Adam P. Buckley, M.D. ’96, FACOG, didn’t have a background in information technology when he interviewed for the chief information officer position at the University of Vermont Health Network, but he had a wealth of ideas on how to improve the electronic medical records (EMR) system.
“All I cared about was [how electronic medical records could] lead to better health outcomes,” Buckley recalled. “How do you get the providers to feel like they’re doing more impactful care because of it?”
As he explained in “The Ins and Outs of Clinical Informatics,” the 8th Annual Allan B. Weingold Lecture presented during the 2016 Alumni Reunion Weekend, Buckley spent the first three months of his new role “getting yelled at.” Then, however, he started streamlining the EMR system by focusing on value optimization, or how the EMR could best serve the needs of health care staff.
Tracing the history of EMR value optimization, Buckley described the original approach, or “best in class,” as a luxury car: Bentley, Jaguar, Maserati, Mercedes. “The ‘best in class’ approach was that for every need that I have, I will find the very best way of meeting that need,” he said. “The downside is these are all different manufacturers using different parts. In fact, they all speak different languages, and that’s analogous to how the system had been created with the best in class approach.” In other words, while every department loved the EMR system it had, there was a lack of integration, and records were kept in silos.
To address those deficiencies, the health system’s approach shifted to a single-platform integrated EMR system. “All that information moves freely, [but] the downside is you have something that makes no one happy; you have the minivan, effectively,” Buckley explained, adding that the system “got the job done,” but it met the 80/20 rule: it satisfied people about 80 percent of the time. Buckley wanted to try something different.
“The conundrum was, how do we get value … without going in a completely different direction, because the best in class approach is inherently unsustainable,” he said. “The real focus that we took, at least in the early stages, was to drive as much value into the EMR as possible.”
The result was a one-stop shop with more clinical information, enhanced usability and documentation, improved data quality, and more clinical decision support and functionality. “The key was how to make things better for the providers in the EMR space,” Buckley said. So, to complete the analogy, he created a sleek, user-friendly, modern minivan.
Under his guidance, the EMR system expanded to include specific goals, such as training and standardization, and projects, like improving transparency with opioid prescriptions and developing COPD and asthma tools. With COPD, for example, Buckley created an option for action plans, which clinicians can build on a smart phone, and patient self-management goals. He also included “smartphrases,” such as “asthmaplan,” for documentation.
In addition to other initiatives, Buckley decided to leverage internal talent at the University of Vermont Health Network. The research and development team, he said, built a whiteboard with real-time clinical information for the echocardiography department and developed student evaluation and provider evaluation tools, among other initiatives. “We have a very talented, small group that delivers on things [outside of what] vendors haven’t considered or don’t deliver yet. There’s always a difference between what you can get on the market and what you could do yourself.”
Between all of Buckley’s changes, it took about two years to get the EMR system into a stable position. Since then, patient participation in the EMR portal has doubled and the clinicians at the University of Vermont Health Network have given a dozen national presentations and submitted nine manuscripts for publication, thanks to data available on the new EMR system.
“What I’m happiest about is [that] our provider satisfaction results have shown significant improvement between 2012 and 2014,” Buckley said. “It’s a statistically significant improvement in the provider satisfaction with the EMR itself, but also with the belief that they think they’re getting better outcomes because of it.”
