Infused within the culture of ProMedica Physician Group is a focus on our core mission: providing value to our community’s patients and their providers. The added value to our community is measured by outcomes in quality, service and cost efficiency. As part of ProMedica Health System, PPG is an employed provider network, fully intertwined within an integrated delivery system that includes 27 contiguous counties in northwest Ohio and southeast Michigan.
Ranking in the top 5 of Verispan’s “most integrated” delivery systems in the country for the past five years, a commitment to pursue and fully deploy an electronic health record was an important and natural next step for ProMedica. A fully integrated EHR was seen as a tool to accomplish true innovation through digital transformation, and received the full health system board endorsement in 2004. An extensive competitive demonstration and bidding process took place to determine the best fit for our IT infrastructure, existing system interoperability, end-user functionality and our capital capacity. The health system committed to substantial capital and human resources and in 2005, an agreement was struck with the preferred vendor.
The first phase of implementation was to pilot the system at a number of sites, beginning in 2006. Since that time, PPG has implemented the EHR at 11 more sites, totaling 26 providers in varied specialties such as family practice, internal medicine, pediatrics, obstetrics/gynecology, orthopedics, cardiology, oncologic surgery and otolaryngology, making PPG a “meaningful user” in every sense. ProMedica has invested several million dollars in IT hardware, software and support personnel during this pilot phase.
The purpose of the pilot phase was to allow our EHR training teams and IT support staff, as well as clinical services and office staff, to work through all of the pitfalls and obstacles in the entire process of EHR implementation and support. PPG employs nine EHR FTEs to support the original pilot practices. Throughout the pilot implementation period we did ongoing LEAN and Six Sigma analysis to develop and optimize the clinical practice design processes necessary to assure that the outcomes of quality (transparency in data, safety, risk, preventive care), service (portability, access, Web interaction, scheduling) and operational efficiencies would be achieved in a variety of specialties and settings. In addition, we piloted in multiple regions throughout our 27-county encatchment to verify connectivity and interoperability throughout our regions. In short, through our pilot site implementations, we have developed a team, armed with processes and support that is second to none in the industry. It is vital to our success that we retain the knowledge and capability of these personnel and, in fact, hire more. An infusion of capital support from the American Recovery and Reinvestment Act of 2009 will be vital as we take the EHR to the next level of full network deployment and family practice residency integration up to 300 providers, and more than 1,200 end-users.
The pace of change in the healthcare IT environment has been at an ever-increasing rate. The demand is palpable from all sectors: the CMS, insurers, consumer drivers, businesses and local communities. PPG has taken the challenge from the Obama administration and is moving to upgrade its systems and fully deploy with “the fierce urgency of now.” A plan to upgrade our practice-management system for our entire 260-member network has been put into place to provide a more robust billing/collection system foundation. A “train the trainer” approach will be utilized to conserve cost and use the existing expertise in our current EHR teams. The “go live” timing to convert our existing 11 EHR sites is October. Once the 11 original sites are converted, PPG will move forward in a “rolling rollout” of the complete EHR solution through 2011.
Concurrently, PPG has been asked by community members to provide a solution option for nonemployed, private physicians to help gain entry into an EHR. The expertise and purchasing partnerships that PPG has garnered would be a significant advantage and opportunity for collaboration with non-PPG providers. We plan to hire an additional EHR implementation/support team to do just that. As a management services organization as well, PPG already supplies a variety of services to private, nonemployed physician groups and we are working closely with our vendor to develop a competitive offering for independent practitioners. This would also further the development of the broader policy aims of interoperable regional health information networks.
The capital and operating budgets developed for this ambitious agenda are nothing short of daunting. More than $9.1 million is required to complete the three-year implementation. While PPG and our parent health system are committed to long-term sustainability, additional funding from the stimulus act will serve as a catalyst to rapid deployment. Once completed, we are confident that the myriad sources of return on investment from pay-for-performance strategies, operational efficiencies, avoidance of duplication and risk management will all run to the sustainability of the operation. In addition, as competitive user fees are collected from the providers after full deployment, the ongoing operating costs will be largely covered and sustainable.
In summary, ProMedica Physician Group stands as a “meaningful user” of an EHR that has painstakingly prepared itself with the knowledge, expertise and dedication to utilize health information technology funds in the most meaningful way: successfully and sustainably improving patient and provider value. We will do so with stewardship and dedication to our mission … with “the fierce urgency of now!”
David Selman
Chief information officer
David Jame
Senior vice president of medical affairs
ProMedica Health System
Toledo, Ohio
