Every practice can boast of at least one physician who takes the lead in motivating the team. You’ll know who your champion is by his or her language, enthusiasm, and lifestyle. Your champion will dive into a damaged system while two or three people hover outside the closed office waiting to get back to work. Your champion is likely to get more junk mail than anyone in the practice and actually hoards the most promising brochures. Your champion may have built his or her first computer at the age of 12 and may secretly store a rebuilt server in a closet. When implementation seems too overwhelming, your physician champion will listen to frustrations while maintaining a focus on the move to a digital office. This is also the dream of electronic health record (EHR) vendors.

Most practices already know who their physician champion is. He or she has:

• strong leadership skills;

• good listening skills and the ability to motivate people to action;

• the understanding of how information moves throughout the practice and the health community;

• the ability to maintain a focus on quality of care and patient safety;

• the ability to assist in leading the practice through a long-term plan—where will we be in five years? 10 years?;

• the ability to take the lead on the technology evaluation team;

• the understanding of and ability to delegate the adoption and implementation timeline to the implementation team; and

• the ability to maintain focus on the outcome.

Being a visionary can be a full-time job. Before assigning one physician as your champion, ask other clinicians the following questions:

• Will other physicians pick up the patient load while the physician champion develops and implements the plan?

• Can other physicians within the practice agree on a common EHR solution? Well-intentioned software vendors can cause internal dissension when they align with individual physicians within the practice or community hospital. As a result, vendors pit physicians against each other, sending the practice into EHR hibernation. If the visionary hesitates, it can cripple the momentum that set the group on a digital path.

• Will the practice make a commitment of time, finances, and resources to assist the visionary and a health information technology (HIT) team? The selection and implementation of HIT is a long-term commitment—too much for one person to handle alone.

• Is there a disruptive activity in place, such as a merger among several practices? The move to a digital environment will exacerbate any existing large-scale event. Put off EHR implementation until these types of problems are fixed.

To see how physician champions excel, this column profiles two visionaries who are leaders in anesthesiology and gastroenterology. Their vision went far beyond which EHR to select. Each saw how the data captured by EHRs would improve patient safety and satisfaction, generate new revenue streams, and reduce healthcare costs.

Richard L. Gilbert, MD, MBA
Chairman, Department of Anesthesiology, Carolinas Medical Center
CEO, Southeast Anesthesiology Consultants
Founder, Southeast Pain Care
Charlotte, N.C.

Southeast Anesthesiology Consultants is a 60-physician group whose physicians service seven hospitals and nine pain centers ranging from tertiary care centers to small, rural hospitals. The group sees approximately 100,000 patients each year—70% through anesthesiology and 30% in pain management.

Their IT needs grew out of the frustration of dealing with anesthesiology reports that measured closed claims from incident reports. “When there is a problem in surgery, it’s easy to say it’s the anesthesiologist’s fault. We wanted to measure everything we did, not just incidents,” says Gilbert, who adds that the practice’s goal was to be a continually improving, high-performance anesthesiology group.

For several years, members of Southeast Anesthesiology Consultants researched and developed a quality assurance tool that incorporates 50 indicators used to measure results from several hundred thousand patients.

The data measure several outcomes:

1) Efficiency measures, such as case delays and cancellations

2) Practitioner performance, including measuring complications or incidents

a. Which doctor is not performing according to practice and industry guidelines?

b. How can we mentor the doctor to become a better practitioner?

3) Critical quality indicators (CQIs), which assist in meeting JCAHO standards and also produce reports by location and by physician for individual doctors and department chiefs. Numerous improvements have been instituted based on CQI results.

4) Patient satisfaction — “More than 99% of patients rate their care as excellent or good, and our Southeast Pain Care patients rate their overall impression of care as more than 4.5 on a 1-to-5 scale,” says Gilbert.

Patient satisfaction is captured in seven steps throughout the treatment process as outlined in Diagram 1.

Clinical Decision Support
Data gathered through patient satisfaction surveys and CQIs resulted in defining best practices for all hospitals served by the group and also helped identify the source of problems such as corneal abrasions, sleep apnea, and poor medication labeling.

Online Patient Education
Data gathering has also helped Southeast Anesthesiology Consultants hone its patient education programs. Patients can go online and learn about pain management options, possible treatments, and the physicians’ research credentials and educational backgrounds. They can also download preoperative instructions for both inpatient and outpatient surgical procedures, plus there are plans to use the Web site to recruit patients for clinical trials.

Worth the Effort
Southeast Anesthesiology Consultants will be better equipped to negotiate a pay-for-performance contract because it won’t have to rely only on the payor’s data. It will also use its data for marketing and to provide comfort to patients and families. The anesthesiology group has also provided demonstrable evidence to hospitals that it can beat every national benchmark when delivering care.

Following evaluation from a top-10 accounting firm, Southeast Anesthesiology Consultants plans to make its copyrighted and patented CQI measurement tool available to others.

Gilbert can be reached at rlgilbert@seanesthesiology.com. You can learn more about Southeast Anesthesiology Consultants at www.seanesthesiology.com.

William (Chris) Dengler, MD
General Surgeon
Founder, President, Heartburn Treatment Centers
Rocky Mount, N.C.

Dengler is a general surgeon who teaches the latest antireflux surgical techniques for gastroesophageal reflux disease (GERD). In his 18 years in medicine, he has tracked a major public health issue that afflicts 35% of the general population, many of whom have had marginal or unsatisfactory responses to initial treatment attempts.

“GERD has changed tremendously in the last four to five years,” Dengler says. “Patients with heartburn may have easy access to a purple pill, but heartburn can be a symptom of other problems. The real risk here is that heartburn can actually be symptoms of a heart attack or cancer and [can be] misdiagnosed as an intestinal disorder.”

But he says if patients don’t have an “in,” they are on their own to find relief—an often next-to-impossible task. For that reason, Dengler opened the nation’s first heartburn treatment center at Nash Health Care Systems in Rocky Mount, N.C.

To help manage the multidisciplinary approach to GERD, he also created Legato Medical Systems, a Web-based patient relationship system (PRS) that tracks medical and treatment information. “PRS is based on the novel idea that if doctors communicate, the outcome is in the best interest of the patient,” Dengler says.

It works like this:

• A patient makes an appointment or is referred by a physician to the heartburn treatment center. The center is located within a hospital and staffed by a nurse coordinator—usually a nurse practitioner—who conducts an initial evaluation. The nurse coordinator is familiar with what the hospital or clinic offers and knows which doctors can deliver appropriate treatment.

• Based on the patient’s medical history and presenting symptoms, the nurse then refers the patient to the appropriate specialist for continued care. The nurse practitioner tracks all lab results, medications, procedures, billing, and scheduling and coordinates care with the patient and designated family members.

• The PRS organizes pertinent information and appointments in addition to ensuring appropriate follow-up and continued contact with heartburn center patients.

• Details about treatment are regularly shared with the referring physician, who is usually the primary care physician.

• The patient’s satisfaction is measured throughout the care process. Intermittent questionnaires evaluate how treatment is progressing and include outreach questions such as, “Would you like the nurse coordinator to contact you?”

The end result is that the hospital can treat GERD in a world-class way by tying together health information that isn’t typically linked. Under the Legato system, patient satisfaction rates exceed 95%, far above those seen in the traditional “fragmented” medical community. Twenty percent of new patients come from established patients who recommend their family and friends for treatment.

Legato Medical Systems Goes National
Under Dengler’s direction, Legato Medical Systems has experienced impressive growth, with 21 client hospitals in 10 states now under contract. According to Dengler, hospitals that bring a heartburn treatment center into their facility are usually operating in the black within 12 to 18 months.

Dengler can be reached at wdengler@legatomedical.com. Learn more about the Heartburn Treatment Centers at www.legatomedical.com.

— Carolyn P. Hartley is president and CEO of Physicians EHR in Cary, N.C., and editor-in-chief of “The Physician’s eHealth Report.” She can be reached at Carolyn@physiciansehr.com.

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