To people who work with him, John Norenberg is known as the “Data Renaissance Man.” As the vice president of corporate information systems at Advocate Health Care System in Chicago, he earned the moniker by championing data’s transformative possibilities in health care. When he joined Advocate in 2004, the concept of health-care data was still new. For five years, he led the team in charge of developing and implementing the company’s hospital electronic medical record (EMR) system. Since then he has moved on to do the same for Advocate’s ambulatory data, which includes the services delivered in physicians’ offices. Throughout all of these steps, Norenberg knew the ultimate trajectory was toward better patient care.
EMRs have contributed substantially to Advocate’s National Committee for Quality Assurance (NCQA) recognitions
Practice sites that earned NCQA Level 3 Patient-Centered Medical Home recognition
Physicians with NCQA Heart/Stroke recognition
Physicians with NCQA Diabetes recognition
Areas with Top Decile Performance by NCQA standards
“Our focus is on creating an environment that supports clinical excellence and best practices,” Norenberg says. “That’s important because when they are achieved, patients tend to be healthier, clinical outcomes are better, and the cost of care is lower.”
Even as Advocate established new systems in Norenberg’s early years, other significant changes were on the horizon. The company was also in the process of becoming an accountable care organization (ACO), which meant sharing risks with payers (i.e., Medicaid, Medicare, private insurers), seeking a more comprehensive perspective of patient care, and becoming more proactive in maintaining patients’ overall health. And all of these initiatives were coming forward just as Advocate was about to expand its roster of providers by more than 300 percent.
Norenberg tackled these challenges by creating Advocate’s internal health information exchange (HIE). The exchange provides clinicians, as well as support and office staff, with a holistic view of all patient care—both acute and wellness—that can be provided anywhere in the Advocate system, whether it is hospital-based or within the ambulatory network.
When a physician needs patient information, the system reaches out to compile all data for that patient from hospital and ambulatory EMRs. This creates a real-time longitudinal record of care, including imaging studies and clinical test results.
Not only does this provide up-to-the-minute clinical information, but the resulting longitudinal record helps support best practices for wellness care and chronic disease management, both critical factors in successful accountable care management. For example, diabetic patients need regular foot and eye exams and ongoing monitoring of blood sugar levels. When a diabetic patient is scheduled to be seen by a physician, the HIE automatically checks to confirm that those procedures have occurred within a reasonable timeframe and recommends them to the clinician and staff if they have not. The system also provides incentives by analyzing individual physician compliance with these best practices to determine potential financial bonuses.
Even with EMRs in place and providing extraordinary new toolsets, Norenberg admits that many physicians have been hesitant to fully embrace the system, because they feel it negatively impacts their productivity.
“To address this, our next big initiative is to analyze how people work with the system and to develop native workflows that are more appropriate for the digital environment,” Norenberg says. “Just automating the old existing processes isn’t sufficient, so we’ll create new strategies to optimize the new features and capabilities and restore productivity.”
In the Chicago area, where Advocate is located along with eighty-two other hospitals, sharing patient information globally would help support the success of all institutions operating on an ACO model. For example, if a patient needs an MRI but recently had one at another institution, shared data would eliminate duplicate services.
“As an ACO, we own the risk for patient care and share in any profit or loss associated with it,” Norenberg says. “But we typically provide only half of a patient’s care with no visibility into services provided outside our system. With universal HIE, we could see all treatments, tests, and results drive down costs and improve clinical care.”
Norenberg understands how disruptive the shift to EMRs and the HIE have been, having experienced similar changes when he worked in manufacturing and finance prior to health care. While Advocate is still in the adaptation and adoption phases, he is confident that the long-term benefits will be worth the bumps along the way.
“In health care, the magnitude of data and amount of hardware needed to handle change are staggering,” Norenberg says. “The information is all part of a larger context that has to be taken into account. It’s astounding that physicians are able to make sense of all of it to deliver the quality of care that they do.”