By H. Douglas Sears, Bon Secours Health System

The American Recovery and Reinvestment Act of 2009 established significant incentive payments for healthcare providers and physicians who can demon-strate meaningful use of interoper-able health information technol-ogy (HIT) and qualified electronic healthcare records (EHRs). These incentive payments are

part of a broader effort of the Health Information Technology for Economic and Clinical Health (HITECH) act to accelerate HIT adoption and EHR use across the nation.

The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services Office of the National Coordinator (ONC) for HIT recently issued their much-anticipated final meaningful-use IT regulations that hospitals and physicians must follow to tap into the $27 billion in financial incen-tives authorized by the stimulus act. To qualify for the incentives,

organizations must demonstrate meaningful use of a certified EHR. The goals arent to purchase and

implement IT; they are to improve the quality, safety and efficiency of healthcare services; reduce health-

care disparities; engage patients and their families; improve the coordina-tion of care and the publics health; and ensure the privacy and security of personal medical information.

Reason for concern?

A key concern among enlightened healthcare leaders is that organiza-tions will run for the incentive dol-lars in search of the silver bullet and suboptimize their organizations by not taking a holistic approach to this significant and unique opportunity.Those familiar with major HIT

implementations know that to real-ize the benefits of new technology, an organization needs to approach the work from a much broader perspective. Disruptive technol-ogy provides a unique opportunity to transform, rather than simply improve, care-delivery processes.

An ASQ team has been work-ing with the ONC to transition the HITECH paradigm from an IT-centric perspective. The team is using the Baldrige criteria to pro-vide a systems perspective that syn-thesizes, aligns and integrates the key organizational requirements for success.The ASQ team has met with

David Blumenthal, the national coordinator for HIT, and the ONC team several times to refine this Baldrige-based approach. Working together, the teams have developed and are testing a Baldrige-based assessment tool that allows orga-nizations to assess their ability to

leverage HIT from a systems per-spective and successfully attain the end goals of HITECH.One organization involved in the

development of a systems approach to HIT is Maryland-based Bon Secours Health System, which is implementing ConnectCare, a $200 million systemwide clinical infor-mation system that will standardize care across all of its facilities.As a precursor to this rollout, a

comprehensive clinical transfor-mation redesign focus is fostering a new paradigm of care delivery. By harnessing accelerated perfor-mance improvement and rapid learning across all of its facilities, Bon Secours pursues consistency, integration, quality and transpar-ency of patient care as it leverages the scale and scope of its operations for higher efficiencies.

Clear vision

The vision behind ConnectCare is to achieve world class outcomes; enable caregivers to provide supe-rior, consistent care; and enhance operating performance by lever-aging leading clinical practices through an integrated system of clinical information.The programs guiding principles

are to make patient-centric decisions that improve quality and safety, and enhance the patient and caregiver experience; commit to standardiza-tion to realize systemwide benefits; adopt leading clinics practices based on evidence and national practice standards; be accountable for the transformation required to achieve a successful implementation; and dedicate necessary resources to sup-port an optimized system for sustain-able transformation.ConnectCare links all clini-

cal information into one patient

YOUROPINION

30 I N o v e m b e r 2 0 1 0 I W W W . A S Q . o r G

Healthcares Next Big HIT?

Disruptive technology proviDes a uniqueopportunity to transform rather than simply improve healthcare-Delivery processes.

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record and enables integrated care delivery. The clinical information system was designed specifically for Bon Secours and provided the framework for the implementation and process redesign. Almost 200 clinicians from Bon

Secours attended meetings to make decisions that would determine the ConnectCare structure and to tailor the system to patients needs. As part of this work, clinical leadership made key decisions involving the design of the improved patient care delivery system, including: Using common order sets and care plans across the system.

100% adoption of computer-ized order entry.

Establishing common work-flows across the entire system.

Implementing early goal-directed therapy for sepsis, renal failure, coronary artery disease, hypertension, diabe-tes, congestive heart failure, pneumonia, chronic obstruc-tive pulmonary disease, dementia, CMS measures and other appropriate areas.

Performance improvement, par-ticularly design for Six Sigma think-ing and tools, supports the imple-mentation of ConnectCare. Eighty percent of the benefits realization will come from workflow redesign, and Bon Secours clinical and oper-ational leaders are developing lean workflows that leverage the strong points of this electronic system. Improvement projects linked

to performance gaps in balanced scorecard dashboards are executed using lean Six Sigma methods and rapid cycle improvement. After the improvements are identified, theyre replicated at all facilities. A key aspect of this work is knowl-edge transfer, which links people, processes and technology to deliver results faster and to reduce improve-ment cycle time (see Figure 1). Using these tools resulted in sever-

al positive outcomes. Among them: Nursing engagement increased from the 31st to 66th percentile.

Turnover has been reduced by 30% in the past three years.

Employee engagement rose to 4.09 out of a possible 5 rating.

The Joint Commission Journal on Quality and Patient Safety ranked Bon Secours 23rd in its top 100 systems based on quality of care and patient sat-isfaction.

Sepsis mortality present on admission to the emergency department decreased 26.5%.

Patient satisfaction reached the 67th percentile, with many facilities achieving national awards.

Physicians perceptions of overall quality increased to the 75th percentile.

Overall, the significant clinical, service and operational improve-ments across the system resulted in a $120 million net financial impact in the past three years.

H. DOUGLAS SEARS is the director of per-formance improvement and knowledge transfer for Bon Secours Health System. He earned an MBA from the University of Richmond in Virginia. Sears is a senior member of ASQ, a certified quality engi-neer and Master Black Belt, a Baldrige Alumni Senior Examiner and the lead judge for the Virginia Senate Productivity and Quality Award.

Other clinical processesintegrated with ConnectCare

process and technologyimprovements.

5060% of potential benefits

A set of processesnecessary to optimize

ConnectCare.3040% of potential benefits

A core set of processesrequired to successfullyimplement the system.

10% of potential benefits

Enhanced performance beyond systemelectronic medical records improvements

Necessary workflow decisionsaligned to ConnectCare

ConnectCaresystem-related

decisions

Clinical transformation

Figure 1.ConnectCareperformanceimprovementintegration