Eric Herman, MD, Medical Director, Population Health and Family Physician, for MultiCare's Kent Clinic, talked about the power of the EMR is only as good as the person using it.

1. Eric Herman, MD
Medical Director, Population Health
Family Physician, Kent Clinic
MultiCare
Using the EMR to Drive
Improved Patient Outcomes

2. Overview
•The EHR as a clinical tool
•EHR Clinical Improvement Checklist
•Example at MHS
•Conclusion & Questions
2 | Creating Healthier Communities | Best practices for managing high-risk clinical populations

3. The EHR as a Clinical Tool: X-ray Analogy
• Albeit extraordinarily powerful, it is a merely a software application
– Like an X-ray is directed radiation, EHRs is a directed database of information.
– Only as good as someone else programs it: “Garbage in -> Garbage Out”.
– Computers are NOT medical decision makers – People are!!
• Before you dive, learn the intended use, capacities, and limitations
– Radiologic competencies required time and training to understand the tool and
processes.
– EHR is also a tool, with risks and benefits. (See EHR Clinical Innovators Checklist)
• Insist on an excellent instructor / liaison
– Right IT liaison for a non-techy doc = Right doctor for a complex patient.
– Research your Organization: Is there a Clinical Informatics MD on your team?
– Don’t be afraid to push the envelope; Our patients deserve it.
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4. The EHR as a Clinical Tool:
Framing the Right Questions
• Are You in Alignment with Your Organization’s Goals & Vision
– What are goals: More high level, 10,000 ft. view.
– What are your objectives: Measurable processes and/or outcomes.
– Triple AIM is a valuable litmus test. (Quality; Patient Experience; Cost)
– Critical for resources, overcoming barriers, delays, unmet expectations.
• Who will be the target audience
– What is the value of your effort and outcomes to them?
– Are you speaking their language and their culture?
– Will your approaches be easily adopted by all stakeholders?
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5. The EHR as a Clinical Tool:
Form Follows Function – EHR Follows Operations
• Even if you had the most valuable data at your fingertips,
do you know how to be successful with it!
– Like ordering a study, what will you do with the results afterwards.what will you do with the results afterwards.
– Your success depends on a healthy partnership with operations
• Collaboratively plan your steps with your operational team.team.
– Set the clinical stage to capture the right data.
– Support workflows necessary for targeted interventions.
– Perform invaluable work on behalf of clinicians.
– Analyze outcomes and variances.
– Training everyone to do the above correctly
– They will identify critical success factors unknown to you.
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6. Readiness Assessment Checklist
Comprehensive Considerations Critical To Success
See Referenced Handout
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7. CHF Example: Multicare Health Systems
• Goal = Improve Triple Aim for CHF Pts
– Improve quality of care, patient experience of care,
and cost of care for patients at a pilot PCP office.
(n=196; ~ 6.0 Provider FTEs [FP/IM]).
• Outcomes:
– Appropriate ACE/ARB & Beta Blocker Management.
– Decrease CHF Readmissions.
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8. CHF Example: Multicare Health Systems
• Stakeholders
– Clinicians (Primary Care & Specialists; IP/OP/ED)
– Clinical collaboratives; Hospice and palliative care
– Executive sponsors and administrators
– Clinical operations
– Clinical care coordinators and home health
– Patient’s and their families
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9. CHF Example: Multicare Health Systems
• Processes
– Establish the clinical best practices
– Determine the outcomes of interest
– Determine the interventions, resources, and workflows
to facilitate best practices
• Work extensively to research all IT/Operations processes
– Pilot the interventions (Plan, Do, Check, Adjust)
– Diffuse what was of value (Dashboards & Pop Health)
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10. CHF Example:
CHF Dashboards – The New Workhorse
• Most relevant content immediately available.
• LEAN design with further detail dives.
• Valuable for clinicians, patients, and staff
• Focused on the content NOT than the EHRFocused on the content NOT than the EHR
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13. CHF Example: Outcomes
• Beta Blocker Chemoprophylaxis (LVEF < 40%)
– 26 of 26 patients = 100%
• ACE/ARB Chemoprophylaxis (LVEF < 40%)
– 25 of 27 patients = 93%
• Readmissions
– Internal = 0% in a recent rolling 12-month time frame
– External = ? Pending further investigation
• Diffusion
– Dashboards now available in production
– Best Practice Workflows being considered for system-wide
processes
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14. CHF Example: Challenges
• Data clean up (Problem List; CHF Stage / Class).
• IT Enhancement Requests (Discrete Stage / Class / EF).
• Pharmaceutical data dependent on third party.
• Availability of External Data.
• Keeping all stakeholders informed.
• Education of technical and operational innovations.
• Challenges isolating the effectiveness of a specific
intervention.
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15. Next Steps For Dashboards
• Published dashboards for DM, HTN, Depression
• Prioritize new dashboards (CKD, Chronic Pain…)
• Consideration of a SuperDashboard (Life Care Plan)
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16. Conclusion
• Love the EHR, but…
– Understand what it can and can’t do
– Be careful what you ask for
– Be nice, oh so nice, to your operations team
– Be true to the triple aim and clinical best practices
– Think outside the EHR box toThink outside the EHR box to innovative systems of careinnovative systems of care
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17. THANK YOU