How Geisinger Does It

Geisinger Health System, Danville, Pa., is one of a handful of clinically integrated health systems in the country. The three-hospital system is regularly recognized as one of H&HN’s 100 Most Wired and has invested more than $80 million since 1995 to implement its electronic medical record system, which includes nearly 3 million patient records.

Bruce Hamory, M.D., executive vice president and chief medical officer, says the EMRs underpin the system’s clinical integration programs. The EMRs enable Geisinger to inform physician leaders and hospital administrators about patient conditions and the results of their treatment—information that drives improvements in screening programs for breast and colon cancer, chlamydia and other conditions.

“We are increasingly able to talk about the financial consequences of doing that, and we are currently working with IBM to develop a data warehouse with clinical and financial information in a single place to model the impacts of changes in care on efficiency and cost-effectiveness,” Hamory says.

Geisinger already offers a 90-day warranty on coronary artery bypass graft operations to cover complications and promotes other procedures road-tested through its clinical integration programs. “Those patients are seen less in our emergency rooms and are admitted to our hospitals less frequently with shorter hospital stays,” Hamory says.

Joseph Bisordi, M.D., Geisinger Medical Center chief medical officer, says the strategic goal was to improve what a decade ago was a fragmented, discontinuous and ineffective system of handoffs. Primary care physicians and specialists frequently complained about the lack of information they received—or failed to receive—from each other.

“That’s gone,” Bisordi says. “Now, a primary care physician will have my notes on his desk several counties away; not a week or two later, but as soon as his patient left my office. We’re really acting as partners, which doesn’t typically happen in the real world outside of an integrated health network. These are the day-to-day things that doctors notice.”

Medical records previously were scattered between various physician offices, hospitals and clinics, with doctors sharing some but not all patient information—and sometimes missing critical data. “Doctors got used to making decisions based on limited data sets,” Bisordi says. “Now, through our EMRs, doctors here have all that information, and we’ve extended those records to 1,000 community doctors who refer their patients to us so they can have a more complete view.”

With a complete medical record in electronic form, Geisinger can do things otherwise not possible, such as monitoring and improving the comprehensive care of chronic-condition patients like diabetics. For instance, diabetics should receive regular foot and eye examinations and blood pressure tests to reduce complications. “Today, less than 1 percent of all diabetics get those things done all the time,” Bisordi says. “But we’ve used our EMRs to identify all diabetics and build in alerts and reminders. And because of that, we’ve seen a nine- or tenfold increase in the number of patients getting everything done. We’ve substantially improved care for more than 25,000 diabetics by making it easier to do the right thing.”

More than 80,000 patients now interact with clinicians via the MyGeisinger patient portal, viewing lab results, scheduling appointments and accessing medical content, notes Ronald Paulus, M.D., chief technology and innovation officer. Some can avoid physician visits by completing follow-up surveys online.

When shopping for an EMR, Paulus says, “You can make great strides in configuration if you spend time walking through the eyes of the user. These aren’t ‘one size fits all’ systems. There’s a certain amount of customization and configuration required.” Early on, it’s important for the vendor to agree not to make significant changes in code that would alter or make inoperative the system’s customized code years later. “That’s a maintenance nightmare to be avoided at all costs,” he advises.

A successful EMR system requires a balance between customization and standardization, making allowances for clinician judgment and autonomy without jeopardizing the benefits of uniformity. “If you customize to make it perfect for each individual, you then make it less valuable for others and destroy the standardization,” Paulus says.

Geisinger will complete work this year on a data warehouse to aggregate all patient interactions into a clinical decision-making intelligence system combining clinical, financial and operations data and patient satisfaction information. “We can mine that data to look at trends in patient population and how our outcomes measures are improving over time,” Paulus explains. “We can mine where gaps in care are occurring, for example, and query all patients with elevated cholesterol not on medication. What we learn from the system can be fed back to create smart sets to help automate care processes and measure things for which there is no randomized clinical trial and develop our own empirical clinical standards.”

Better outcomes, lower costs and higher patient satisfaction will, in the long run, make Geisinger more valuable both to patients and other payers. “Our goal is to become the delivery system of choice,” Paulus says, noting that proposed pay-for-performance and gain-sharing programs will eventually reward Geisinger for keeping its patients healthy.—Mark Taylor

Fact Sheet -- Geisinger Health System

• Three-hospital, Danville, Pa.-based system founded in 1915.
• Annual revenue: $1.7 billion.
• Serves a 2.6 million population residing in 41 of the state’s 67 counties.
• Three outpatient surgery centers, a drug treatment center and 38 community practice sites.
• Reported 1.5 million outpatient visits in 2006 and 32,000 hospital discharges.
• 650 employed physicians; 200 are primary care doctors.
• More than 3 million patient electronic medical records.
• Spent more than $80 million since 1995 on EMRs; 80,000 patients use MyGeisinger patient portal.
• Participates in more than 100 clinical trials.

Source: Geisinger Health System, 2007

This article 1st appeared in the January 2008 issue of HHN Magazine.

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