Patient care, research and teaching throughout Northwestern Medicine will benefit on countless fronts starting in 2018. That’s when Project One, a unified electronic health record (EHR) system initiative, goes “live.”
Currently in the planning and input gathering stage, the ambitious undertaking will bring about greater clinical collaboration and patient engagement, seamless sharing of reliable clinical and administrative data and a streamlined revenue cycle to improve financial performance.\
“This is an amazing opportunity for us to really shift health care in our region,” says Nancy Sassower, MD, ’97 GME, a Project One physician leader. “Our patients will be blown away by what they’re going to see over the next couple of years.”
Our patients will be blown away by what they’re going to see over the next couple of years.
When Northwestern Medicine formed as a system, leaders quickly saw the need for an integrated electronic platform, explains Jay Anderson, senior vice president of quality and performance. “Project One is creating a space where clinicians and operating teams work together to build an integrated academic health system where patients come first,” he says. “Bringing all health system data into one place forms a powerful tool for patients and caregivers, essential to achieving our vision for world-class clinical care and the advancement of medical science and knowledge.”
Project One will build off the existing Epic inpatient and outpatient EHR systems. Put in place during the 2000s, these then-revolutionary tools transitioned the traditional recordkeeping system from paper to electronic records. After several years of experience, doctors, researchers and patients soon learned what they really want to see in an EHR system.
Phillip Roemer, MD, vice president and chief medical officer for Northwestern Medical Group, routinely describes Project One as EHR 2.0. “Everyone is now up to speed on how an electronic health record works,” he says. “This allows us to spend more time on making the patient experience more effective and efficient.” The more seamless system hopefully will quell some of the backlash against EHRs from physicians and patients not just at Northwestern Medicine but also throughout the medical field. Says Roemer, “One of our many guiding principles is to improve the caregiver experience.” So far Project One has pulled together several advisory groups spanning inpatient clinical, procedural, ambulatory, technical and access, plus revenue cycle and other health information management concerns and interests. “We have gone through sessions of scaffolding what the future state is going to be,” says Tom Moran, MD, vice president, chief medical information executive and Project One physician leader. “We’re bringing our experts to the table and asking what they want in a unified system.”
All Together Now
Patient care is perhaps the most obvious area of benefit for the new unified system, with charts available instantly to all physicians and other clinicians. “Currently it’s not uncommon for a patient to provide information [as an outpatient] and be admitted to the hospital only to find that much of the information is not available there,” explains Roemer. “Patients have to start over.”
A unified system across the entire Northwestern Medicine network ‒ from the flagship hospital in downtown Chicago, to Lake Forest in the northern suburbs, to DeKalb out west ‒ the system will create greater efficiencies within and across facilities, predicts Jennifer Bloomquist, director of information services. “Today if patients come to see one of our providers and gets a lab test at a hospital, even though it might be one floor away, they might be asked to give their information all over again.” The efforts of Project One should help improve caregiver effectiveness, allowing more time for face-to-face patient and co-worker interaction and less time spent on stenography. “How do we make the record tell the story of the patient more effectively?” says Anderson. “We’re making sure we minimize double documentation. If a fact already exists in the health record, it doesn’t need to be re-entered.”
Patients entering a doctor’s office will no longer need a clipboard of forms to write down all their key information, which then has to be scanned or keyed in by office staff. “It’s miserable and not as accurate because of the chance for error,” adds Anderson. “Patients will be able to fill out [online forms] on their couch at 7, 8 o’clock at night. We will be empowering patients.” Patients also will be able to access their own records on the system, says Lee Ann Arnold, DNP, MS, RN, informatics nurse leader and a Project One leader. “As a patient, I can go in and request appointment times, view my labs and communicate electronically with my physician. Other technology software allows me to see how busy the urgent care is,” she says. “I will be able to watch the handoffs between people who are guiding me through the continuum of care.” Moran notes that physicians, pharmacists and lab technicians will be on the same page when it comes to patients taking antibiotics, for example. “We want to make sure we have the right patient with the right identified infections and the right antibiotic,” he says. “So we don’t overuse the antibiotic, don’t escalate it too far and increase [bacterial] resistance, but, at the same time, give patients what they need to overcome their infection.”
The ability to capture individual patient data and pool it with that of many others will enhance the research enterprise at Northwestern Medicine and ensure that patients have access to the latest cutting-edge treatments. Simply making it easier for providers to know what research projects are being conducted and the eligibility requirements for patient enrollment will be a huge first step.
“While the unified system won’t change how research is being done here, it will change how we communicate with one another,” says Moran. “Once a patient is in the program, everyone who touches that patient can see that they’re in a research project.” Rex Chisholm, PhD, associate vice president for research and Feinberg vice dean for scientific affairs, says he’s excited by the prospect of the system’s enterprise data warehouse connecting into a single, system-wide database that also links to the campus-wide clinical research study tracker. “That will give us much better integration with the hospital to facilitate new types of research and improved efficiency for compliant research study billing,” he says. Project One will enable researchers to pool data from different locations and have a much deeper well from which to draw. “When researching management of chronic care for diseases like diabetes or hypertension,” says Sassower, “we will be able to better manage our extensive patient data, enabling us to better identify patient populations, as well as more easily provide long-term treatment plans and management for such populations.” Among the future research scenarios, the unified system will help to further accelerate precision medicine, especially in drug development. “It will give us access to much more data,” explains Chisholm. “We’ve developed genomics-based clinical record information tools to improve the precision of medication prescriptions, or dosage, depending on patients’ genetic makeup.”
On the medical education side, new doctors will learn how to interact with a state-of-the-art EHR system. Residents as well as medical, nursing and pharmacy students training at Northwestern will gain real-life instruction in how to best use the system. And the system will stay on top of the learning process by tallying clinical procedures a student or resident has participated in, such as number of appendectomies.
Project One’s working groups always have medical education in mind when making decisions on how the system will look. “Education infuses into everything,” says Sassower. “We have carved out a workflow to make it easy for students and residents to focus on their medical education.” “It truly takes a village,” adds Arnold, describing the monumental task ahead. “It comes down to every single team leader, plus our patients, weighing in on how we can do this better. Something of this magnitude will position us to better serve and provide care for our patients and our communities. That’s what it’s all about.”