Innovation With Heart

Tulsa cardiologist Michael Spain, M.D., has found himself in an unusual place for a doctor – he has become a nationally known IT innovator in the field of electronic medical records.
The CEO of Cardiology of Tulsa, a paperless 14-physician cardiology group, Spain drove the creation of the 52-bed St. Francis Heart Hospital as one of the first all-digital specialty hospitals in the nation. Cardiology of Tulsa occupies 28,500 SF in the same building as the heart hospital at 10501 E. 91st St.
In the hospital and clinic’s EMR systems, patients’ files are immediately updated with new information and results of tests and are available to physicians on computer screens from the examination room to any place in the world where the doctor has access to a computer with an Internet connection.
“What we are doing here is unusual,” said Spain, “but its not going to be unusual in 10 years. We are really out on the edge of the pioneer curve.”
“Right now is still really special,” he said, “and it is our job to figure out how to make all the problems and bugs go away so that the people who are not so interested in being on the front edge of the curve will be able someday to drop EMR into a practice and it will be routine.
“It is our job to make this not special as quickly as we can.”

Failure Breeds Success
Spain attributes a large part of the success of the EMR systems at the hospital to an early failed attempt to automate Cardiology of Tulsa in the mid-‘90s. The hospital and clinic opened all-digital in April 2004.
“Until you tried this once and failed, you didn’t even know to ask a question,” he said. “It’s kind of a cliché, but I don’t think you could do a project of this magnitude successfully without failing before hand.”
Spain, who augmented his medical education with an MBA from the University of South Florida in Tampa, pointed to inadequate technology and planning for the early lack of success.
“There are several success factors,” he said, “and one is the technology has to be good enough.”
“The technology has just crossed the line now where it is good enough, fast enough, cheap enough and integrated enough that you can make different systems talk to each other and work together,” he said.
To help manage the technology and correct any problems which might arise, the hospital and cardiology group have established developmental partnerships with IT providers. The hospital is partnered with England-based GE Healthcare, and the clinic with NextGen Healthcare Information Systems of Horsham, Pa.

It’s All in the Plan
The next critical element for success in implementing an EMR system is planning, he said.
“That is where we really fell short – it is not understanding the scope of the planning it takes to really pull something like this off. This is extremely complex,” Spain said.
The implementation of the technology is critical, he said.
“Our planning got down to such a detailed level that we mapped out the ‘go live’ schedule for every doctor and every person who supported them for a year to the day,” he said.
A part of that planning was in making the conversion from the paper world to the electronic world, Spain said. That included making the charts of existing patients available on the digital system.
“We had 180,000 patients,” he said. “We had to sit down and really try to predict, of those 180,000 charts, which patients are most likely to need our services in this coming year and in what order. That is impossible to do for 180,000 charts, but we could do it for 20,000-30,000.”
The third element of success is cultural, Spain said.
“It’s managing change,” he said. “I don’t care if you are managing change in the banking industry, the airline industry, the hotel industry, the NFL or medicine. If you don’t really think about that and anticipate what it is going to take to guide people through that magnitude of change, you are going to have a huge problem as well.”

The Benefits of Digital
Spain said one of the greatest benefits of going to all-digital medical records is that the quality of medical care goes up “because you are managing patients from a database.”
“Now you have all of their information at your fingertips, instead of trying to go back through old records and carve through things,” he said. “You have access to an amount and type of information that you have never had before, so you are going to do a better job, particularly in something as information intensive as cardiology.”
“If you walked into the ER and said, ‘I had a stint last year,’ that’s not enough for me to know what to do,” he said. “I need to know what diameter, what the length was, what the type was, what the coating on the stint was, which segment of the vessel it went into. I need all those technical pieces of information that you can’t tell me as a patient. It just takes so much more information to really manage patients today than what it used to.”
In addition, digital files reduces errors and brings unprecedented access to records, Spain said.
“These systems reduce errors, and they do it dramatically,” he said.
“And if you show up at four in the morning on a Saturday in the hospital ER, I can get your records,” he added. That is compared to 10 years ago, “when your records are sitting over in my office and I really don’t have that information.”
“If you are having a heart attack, I need to know that in three minutes,” he said. “In the old days, I never got the information at that time, I just had to go on without it.”
“Those have been real advances in terms of doing the right thing for patients.”

A Revolution in Access
The introduction of fully digital records and the access they provide has changed how physicians and staff deal with patients on a daily basis, Spain said.
“We did not anticipate this, but we now talk with this openly with our staff all the time. We now say that when you interact with the EMR, you are interacting with the patient,” he said. “We are really trying to put the identity of those two things together in people’s minds.”
“If you are in a hospital setting and there is a test result, we want our staff who work on the hospital side to log on from the hospital and put that information in and update the database, because when you are doing that you are really doing something for the patient,” he said.
Then when that patient comes back to the office, the information is already there, Spain said. “It’s not somebody trying to find it, go track it down, put it in.”
That kind of immediate access to information “is very addictive” for physicians, he said.
“If I am at a hospital across town, and somebody is over here, my nurse can just call me and I’ll log on and we are looking at the same record at the same time,” he said. “If I am on a computer with Internet Explorer on it, I can get in. I have done patient questions from a Wal-Mart in Mexico.”
Spain said the idea that a patient’s data is available wherever the physician is and the fact that multiple people can be looking at it at the same time in different locations “really starts creating a spider web in an organization of information that doesn’t exist if it’s limited to the (physical) holder of the (paper) chart.”
“That is quite revolutionary,” he said. “This is more than just electronic paper.”

Added Security
Spain believes that an EMR system adds levels of security of a patient’s health data that are not available in a paper records system.
The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, which addresses the security and privacy of health data, coincided with the early introduction of EMR systems, he said, “so it worked out pretty well together.”
“I don’t believe you can be truly HIPAA compliant in a paper world, that’s how stringent the security guidelines are,” he said. “Theoretically, every time you opened a patient’s chart and looked at it, somebody should put in a log that somebody looked at it. Who can do that?”
“But the computers do that,” he said. “It logs who looks at what screens, who signs on and what time they were there. These systems, even though they provide a lot more access, they provide a lot more security and privacy of the record.
“Prying eyes are blocked from the very beginning.”
Cardiology of Tulsa also provides an integral backup of files every 20 minutes and an offsite backup every week, Spain said.

A World of Interest
Spain’s efforts to use information technology to change the way specialists practice clinical care has drawn national attention.
“We went into this realizing we had a chance to make an impact on our patients and the safety of their care,” he said, “but by getting there so quickly and much earlier than other practices, as it has turned out, we built a mousetrap and we have people coming from all over to learn.”
“We are starting to realize this as a bigger goal. We are really fundamentally affecting health care across the country.”
Spain was honored by the online industry newsletter Healthcare Informatics as one of the winners of its 2005 Healthcare IT Innovators Award.
He said the combination of the success of the EMR systems at the clinic and the hospital has even drawn international attention with site visits by people from around the world.
“We are now one of a handful, and probably the first in the world, to be completely paperless hospital and office combined in one facility,” he said. “You can count them on one hand if they are out there.” ?

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