Cleveland Clinic Center for Connected Care: Creating a Connected Continuum

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Musood-Pirzada-thumbThe world-renowned and highly respected Cleveland Clinic has made platform integration the number-one priority of its IT department.

Recently, it created a new center with the express purpose of integrating home, transitional, and post-acute care into its overall continuum of connectivity. Falling under the purview of Musood Pirzada, director of information technology, the Center for Connected Care is expressly concerned with patients suffering from chronic diseases who are often readmitted to the hospital.

The Center for Connected Care’s mission is to be a resource and partner to Cleveland Clinic’s transitional-care programs and its institutes and hospitals, as well as actively building relationships with national and local providers.

The Center’s focus on home-care services includes physician house calls, Cleveland Clinic’s home-health agency, its home-infusion pharmacy, respiratory-therapy program, and its hospice and palliative-care programs.

The Center for Connected Care is also working to integrate Cleveland Clinic’s in-patient rehab facilities and telemonitoring programs as a way of reducing readmission rates.

These programs include Heart Care at Home, a multidisciplinary transitional program for heart-care and cardiac patients, and the Post-Acute Knowledge and Solution Center, which is helping to expand Cleveland Clinic’s reprioritization around outpatient care.

Pirzada said EMR integration, distance health, outcomes, and research all play into these programs.

“It’s all about changing healthcare to value-based rather than a la carte. It’s all based on value. The bottom line is the program aims to reduce 30-day readmission rates. Basically, we are doing what we set out to do years ago.”

Eliminating disconnect among providers

Pirzada and his team are especially concerned with eliminating the disconnect that seems to exist between providers inside and outside the Clinic, making integration an ongoing mission for Pirzada. He wants physicians to be able to see where their patients stand in the post-acute setting after they’ve been discharged simply by looking them up on the Clinic’s EMR.

“Otherwise, it seems to be a total disconnect,” he said. “More of a silo mentality. You have to be able to coordinate care, measure quality, and report outcomes, and include patient experience. Basically, that’s the mantra that has been set for us by our CEO.”

In addition to the Center for Connected Care, Pirzada has been working on integrating wireless technology. Some of the Clinic’s physicians already connect to the EMR using their iPhones or their laptops.

But, Pirzada said, Cleveland Clinic’s IT infrastructure must be so sophisticated that a physician should be able to connect to the system at any time in any place.

“The goal here is whatever documentation is being done, it has to be pushed out to the EMR so the clinicians can see all of the documentation in one place, even though they could be doing documentation in different systems.”

A growing need for effective post-acute care

An amazing number of patients, at least 33 to 34 percent, are in need of post-acute care upon being discharged from Cleveland Clinic, Pirzada said. He expects those numbers to go up with the baby boomers retiring in droves. Cleveland Clinic already discharges over 160,000 patients each year across its nine hospitals.

“That’s why this continuum of care, this transition becomes an important aspect of the future of health care,” he said.

He believes this need for connectivity will require mobile devices and cloud-based systems to play more of a function in day-to-day health care, especially with technology becoming cheaper and more portable.

With more tools and greater functionality being available to physicians, Pirzada said there will be a greater commitment to outcomes reporting, especially as data visualization and dashboards become increasingly user-friendly.

“That is also going to be a big part of health care because you’re going to get paid based on the performance, and you have to be able to show that performance,” he said.

As the future leans on him with greater speed, Pirzada and his team feel the urgency to get the Cleveland Clinic on to one integrated system, instead of the numerous platforms from which it’s drawing right now.

“That’s one of the things that we are working towards, having an enterprise-wide data mart where we are able to have access to data easily,” he said. “The changing dynamics of health care, of reimbursement, we have to be able to connect dots a lot more now, to be able to generate the outcomes for the patient in order to get reimbursed and being able to provide the tools for the physicians to be able to document better and take care of the patients better.”

Cleveland Clinic receives patients from all over the world. Therefore, it needs to be able to find providers from any state in the country. The discharge planners, he noted, touch every aspect of a patient’s stay in the hospital and their transition to a post-acute care setting.

“We have to change with the changing environment,” Pirzada said. “We have to be able to provide better technology that is portable, fully integrated, and maybe cloud-based technology, where it  provides better tools for all caregivers to manage patients across all care settings while improving outcomes – an overall shift towards more proactive care and greater quality of life at less cost to the system.”

-by Pete Fernbaugh

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