Every year, more than 1 million patients receive care at MetroHealth, based in Cleveland, many of them who are considered "at-risk" or underserved. The health system leverages its IT efforts in a tailored way to these populations, and it's numerous IT initiatives earned the system a 2015 HIMSS Enterprise Davies Award.
Through its IT initiatives, MetroHealth has improved care outcomes for its diabetic population, doubled the number of HIV screenings for at-risk patients and reduced drug-resistant infections by more than 30 percent. Overall, care efficiencies have saved the health system nearly $8 million.
Here, David Kaelber, MD, PhD, CMIO of MetroHealth discusses IT at the health system and how it caters healthcare to its diverse population.
Note: Answers have been lightly edited for length and clarity.
Question: In your Davies application, you outlined 15 examples of using IT and the EHR to boost clinical value. How did MetroHealth decide to focus on these areas?
Dr. David Kaelber: If you look at the 15 cases, they're pretty varied. Some of them are inpatient-focused, some are outpatient-focused, some are on referrals, some are improving quality of care — it's the whole gamut. The reason we chose the examples we did is they really are representative of the huge array of different areas where the EHR and health information technology has transformed our healthcare system. One of the analogies I use is EHRs and health IT are becoming the nervous system of the healthcare system of the future, and MetroHealth is an example of that today. The idea is it's permeating all areas of the healthcare system and becoming essential for all areas of our healthcare system to coordinate appropriately and get the outcomes that we want.
Q: Your population is considered "at-risk," so what are some of the challenges or different focus areas you look at that other hospitals may not?
DK: When we say "at-risk" population, it just means it's probably more of a heterogeneous population than some other healthcare systems. When we say heterogeneous, it's usually the social determinants of health. We have more economic diversity and educational diversity. We probably have [higher] rates of ethnic heterogeneity or diversity. Then the question is, how does that play out from a health IT perspective?
There are a couple examples of that. First of all, our personal health record. In our population we don't expect all of our [patients] to have home Internet access. It makes us think a little bit different, harder and maybe smarter about how we need to use tech. We found while home Internet access may not be prolific to 100 percent of patients, actually a huge majority of our population do seem to have smartphones. A lot of our initiatives are more thinking about our smartphone as the device people will be using as opposed to the home computer.
Q: MetroHealth has a lot of interoperability and data exchange initiatives. Can you share some insights here and lessons for the rest of the country that's still trying to connect?
DK: I'd break it down into two areas: typical informatics and non-tech and tech issues.
When I talk to other leaders in the healthcare systems, there's still what I see as a fear of health information exchange in some corners, this idea that if we exchange information, the patient might leave us or other doctors might see what we're doing. There's sort of that psychological element, and it becomes a real impediment where a system says we do not want to do health information exchange. People just need to get over that. We're in an age where everybody needs to value the free flow of information.
On the tech side, you really want to remove as many barriers to health information exchange as possible and make it as [achievable] as possible. We removed the barrier that required written consent and we did a whole bunch in our Epic EHR with auto querying. That increased our ability of HIE by an order of magnitude.
Q: How do you leverage your Epic EHR for HIE initiatives?
DK: What happened in northeast Ohio is we were able to get a whole bunch of other systems to all agree that health information exchange is a good thing for our patients, and that broke a lot of the technical and administrative barriers that made it harder. It's not only us doing things with our Epic functionality, but everybody else doing things with their EHR functionality as well. Health information exchange is about two parties communicating.
Q: What does receiving the Davies Award mean to MetroHealth?
DK: We've had a three-year plan to first become HIMSS Stage 6 certified and then HIMSS Stage 7 certified in both ambulatory and inpatient settings, and then work toward the Davies Award. In three years, we did all of those things. It's really external validation that we are a leader in using health IT and EHRs to benefit our patient.
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