The Cleveland Clinic Way, Lessons in Excellence from One of the World’s Leading Healthcare Organizations, by Toby Cosgrove, MD, McGraw-Hill, 2014Not just “one of the world’s leading healthcare organizations,” but in fact, Cleveland Clinic is ranked 4th in the country by US News and World Report and number 1 in cardiac care. Even so, this innovative and renowned institution had soft spots, “opportunity areas” – like EMR (Electronic Medical Records), Big Data and quality. In the 1990s The Clinic was in the initial stages of completely digitizing patient records. Although some smaller groups were dipping into digitizing, none were fully digitized. And in fact when Dr. Anil Jain, a young internist arrived at Cleveland in 1991, the patient records protocol was horrifyingly primitive, requiring basement physical storage space the size of a football field jammed with shelves and folders OF EVERY PATIENT WHO HAD VISITED CLEVELAND CLINIC SINCE 1921!
When a physician needed patient data, folders were retrieved and piled in carts that traveled the long corridors “from floor to floor on metal tracks like cars in a mine shaft.” Dr. Jain’s initial work grew to a full-blown EMR system that put computers in every exam room and connected them. The systems provider, Explorys, starting with office space and seed money scaled up Jain’s initial work into a full blown search engine that covered 14 major integrated healthcare system with over 100 billion data elements, 40M cared-for lives, 200 hospitals and over 100,000 providers. So no longer was the patient the sole source integrator for his own medical history.
Not only does data integration become the foundation for predictive analyses of findings, but it is the key building block for monitoring and improving healthcare quality. The author states that Cleveland Clinic’s hospitals were safer in 2013 than they were just ten years earlier. Central line infections, for instance, which are associated with the insertion of an IV tube and needle into a large blood vessel of the neck, chest, or groin, that used to cause death in a quarter of its victims, has dropped. In 2009 the Clinic saw eight central line infections in its ICU units for every 1000 patient line days; three years later the number of central line infections per 1000 line days had fallen from 8 to 2. But the thriller is that the Clinic avoided 27,000 patient deaths an saved $1.8B in costs associated with treating those infections and it did so by studying the data, and identifying fixes, the same way companies have used SPC have for decades.
The Mill Girl’s Verdict: well-written, entertaining, focuses on one beautiful healthcare institution example. Supported by great before and after stats, this is a persuasive and simply written examination of a great system – not a lot of lean philosophy, no Obamacare, nothing on layoffs, and not a cookbook.