Health
Trinity Health is the fourth-largest Catholic health care system in the country. Based in Novi, Michigan, Trinity Health has 31 owned and 15 managed hospitals, 379 outpatient facilities, 26 long-term care facilities, and numerous home health offices and hospice programs based in seven states.  Employing approximately 45,100 full-time staff, Trinity Health reported $6.1 billion in unrestricted revenue and $307.0 million in community benefit ministry in fiscal year 2006. For more information about Trinity Health, visit www.trinity-health.org.

About the American Health Information Community
The Secretary of Health and Human Services (HHS) formed the American Health Information Community (AHIC) in 2005 to help advance efforts to reach President Bush’s call for most Americans to have access to an interoperable electronic health record within ten years. The AHIC is a federally chartered advisory committee and provides input and recommendations to the Secretary of HHS on how to make health records digital and interoperable in a smooth, market-led way, and to ensure that the privacy and security of those records are protected.