2008 System Review

Technology | Redefined

Information and technology make for powerful medicine

Increasing health care costs, the growing number of uninsured and the underinvestment in preventive health care are among the challenges being tackled by Marshfield Clinic. The Clinic’s electronic health record (EHR) and its commercial version, CattailsMD™, provide a powerful tool to help develop solutions for today’s dynamic health care environment.

Information age medicine

“Recent decades have seen a knowledge explosion including new diagnoses, treatments, medications, clinical trials and scientific advances,” said Robert Carlson, M.D., chief information officer and director, Marshfield Clinic Applied Sciences. “Effective use of this information and robust new technology to support it require tremendous change in the practice of medicine and how chronic disease, such as diabetes and heart failure, is managed.”

Development of information technology is critical for meeting today’s challenges in health care delivery. Mark Nymo, M.D., family medicine, Marshfield Clinic Rice Lake Center, checks the electronic health record of patient Richard Nelson, Rice Lake.

A pioneer of the EHR, the Clinic developed and has used integrated computer technology for patient care for almost 20 years. Marshfield Clinic completed a move to a chartless medical environment in 2008.

With portable wireless tablet computers linked to the EHR, physicians and support staff can instantly access medical history, radiology reports and images, test results and expert opinions. They can take notes, enter orders and write prescriptions electronically.

“EHR technology gives me an ongoing connection to the health status of my patients,” said Mark Nymo, M.D., Marshfield Clinic Rice Lake Center family medicine physician. “It helps me to move patients to improve their health and their quality of life.”

“For patients and doctors it’s a win-win,” Dr. Nymo said. “I can follow a patient who’s had a hospital admission or who has called the Clinic’s 24-hour Nurse Line. For patients with diabetes or congestive heart failure, I have the latest evidence-based care protocols right at my fingertips.”

Data increases effectiveness

“EHR technology is increasingly recognized as an effective tool to improve care for patients with chronic diseases or to keep patients current with preventive health care needs,” said Marilyn Follen, R.N., M.S.N., Marshfield Clinic Quality Improvement and Care Management administrator. “Behind the Clinic’s EHR, powerful data collection capabilities exist. This enables us to evaluate and make timely improvements to care processes, which lead to better patient care.”

Extensive collaboration between Clinic providers and information technology professionals has resulted in an evolving EHR tool. Enhancements include prescription prompting to prevent drug interactions and provide generic alternatives; an intervention list to help the care management team monitor and manage care of patients with chronic diseases; and a patient wellness summary much like a health report card for patients.

“When their summary shows an elevated blood pressure or ‘overdue’ next to an annual mammogram, patients seem more willing to follow through on their care,” said Dr. Nymo. “Proactive attention to health matters can prevent needing more extensive services or even hospitalization.”

Only the beginning

“EHR development is really the race to the starting line,” Dr. Carlson said. “Once you have one, you can start implementing the tools to improve the delivery of patient care.”

Information and technology have been incorporated into every aspect of the practice of medicine at Marshfield Clinic. Care management features embedded into the EHR and the ability to collect and analyze data on populations with a specific disease enables a shift from reactive to proactive medicine. Making this information technology available to other health care providers is the next step.

CattailsMD™ was chosen this past year for use by Ministry Health Care as its EHR. “This is a big accomplishment,” said Dr. Carlson. “CattailsMD™ was developed with physician input and offers data warehouse capabilities.”

Information technology and continued development of EHR is critical for meeting today’s challenges: Managing disease and preventing its consequences while adapting to an increasingly regulatory climate Dr. Carlson said.

“An ideal achievement will be when communities have access to knowledge and information to improve health, and providers have access to the right information for the right treatment at the right time,” said Dr. Carlson. “With the Clinic’s EHR and long history of data available, we’re at the start line and ready to run.”