High-tech health care
The doctor is in and wired to help
MU employee Kenneth Bunting, a diabetes patient, has a checkup with his physician, Karl Kochendorfer (left). Bunting stays in touch with Kochendorfer and keeps a close eye on his medical condition with help from electronic tools such as Diabetes Dashboard.
Kenneth Bunting’s Thanksgiving Day visit to the emergency room began as a nightmare of stroke symptoms. He had no balance, he kept falling, and his speech was slurred.
After arriving by ambulance at University Hospital, Bunting, who directs MU's Freedom of Information Center, did an unusual thing. He e-mailed his family-medicine physician to tell him he was in the ER.
The emergency ended well. Bunting, who has had diabetes for 25 years, learned his symptoms were caused by low blood sugar rather than a stroke. Relieved by the diagnosis, he now watches his diet and records his glucose levels more diligently.
Bunting’s approach to his health is an example of how technology is improving the quality of care for patients of MU Health Care.
Before the Thanksgiving problem, Bunting had set up a patient health portal called Healthe, which is how he alerted his MD, Karl Kochendorfer, to the emergency.
“I’m not the most facile person with technology, yet I realize the health portal’s potential, and I’m comfortable with it,” Bunting says of the secure e-mail system.
Open a portal
Patients who open a Healthe portal create a way to communicate with their MU Health Care physicians and get results efficiently.
Through his electronic portal, Bunting can ask his doctor a quick question online, request an appointment and review his lab tests. He can update a list of his medications and read summaries of medical visits. He can even request a prescription refill, accomplishing in minutes what used to take the greater part of a day.
Other providers caring for Bunting can access the information only with his approval. So if Bunting has a medical emergency while traveling, he can allow an out-of-state physician to read his electronic medical history.
University Health Care Family and Community Medicine went live with the Healthe portals in March 2010. In the next few months, portals will be available to all patients of MU Health Care. That includes University Hospitals and Clinics, Ellis Fischel Cancer Center, MU Women’s and Children’s Hospital, University Physicians and the Missouri Psychiatric Center.
Patients may request a Healthe portal during a health-care visit or sign up online.
The Web-based Healthe portals are part of a new Medical Home model of care developed as a pilot project by MU’s School of Medicine and Cerner Corporation of Kansas City.
MU began working with Cerner technicians on paperless records in the late 1990s, and the collaboration expanded into the Tiger Institute in 2009, with the goal of transforming health care of Missourians.
A Medical Home coordinates patient care electronically. With patients actively engaged, their caregivers — physicians, nurses, case managers, therapists, pharmacists and educators — collaborate and share information.
By improving the flow of information available to caregivers and patients, a Medical Home enhances continuity of care. The project has been recognized nationally for management of patients with chronic diseases such as diabetes and asthma.
Since release of the Medical Home project to other institutions in 2009, one site has implemented it, one is installing it, and 25 are evaluating it for their use.
Because Bunting deals with diabetes, he and Kochendorfer use another tool on Bunting’s Medical Home: a Diabetes Dashboard, developed by the Tiger Institute to help manage diabetes.
The dashboard provides key indicators to chart Bunting’s vital signs, health conditions, medications and laboratory tests pertinent to diabetes.
As an added advantage, it displays links to national standards of care for diabetes, providing helpful comparisons for patient and doctor.
MU Health Care physicians who tested the dashboard gave it high marks for efficiency in retrieving information and saving search time.
Instead of reading paper charts, MU Health Care providers now retrieve updated patient information online, including diagnostic images such as X-rays and CT-scans. They use laptops to document clinic visits.
Physicians send prescriptions and orders electronically to pharmacists, dieticians, therapists and other providers, who view them instantly. E-prescribing helps make physicians' lives easier.
“Doctors say we have better-running clinics. And patients are the beneficiaries,” says Joanne Burns, executive director of the Tiger Institute.
The institute is working to expand the exchange of health information with a growing membership of health-care organizations statewide, regionally and, eventually, nationally.
“It’s nice to know as a patient that I can go where it’s appropriate for the care and that I’m not going to lose continuity in the care. These organizations can start to work together on referral patterns,” Burns says.
The switch to electronic health records resulted in MU Health Care’s ranking as a 2011 Most Wired Hospital by Hospitals & Health Networks magazine.
“We’re a long way ahead of most organizations,” says Michael LeFevre, chief medical information officer for MU Health Care, who represents the physicians’ point of view in deployment of information technology.
A team of MU doctors examining use of electronic technology found that having immediate access to their patients’ health information in one place offered vast improvements in patient care. Among the advantages were reduced duplication of tests and treatments and time saved because of fewer phone calls and faxes.
Innovations to come
The Tiger Institute develops innovations that push the boundaries of health-care delivery. A team of software engineers, clinicians, researchers and students tests innovations through the institute’s Living Lab.
In a current project, researchers are building a search capability into patients’ records that will offer better methods to verify information.
With the new search functionality, doctors will be able to access files of their patients’ medical histories, as well as textbooks and databases of medical journals, the Center for Disease Control and other health-care-related organizations.
“If I have a question, I can find the answer,” says Kochendorfer, medical director of the lab.
Kochendorfer, for example, can enter “colonoscopy” in searching a patient’s records to discover the date of his or her last test, which the patient reported as three years ago. His search finds e-files confirming the patient did indeed have the test, but it was 10 years ago.
Applied uses for the search capability are numerous. Drugstores can upload data useful to doctors, such as prescriptions and dates of flu shots. Physicians can find information from clinic and pharmacy records; locate exercises for patients and print them as handouts; and access insurance coverage information.
In another Tiger Institute innovation, a recently developed iPhone application gives health-care providers mobile access to their patients’ health records. The app, called Physician Express, lets doctors access patient information and send orders by phone.
The device is expected to go live for MU Health Care in 2012. Kochendorfer says MU physicians testing the app describe it as “unbelievably beneficial.”
Patients are a curious group. They search the Internet for health information and sometimes take advice that shouldn’t be trusted. MU doctors hope to change that with Gateway to Health, another Tiger Institute development.
Researchers are building Gateway to Health online management tools to educate patients through doctor-approved, evidence-based information, such as the Rethinking Drinking site.
“When I see a patient at clinic and know he screened positive for being overweight or for at-risk drinking, I could have a quick conversation with the patient and enroll him. Eventually we’d like to make the sites available to the public. It’s better than a Google search because the information is evidence-based,” Kochendorfer says.
Pilot studies at MU have shown that evidence-based websites help patients adopt healthier behavior.