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The views of Utah’s Wasatch Mountains are spectacular from the east side of Intermountain Medical Center, but as 40-year-old Lee Pierce walked down a hallway on the fifth floor of the hospital’s administrative building, he hardly noticed them. Pierce, Intermountain’s chief data officer (CDO), was more focused on the giant countdown clock the implementation team had put up in the corridor. The clock was approaching zero, which marked the moment in February 2015 when Intermountain Healthcare would switch on its new electronic health records (EHR) system in two of its 22 hospitals and 24 of its 185 clinics.
Pierce was hardly the only health care executive concerned about a major EHR installation. Indeed, a year earlier, a key provision of the American Recovery and Reinvestment Act of 20091 went into effect, mandating that all health care providers adopt and demonstrate “meaningful use” of EHR systems to maintain their Medicaid and Medicare reimbursement levels.2 But while others scrambled to meet the deadline, Intermountain executives were thinking past it — because Intermountain was replacing an EHR system, not installing its first one.
In fact, Intermountain had created its own EHR system in the 1970s, helping the not-for-profit hospital develop a reputation as an innovator in evidence-based medicine. But that system had aged: It had become incompatible with new forms of input, like speech and data from wearable devices, and it was cumbersome and challenging for the nurses and physicians using it to navigate the antiquated interface to document and retrieve patient information.
Over the years, clinicians had learned to work with the system. It was part of a concerted effort to bring data-based insights to clinicians and managers across the Intermountain Healthcare organization. All clinical programs had embedded analytics support teams; procurement decisions were heavily influenced by data and analytics; and patient interactions were continuously enhanced by data, from the application of population health analytics to analyses of patient self-reports. A culture of data use was widespread among Intermountain’s clinicians and managers.
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1. The complete provisions of the American Recovery and Reinvestment Act of 2009 can be obtained here: http://www.recovery.gov/arra/About/Pages/The_Act.aspx
2. The Centers for Medicare and Medicaid Services (CMS) Webpage http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html details incentives for adopting EHRs. A related page at the Indian Health Service website, http://www.ihs.gov/meaningfuluse/incentivesoverview/incentivesreduction/, outlines some of the penalties faced by organizations that don’t effectively use EHRs.
3. K. Stewart, “Father of Medical Informatics, Utah’s Homer Warner Dies,” Salt Lake Tribune, Dec. 3, 2012, http://www.sltrib.com/sltrib/news/55391911-78/warner-medical-homer-utah.html.csp; P. Owens-Liston, “Homer Warner, Founder of Biomedical Informatics,” University of Utah Healthcare HealthFeed, Nov. 30, 2012, http://healthcare.utah.edu/healthfeed/postings/2012/11/113012homeobit.php.
4. Intermountain Healthcare: About Us — Medical Informatics: Our History. http://intermountainhealthcare.org/qualityandresearch/informatics/about/Pages/history.aspx (from video), accessed April 4, 2015.
5. K.W. Jones, A.S. Cain, J.H. Mitchell, R.C. Millar, H.L. Rimmasch, T.K. French et al., “Hyperglycemia Predicts Mortality After CABG: Postoperative Hyperglycemia Predicts Dramatic Increases in Mortality After Coronary Artery Bypass Graft Surgery,” Journal of Diabetes and its Complications 22, no. 6 (November–December 2008): 365–370. http://www.sciencedirect.com/science/article/pii/S105687270700061X
6. J.B. Muhlestein, D.L. Lappé, J.A.C. Lima, B.D. Rosen, H.T. May, S. Knight, et al., “Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High-Risk Patients With Diabetes: The FACTOR-64 Randomized Clinical Trial,” JAMA 312, no. 21 (December 3, 2014): 2234–2243. http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2014.15825
7. R.J. Gibbons, “Optimal Medical Therapy vs CT Angiography Screening for Patients With Diabetes,” JAMA 312, no. 21 (December 3, 2014), 2219–2220. http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2014.15958
8. According to research published by Material Handling & Logstics: http://mhlnews.com/global-supply-chain/healthcare-companies-using-supply-chain-stay-competitive
9. Organisation for Economic Co-operation and Development. "OECD Health Statistics 2014: How does the United States compare?" http://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATES-2014.pdf.