“A resilient population” – Baltimore Medical System

We are three months into the PCHIT initiative, and we would like to add additional sites that are local to the Center for Information Therapy, to establish a longitudinal relationship of proximity to care systems.

One such care system is the Baltimore Medical System, which I toured with Chief Medical Officer Kyu Rhee, MD yesterday. We went to the Belair-Edison site and the Middlesex site.

I have to say here that the day was a very interesting one for me, as I spent the morning at a Kaiser Permanente medical center in a nearby community, and the contrasts were very striking. Both organizations are working hard to improve their service in admirable ways, even if their service challenges are vastly different.

BMS is undergoing a significant transition, into the electronic age. It is also undergoing a leadership transition, with Kyu accepting a new position at the National Institutes of Health, where he will further pursue his interest in reducing disparities in health. Our tour was a little bittersweet because of this, as Kyu bonded with colleagues at the two medical centers we visited.

Kyu has been Chief Medical Officer of BMS for 2 years, with previous experience as a medical center Medical Director and internal medicine/pediatrics physician in a safety-net medical system in Washington, DC. BMS serves about 55,000 patients at 11 sites (as of 2006), and it funded acquisition of its EHR, manufactured by Misys, on its own, which is remarkable for an organization like this. As the data that Kyu pointed out, 8% of community health centers have EHRs. This puts BMS in the 92nd percentile. It also frames my work a bit, as I have been tending to visit the early adopters – having an EHR is far from being the norm.

Kyu greatly enhanced my understanding of the reimbursement model of a safety-net medical system, which I have been learning more about along the way. There is a strong reliance on in person visits for revenue. I remembered that a physician in Berkeley told me how valuable the in person visit was. I then remembered how La Clinica in Oakland celebrated that they had the highest number of encounters in the previous month. Visits are important for survival. We need to think about that in the context of a new model of care that supports patient centered health IT. Kyu told me that at any given time, there can be 2 weeks of cash reserves available. Turnover is also an issue – up to 30% of all staff in a particular year. Kyu is adept at welcoming new staff, as I saw when I was with him. At the same time, BMS enjoys rich collaborations with its medical neighbors, the National Institutes of Health, and Johns Hopkins Medical Center. In the communities it serves, it provides the bulk of the health care, efficiently, because there aren’t other urgent care centers around.

I met an engaged staff who are joining the future through their use of the tool. Belair-Edison is live on the system. Middlesex is not yet, and it’s planned that they will in February, 2008. Physicians at Middlesex told me that they are looking forward to the system. At Belair-Edison, staff were very positive in their recommendation of the EHR. When I asked about any downsides, the answer was, ‘ downtime.’ People don’t like going back to paper, even for a little while.

As I am one to do, I asked questions about Internet penetration and possible use of secure e-mail with patients. Physicians told me that there is a heavy telephone message component to their work. I received very different estimates of penetration from various staff, everything from, “No, not really,” to “Just about everyone.” I think this is a good sign – there is curiosity. My overall takeaway is that the data we’re collecting and my experiences on the shop floor lend toward a world where a PHR can be used in almost any population. At the same time, I personally need to learn more about the operations of a safety-net system because the hooks in a system like this are different; I think they are there, though.

The Middlesex site is engaged in an effort with the Federal Office of Disease Prevention and Health Promotion to evaluate a prevention information prototype for this population. I think the idea of our nation’s Prevention Office working with a real health care delivery system is exciting, in a very LEAN way. To be able to do it in the context of a functioning electronic health record is even more exciting.

Josh and I would like to come back to Baltimore and follow the progress of Baltimore Health System. We also plan to stay connected to Dr. Rhee, who shares many of our interests around using the best tools to reduce disparities. With thanks to the staff and patients at Belair-Edison and Middlesex Health Centers for the warm welcome and for their time.

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Ted Eytan, MD