On January 1, 2014, SETMA set goals for 2014.  After having renewed the National Committee on Quality Assurance (NCQA) Patient-Centered Medical Home (PC-MH) recognition at the highest level (Tier III) and having renewed our NCQA recognition for excellence in Diabetes care, we faced a daunting challenge.   Because SETMA had begun using electronic medical records (EMR) in 1998, our deployment of NextGen did not qualify as a certified EMR for Meaningful Use 2 (MU2).  It was unclear, how much work or what cost would be required to make the necessary changes so that SETMA could meet MU2.

For 2014, SETMA set the following goals:

1. Preparing to meet MU2 - accomplished August 30, 2014
2. Preparing to deploy ICD-10.   This required mapping 584,000 ICD-9 codes to ICD-10 Codes in 98,000 unique patient charts by automation and mapping 46,000 ICD-9 Codes to ICD-10 Codes in 21,000 unique patient charts manually.  - accomplished December 10, 2014
3. Preparing to deploy Systematized Nomenclature of Medicine (SNOMED) - accomplished December 10, 2014
4. Achieving URAC accreditation for ambulatory care and for PC-MH - accomplished in February,2014
5. Achieving Joint Commission (JACHO) accreditation for ambulatory care and for PC-MH - accomplished in March, 2014

(Having renewed NCQA PC-MH recognition in July, 2013, SETMA is now recognized by all four PC-MH accreditation agencies and achieved that in 53 weeks, making SETMA the only practice in the United States to have all four accreditations.)

6. Renewing Accreditation Association for Ambulatory Health Care (AAAHC) for ambulatory care and PC-MH - accomplished in July, 2014
7. Achieving JAHCO accreditation for SETMA’s laboratory - accomplished September, 2014
8. Achieving NCQA PC-MH Distinction in Patient Experience Measurement with the deployment of the Consumer Assessment of Healthcare Providers and Services (CAHPS) survey conducted by an independent organization - achieved in April, 2014.

(Along with Diabetes and Heart & Stroke Risk recognition, and PC-MH Tier III renewal, SETMA became qualified for all awards and recognitions available from NCQA )

9. In January, 2014, SETMA opened its sixth clinic in Lumberton, Texas.
10. Inviting six new partners to leadership in SETMA. -- accomplished
11. Recruiting six new physicians to join SETMA  - accomplished
12. Establishing a SETMA Accreditation Team for the purpose of achieving and sustaining all accreditations for excellence over the life of SETMA - accomplished.
13. Meeting the challenges of the Accountable Care Act (ACA) by participating in providing care for those insured through the ACA while maintaining fiscal soundness.
14. Completed HIPPA IT Security Analysis and updated all security gaps and began HIPPA Privacy Review updating all privacy issues. 

SETMA accomplished all of our 2014 goals.  We report this not with arrogance but with the gratitude for all of SETMA team members, including SETMA’s patient-partners, who worked hard all year to achieve these goals.

It is unlikely that we will ever have another year which repeats the extensive demands of 2014, although we will continue to challenge ourselves by setting very high standards and doing our best to achieve them.  As we look forward to 2015, we look back to 1995.  In this year, we will complete SETMA’s twentieth year and for those of us who began practice in Beaumont in 1975, we will complete our 40th year in service to Southeast Texas. 

As always, we looked to the future by remembering the past, establishing and maintaining a continuity of growth and development.  We also renew our commitment to the lessons of the seminal events and understandings which we learned in May, 1999 which were:

• The commitment to excellence in healthcare through electronic patient management.
• The commitment to quality and safety marked by a celebratory spirit allowing us to recognize what we have achieved while acknowledging where we need to improve.

We are challenged by Abraham Lincoln’s 1856 “House Divided” speech in which he said:  ‘If we could first know where we are, and whither we are tending, we could better judge what to do, and how to do it,”  It is SETMA’s goal to always know what to do and how to do it.

• Following the principles enunciated in SETMA’s May, 1999 white paper:  More Than a Transcription Service: Revolutionizing the Practice of Medicine With Electronic Health Records which Evolves into Electronic Patient Management
• Following the ten principles derived from Peter Senge’s The Fifth Discipline, which guided both our development of an EHR and our practice transformation. They are:

1. Pursue Electronic Patient Management rather than Electronic Patient Records
2. Bring to every patient encounter what is known, not what a particular provider knows
3. Make it easier to do “it” right than not to do it at all
4. Continually challenge providers to improve their performance
5. Infuse new knowledge and decision-making tools throughout an organization instantly
6. Promote continuity of care with patient education, information and plans of care
7. Enlist patients as partners and collaborators in their own health improvement
8. Evaluate the care of patients and populations of patients longitudinally
9. Audit provider performance based on endorsed quality measurement sets
10. Integrate electronic tools in an intuitive fashion giving patients the benefit of expert knowledge about specific conditions

In this context, we set the following goals for 2015:

1. Expanding our service to Southeast Texas by inviting ten physicians to join SETMA’s healthcare team, including psychiatry, and other greatly needed services.
2. Expanding our mental health services to all of our patients who need help in coping with complex healthcare challenges.
3. To deepen our understanding of and practice of Patient-Centered Medical Home particularly in the areas of patient-centered conversations, shared decision making and patient activation and engagement.
4. Expanding our laboratory services to include patient safety in managing pain and pain treatment and in expanding our services to include genomics.
5. Continuing to support each member of SETMA’s healthcare team by meeting their needs for a safe, secure and stable work environment free from discrimination, harassment or unnecessary stress.
6. Renewing our commitment to SETMA’s mission statement:  To build a multi-specialty clinic in Southeast Texas which is worthy of the trust of every patient who seeks our help with their health, and to promote excellence in healthcare delivery by example.
7. To renew our commitment to SETMA’s Community Council which allows patients to have a direct input into SETMA to which input SETMA is committed to respond.
8. To continue to invite medical students and residents, and healthcare groups to visit SETMA’s Medical Home, giving us the opportunity to share our innovations with them and for us to learn from them.  The next group to visit SETMA is a delegation from Australia in March, 2015.
9. To continue to participate in educational opportunities to share SETMA’s vision, passion and principles with others.  In March, 10 members of SETMA’s Accreditation Team, SETMA’s PC-MH and SETMA’s Community Council will present a national conference in Philadelphia. This group includes three SETMA patients who will attend the conference to give their perspective of 21st Century healthcare.
10. To improve SETMA’s provider education process with our monthly four-hour meeting for training, which process will focus on SETMA’s 2014 achievements and SETMA’s goals for 2015. 

The nature of these goals is different than those for last year. They represent the fact that SETMA’s infrastructure is largely in place and that it is now our goal to refine and improve our performance with that infrastructure.  Measuring our success in these goals may not be as easy but their achievement will represent the maturity of SETMA and our commitment to excellence of care for all patients.  In December, 2015, we will report to you our progress.