When Edward Murphy, president and chief executive officer of the Carilion Clinic system in Roanoke, Va., decided to orchestrate one of the largest patient-data conversions ever conducted by a health system, his motivations went beyond health IT goals.
“Healthcare costs are on a trajectory that is unsustainable. We spend as much on healthcare services to patients as we spend on foreign oil,” said Murphy, who has been at the helm of the six-hospital system since 2001. “We’re in a position to improve efficiency and improve service and outcomes and provide more-coordinated integrated services of care.”
In achieving these goals, you can’t simply rely on information technology. IT efforts need to be combined with other measures, such as the development of medical homes, and incorporating the patient as an active participant in their care, Murphy said.
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“Healthcare as a profession is used to taking care of the patients in front of us. It’s been poorly designed to manage handoffs between patients,” Murphy said. He emphasized that quality of patient care and experience and coordination are “as much about handoffs” as about anything else.
The 12 weeks it takes a patient to present to a doctor with a cough to the time that patient gets treated for lung cancer is too long, Murphy said. There needs to be more medical practices that are accountable not just for outcomes but service to patients and patient experience and efficiency, he said.
A graduate of Harvard Medical School, Murphy’s career has focused mainly on management, administration and academics. Prior to Carilion, he was the president and CEO of Seton Health, Troy, N.Y. Over the past eight years, Murphy has undertaken numerous projects to improve IT operations at Carilion, such as introducing a “balanced score card” to manage the healthcare system’s performance and outcomes, and establishing a physician technology committee to review and guide technology for clinical use at Carilion.
With his medical school training, “he understands the importance of evidence-based information and the importance of gathering accurate information to make better decisions,” says Douglas Hawthorne, CEO of Texas Health Resources, Arlington, and one of the judges for the 2009 CEO IT Achievement Awards.
Murphy can also be credited for reformatting Carilion’s collection of hospitals and practices to establish the Carilion Clinic in an effort to deliver more coordinated care for patients, and creating the Virginia Tech Carilion School of Medicine, Roanoke.
And in converting Carilion’s healthcare network to one integrated electronic record, Murphy brought health IT at Carilion to a new level by streamlining communication among physicians, other medical staff and patients.
Previously, Carilion’s primary-care physicians had been using the Centricity EMR, an electronic medical record manufactured by General Electric Co., a fairly comprehensive, primary-care-oriented outpatient ambulatory medical record. In the meantime, other parts of the network of Carilion’s hospitals, operating rooms and emergency departments were all on completely different electronic systems.
Murphy’s antidote to a fragmented communication system was an electronic health record from Epic Systems Corp., a tool designed to give each patient a longitudinal, portable record and allow geographically diverse physicians to coordinate a patient’s care using standardized best practices. In Carilion’s case, a large-scale conversion of the Epic EHR took place, which involved taking out all other single-platform systems, Murphy said. The decision to implement Epic took place in October 2006, although the actual rollout began in February 2007.
Even before the first Carilion clinic went live with Epic, Murphy made the preparatory decision to convert all medical records from Centricity to the new EHR. The process took five employees six months, and converted more than 35 million data elements from 780,000 patients before the first practice went live.
By November 2008, 28 physician practices with more than 150 providers and all 500 physicians and 3,200 nurses at Carilion’s flagship, 589-bed Carilion Medical Center, Roanoke, were using Epic for documentation of care, order entry and medication administration.
“We plan to complete our base installation in late 2010,” Murphy said, although with 80% already installed, “it may be sooner than that.”
The conversion wasn’t cheap; Carilion estimates total capital costs will amount to $65 million from 2007 to 2011. This is where the health system wanted to go, however, in terms of improving care to patients, Murphy said. “We asked whether we could afford it and the answer was yes. Then we asked the question: Could we afford not to do it? And the answer was no.”
Murphy emphasized the decision to convert to Epic wasn’t just about the installation of an EHR. “It’s not just a base tool, but an important clinical support system for nurses and doctors and hospitals.”
One of the Epic system’s goals has been to promote the concept of the medical home, which seeks to improve outcomes by appointing a personal physician to manage and coordinate care of the patient. To see how the EHR operates in this type of practice environment, Carilion has been using Epic in one of its practices, a six-physician family medicine office in Vinton, Va., which is in the process of being certified as a medical home.
The practice has been using Epic since April and, so far, the results have been fairly promising, said Mark Watts, a physician with the practice who’s also the president of the Virginia Academy of Family Physicians.
Epic’s EHR “makes it easier to coordinate patient referrals and get updates from the emergency room on a patient. When I see a patient, I’ve got all their information,” Watts said.
To further promote the concept of medical homes, Epic recently adopted MyChart, a tool that allows patients direct access to their own medical record via the Internet, Murphy said.
MyChart started a few months ago and to date is available in two physician offices. Murphy estimated that at least 100 patients have a MyChart account. Under this system, patients can log on to their account on the Internet and ask for refills, get a nonemergency health question answered or look at test results.
Carilion has yet to produce statistics on whether the new Epic system has resulted in a reduction of medical errors. However, the patient medical record has significantly increased Carilion’s rate of medical reconciliation at the time of admission and discharge by at least 5% and 10%, respectively.
Even when the system is completed, Murphy offered that with IT, the work is never really done, given the pace of the ever-changing technology.
There is a bit of naivete out there that if you develop an EHR, that’s enough, Murphy said. Medical records alone won’t improve healthcare; it’s a first step.
“Simply converting paper to electronic is necessary but not sufficient," Murphy said. "You can’t declare victory because you digitized information. We have to get a lot further down the road to get records to work for us in a more sophisticated way.”
This story initially appeared in this week's edition of Modern Healthcare magazine.
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