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	James L. Holly, M.D.

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Your Life Your Health - 2010 - SETMA and the Future

James L. Holly,M.D.

December 31, 2009

Your Life Your Health - The Examiner

In 1949, George Orwell wrote a book entitled 1984, which year came and went. In the year 1984, the movie 2010 was released and now we approach that year. More of the science fiction of the latter movie has become reality in the intervening 25 years than have the dire predictions of Orwell in his 60-year-old prophesy. As we approach the beginning of the second decade of what only recently was a new century, I pause to think about the past and the future. In 2010, SETMA will celebrate fifteen years since its founding. Only one of the founding partners remains and sadly in March of the new year, we will experience the one-year anniversary since the death of our dear friend and colleague, Mark A. Wilson.

The SETMA Foundation

As I summarize the past fifteen years and particularly the last year in my own mind, I am amazed at all that we have attempted. In 2009, The SETMA Foundation matured into a significant force in the life of our practice and in the lives of our patients. SETMA's partners made a $500,000 contribution to the Foundation and under the direction of one of the partners, Dr. Vincent Murphy; The Foundation's first fund raiser is planned for the Spring of 2010. SETMA has discovered that even people with excellent insurance often need assistance in accessing the best healthcare. We have experienced remarkable events in our patients' healthcare which would not have been possible without the resources of the Foundation. The Foundation is small but it establishes an ideal which if imitated by others can make a difference in our community.

Healthcare Policy

During 2009, SETMA has participated in the vigorous healthcare policy debate which has taken place in our country. SETMA published a four-part analysis of the President's address to the American Medical Association in the early summer 2009. That analysis is posted on our website (www.jameslhollymd.com) under Your Life Your Health.Â SETMA also published a three-part critique of the entire concept of healthcare "reform" concluding that healthcare does not need "reformation" which by its nature is the result of pressure from without, but that healthcare needs "transformation" which by its nature is the result of creative and generative energy from within. That critique is also published on SETMA's website. SETMA has also participated in Washington D.C.-based conferences and dialogues with key legislators about the future of healthcare.

SETMA's position is that the demonization of health insurance companies will not transform healthcare and neither will the pressure of decreasing reimbursement for the care of the most vulnerable of our citizens, which is our children and our elderly. SETMA is making plans to survive and even to succeed in the new healthcare environment but it will require sacrifices on everyone's part to endure what may be a storm before the failure of the polices currently planned are recognized and corrected.

Patient-Centered Medical Home

In February of 2009, SETMA began exploring a new concept called "Patient-Centered Medical Home." Not satisfied with the answers given by others, SETMA did a complete analysis of our practices, procedures, protocols, policies and plans. In an almost 500-page report, SETMA set about the process of transforming itself into a dynamic new organization. SETMA's next major step in this transformation was an analysis of the 9 Standards, 30 Elements and 183 Data Points designed by the National Committee for Quality Assurance (NCQA) to define and describe a Patient-Centered Medical Home. In 2010, SETMA will complete the application to NCQA for formal recognition as a Patient-Centered medical Home.

COGNOS Project

In this transformative process, SETMA realized that information on and auditing of provider performance and patient compliance were essential elements not only for qualifying as a tier-three medical home with NCQA, but also to the initiating and sustaining of the transformative process which we envisioned for our future and for the future of healthcare. At that point, SETMA chose the IBM Business Intelligence software package, COGNOS, with which to build the capacity to mine our electronic patient records (EMR) for the information needed to measure provider performance and with which to improve patient compliance. SETMA also realized that the power of COGNOS would only be released by the proper and excellent design of reports. As a result, we engaged the consulting firm LPA Systems (www.lpa.com) to assist us in this design. This project, when completed, will have cost over $300,000.

At each point of these 2009 projects, we have discovered that each step has taken longer and cost more than we originally expected, but we have also found, as each project has moved forward, that the benefit and potential of each has far exceeded our expectations. The first phase of the COGNOS Project is almost finished and the second phase will start immediately.

Quality Metrics

The generative power of SETMA's EMR has been captured as we have deployed every set of quality measures in existence. And, when we had deployed those and found that they left some areas of our special concern unaddressed, we designed some of our own. In 2009, we deployed HEDIS, NQF, PQRI, PCPI and AQA quality measures. Based on the Data Points of NCQA's Patient-Centered Medical Home, SETMA designed new measurement sets which allow us to audit provider performance in these areas. Because each of the "alphabet-soup" names is new to most of us, SETMA has redesigned our website to help everyone understand what we are doing.

Website Redesign

Each of the previously mentioned quality measures is explained on our website both as to the organization which designed them, their content and the intent of the measurement set. In addition, all of SETMA's electronic- patient-management tools (EPM Tools) which support the fulfilling of these measurement sets are displayed on our website under the heading EPM Tools. All of our patients and colleagues and all of the practices and organizations across the country with whom SETMA collaborates will be able to review the content and display of our EPM Tools. Anyone can use these, without cost, in order to guide their development of similar capacities in their practices.

Public Reporting

Additionally, SETMA has designed a Public Reporting section of our website. In this section, SETMA defines and describes all of the measurement sets which we are tracking. And in 2010, we will begin posting our performance in all of these areas for everyone to see. We believe that this will improve the consistency of providers in excellent performance and that it will encourage patients in their compliance with care recommendations.

As part of this website redesign, all of our Patient-Centered Medical Home tools have also been displayed so that anyone can see what we are doing and use that as a starting point for their own efforts. All of this is supported by the dozens of articles which we have published on Patient-Centered Medical Home and which are posted on our website at Your Life Your Health.

Finally, our website redesign includes a link to NextMD which is our EMR vendor, NextGen's, secure and encrypted web portal for patient communication and education. Not only does this fulfill several NCQA requirements but it expands SETMA's patient's current access to services from SETMA. This portal will allow patients to access portions of their charts and some of their laboratory and test reports. It will allow patients to complete part of their own medical record prior to their visit to the clinic.

Technological Advances

In 2009, SETMA totally replaced our telephone systems with a new digital system which allows complex analysis of calling activity. It allows our management staff to improve the service which our patients receive via telephone communications. It allows us to tract who call, why they call and to whom they spoke and for how long. It allows the routing of incoming calls during peak periods to staff who normally do not answer incoming calls but which rerouting improves efficiency and patient satisfaction. This new system will allow us to add multiple other locations and if needed thousands of new telephones without purchasing any additional equipment other than the telephones themselves. This system allows all of SETMA's locations to be on one telephone system no matter how widely spread they are increasing the integration of multiple-location practice.

In 2009, we began placing printers in every examination room so that we could ensure that patient received education materials and evaluational materials such as the LESS Initiative, Disease Management plans of care and treatment plans and in the New Year, a comprehensive coordination-of-care review which will allow patients to know what care they need, what they have received and what remains to be done for them. This will allow patients to ask for the fulfillment of quality measures in their care and to expect that care to be given. This printer project alone cost over $80,000 but we believe will result in great benefit to our patients and practice.

In 2009, SETMA purchased the necessary computer software and hardware to redesign our network to improve the efficiency and increase the power of the server farm - now with over 50 servers and over 70 software packages integrated into our system - which already exists. This will save money in the future and will prepare SETMA for expansion.

In 2009, SETMA obtained licenses from NextGen not only for the previously mentioned web portal, NextMD@, but also for CHS@ (Community Health Services@). This NextGen product will allow non-SETMA providers and groups of providers to collaborate on sharing patient-care information, compliant with HIPPA and in a secure, encrypted environment. It will increase efficiency and decrease cost of referrals, communications and repeating of tests.

2010

Like the movie of the same name, most of SETMA's advances for 2010 are the product of the use of computers in the practice of medicine. For 2010, SETMA has expanded the quality metrics reporting we have been doing for 2009. We are planning our strategies for responding to the challenges of ICD-10, which is a new set of diagnostic and billing codes which have been mandated for use beginning in October, 2013. This is a major undertaking and is expected to cost the healthcare industry hundreds of millions of dollars. SETMA is starting early in order to be ready in 2013.

In 2010, SETMA expects to complete the affiliation with Diabetes Center of Excellence at Harvard University which has been in the planning stages for over two years. The uniqueness of this affiliation with a multi-specialty group has stretched the imaginations of everyone but is soon to be finalized. This affiliation will bring a new energy and dynamic to diabetes care in Southeast Texas.

In 2010, SETMA will complete the process of Medical Home recognition. We will report to you the results of that process. We expect it to be positive and we expect the results of our re-engineering of our practice to have significant benefit to all of our patients and to our community.

In 2010, the product of our COGNOS Project will be fully visible to everyone in our community. In our strategic planning sessions we have all expressed the belief that none of us fully appreciate how transformative this project is going to be upon healthcare delivery.

August 1, 2010 will be the fifteenth anniversary of the founding of SETMA. We believe that at that time, we will be prepared to issue a report on SETMA which will show that all current projects have been completed successfully. None of this came easily. The major cost was not financial, but emotional through risk taking and mental and intellectual through envisioning and executing the changes needed. Even with the political turmoil, the future of healthcare in the United States is still the most exciting professional enterprise on earth. SETMA is pleased to be a small part of that professional enterprise.

Related Articles

	COGNOS and SETMA - Why and What is our goal? Patient-centered Medical Home SETMA's COGNOS Project Transforming Healthcare: Public Reporting of Provider Performance on Quality Measures

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