The Power of Clinical Advisors, Part 2: Putting The Horse Back In Front

[To view Part 1 of this series, click here.]

The FDRHPO isn’t immune to the mistake of “putting the cart before the horse.” Before the formation of the PEC, we built a state-of-the-art, region-wide, fiber optic network connecting medical facilities in five counties — a network that, until recently, was underutilized. We continue to seek applications for the solution we previously created.

Health systems with a hierarchical structure and lack of clinical leadership may succumb to similar pitfalls, chasing grants without regard to an initiative’s actual impact, contributing time and energy to address issues that aren’t of highest priority or need, or pursuing technology because it is easy to implement, easy to measure, or just seems “cool,” but isn’t necessarily practical or important. Lucky for us, our fiber optic network laid the groundwork for a number of telehealth applications that we hope will increase access for our medically underserved health provider shortage area; projects that similarly start with the solution and work backwards aren’t usually as promising.

By leveraging the PEC’s clinical leadership to identify key needs and gaps in the care continuum, we can better focus technology decisions to bridge existing gaps and help avoid HIT pitfalls. Although the PEC was not officially in existence during our HEAL-NY-10 grant application process, we were already seeking advisement from many of its current members to shape our project. With their guidance, we chose to focus on chronic obstructive pulmonary disease, for which our region demonstrates extremely high mortality and hospitalization rates, and selected appropriate measures.

Later, when we were working to measure process and outcomes, as well as to prepare our community to move into massive changes in regulatory and financial aspects of healthcare, the PEC helped us select a disease registry — our most promising tool. We were looking for a single-source solution to which all participants could submit their data and retrieve clinical quality measures — including process and outcome measures — and move forward into predictive modeling. For example, a problem we were able to avoid is by having IT experts come up with something like data warehousing as a solution without consulting with clinicians. In our community, all practices would need to have access to the data and drill it down to their scale easily; therefore, in our case a data warehouse would have essentially been a very expensive paperweight. By discussing the investment first with the PEC, we were able to tease out limitations and potential issues early on.

Challenges: Lack of Authority and Conflict

With this governance structure comes a fair share of challenges. Most notably, although the FDRHPO seeks to implement region-wide initiatives, we have no direct control over our partner hospitals and practices — unlike most health systems.

Although this lack of traditional authority may be difficult at times, it ultimately benefits the FDRHPO and the community by creating a productive partnership. There is a natural sense of ownership in the clinical community that comes with this model because the PEC serves such an instrumental advisory role. Clinicians on the committee talk to physicians throughout the community, encouraging them to participate in and support initiatives; physicians throughout the community speak positively to staff and patients about HIT initiatives; and patients speak positively to family and coworkers about how HIT is changing their doctor’s office. Word spreads fast, and the support of the entire community is essential when we embark on region-wide initiatives like the HIE, telemedicine, and the disease registry.

Another challenge that comes naturally with a large group of people — 24 in the case of the PEC — is conflict. There are many ways to improve patient care in a rural health provider shortage area, and sometimes different stakeholders have different ideas of what steps are the most crucial. A specialty provider may want to see a vendor-neutral archive so he can have instant access to medical images on demand, while a primary care physician may see more value in electronic referrals. Both solutions mean better care, but working through the conflict with the PEC helps us identify what should be most prioritized and how best we can pursue initiatives with the greatest benefit to the entire community.

In conclusion, seeking leadership from our region’s physicians has been instrumental in shaping the FDRHPO’s HIT decisions. Without the participation and support of all our stakeholders, many of our programs could fall flat. The advisement of the PEC helps us determine which technologies are most important to the region’s medical community and how best to implement them such that they can improve patient care throughout the region.