Signature Initiatives Showing Results
Since its conception nearly three years ago, the Signature Initiatives project—aimed at transforming Partners HealthCare Systems into a truly integrated health care system with improving quality and effectiveness of care—has made notable strides.
PHS President and CEO James Mongan, MD, under whose leadership the Signature Initiatives were formulated, said, “Through this program, we are truly establishing Partners as a national leader in the design and delivery of high-quality, cost-efficient medical care. We aspire to be leaders in improving health care delivery in the same way we are leaders in advancing knowledge about health care itself. I believe that the progress we’ve made, and the fact that we set about this ourselves as a means of solving the ‘value equation,’ set us apart from other hospitals and health care systems locally and around the country.”
Among the highlights of the first two years of Signature Initiatives implementation are the following: full adoption by all acute care hospitals of computerized provider order entry (CPOE) by the end of 2006; continued significant progress in implementation of electronic medical records (EMR) by primary care physicians; continued progress in developing a fail-safe medication administration process—partially implemented or in the budget at all the PHS acute care hospitals, and nearly entirely at BWH; excellent results in diabetes management; excellent and improving scores in management of cardiac patients; significant progress toward designing an effective disease management system for high-risk patients; and continued progress in managing cost and utilization trends, particularly in pharmacy management.
That’s the good news. Yet much work remains for the five SI teams working on IS infrastructure, patient safety, uniform high quality, disease management and trend management.
A challenge in the third year of the Signature Initiatives is the continued roll-out of the EMR among physicians. “We are making progress with primary care physicians in the community, and expect EMR adoption by this group to exceed 50 percent by the end of the year, but we’ve still got a long way to go with community-based specialists,” Thomas Lee, MD, PCHI CEO and director of the SI project overall, said.
While barriers to EMR implementation are sometimes financial, particularly for small physician practices, they also involve fundamental changes in the way practices organize their work processes in general, and require physicians to integrate decision supports built into EMRs.
Another challenge is the complex decision-making process involved in implementation, from agreeing on the content within the clinical guidelines to allocating resources to fund needed information systems. “We have great system-wide teams, working groups, subcommittees and leadership groups all coming together on these initiatives,” Lee said. “Most often, the subject experts are at the table. For example, if it’s a system-wide approach to smoking cessation, those who are responsible for smoking cessation programs are there, working to come to agreement on the optimal approach to smoking cessation. But often, these people can’t speak for their organizations when it comes to committing to the course of action recommended.”
A final, and perhaps the ultimate, challenge will be ensuring that the quality- and value-improvement systems that are implemented will be used reliably. “It’s one thing to have EMR and CPOE on your desktop,” Lee said. “It’s another to use them—to really make the most of the decision supports they offer, to order x-rays and tests, to write prescriptions electronically, to document care so that information on patients is complete, up to date and accurate. For some physicians, this is already their MO. For many others, it will mean doing things differently. The payoff is better, safer and more efficient care for our patients.”