Lee Memorial lights the way for patient engagement in the Sunshine State

With more than one million patient contacts each year, Lee Memorial Health System considers patient engagement the order of the day every day. For Mike Smith, CIO of the six-hospital, 1,423-bed organization based in Fort Myers, Fla., this enterprise-wide emphasis means constantly working to ramp up IT-enabled interactions via—among other interfaces—an increasingly in-demand patient portal.

It also means taking into account the engagement needs of patients’ families.

“We serve a population that is, on average, in the neighborhood of 10 years older than the rest of the country,” Smith explains. “Oftentimes our patients have adult children living in one or more other states. The more we can do to engage patients and their families,” including with IT-enabled offerings such as secure proxy access to relatives’ patient portals, “the better the chances of good patient follow-through on things like care protocols, medication adherence and doctor appointments.”

Such close connections between individuals and a massive regional institution are only attemptable because of IT, Smith points out. That’s why his division isn’t alone within the system when it thinks of patient engagement and IT as inextricably linked.

“Ultimately we’re looking to draw from our patient-engagement efforts to move as much care as possible from hospitals and assisted-living facilities to the comfortable surroundings of home,” with greater use of outpatient and ambulatory settings as a step along that road, says Smith, who was selected this year as one of healthcare’s “CIOs to know” by Becker’s Hospital Review.

It’s no coincidence that this goal is aligned with the movement of U.S. healthcare toward value-based approaches that stress improving care while lowering costs. 

“We’re in an early stage of some really profound shifts in how that transition can happen, standing at the intersection of where the technology evolution and the payment evolution are in sharper focus,” Smith says. “We all know healthcare is too darned expensive right now, and we are working on new ways to deliver medicine.”

The secret sauce

Those new ways hinge in large part on the capabilities of IT, Smith believes. Working toward the seamless interoperability of wide and varied IT systems is a key objective.

“We want to make that seamlessness available to the patient,” says Smith. “When they log into their portal and they see their results, they’ll also be able to pull up their own imaging, after privacy and security have been ensured, with quality and appropriateness checked by the interpreting radiologist. That’s the kind of thing we want to do, and we’re moving toward bringing it about as quickly as we can.”

Key to that effort will be integrating the patient portal with Lee Memorial’s Epic EMR, which had its latest go-live in 2013, and with its Fujifilm Synapse PACS, which finished its full rollout in May 2014.

Ann Jewell, IT team leader for diagnostic imaging, is confident all will go well. After all, the team went from running different PACS in all six hospital, she says, to where they’re now offering a unified solution across all hospitals, outpatient centers and radiology practices.

Already the clinicians “love the integration of the PACS within the EMR,” adds Jewell. “As they’re looking at the patient record, they can just hit a hyperlink to launch Synapse and go directly to a patient study,” complete with imaging and associated dictated reports. The previous solution entailed separate log-ins, monitors and steps for EMR and PACS.

“We’ve gotten a lot of positive feedback,” Jewell says of the greatly improved ease of use and reliability of content. The pleased physicians include subspecialty pediatric radiologists in Miami, around 150 miles away, who tele-consult for Lee Memorial’s Golisano Children’s Hospital.

Jewell recalls how Lee Memorial settled on Synapse PACS after considering the concerns and wish lists of PACS end-users. Customization at the individual level was a standout feature, she says, as two separate radiology practices support the acute-care facilities and each has its own reading style and radiological approach.

“To provide a high level of customization while still supporting a unified system that could allow for clinical standardization—that was a tightrope we knew we’d have to balance,” she says. “And there are some unique features of the Fuji application, such as allowing our private-practice radiology locations to pull in priors from non-associated practices. That was a big plus for us. In fact, we refer to it as the ‘secret sauce.’”

Smart solutions meet satisfying work

Smith tells how use patterns of Lee Memorial’s new PACS gave rise to a “good problem to have” that was still a problem in need of a solution.

With all those facilities successfully connected imaging-wise, any radiologist in the system could pick up any unread image from any work list and render a finding. This nicely filled ebbs and distributed overflows in workloads, says Smith, but it didn’t initially go over well with emergency physicians. Most were used to doing preliminary reads of their own in the ER before getting a final read from a radiologist.

“Our radiologists were picking up the images and reading them faster than the ER doctors could get to them,” Smith explains. “That messed up the workflow, creating an unintended consequence that we had to deal with. It was right in our face, and Ann had to work her magic to fix it.”

“We were able to tap into Synapse capabilities to solve the issue,” Jewell says. “The Synapse Web Administration Tool—SWAT—allowed us to build logic into the folders to force a delay before the study is available for radiologists to read. The software looks to see if there is an interpretation from an ER physician before it releases the study to the radiologists’ unread work list. And then, in the event that there is a delay and it doesn’t get there, there is a failsafe. After a period of time, even if there is no ER interpretation, it will go ahead and release the study.”

In the end and all in all, adds Smith, radiologists’ productivity has increased “considerably” at Lee Memorial Health System, thanks partly to efficiencies built into Synapse and partly to Lee Memorial’s deploying it across all facilities.

At the same time, the success is of a piece with many advances underway throughout the system. Lee Memorial is considering building an innovative outpatient village, for example, as well as moving toward incorporating the “Internet of Things” for home-based care.

For CIO Smith, these are heady times for hospital-based IT. In a time and place in which patient engagement is a high priority and rising higher every day, “we’re having more fun than we ought to be able to have,” he says. “It’s just an exciting time to make a difference.”