Why Can’t Electronic Medical Records Communicate Easily with One Another?

Recently, the GBMC Chesapeake Regional Information Sharing for our Patients (CRISP) governance team got together. This meeting provides us with an opportunity to meet with our CRISP colleagues to improve our use of the network, to connect with other providers of care, such as private practicing physicians, hospitals and nursing homes that don’t use Epic so that we can better serve our patients and reduce the time spent searching for information, which frustrates clinicians.  We have also made so much progress in the use of the network. An example is that every morning our patient-centered medical homes get a report from CRISP on each of our patients who were seen in any Maryland hospital in the preceding 24 hours. This allows our care managers to check-in with them and make sure they have what they need.

But during the meeting, I became frustrated on more than one occasion because of the incredible complexity of getting one company’s record to “talk” with another company's record. The medial record companies keep their source code secret to maintain the value of their investments and this is understandable, but the net effect is that even in the 21st century it’s really hard to have all of one patient’s record available for clinicians who need the information. We are dealing with a real “Tower of Babel” where no two vendors' records talk easily with one another. In addition, the U.S. has not created a “unique patient identifier” (such as a social security number) to make sure that we are truly connecting records of the same person.

I am concerned that the citizens of the U.S. have no idea that this is happening. If they did, I believe that they would advocate for better planning and some stronger rules about cooperation around the goal of better information sharing. Market forces are not working and our country’s doctors and nurses and their patients are paying a very high price in safety and efficiency while billions of dollars are being spent to work through the confusion to try to make these records talk to one another.

Yes, we do have one patient, one record for patients served by our hospital, our employed physicians and Gilchrist and to the extent that the records are coming from the same EMR (Epic at other hospitals) we are okay, but when they are not, it’s a mess.  The American people need to think about this, decide what they want and make their opinion known to those in power.

We must all be united around the quadruple aim: The best health outcomes with the best care experience, with the least waste and the most joy for those providing the care. None of these four aims are truly possible without the efficient movement of information to those with a legitimate need to know.

Thank You!
Mother Nature was cooperative for the recent Baltimore Running Festival. Thousands of people participated in this year’s event including approximately 90 runners who joined team #RunGBMC to raise funds in support of the Gilchrist Center Baltimore – Joseph Richey House. The 19-bed inpatient center has been serving patients in Baltimore City for more than 30 years by providing residential, acute and respite care. We’re still counting, but so far we have raised more than $10,000. The money raised by team #RunGBMC will help cover Joseph Richey House’s operating expenses not covered by insurance or patient payments.

I’m very grateful to all of the employees, volunteers, patients and supporters of GBMC Healthcare who helped us raise money and awareness of the outstanding work at Joseph Richey House.  I hope you all had a great time in support of this fabulous part of our system of care.

What’s in a name? Gilchrist rebrands itself

Over the last 23 years, Gilchrist Hospice Care has done so much to help so many people at the end of life, and their families. A few years ago, we changed the name to Gilchrist Services to show the community that Gilchrist was more than excellent end of life care. Annually, Gilchrist provides elder medical care to 7,500 individuals, hospice care to 5,400 patients and grief counseling and bereavement services to 6,500 family members. The organization also counsels individuals on care planning, guiding them through decisions about their treatment and helping them make informed choices for their advanced chronic disease. We were still concerned that “Gilchrist Services” was not working as a name.

Earlier this week, Gilchrist launched a new branding and advertising campaign that aims to educate the public that Gilchrist is “more than hospice.” I've asked Cathy Hamel, President of Gilchrist and our system’s Vice President for Continuing Care, to talk about it in this week’s blog.

What triggered the new brand and advertising campaign? Why now?
The mission of the “new” Gilchrist is to provide quality compassionate care, counseling and support to people at every stage of serious illness, so that they may live life to the fullest.  Although a lofty goal, at no time in history is this work needed more than now.  As medicine continues to advance, people are living longer.  And as the population ages, more and more people are struggling to cope with a serious illness or caring for an aging parent.  We want people to know that today’s Gilchrist is here to meet their needs, whether guiding them through treatment options, providing medical care in their home or residential care community or helping them to navigate the often complex, health care system.

What’s the primary goal of the campaign?
We hope that this campaign will allow us to better communicate the broad range of services that Gilchrist offers for people with serious illness.  Our new campaign aims to educate people that “even before hospice, there’s Gilchrist.”  From elder medical care to grief counseling to volunteer assistance and more, Gilchrist will provide clear information and loving care at every stage of serious illness, so people can live life to the fullest, on their own terms.

Are you hoping that through this campaign you can address some of the public misconceptions or stigma surrounding hospice and end-of-life care?
Gilchrist will always be known for the compassionate end-of-life care and services that we provide.  And believe it or not, although most Americans are still afraid of dying, the use of hospice has grown exponentially in the past 20 years.  But that is really not what this campaign is about.  It’s about communicating the point that today’s Gilchrist extends services to individuals with serious illness who need our care and support well in advance of hospice care.

Can you describe the programs that Gilchrist offers? What new services are you thinking about?
We have reorganized our programs into three main service lines: Counseling and Support, Elder Medical Care and Hospice Care.  By clearly defining our services under this continuum of care, we believe that we can more effectively communicate the breadth of services we offer to those with serious illness—through every stage—so that they may live life to the fullest.  Our physicians, nurse practitioners, and social workers provide medical care for people who can no longer safely access their care in medical offices by going to their homes. We provide palliative consultations in nursing homes and assisted living facilities in addition to acute care hospitals.  We provide the care in the GBMC rehabilitation unit, (previously known as Unit 54), and we, of course, continue to provide nationally recognized hospice care for children and adults.  We are also the only hospice in Central Maryland who offer Medicare patients on-going treatment for their disease and hospice care concurrently for select diagnosis.

In summary, we are deeply committed to giving people the clear information and loving support they need to make informed choices about their care.

I would like to invite you to visit our new website, www.gilchristcares.org to learn more about the new Gilchrist.

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I sincerely thank Cathy and the entire Gilchrist team for all that they do every day for elders and patients at the end of life. I applaud them for their person-centeredness and their excellence!

How Reliable is Our Care?

As I write this blog, we are a couple of hours into our triennial unannounced Joint Commission survey at GBMC. Think of it as a checkup. The surveyors are going to check to see how reliable our care is.

I was thinking back to 2011, when I first touched on the concept of reliability in this blog:  http://ahealthydialogue.blogspot.com/2011/03/best-way-should-be-only-way.html. To reduce the concept to its simplest definition, reliability means “what should happen happens and what should not happen….doesn’t.” To get to very high reliability, or error rates close to zero, an organization must find the potential causes of failure, the so-called “holes in the Swiss Cheese”, before they can line up to cause a miss, that might lead to patient or staff harm. Being vigilant about filling in those “holes” is also called preoccupation with failure. Are we zealously looking for problems and fixing them when we find them?  When we see people drifting from our designs for safety are we calling it out or are we looking the other way? We know we are not perfect but it’s good to have outside eyes looking at our processes and to see just how reliable we have become and where we can still improve.

During LDM this morning, I learned of a phenomenal success that took place in Family Care Associates, one of our patient-centered medical homes, on Tuesday. They received 271 phone calls and answered every one within their 20-second standard! This is an incredible accomplishment after having implemented the phone call redesign that was created during the recent Kaizen led by our Lean facilitator, Farrukh Kidwai. What should happen…the phone gets answered efficiently…happened without a failure! An example of a 100% reliable process! Congratulations to Family Care Associates for achieving the President’s Four Aim Recognition. Family Care is now the third advanced primary care practice, along with Owings Mills and Hunt Manor to have implemented the new standard design for telephone calls.

National Physician Assistant Week
Please join me in celebrating all GBMC physician assistants (PAs). This week is National PA Week (Oct. 6-12) and is a time when PAs celebrate their profession and showcase the value they bring to today’s healthcare team.

The physician assistants at GBMC practice in many areas from the outpatient offices to the inpatient units in a wide variety of specialties. A PA is a nationally certified and state-licensed medical professional who begin their careers with rigorous education in a highly competitive field.  Upon completion of a bachelor’s degree, prospective students must then attend an intense three-year program and complete at least 2,000 hours of supervised clinical practice.  They then must pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).

Please join me in thanking our PA’s for their hard work and for their important role in caring for our patients.

2017 Healthcare Security and Safety Week
I want to thank all the members of our GBMC security staff as this week is Healthcare Safety and Security Week (Oct. 9-15).

The GBMC security team can be seen walking or stationed throughout our medical center from the emergency department to labor and delivery. Our security and safety officers meet the challenge every day to keep all of us safe at GBMC. They are vital members of the healthcare team and we cannot be successful without them.

Please join me in thanking our security staff for their hard work and for their strong commitment and the diligence they display in the practice of their profession.

Help Support The Joseph Richey House
Later this month employees, volunteers, and patients will be participating in the Baltimore Running Festival and fundraising for GBMC HealthCare's Gilchrist Center Baltimore – Joseph Richey House.

Gilchrist Hospice has helped so many individuals and families through the end of life.  The Gilchrist team not only delivers world-class medical care to patients in their final days, but they also provide the emotional and spiritual support needed through the bereavement process. One of the founding principles of the Joseph Richey House is to provide services to everyone, regardless of their ability to pay. Joseph Richey is a 19-bed residential hospice designed to care for terminally-ill patients and serves 150 of these individuals each year, 80 percent of which are Baltimore City residents. The GBMC system and our community are very lucky to have Gilchrist to help individuals complete their lives with dignity and on their terms.

I want to thank all of our employees, volunteers, patients and supporters of GBMC Healthcare who are running during the Festival and helping to raise awareness of the great work at Joseph Richey.

Unfortunately, registration for running to support the Joseph Richey House is closed, BUT, you can help still support RunGBMC in other ways. Please consider being a volunteer the day of the race, by contacting Morgan Cook at MCOOK@gbmc.org or click here to join us in raising money for The Joseph Richey House and giving back to our community. Thank you!

Proud of a Wonderful Accomplishment

Last week, I went to Verona, Wisconsin, for the annual Epic Users Group Meeting. Healthcare companies that have installed Epic from all over the country gather to hear what is new and to share information about how to use the software to improve care.

I took a bus, with others, from the hotel to the Epic campus and walked into the building outside the large theater where the opening address from the CEO of Epic, Judy Faulkner, was about to begin. I was delighted that the first thing I saw upon entering the building was a banner announcing our achievement of HIMMS Analytics Stage 7. I can’t tell you how proud I was to see that banner. Being the first healthcare company in the state to achieve Stage 7, the highest stage, on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) for both our hospital care and ambulatory services shouldn’t be taken lightly. HIMSS Analytics developed the EMR Adoption Model as a tool to benchmark information technology maturity in healthcare organizations. Less than five percent of hospitals in the United States have achieved Stage 7 certification.

The award is recognition for operating in a paperless environment and representing best practices in implementing electronic health records. Make no mistake this accomplishment is due to the commitment and the hard work of the GBMC staff which includes our highly-skilled team of physicians, nurses, other clinicians and IT professionals. Our achievement was not without its challenges but the resiliency of our people in working through glitches has been impressive. Within our hospital, our physician company, and Gilchrist we have now achieved ‘one patient, one record’ and we continue to work with our private practicing physicians, nursing homes and other providers to connect with them through the Chesapeake Regional Information Sharing for Our Patients (CRISP) network. Without this, we cannot achieve our vision of being the community-based health system where every patient gets the care that we would want for our own loved ones.

Earlier this week, here at home, we celebrated our one-year anniversary of being live with Epic during EPIC 2017: CELEBRATE THE EPIC ADVENTURE. This star-studded, fun-filled event gave us a peek into the future of our clinical and administrative information system. As part of our continuous improvement efforts to ensure we have the most current technology infrastructure, next week we will upgrade to Epic 2017. This upgrade will include enhancements to the overall look and feel of Epic, have simpler and more consistent icons, and improved wayfinding for navigating the system. New functionality will also be available to optimize workflows and assist with improving end-user efficiency. There are many projects underway which will further leverage Epic’s functionality such as electronic prescribing of controlled substances and electronic pre authorizations. MyChart continues to grow with added features and functionality. Later this month, we will begin releasing ambulatory history and physical notes to MyChart and eventually progress notes. These initiatives will continue the push for empowering our patients with their information and encourage participation with their care.

Two years later…
You know, it’s been two years since our 50th Anniversary Gala. I can’t believe how time has flown by. Our 50th Anniversary celebrations were a wonderful recognition of GBMC’s rich history and its bright future. The community’s philanthropic support during the anniversary year was phenomenal and has aided our ability to continue with our transformation by supporting our patient-centered medical homes and tools like Epic.

October is National Cyber Security Awareness month 
The sharing of electronic information in all aspects of care delivery is important but is not without its risks. Through the Internet, health systems and other industries are under attack from criminals who look to profit from stealing information that should be private. You’ve probably all seen the headlines regarding the Equifax breach which impacted over 100 million people. It has been proven that the highest vulnerability for data breaches is not with the software itself but is through us, the users. Criminals know this and set out to trick us into opening our systems to them so that they can do their dirty work. We must all be vigilant and own the security of our information systems. Please bring the same questioning attitude that you use when delivering patient care to your use of e-mail, the electronic record, and other applications. Don’t click links unless you are sure it’s safe, don’t go to websites you aren’t familiar with and ask IT for guidance if something doesn’t quite “seem right”. Together, using simple internet safety precautions, we can help keep GBMC safer from cybercrime. I want to thank Dave Hynson, GBMC’s Chief Information Officer, and his team for all their hard work in addressing the issues and keeping us on normal operations. Also, don’t forget to look for our IT Security team’s educational materials and tips throughout the month and throughout the year.

Another Wonderful Celebration in the Sun

The 17th running of Legacy Chase at Shawan Downs was a huge success. Mother Nature was kind enough to provide us with nice weather, allowing us to enjoy the beautiful horses, a picturesque countryside setting and fun with family and friends – there were approximately 8,000 attendees this year – coming together for a fabulous time.

Stretched across 300 acres of green meadows at Shawan Downs in northern Baltimore County, Legacy Chase attracts visitors of all ages for a day of steeplechase races, railside tailgating, live music, great food and family-friendly activities. Many of the crowd-pleasing traditions continued this year—such as the G. Leslie Grimes Memorial Stick Pony Race for kids— and GBMC added some exciting new components to help make this year’s event a success. Brand new this year, was the Survivor Shuffle, a unique and exciting dance aimed to draw attention to the fight against cancer. I want to thank the more than 150 volunteers who took part in this fun and new effort which ultimately was a great way to show support for our Oncology services. Hats, Horses, and Hope was the theme to celebrate cancer survivors. Each of the symbols create a sense of comfort and strength for cancer patients. Children also came dressed as their favorite superhero or received a free cape on-site to show their support for the fight, while some guests boasted their best hat to show support for oncology patients, as funds raised benefit oncology support services at the Sandra & Malcolm Berman Cancer Institute at GBMC. In the 2017 calendar year, at the end of Legacy Chase we raised $1.25 million for Oncology Services from 435 community supporters, including fundraising and sales from Legacy Chase.

Legacy Chase also gives us an opportunity to engage with the community, employees, donors and local businesses in the work of our healthcare system. We are proud to receive tremendous support from the community-at-large and our family here at home. 

Despite no incentive of a world record to break like last year – a record which we still hold by the way – we continue to receive great community and employee support. There were 35 GBMC departments that participated in activities throughout the summer to engage the community, promote the event and encourage fundraising. And they had some fun too! Special recognition goes to the GBMC Epic team, which raised almost $3,000 through a car wash and other activities.

The Sandra and Malcolm Berman Cancer Institute is able to provide patients with the best treatment and care possible thanks to continued annual support. The Institute is the only comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer in the Baltimore region. GBMC has invested in talent and technology to provide the best for oncology patients. Whether they are in need of outpatient, inpatient, home care, hospice or survivorship services, the more than 2,000 new cancer patients annually at GBMC get the best care.

This wonderful event (highlighted in the below video) would not have been successful without the support of our loyal volunteers, who helped us make this year’s event very special. I thank all those who attended and all those who donated time or treasure. Special thanks to the GBMC Philanthropy and Marketing Departments, who worked so hard in putting the event together. There’s still time to support the cause by visiting www.legacychase.org