As we were building our electronic medical record (EMR) system, which serves our physicians and nurses both in the physicians’ offices and in the hospital, we also built tools for patients that allowed them to access that information from home. We built tools for those physicians whom we did not directly employ, and we thought about approaches to interoperability. This meant acquiring data that we didn’t generate, but that we could take into our systems and then use to make the best possible decisions for the patients we care for. In that sense, IT is strategic, because it truly facilitates a new transformed care delivery model.
But adoption of new technology remains a challenge today. Our goal was to improve the process of care over time. We thought about the best sequence for implementing the technology so that it delivered the most value at each step. So unlike many organizations, we did not implement the hospital information system first, but rather we began with the largest part of our organization, which is the ambulatory practice. That way, we could put a lot of patient information into the EMRs. When it became time to move to the inpatient side, our physicians were already using the technology on the ambulatory side, and they could immediately see the value. They could see information that had been collected prior to the patient’s admission.
We found that by adhering closely to our practice goals, and applying the technology in a sequence that added value for the caregivers, we could overcome many of the barriers to technology adoption.
S+B: The topic of information exchanges in promoting EMRs in the healthcare industry has received a great deal of attention. How do you see this playing out?
HARRIS: Information exchange is the last mile in getting the most value out of EMR technology. Within an organization, you must be able to exchange information among departmental systems — like between a laboratory system and a radiology system — or from one site to another to provide value to patients.
Every day at the Cleveland Clinic, however, patients come in who have been seen by physicians who are not part of our organization. That brings us to what I call the regional or state-level requirement for information exchange. We would like to be able to get that information into our electronic records to provide the best care to patients, so that no matter where the patients come from, we will have the information we need to make good decisions on their behalf.
This will happen first at a state scale — the state of Ohio is working on it now. But the challenge in a mobile society like the U.S. is to make it happen on a national scale. How quickly this can be executed is the critical question, and there are really multiple avenues to that end. Some will be private and others will be public. These efforts will involve large numbers of people every day. And when I say large numbers, although the Cleveland Clinic probably sees more than a million patients in any given calendar year, we’re talking about tens of millions or even hundreds of millions.
Over the past few years, we’ve worked with technology companies like Microsoft to allow patients, at their direction, to pull information from their local market into accounts that they control. The patients can make independent decisions to move that information to the Cleveland Clinic, thereby completing the loop and making the information available so that our physicians can provide the best care. Our goal is not to dictate which information exchange the patient wants to use. We just want to be connected to any service that they find valuable. No matter what the service is, they all have one fundamental requirement, and that is that they maintain the security and confidentiality of the patient’s information.