Arun Mathews saw the power of technology in improving patient care when he was still training at Johns Hopkins University as an informatics researcher. In a limited pilot study there, during his fellowship year, he supplied Xboxes to kids undergoing hemodialysis and observed a strong correlation between their game-playing and a variety of positive effects.
For example, the children felt included as part of the gaming community and were freer to “vent and complain” about their medical situations—bettering compliance with treatment and overall improved quality of life.
The experience had a profound effect on Mathews, a self-described “techie-physician,” and it ultimately strengthened his dedication to combine technology and medicine to deliver better patient care.
Since 2010, he has seen tangible results from that crucial combination. As chief medical information officer at Medical Center Health System (MCHS)—a 400-bed, full-service community academic medical center and L2 trauma center serving a 17-county region surrounding Odessa, Texas—Mathews has helped to spearhead several of MCHS’s more notable technology-driven successes, including ARRA attestation of Meaningful Use Stages 1 and 2, and HIMSS Analytics Stage 6 certification.
ARRA compliance and Arun Mathews’s initiatives have led to impressive statistics at MCHS
and counting: Number of days with no ventilator-associated pneumonia as a result of employing EMR checklist
or higher: Adoption of computerized physician order entry (CPOE) within 6 months of EMR launch
Increase in HCAHPS patient satisfaction with discharge scores, as shown in a readmissions analytics pilot
Meaningful Use, Data, and Outcomes
Mathews quickly acknowledges that there was already substantial momentum toward Meaningful Use compliance when he arrived at MCHS, but it may have been lacking the “physician’s voice.” In other words, complying with Meaningful Use for successful certification is one thing, but using it to make practical improvements in patient care is another.
For example, as part of its effort to fully implement electronic medical records, MCHS revamped its medicine reconciliation process. This included a plan to require physicians to enter all drugs and medicines into each patient’s record. As a clinician who still sees patients one week each month, however, Mathews recognized this as an inefficient process that would interrupt the work flow of busy admitting physicians.
“We introduced emergency-room pharmacists into the process for a more compatible solution,” Mathews says. “They provide true medicine reconciliation in the EMRs, and then physicians sign off on them. That created a more realistic scenario with substantial improvements in work flow, patient safety, and a reduction in the likelihood of medication errors.”
That situation also benefited from his efforts to integrate Lean Six Sigma methodologies at MCHS. These helped increase collaboration between departments and facilitate more-effective processes to identify issues, develop improvements, and create technical solutions to implement them.
“In addition to a newly created analytics department that I’m especially proud of, there’s an ongoing culture change here that’s making terms like ‘champions,’ ‘project charters,’ and ‘waste reduction’ part of our vocabulary,” Mathews says.
Pros and Cons of Combining Medicine and Technology
Mathews, like many CMIOs, began his career in medicine and then mixed in his fascination with technology. He feels it gives him the opportunity to draw on the best of both worlds.
“As physicians, we’re trained to be empathetic, which helps lead to very strong relationships with patients and colleagues,” he says. “In informatics, we learn how systems-based approaches and technology help improve processes and outcomes. But ultimately, the two disciplines are complementary, since the endgame for both is high-quality patient care.”
Mathews is candid when discussing the outcomes that have resulted from focusing the two on meeting the requirements of ARRA Meaningful Use. For example, the consistency and legibility of EMRs are positives, as are improved quality assurance indicators, such as reductions in patient readmission and inpatient infections.
However, he believes there are requirements that still need further refinement in order to be truly useful. Personal health records (PHRs), for instance, often require patients to log in to review their contents. “If patients aren’t used to electronic interactions as part of their healthcare, PHRs require a behavioral change that we can’t control,” Mathews says. “And even though I believe those types of transactions are where true patient engagement is headed, tying that change to an institution’s potential incentive funds creates quite a challenge.”
Continuity of care documents are another element of “digitized medicine” he feels need more fine-tuning and improvement. In a rush to meet regulatory requirements to forward treatment details to outpatient providers, physicians receive pages and pages of raw data that are less meaningful than traditional narrative summaries. He characterizes such efforts as “well meaning but driven more by attempts to meet deadlines and requirements than practical implementation of those requirements.”
“We’re headed—to the ‘invisible EMR,’ That’s where the underlying technology gets out of the way to highlight the most-relevant contextual data to help physicians be more informed, and to facilitate better outcomes.”
Better Data, Better Care Decisions, and the Invisible EMR
The increasing focus on user-centered interfaces and contextual design in software and systems are all leading to what Mathews sees as better data for better decision making. He envisions real-time, at-a-glance access to patient medications and allergies, procedure and laboratory results, and vital signs, as well as detailed care plans side-by-side, with analytics capable of displaying culture data for antibiotic-resistant bacteria and recommended options for medication.
“It takes terabytes of data to create practical, actionable intelligence, but I think that’s where we’re headed—to the ‘invisible EMR,’” he says. “That’s where the underlying technology gets out of the way to highlight the most-relevant contextual data to help physicians be more informed, and to facilitate better outcomes. And those are the results we all want.”