Use of electronic medical record systems makes it easier for physicians to create patient care dashboards
Just as more clinical laboratories are using real-time dashboards to manage operations and workflow, a similar trend is happening with office-based physicians. Physicians using electronic medical records (EMRs/EHRs) in their medical practice are creating dashboards that give them detailed, real-time information about their patients.
One example is the Marshfield Clinic, based in Marshfield, Wisconsin. A recent story by Healthcare-Informatics.com (HI), reported that Marshfield Clinic has created a real-time dashboard for physicians. Marshfield is a 779-physician multi-specialty group. The dashboard application provides doctors with usable data across their entire patient population.
“Progressively, we’ve been building the ability to mine data and provide that data in the form of usable, actionable information to providers,” said Theodore A. Praxel, M.D., M.M.M., Medical Director of Marshfield’s Institute for Quality, Innovation, Patient and Safety (IQIPS). “Not just at the point of care,” he continued, “but in between care and in between visits. And [the dashboard] allows us to work on taking care of populations.”
Marshfield Clinic says its internally-developed CattailsMD electronic health record is unique in healthcare because it supports the use of digital “ink-over” forms. Voice, script, or typing are each a way that data may be entered into customizable templates. Marshfield Clinic designed the CattailsMD system to show physicians a real-time dashboard that includes an overview of a patient’s health status, medication, alerts, and allergies. (Photo copyright Marshfield Clinic.)
The application itself works within the same data set as Marshfield’s internally developed EHR, called CattailsM.D. Physicians collect data on their tablet devices at the point of care. The application allows them to send that data to an enterprise data warehouse for storage. Later, it sends the data back to the EHR for real-time analytic usage.
Evidence-Based Management of Patient Populations
According to Kate Konitzer, Solutions Director–Clinical Informatics at Marshfield, the patient dashboard application evolved over a seven-year period from data on spreadsheets to a fully automated dashboard with automated feedback. The project started out from a desire to make evidence-based management of patient populations a priority. It then developed into a full-fledged collaborative effort between Marshfield’s information systems team and its data analytics and data warehouses groups.
Praxel, Konitzer, and Marshfield’s Chief Information Officer, Ken Letkeman, lauded the benefits of the real-time dashboard. In particular, they noted the following capabilities of the application:
- Shows physicians the entirety of their patient populations, as well as allows them to view and use real-time specific data across all levels of care.
- Can produce a wide assortment of metrics across a broad system in a timely manner, to make it easier for clinicians to intervene in the short-term, as well as to improve the healthcare quality and cost curve in the long-term by keeping more patients out of hospitals.
Physicians Adopt Population Health Management Dashboard
According to Letkeman, the idea that physicians might not be willing to compare their outcomes against each other was never an issue. In fact, Letkeman noted, the comparison against other physicians had the opposite effect during the initial physician demonstration project.
“In some practices, that might cause issue,” he said. “In ours, they were told, ‘it will be blind for a period of time, then it will be unblinded.’ One of the revelations that we saw was that this was very effective in getting the [real-time dashboard] tool more widely used.”
At Marshfield, 65% of the physicians and managers have adopted the dashboard application. As a further indication of the value of the program, the Center for Medicare & Medicaid Services (CMS) awarded Marshfield around $56 million for achieving shared savings of $118 million from participation in the Medicare Physician Group Practice (PGP) Demonstration program.
The Marshfield team acknowledges that there is still work to be done on the population health management dashboard application. One goal, according to Konitzer, is to integrate the application into more point-of-care processes to create even more real-time feedback. “We want to use the same data to facilitate the scheduling process more—to make sure patients are coming in and, for instance, if they are diabetic, getting their [hemoglobin] A1c, LDL, and microalbumins scheduled. That’s marrying population health with real clinical care, CPOE [computerized physician order entry], care plans, and order sets,” she stated.
“I think we’re just starting to scratch the surface of understanding how to turn data into actionable information…to benefit patients,” Praxel added.
Clinical laboratory managers and pathology groups should take note that integrated health informatics—including medical laboratory test data—is being quickly adapted for data mining and real-time dashboard purposes. This affirms the need for labs to invest appropriately in information technology to stay current with the needs of their client physicians.
—Pamela Scherer McLeod