Our week in California was a very productive one, in addition to our time at the Health2.0 Conference, because we visited several innovative practices in San Diego and the Bay Area.
One of those is Sharp HealthCare, which bills itself with the following (impressive) credentials:
Sharp HealthCare is San Diego’s health care leader with seven hospitals, three affiliated medical groups and a health plan. We are a 2007 Malcolm Baldrige National Quality Award recipient thanks to our doctors, nurses and 14,000 employees. Sharp is a not-for-profit and relies on philanthropy.
We spent our time with the Rees-Stealy Medical Group, at their downtown campus.
Sharp is a local and national leader in quality and a star in achieving goals as part of pay for performance programs.
First, the pictures, click on any to see full size:
We began our shadowing experience with Huy Ho, MD supported Mara, in the Internal Medicine section. Sharp uses an electronic health record manufactured by Allscripts, Inc. , as well as companion applications such as PACS, which allows for quick access to radiologic images. Each exam room is equipped with flat panel displays. Currently, documentation and order entry occur on paper, which is scheduled to change. From that perspective, several of the processes I observed were very similar to what I used to use before the era of the EHR in my organization. There are challenges around filling out forms, and completing documentation, which may be either dictated or on paper. Huy enjoys the rapport with patients that he can create as a primary care provider in this system.
We also spoke with John Pauls, MD, Ph.D., a specialist in Asthma, Allergy & Clinical Immunology, who has been with Rees-Stealy for about a year and enjoys his practice greatly, especially considering past experience in private practice, and experience in the Canadian medical system. He’s very supportive of the technology that Sharp uses to connect its group practice, and the opportunities it provides to improve the overall quality of care for all practitioners. Unfortunately, we missed his last consult of the morning so were unable to observe him in a clinical interaction. We spoke some about some of the challenges of electronic health records in general providing for patient needs, with one example being the ability to prescribe and/or add useful interventions like saline irrigation tools to the patient’s health record. This has been a challenge in many EHR systems – to record all of the things patients do, whether or not they are physician-prescribed activities.
We met Randy Hawkins, MD, who’s the Chief Information Officer for the group and a practicing Neurologist. He’s concerned with supporting the entire medical group in moving forward on all technology fronts. We looked at the features of the electronic health record in use and upcoming improvement work slated to occur, specifically on order entry and documentation. Randy has a very rich fund of knowledge regarding health information technology and awareness of the current systems’ capabilities. The real and reasonable question arises on where to put patient access into that plan.
We spoke some about the population served by this campus, which is felt to have good access to the Internet. At the same time, this is still an abstract concept for the group, since they are early in their planning. It was intentional that we interact with this group, and I know from experience that this transition requires a lot of shared information and discussion. I spoke with Randy’s Medical Assistant, Nancy, a bit about provider-patient e-mail and I appreciated her response to the question about her interest in doing this with patients. She said, “I would have to see how it works.” I think that is a great approach, because my experience so far is that everyone wants to do what works for patients.
The Rees-Stealy Medical Group is the first multispecialty group we have visited on this journey that does not currently have an operational patient-access system to their electronic health record (consistent with the majority of medical groups in the United States), so it was a unique experience. The physicians and staff here are obviously committed to a quality care experience and have the results to show it. From that perspective, I think they would be successful in working with patients this way. Sharp is fortunate that they have several medical groups to gain expertise from as they move ahead, and I think they could be a model for other multi-specialty groups and their community when they succeed.