TMC named 2016 ‘Most Wired’ — using technology for a better patient experience

MW_Winner2016_ColorEPS.epsCHICAGO, July 6, 2016—Technology is improving the efficiency of care delivery and creating a new dynamic in patient interactions, according to results of the 18th Annual Health Care’s Most Wired® survey, released today by the American Hospital Association’s Health Forum.

According to the survey, Most Wired hospitals are using telehealth to fill gaps in care; provide services 24 hours a day, 7 days a week; and expand access to medical specialists. This year’s results show:

  • The top three telehealth services offered in hospitals are consultations and office visits, stroke care, and psychiatric examinations and psychotherapy.
  • Stroke care is the most rapid growth area for telehealth services up 38 percent from 2015, as evidence-based studies emphasize the time urgency of stroke care.
  • More than 25 percent of hospitals use internet-enabled monitoring devices for chronic disease management of congestive heart failure, diabetes and heart disease.

“Today’s patients are technically savvy and are increasingly expecting their health care services to be provided where, when and how they want it,” said Frank Marini, vice president of Information Services at Tucson Medical Center. “TMC is stepping up to meet that challenge by investing in telehealth, e-visits and other mobile means of engaging our patients. Improving convenience and access to care will lead to improved patient outcomes.”

In redefining the way that they provide care in their communities, Most Wired hospitals are using technology to build patient engagement with the individual’s lifestyle in mind, which includes electronic access to their care team.

  • 68 percent accept patient-generated data through the patient portal.
  • 26 percent of Most Wired organizations offer e-visits through a mobile application.
  • 61 percent use social media to provide support groups.

“Hospitals are breaking out of their traditional four walls and providing care where and when patients need it,” said Rick Pollack, president and CEO of the AHA. “These Most Wired hospitals exemplify this transformation by harnessing technology, engaging patients and offering services remotely. And, removing policy and other barriers to telehealth will allow even faster adoption of these amazing technologies.”

Most Wired hospitals are utilizing population health management tools and partnering with other health care providers to share critical clinical information used in analyzing interventions aimed at key patient groups, such as those with diabetes. To get patients the right care, hospitals are using predictive modeling to eliminate preventable problems.

  • 53 percent interface electronic health record data with population health tools.
  • 62 percent stratify patients according to risk.
  • 51 percent aggregate data from patient encounters to create a community health record.

The versatility of mobile technologies makes it possible for clinicians and care team members to have the right tools for sound clinical decision-making wherever they are: 81 percent of Most Wired hospitals use mobile applications to notify clinicians of sudden changes in patient conditions and correlated events such as falls or respiratory distress or failure.

As they build out new capabilities, hospitals are also taking strong actions to ensure health data is secure.

  • More than 90 percent use intrusion detection systems, privacy audit systems and security incident event management to detect patient privacy breaches, monitor for malicious activities and produce real-time analysis of security alerts.
  • 84 percent conduct a third-party security audit annually to ensure that guidelines are followed.

HealthCare’s Most Wired® survey, conducted between Jan. 15 and March 15, 2016, is published annually by Health & Hospitals Networks (H&HN). The 2016 Most Wired® survey and benchmarking study is a leading industry barometer measuring information technology (IT) use and adoption among hospitals nationwide. The survey of 680 participants, representing an estimated 2,146 hospitals—more than 34 percent of all hospitals in the U.S.—examines how organizations are leveraging IT to improve performance for value-based health care in the areas of infrastructure, business and administrative management; quality and safety; and clinical integration.

Detailed results of the survey and study can be found in the July issue of H&HN. For a full list of winners, visit www.hhnmag.com.

About the American Hospital Association
The AHA is a not-for-profit association of health care provider organizations and individuals that are co
mmitted to the improvement of health in their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks and other providers of care. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit www.aha.org.

About Health Forum
Health Forum is a strategic business enterprise of the American Hospital Association, creatively partnering to develop and deliver essential information and innovative services to help health care leaders achieve organizational performance excellence and sustainability. For more information, visit www.healthforum.com

TMC ahead of the curve: one of less than 200 hospitals nationwide to attest to Stage 2 of meaningful use for its electronic medical record

1_Meaningful-Use_ArrowIn July, Tucson Medical Center attested to the U.S. Centers for Medicare & Medicaid Services, or CMS, that it has met Stage 2 meaningful use requirements for implementation of its electronic medical record. As a result, the hospital expects to receive $1.9 million this year in incentive payments made available under the 2009 economic stimulus package.

While the use of electronic medical records has dramatically increased throughout the country, many hospitals are finding it difficult to meet Stage 2 requirements. At the end of July, TMC was one of 78 hospitals, out of 4,741 hospitals registered for the incentive program, which had attested to Stage 2. As of Sept. 30, only 143 hospitals had attested.

After successfully attesting, TMC was contacted by the Office of the National Coordinator for Health Information Technology for a conference call to learn how the organization succeeded.

Two areas have proved especially challenging for hospitals around the country: patient electronic access, often realized through the use of a patient portal, and transitions‐of‐care measures requiring an electronic document be sent to the physician or care facility that will care for a patient after discharge.

TMC succeeded, in part, because of a team of more than 150 people from various disciplines, including executives, nursing, health information management, admitting, quality and information services.

The hospital first began investing in its electronic medical record infrastructure in 2002. Then in 2008, the TMC HealthCare Board of Trustees approved a $31 million plan to implement a fully electronic medical record, which went live in 2010. Presently, the organization is working toward connecting its internal electronic records system with other hospitals and health providers to share patient records.

This blog is one in a series as part of an Oct. 22 celebration at Tucson Medical Center for successfully attesting to the U.S. Centers for Medicare & Medicaid Services for meeting Stage 2 Meaningful Use requirements of its electronic medical record. This success was a great and collaborative effort across many areas of the hospital. It represents another milestone achieved toward improved patient care and safety.

Most Wired: Health Information Exchange

Most Wired 2012 artHaving the right tools in place so that care providers can share information is key to creating a successful 21st century health care delivery system. The right technology can connect health care providers across the continuum ‑ including primary care doctors, specialists, assisted-living facilities and nursing homes, hospitals, rehab facilities and public health agencies ‑ to ensure more streamlined continuity of care.

TMC has been at the leading edge of health care information technology. It was the first hospital in Arizona to implement a comprehensive electronic medical record to achieve Stage 7, the highest level to date, on the HIMSS Analytics scale. But health providers use a plethora of electronic records systems – and those systems don’t readily talk to one another. Enter the health information exchange, or HIE, which will provide the infrastructure that will allow the systems to communicate.

TMC is developing this information-exchange capability on two fronts. It is part of a public system being developed at a statewide level by a community-based nonprofit known as the Health Information Network of Arizona. This system, which includes hospitals, health plans and other providers who opt in, is likely to start small when it goes live later in 2012 and will expand incrementally across the state.

TMC, however, is also committed to building its own information exchange to help serve as a building block for its participation in the accountable care organization Arizona Connected Care. With more than 200 providers participating, it’s important to connect these practices, especially in treating those with chronic conditions, especially diabetes and cardiovascular disease.

This private system will be customized to fit the needs of its participation in Arizona Connected Care and will include some advanced features. A basic system allows a user to access patient information. A more sophisticated system could automatically alert the provider that a patient has received emergency care, for example, instead of requiring a provider to search for that information.

TMC is also committed to the public effort as well, since as a practical matter, patients will be getting care from providers who may not be participating in Arizona Connected Care. Read more at Initiative to Link Doctors for Delivery of Stronger Patient Care.

Most Wired: Digital Imaging Streamlines Process, Reduces Delays

There was a time not so long ago when images from heart tests needed to be burned to a CD and stored away to preserve for future reference.

That process took up a lot of space and it consumed a great deal of time when physicians wanted to pull up the historical clinical record, since it required physically locating it. There was also the risk that discs could be misfiled, making the record more difficult to find. And with EKGs, for example, needing to be printed and scanned individually, the process used a great deal of paper.

Electronic medical records have changed all that.

Whether doctors are using an electrocardiogram, or EKG, to test the electrical activity of the heart and look for abnormalities, or whether they’ve sought clues in an echocardiogram, which creates a moving picture of the heart to determine its health, the images are now available within seconds from their computer.

“It’s really amazing to see how far technology has come,” said Anita Bach, the director of cardiac services. “The physicians and staff now have immediate access to the information they need, anywhere in the hospital.”

Bach explained on the echocardiogram, which is more detailed than an X-ray since it allows doctors to see the heart beating, the technicians used to have to write measurements on a piece of paper while doing the test. Those measurements would subsequently be dictated by a physician and then transcribed afterward. Entering the measurements electronically has eliminated the need for transcription, shaving hours off the turnaround time for results.

The electronic imaging capabilities also are used in the vascular and gastrointestinal labs, which used to be scanned on paper into the medical record.

“This technology has not only led to greater efficiencies, but the important thing is that it has allowed for enhanced patient care through faster diagnosis and access to integrated information,” Bach said. “It also ensures a complete, accurate permanent archive of historical clinical information.”

TMC case study highlights achievements of instituting Stage 7 EMR

Last month, Tucson Medical Center was among 16 hospitals and health systems recognized at the HIMSS12 annual conference in Las Vegas for achieving the pinnacle of implementation of its electronic medical record. Since 2005, the Healthcare Information and Management Systems Society’s Analytics’ EMR Adoption Model has tracked the adoption of ell has tracked the adoption of electronic medical record applications within hospitals and health systems across the United States. Institutions work to complete the 8 stages (0 – 7), with the goal of reaching Stage 7: an environment where paper charts are no longer used.

As part of its recognition of these systems and facilities, HIMSS published case studies on 14 Stage 7 hospitals, including Tucson Medical Center, that provide insight and guidance that other health care organizations can emulate. They are also a summary of each winner’s journey to the top of the EMRAM.

Only 65 hospitals in the United States have Stage 7 EMRs. A study by HIMSS and The Advisory Board show they have a very real competitive and quality advantage, as they support the true sharing, information exchange and immediate delivery of patient data to improve process performance, quality of care and patient safety. New research from HIMSS Analytics and The Advisory Board affirms these gains, showing that hospitals with advanced EMR systems report achieving a broad range of benefits, including quality, safety and operational efficiencies.

The data collected for the report, EMR Benefits and Benefit Realization Methods of Stage 6 and 7 Hospitals, indicates that highly advanced EMR environments can produce substantial benefits for individual hospitals and the health care system as a whole. The survey is the first to report results from hospitals that have achieved Stage 6 or Stage 7, providing unique insight into how ERM systems are working for hospitals further along the development track.

Saguaro Physician Offices Certified as Patient-Centered Medical Home

By M. Scot Skinner

The effort to provide patient-centric medical homes, complete with certification that you are doing so, is gaining traction at Saguaro Physicians.

Three of the TMC-owned group’s providers earned recognition recently from the National Committee for Quality Assurance: Drs. Kathleen Iveson, Wesley Vaughn and William L. Abraham.

As certified adherents of the Patient-Centered Medical Home philosophy, these doctors join a fairly exclusive club.

As of July 31, only a handful of Tucson groups are registered as medical homes, according to the NCQA, an independent, nonprofit group. Doctors at New Pueblo Medicine are listed, along with providers at Desert Star Family Medicine and several in the El Rio network.

It’s no coincidence that all of the above are fully on board with electronic medical records. The conversion to EMRs, which Saguaro Physicians completed in October 2009 and TMC completed in June 2010, is required before a practice can be deemed a PCMH. That’s because medical homes are built with EMRs at the very foundation.

“The EMR does a bunch of stuff for you,” says Dr. Richard Johnson. “It automates everything that can be automated. It tells you which patients are coming due for which test, and so much more.”

Johnson, Saguaro’s medical director, says that the medical-home model, which is delivered at no additional cost to patients, is particularly helpful for those with chronic conditions such as diabetes or high blood pressure. The many tools available through the use of electronic records greatly reduces the chances that patient needs will fall through the cracks.

It all makes for a return to something like old-fashioned care, says Johnson.

“The primary care provider becomes the integral part of your health maintenance, making sure you get the appropriate interventions at the appropriate times,” he says. “One of our catch-phrases is ‘Do the right thing for the right patient at the right time, every time.’”

The medical-home approach is being tested by UnitedHealthcare, which is nearing the end of a three-year pilot program in Arizona. The model is believed to be one of the best ways to get a grip on runaway medical costs. It’s getting a trial run, in one version or another, by insurers across the nation.

The idea is that by offering a home base for patients, coordinating their treatment and doing meticulous follow-up, doctors can reduce hospitalizations, prevent overuse of emergency rooms and lower medical spending overall.

“Life management is really what it is,” says Donna Bergman, Saguaro’s administrator. “It’s about making sure that we know what is going on with all of our patients. Because we are coordinated and fully connected with electronic medical records, it means that all of the records are immediately available to all of our doctors.”

The result of such coordinated care, achieved by making full use of nurse practitioners, physician’s assistants, nutritionists and other professionals, is that patients start taking better care of themselves. And healthier people, as it turns out, make fewer visits to emergency rooms.

The medical-home model also takes aim at the hordes who seek emergency care because their problem, while perhaps less urgent than a gunshot wound to the chest, honestly can’t wait for the next opening in their doctor’s schedule.

But what if patients knew they could call their doctor’s office 24-7 and get a next-day appointment? That’s a game-changer, says Johnson, and it’s the reality at Saguaro Physicians and other medical homes.

While only three of Saguaro’s 16 providers are recognized by the NCQA as a patient-centered medical home, all embrace the philosophy and have applied for certification.

“Most of the work in this area was done not just by the current people,” says Johnson, who has been with Saguaro for about two years. “Dr. Scott Van Valkenberg has been a driving force in this for a long time.”

The medical-home concept has won the support of the American Medical Association, the American Academy of Pediatrics (which introduced the term Patient Centered Medical Home in 1967), the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association, among others.

According to Johnson, “everyone who provides primary care espouses the concept of the patient-centered medical home.”

So if this model is so promising for patients and providers, why isn’t it ubiquitous?

Because the conversion to electronic medical records is expensive for an independent practice, says Johnson, who estimates set-up costs at “anywhere from $40,000 to $100,000.”

“We are so fortunate to have the backing of TMC,” he says. “It can be a real struggle for those not affiliated with a hospital.”

But the expense of going digital is not the only reason why some doctors continue to drag their feet.

“Some providers just don’t want to change,” says Johnson. “They like doing things the way they’ve always done things.”

At least one group of doctors has taken the notion of patient-centered care to a surprising extreme, Johnson says. “There’s a practice in Seattle that got rid of its waiting room. They redesigned their offices in order to eliminate it altogether.”

The waiting rooms remain at Saguaro Physicians, but time spent there is minimal, he explains.

“If your appointment is at 1:30, barring any unforeseen issues, you’ll be seen at 1:30,” Johnson says.

Doctors who resist overbooking are the exception, not the norm, he acknowledges. “That’s not patient-centered care,” he says. “That’s physician-centered care.”

For more information about the patient-centered medical home, go online to www.ncqa.org

 M. Scot Skinner, an Arizona native, is an award-winning reporter with more than 25 years of experience in daily journalism. After a long career at the Arizona Daily Star, he is now working for Tucson Medical Center as a freelance writer. He can be reached at mscotskinner@gmail.com.

Awards and Recognition

◦ TMC is the only Tucson hospital recently recognized as a top-ranked Community Value Provider by Cleverley + Associates

◦ TMC has been selected among the nation’s 50 Top Cardiovascular Hospitals by Thomson Reuters for 2011 – the only hospital listed from Southern Arizona

◦ TMC has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes TMC’s commitment and success in implementing excellent care for stroke patients, according to evidence-based guidelines.

◦ TMC is one of the top-ranked hospitals in Tucson named by U.S. News & World Report in its Best Hospitals Metro Area Rankings

◦ TMC is certified as a Primary Stroke Center by the Healthcare Facilities Accreditation Program (HFAP)

◦ TMC has been endorsed as an Accredited Chest Pain Center by the Society of Chest Pain Centers

◦ TMC is recognized for its support of breastfeeding with the IBCLC Care Award from the International Lactation Consultant Association

◦ TMC’s Electronic Medical Record (EMR) system is one of the few to reach Stage 7 on the HIMSS Analytics Database, which tracks hospital EMRs from Stages 0-7

◦ TMC for Children is an associate member of the National Association of Children’s Hospital and Related Institutions

◦ TMC Neurosciences holds designation by NeuStrategy as a Neuroscience Center of Excellence

◦ TMC is a pilot hospital for the national Accountable Care Organization project run by Dartmouth University and the Brookings Institution

◦ TMC is designated as an American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Surgery Center of Excellence (BSCOE)® in conjunction with the Surgical Review Corporation

Last updated: July 2011


Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461