The Vision of Connected Care

Connecting care between departments in an agency, between agencies and between different types of care givers (behavioral health, public health, primary care, social services etc) is designed to improve the quality of care provided to consumers, to reduce the quantity of medical errors (and the costs associated with them) and to improve national defense by more rapidly identifying disease outbreaks.

In addition, Connected Care is designed to achieve another major goal:  bringing the consumer into the care process using consumer portals to provide access to their electronic health records and eventually connecting them to personal health records. 

The genesis of Connected Care at the national level started in 2004 when President Bush outlined his vision of every American having an electronic health record within 10 years and has accelerated as agencies begin to envision the benefits to their clients (listen to what providers are saying).  The figure below provides a real world scenario of how a consumer could use Connected Care:

As consumers move between community mental health centers, county behavioral health agencies, state inpatient psychiatric hospitals, and local public health departments, the goal is to seamlessly transfer clinical data between electronic health records.  Initially this information would contain diagnosis, active medications and reason for referral.  If we can accomplish this, we can dramatically reduce medication errors which cost the country nearly $100 Billion annually.  In future blogs we can discuss each of these areas in more detail.  If you would like to see more information right now visit some of our pre-recorded webinars.

The person leading an Electronic Medical Record (EMR) implementation must know both the clinical and IT terrains. Since these two sets of knowledge don't ordinarily come in the same individual, who is best prepared to lead the EMR implementation effort, a clinician or a techie? I vote firmly for a clinician. Here's why.

At its heart, an EMR implementation should be a clinical and business processes undertaking, not an IT project. While an EMR crucially depends on technology, the ultimate purpose is to advance the quality and efficiency of care provided by people for people. The essential  knowledge underpinning an EMR is an intuitive grasp of the flow of the clinical enterprise: how to think, what to ask, how to decide, how to plan, execute and document. Next in line of importance is understanding the requirements of the complex business environment of health care. Then comes technical knowledge: how to exploit the rich computer systems toolkit to capture and enhance the flow and requirements.

This is NOT to say that technical knowledge is unimportant. It is essential for an EHR implementer to grasp the core concepts of networks, client-server, databases and reporting. When I began my transition from practicing psychiatrist to EMR implementer, I identified my computer naïveté to be a serious deficiency. So I promptly  enrolled in the introductory computer science course at a local college. I learned about hardware, networks, operating systems, reporting… I even became competent at very basic programming. On my own, I studied databases and taught myself MS ACCESS. I participated in many IT meetings. With focused effort, I learned enough to be an effective member of our IT team. To my surprise I found that computers are great fun – and very useful.  

I have talked with many people embarking on an EHR implementation. I routinely ask, “ Is it easier to teach a clinician the technical side or a techie the clinical side?” The answer is always, “It’s easier to teach the clinician.” What's your vote?

I  began my career in the 70's as a community psychiatrist. I was part of a team out in the field working to engage people with Serious and Persistent Mental Illness. The work was challenging and creative. It demanded a wide scope of thought and action. I loved it. In the late 90's in what seemed a sudden shift, I found myself confined to an office and the managed care driven 20-30 minute med check. I wrote the prescriptions, while others were gifted with out-reach and the therapeutic relationship. I felt cut-off, suffocated. As a community psychiatrist I was a dinosaur, an unhappy one.

Then our CEO suggested that I take on the leadership role in the implementation of the newly purchased electronic medical record (EMR). My response: a startled "Me?!" "Yes, you," he said. "Think about it." As a clinician I focused on the human rather than the technical dimension. Why would I join the dark side of the business managers and number crunchers? I was a novice computer user, how could I lead a computer software implementation? The "Why?" answer is short and simple. I'll tell it now. The "How" answer has many, detailed parts and has to wait for later blogs.

So OK, why? I knew enough of trends in the larger world to be totally convinced that computers in clinical care were inevitable. It followed immediately from this realization, that the urgent call was to make the computer serve the work. Another question emerged: "Who better than a senior clinician to try to make this happen?" I pondered this new question. I acknowledged the importance of the goal. Then before my mind’s eye, the question flipped to "Why not me?" I saw the timeliness of the opportunity. The challenge energized me. Yes, indeed, why not me. It became clear that I must try. I accepted the job. My personal buy-in was complete.