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Partners HealthCare System Thomas H. Davenport Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston...

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Read one of the following chapters in your textbook Analytics in Healthcare and the Life Sciences: 18, 19, 20, 21 or 22.

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Choose one effort from the chapter selected and describe the importance of interoperability to its success in 3 5 0 to 7 0 0 w o r d s. Also address how you could apply what you have read to your current or future corporation.

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18. Partners HealthCare System Thomas H. Davenport Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with more than 7,000 affiliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonprofit organization with almost $8 billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teaching affiliate of Harvard Medical School. Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems (the electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, are specific to particular hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such as Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, both centralized and hospital-specific analytical resources are described. The focus for hospital-specific analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although other Partners hospitals also have their own analytical capabilities and systems. Centralized Data and Systems at Partners The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s. Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information officer, initiated an outpatient electronic medical record (EMR) at the Brigham in 1989. 1 This EMR contributed outpatient data to the clinical data repository. The hospital was one of the first to embark on an EMR, though MGH had begun to develop one of the first full- function EMRs as early as 1976. A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient EMR, the Brigham—and Partners after 1994, when Glaser became its first CIO—needed facilities for doctors to input online orders for drugs, tests, and other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solve the time-honored problem of interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether a particular order made sense or not for a particular patient. Did a prescribed drug comply with best-known medical practice, and did the patient have any adverse reactions in the past to it? Had the same test been prescribed six times before with no apparent benefit? Was the specialist to whom a patient was being referred covered by his or her health plan? With this type of medical and administrative knowledge built into the system, dangerous and time-consuming errors could be prevented. The Brigham embarked on its CPOE system in 1989. Nesson and Glaser knew that there were other approaches to reducing medical error than CPOE. Some provider institutions, such as Intermountain Healthcare in Utah, were focused on close adherence by physicians to well-established medical protocols. Others, like Kaiser Permanente in California and the Cleveland Clinic, combined insurance and medical practices in ways that
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incented all providers to work jointly on behalf of patients. Nesson and Glaser admired those approaches, but felt that their impact would be less in an academic medical center such as Partners, where physicians were somewhat autonomous, and individual departments prided themselves on their separate reputations for research and practice innovations. Common, intelligent systems seemed like the best way to improve patient care at Partners. In 1994, when the Brigham and Mass General combined as Partners HealthCare System, there was still considerable autonomy for individual hospitals in the combined organization. However, from the onset of the merger, the two hospitals agreed to use a common outpatient EMR called the longitudinal medical record (LMR) and a CPOE system, both of which were developed at the Brigham. This was powerful testimony in favor of the LMR and CPOE systems, since there was considerable rivalry between the two hospitals, and Mass General had its own EMR. Perhaps the greatest challenge was in getting the extended network of Partners-affiliated physicians up on the LMR and CPOE. The physician network of more than 6,000 practicing generalist and specialist physician groups was scattered around the Boston metropolitan area, and often operated out of their own private offices. Many lacked the IT or telecom infrastructures to implement the systems on their own, and implementation of an outpatient EMR cost about $25,000 per physician. Yet full use of the system across Partners-affiliated providers was critical to a seamless patient experience across the organization. Glaser and the Partners information systems (IS) organization worked diligently to spread the LMR and CPOE to the growing number of Partners hospitals and to Partners-affiliated physicians and medical practices. To assist in bringing physicians outside the hospitals on board, Partners negotiated payment schedules with insurance companies that rewarded physicians for supplying the kind of information available from the LMR and CPOE. By 2007, 90% of Partners-affiliated physicians were using the systems, and by 2009, 100% were. By 2009, more than 1,000 orders per hour were being entered through the CPOE system across Partners. The combination of the LMR and the CPOE proved to be a powerful one in helping to avoid medical error. Adverse drug events, or the use of the wrong drug for the condition or one that caused an allergic reaction in the patient, typically were encountered by about 14 of every 1,000 inpatients. At the Brigham before LMR and CPOE, the number was about 11. After the widespread implementation of these systems at Brigham and Women’s, there were just above five adverse drug events per 1,000 inpatients—a 55% reduction. Managing Clinical Informatics and Knowledge at Partners The Clinical Informatics Research & Development (CIRD) group, headed by Blackford Middleton, is one of the key centralized resources for healthcare analytics at Partners. Many of CIRD’s staff, like Middleton, have multiple advanced degrees; Middleton has an MD, a Master of Public Health degree, and a Master of Science in Health Services Research. The mission of CIRD is to improve the quality and efficiency of care for patients at Partners HealthCare System by assuring that the most advanced current knowledge about medical informatics (clinical computing) is incorporated into clinical information systems at Partners HealthCare. 2 CIRD is part of the Partners IS organization. It was CIRD’s role to help create the strategy for how Partners used information systems in patient care, and to develop both production systems
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