I have read Healthcare Informatics’ article on Texas A&M’s Health IT Academy written by Senior Editor Gabriel after an interview with A&M’s School of Medicine, interim dean, Paul Ogden, MD.  Two things are pivotal in this article.  The Dean’s affirmative statement, “I would like to change the way we practice medicine in the US,” echoes my personal statement from 14 years ago when a friend asked me, “What do you want to accomplish?”  I answered, “I want to change how healthcare is delivered in America.”   Not being delusional, I mean, “I want to help transform healthcare.”   I applaud the Dean’s vision and passion.  As a Clinical Associate Professor of Internal Medicine at Texas A&M, I and Southeast Texas Medical Associates, LLP look forward to doing anything we can do to support and promote this Academy.

However, I have a different judgment as to the nature of the problem.  It is in my judgment that the issue is not so much one of knowledge about electronic medical records (EMR)  or how to use them as it is an issue of why we must use them.  It is the philosophical foundation of the transformation of our healthcare system which demands EMR use and really which demands electronic patient management (EPM) which is critical to the success of using the EMR.   I will discuss this more below.

The Impact of Joint Commission Accreditation as a Patient-Centered Medical Home (PC-MH)

In March of 2014, SETMA completed accreditation by all four organizations which accredit Patient-Centered Medical Home.  With accreditation by NCQA, AAAHC and URAC, SETMA’s success in receiving accreditation by The Joint Commission completed the process.  Perhaps the most significant benefit to SETMA from The joint commission was that the surveyors at how proud our employees are of SETMA.  They commented that it is not commonly seen where all the employees share in the pride of ownership and that they not only understand what they are to do but why they are to do it.  After this, I sent the following set of questions to SETMA’s Accreditation Team members.  I made these conditions:  I would like each of you to answer the following questions for me (this will not be publicized; if I wish to share any of this with anyone, I will get your permission prior to doing so):

1. Have you grown personally during your tenure with SETMA
2. Have you grown professionally during your tenure with SETMA
3. Have your activities and your responsibilities been satisfying to you personally and professionally.
4. Do you feel that you are engaged in a job that is important which gives you personal pride in what SETMA is doing
5. What would you change if you could
6. Do you feel respected and appreciated
7. Are you treated with dignity and respect

When we shared these seven things with Planetree  (http://jameslhollymd.com/medical-home/pdfs/Planetree.pdf), they commented, “These questions are spot on.”

When The Joint Commission surveyors made this comment about SETMA’s team, I told them I thought I knew why.  There are many reasons, compensation, no harassment, safe and supportive environment, but I think the biggest reason is the same for providers, executive management, administration, and staff.   That is, everyone is aware that they are part of something more than a medical practice. Everyone feels that they are part of something which is very special.  Interestingly the very reason that makes others dislike us is the reason which makes us like ourselves.  With 217 articles published about SETMA in national publications posted on our website, we can know that we are considered special by others.  With honors, awards, acknowledgements, achievements posted on our website, we can know that we are doing extraordinary things.  With many of our staff able to attend national meetings where they hear and see how others respond to SETMA, they feel proud and special.  The dividends that our website and these awards pay cannot be found in dollars and cents, but it can be found in satisfaction, fulfillment and personal pride.  Most of all perhaps, is that we continually acknowledge that our achievements while founded on hard work and perseverance are also the result of God’s blessings.  This is why SETMA’s staff is special, feels special and acts special.

1. People at SETMA are experiencing what it means to be part of a great team; that is describe by Peter Senge in The Fifth Discipline:

“Most of us at one time or another have been part of a great ‘team,’ a group of people who functioned together in an extraordinary way - who trusted one another, who complemented each other others’ strengths and compensated for each others’ limitations, who had common goals that were larger than individual goals, and who produced extraordinary results.  I have met many people who have experienced this sort of profound teamwork - in sports, or in the performing arts or in business.  Many say that they have spent much of their life looking for that experience again.  What they experienced was a learning organization.  The team that became great didn’t start off great - it learned how to produce extraordinary results.”  (p. 4)

Being part of such a team:

1. Requires each of us to be better than we have ever been before
2. Enables us to be better than we have ever been before
3. Motivates us to be better than we have ever been before
4. Allows us to take the risk of becoming better than we have ever been before

2. Everything SETMA does is based upon philosophical principles and foundations

Both the surveyors and one of the executives at The Joint Commission commented about the philosophical foundation of SETMA’s work.  Wednesday afternoon (March 5, 2014) I called my executive contact at The Joint Commission. He said “I was just talking to one of my colleagues and showing him SETMA’s notebook which was prepared in response to The Joint Commission’s Standards and Requirements Chapter Seven o leadership.”  The executive said, “Look at this; everything they do is founded upon a philosophical foundation.  They know ‘what they are doing,’ but more importantly, they know why they are doing it.’”  SETMA is not the result of random efforts but of innovations and advances which are consistent with a structured set of ideals, principles and goals. 

It is helpful that The Joint Commission recognized this and commented upon it.  It is one of the strengths of SETMA and it is one of the principle guides to SETMA’s development history, i.e., what caused SETMA to become what it is.

3. Part of SETMA’s culture is our willingness and ability to accept who we are, while expecting ourselves to improve. That can be expressed in the statement:   Rarely can it be said that some one is THE best of ALL because we have strengths that place us at the head of the pack and we have weaknesses which make us one of the pack.  Our progress and success is dependent upon our willingness to celebrate our strengths without arrogance and hubris and to acknowledge our weaknesses with humility and resolve to improve.

Peter Senge expressed this in terms of Personal Mastery which is described by ten principles shared by people with personal mastery:

• The have a special sense of purpose that lies behind their vision and goals.  For such a person, a vision is a calling rather than simply a good idea.
• They see current reality as an ally, not an enemy.  They have learned how to perceive and work with forces of change rather than resist those forces.
• They are deeply inquisitive, committed to continually seeing reality more and more accurately.
• They feel connected to others and to life itself.
• Yet, they sacrifice none of their uniqueness.
• They feel as if they are part of a larger creative process, which they can influence but cannot unilaterally control.  (p. 142)
• Live in a continual learning mode.
• They never ARRIVE!
• (They) are acutely aware of their ignorance, their incompetence, their growth areas.
• And they are deeply self-confident! (p. 142)

4. SETMA is willing to take the risk and to subject ourselves to the scrutiny of the highest standards. We are also prepared to be transparent and to publish by provider name our performance on hundreds of quality metrics. This transparency drives our improvement.  It allows SETMA to be the best we can be.  It allows us to declare:   Once you “open your books on performance”  to public scrutiny; the only  place  you have in which to hide is excellence!

This is the critical requirement for success in EHR utilization.  Without a philosophical commitment to healthcare transformation, all the information about EMR, in my judgment, will not help.  SETMA purchased our EMR March 29, 1998.  We used it for the first time, January 26, 1999.