After the IT part of the equation is resolved, the next major step is getting Marshfield's 800 physicians—who practice in 50 specialties and subspecialties—all on the same page.
“It's more of an operational project than an IT project,” Cummens said.
For example, he said, orthopedic specialists often don't see the value in taking patients' vital signs or recording their smoking status, but these are government quality measures, so the key is to engineer the work flow so that someone else on the care team performs these tasks. This will serve to “minimize the demands on providers as much as possible,” Cummens said.
Marshfield also acts as its own electronic health-record system vendor. In January 2007, Marshfield's EHR, known as CattailsMD, became the first "home-grown" product to earn certification by the Certification Commission for Health Information Technology, and it was also the first certified EHR developed for internal rather than commercial use. (The clinic, however, is now licensing the EHR and has one implementation under way with the Milwaukee-based Ministry Health Care system, an organization that Cummens acknowledged competes with Marshfield's primary-care business.)
“Our big concern right now is Phase 2 of meaningful use, year three,” Cummens said. “Our goal is to qualify all of our providers as early as the rules permit.”
CattailsMD will require some "fairly extensive reworking" to meet certain meaningful-use requirements, but much of that will involve building on what already exists.
“We already do medication reconciliation very thoroughly,” Cummens said, adding that one new focus for the clinic will be building the quality-measure library.
Notable about Marshfield is its view of meaningful use as a step toward other goals—one element of a program that may include transitioning to the new ICD-10-CM medical coding system, transforming all of Marshfield facilities into patient-centered medical homes, participating in Medicare's physician group practice pay-for-performance demonstration project and adopting the accountable care organization business model.
“We see much of the requirements of meaningful use stage 2 supporting ACOs,” Cummens said. “We're not looking at meaningful use as an end in itself.”
For example, Cummens said, meaningful use does not create an explicit plan of care for individual patients—a provision required in the medical-home model. Marshfield will build such plans of care into its Stage 2-related CPOE applications.
The advantage to building its own system is that the clinic can use early prototypes and ensure that the software is clinically sound, he added.
“I can walk across campus and talk with our head of quality or our president and find out what providers need—they don't need to go through a middleman,” Cummens said. “We can be much more agile and respond to changing requirements. That's probably our biggest advantage to being a home-grown system.”