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Monday, November 13, 2006

Putting the Patient in the Picture

I've been writing for CRMGuru since 1998 when it was called CRMTalk, a wonderful community emerged out of that interchange and grew into the Guru thing. My involvement with CRMGuru has been very valuable in teaching me to write and communicate better. This article just came out today - I had interviewed Joel Berman right after he was the star of the Health Information Management Systems Society Conference 2006 in San Diego. He showed us all what was possible in medicine when technology is applied right. I felt the lessons shown there deserved a wider audience outside of the healthcare world and wrote about it for CRMGuru. The full article is posted below. Many thanks to Gwynne Young Managing Editor at CRMGuru.com for great work in slimming it down while bulking up the muscle in content and value. I hope you'll agree! If you do, or if you don't - let me know! It's you I write for!

Nov. 13, 2006
Advances in Customer Management in Health Put the Patient in the Picture

By Mei Lin Fung, www.CIEInstitute.com

Mary Howard (not her real name), 75 years old, went to see her doctor, Joel Berman, M.D. Howard had a case of the shingles, and Berman offered the standard treatment, antiviral and steroid medicines. As Berman related to me in February 2006, after his presentation at the Healthcare Information Management and Systems Society Conference in San Diego, California, his patient then told him, "I had a very bad reaction to the steroid last time. I couldn't sleep, and it made me very nervous. How important is it?"

Together, they looked it up on the computer. Through instant, side-by-side use of information technology, Berman reinforced patient responsibility for her health. He supported Howard, and together after considering several with their differing effects, chose a medicine that did not include steroids. With a sense of control over her destiny, Howard took the prescribed course of treatment, and the shingles subsided without the nervousness surfacing even once.

Together, doctor and patient are using IT to achieve her well-being to the best of their joint knowledge.

Berman, the doctor in this case, is a leading pioneer in the enlightened use of electronic health records in health service delivery. He practices at Capital Region Healthcare, which serves 125,000 people living around Concord, New Hampshire.

We're entering a new era of health, with more and more medical practitioners adopting the use of electronic health records, under a timeline mandated by the U.S. Health and Human Services Department. Although there is no deadline, the agency is indicating that Medicare payments will be linked to conversion to an electronic system.

A sea of forms
Before fall of 2000, when his office moved to Electronic Medical Records to maintain digital records for the history of patients' visits, vital signs records, medications, immunizations and laboratory reports, Berman told me he "was drowning in a paper world."

"In 1998-'99, I couldn't find charts. X-rays [were] misfiled. I had to come in early every day just to find the charts and proper paperwork for the patients I was scheduled to meet that day," he said.

The most sophisticated EMRs even track the health outcomes and the evidence for decisions made.


‘Berman told me he 'was drowning in a paper world.'’


Capital Region Healthcare gradually built 700 electronic forms on seven different servers that had no enterprise-wide coordination and were often duplicative and inefficient. In 2003, Berman's office first began to cull and consolidate the forms, to create a limited number of standardized "smart forms" with built-in decision support.

Berman became a champion of using technology to accelerate patient health improvement and simultaneously improve the well-being of doctors and nurses. In the process, he learned the value of capturing data in a structured way. As he said, "The real power is in its application as a database. ... You can't just put it in as text. We must put it in the right field, so that later one can find [for instance] what percentage of diabetics have foot problems."

What Berman found is that the EMR application offered prompts and reports to doctors that supported the doctor-patient relationship. Data was input in a manner that increased the importance of the doctor-patient relationship. The vision of health service delivery extended well beyond EMR, vitally incorporating key measures of patient health improvement.

Berman worked with Capital Region to re-design the EMR to organize the prompts so that they supported, rather than interfered with, the doctor-patient relationship. It was only after the other doctors could see that IT was helping them that they put effort into inputting data, which, being structured, could later be analyzed to help tie outcomes to patterns of intervention.

Berman has shown that EMR can be patient-centric and can support health practitioners like himself who say, in Berman's words, that "the real art of medicine is in the conversations we have with our patients" (from Silo Practice to Collaborative Care, a slide show by Joel Berman, available at http://www.emr.msu.edu/Documents/chug_2005_fall/pdf/berman_silo_practice_to_collab_care.pdf).

Berman's presentation at that 2006 Healthcare Information Management and Systems Society Conference was a revelation to the large crowd who came to hear it. Afterward, the questions from listeners were full of praise and intent on understanding how he had pulled off the incredible task of having the physicians lead the way back to patient-centered healthcare.

Representatives from Medicare indicated interest in collaborating to spread the success of his approach more widely.

Common metrics
The group practice agreed on common metrics for all physicians, which Berman said really motivated people when colleagues found others doing a better job than them. The EMR was not just a repository; 60 physicians and nurse practitioners were measured by it and responsible for the quality of data to maintain integrity of the database. Those healthcare professionals had to, in Berman's words, "learn the proper ways to enter data into the EMR." As he said, "No one wants a bad report."

It was Berman's key insight to tie the EMR implementation to the national Diabetes Physician Recognition Program (DPRP). The connection was critical to the success of the implementation. The goal was to improve patient health and improved doctor and nurse well-being. EMR was just one of the tools to achieve that goal. Data from the EMR enabled practitioners to have a feedback loop tying outcomes to actions, which, in turn, lead to a series of corrective steps, resulting in accelerating health improvements in patients.

The strategy resulted, in the roughly two years between November 2003 and September 2005, in steep improvements in nine of the 10 metrics of DPRP. Capital Region was able to pull ahead of other physician groups in providing high quality care that supported patient responsibility for their health.

Capital Region was recognized by Diabetes Physician Recognition Program as providing higher quality care than other physician groups. That recognition meant that more doctors referred their patients to Capital Region. Not content with winning kudos in diabetes care, Capital Region is now going after recognition in the cardiac area. In February 2005, Berman's group adopted the NCQA's Heart Stroke Recognition Program as the next enterprise-wide quality initiative.

Capital Region is not alone. Information technology is improving doctor-patient relationships—and patient health.

The Department of Veterans' Affairs, for instance, is adopting a new computer program to help patients make more informed decisions about their care. The Electronic Support for Patient Decisions initiative uses customized software to provide patients with information about treatment options and standardized procedures among clinicians. The program takes physicians through the informed consent process step by step, displays educational materials about risks and benefits of procedures, generates and stores consent forms, and imports information from patient records.

It is clear that IT is leading to a new relationship between doctors and their patients in becoming partners in managing the health of the patient and improving healthcare and healthcare costs.

Technology has, Berman said, "profoundly altered the nature of my relationship with my patients in a good way. It's changed my role from know-it-all authority figure to one in which I'm a collaborator with my patients, an advisor, a coach and a guide."

Mei Lin Fung is Chief Architect of www.CIEinstitute.com, the Customer Innovation Excellence Institute, and director of www.TalkTimeAsia.com She is an expert on Customer Lifetime Value. Her focus is in creating high value and earning customer trust through highly valued customer experiences. She was an early pioneer in CRM, working with both Tom Siebel and Marc Benioff at the start of the industry. She was managing director at Wainscott Ventures, a venture capital firm with offices in New York, Washington, D.C., and the Silicon Valley. In April 2005, Fung was appointed as overseas consultant to the Contact Center and CRM Committee of the Ministry of Information Industry in China. With Lee Pui Mun Ph.D in Singapore Institute of Management, Baumin Lee, Ph.D at 95Teleweb, Beijing and Casey McNeal Ph.D., at The CIE Institute, Fung is developing Customer Innovation Excellence Certification standards and curriculum in conjunction with Oklahoma State University.

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