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High Performance Medicine: Partners expands efforts to improve quality, safety, and efficiency

Advances in medicine and new technology have vastly expanded the capacity of our health care system to prevent, diagnose, treat, and cure illnesses. But often, even as doctors, nurses, and other health professionals strive to deliver the best care they can, standard medical practice has not kept pace with these advances, resulting in a growing gap between what medical care could offer and what it does offer.

There are many challenges in closing this gap. As discoveries come at a rapid pace, it has become difficult for caregivers to know everything that might benefit their patients. Multiple doctors caring for one patient make communication and coordination more challenging, which in turn can lead to increased risks to patients and higher costs.

While clinicians work hard every day to deliver the highest quality of care, there is still much work to be done to broaden and deepen efforts to deliver the safest, most cost-effective medical care possible while also providing patients with access to the latest treatments and technologies.

This is the reason why Partners HealthCare has developed a set of tools that help our doctors, nurses, and hospitals provide better, safer, and more cost-effective care.

Partners is working to improve care in five areas:
1. Maximizing the use of new information technology
2. Increasing patient safety and reducing medical errors
3. Making high quality uniform across the Partners system
4. Coordinating care for patients with high-cost diseases
5. Improving efficiency in the use of medications and radiology

Partners has already made significant progress in each of these five areas:

Maximizing the use of new information technology
In 2005, computerized ordering systems that guide physicians to the most cost-effective drugs and tests were being used in about 8 percent of U.S. hospitals with fewer than 300 beds and 17 percent of hospitals with 300 or more beds. These rates are expected to rise, but very slowly, to only 37 percent and 53 percent, respectively, by the year 2010.

Partners exceeded these end-of-decade national projections in 2005. Computerized ordering systems are now in place at Brigham and Women’s Hospital, Massachusetts General Hospital, Faulkner Hospital, Newton-Wellesley Hospital, Spaulding Rehabilitation Hospital, and will be fully implemented at North Shore Medical Center by January.

Similar progress has been made in the implementation of the electronic medical record (EMR), which allows physicians throughout the Partners system to access a patient’s medical record. EMR is currently available to 85-90 percent of primary care physicians and specialists at Partners’ two academic medical centers and at Spaulding Rehabilitation Hospital. Among Partners community-based primary care physicians, about 70 percent now have EMR or are in the course of implementing it.

Increasing patient safety and reducing medical errors
By 2010, all Partners hospitals will have in place integrated systems to minimize medication errors. These systems begin with computerized order entry. Next come measures like “smart pumps” and “bar coding” to ensure that the right patient gets the right drug at the right dose at the right time.

Use of computerized order entry systems alone reduced medication-related errors by 55 percent in one trial. Another study found that improvements in “decision support” that automatically evaluates a drug’s risk to an individual patient – based on his or her age, kidney function, other drugs and medical conditions – led to an 83 percent reduction in the overall rate of medication errors.

Making high quality uniform across the Partners system
In order to assure the same high quality care for key populations of patients, such as those with heart failure or diabetes, software has been developed and implemented to help Partners identify and track these patients, and then measure the care they are receiving.

For example, optimal treatment of diabetes both improves patient outcomes and lowers overall treatment costs. With the implementation of quality measures, Partners has improved faster than other hospitals in Massachusetts and the nation as a whole. Partners currently exceeds the national 90th percentile in all diabetes care measures.

Coordinating care for patients with high-cost diseases
Because 10 percent of all patients account for 70 percent of health care costs, Partners has targeted certain patients with high-cost diseases for special attention. For example, Partners funds nurse practitioner programs at its acute care hospitals to better manage patients with congestive heart failure. In the first three years of this program, the rate of hospital re-admission among enrolled patients has been reduced by at least 15 percent. Through Partners Home Care, Partners also provides telemonitoring devices to heart failure patients who are being cared for at home.

Another Partners program provides telephonic nurse “coaching” to high-risk Medicaid and uninsured patients. Data on the impact of this intervention on patient and physician satisfaction and health care costs will be available soon,, but preliminary information is very encouraging. Through Partners Home Care, Partners also provides telemonitoring devices to our sickest heart failure patients being cared for at home.

Improving efficiency in the use of medications and radiology
To address two areas of high costs, Partners has developed decision support systems for physicians in prescription writing and in the use of expensive radiology tests. Committees of physician experts, supported by pharmacists and other staff, developed guidelines for which medications and which tests should be used first, ranging from “green” (most favored), to “yellow” (second choice), to “red” (last choice).

The cost of imaging and drugs is of continuing concern to insurers, policymakers and the public, making it even more important that we continue to focus on these high-cost areas of medical practice.

The U.S. health care system faces serious challenges and meeting those challenges will likely require fundamental changes that go beyond what any one organization can do. With the passage of comprehensive health care reform legislation earlier this year, Massachusetts leads the nation in efforts to ensure that all of our residents have access to the best, most cost-effective health care.

While this is an important first step, health care providers also have a critical role to play in ensuring that what is possible in health care today benefits our patients and is affordable for our society. At Partners, we are working very hard to bridge this gap.