One of the ultimate goals of EHR adoption is the creation of a global infrastructure where the medical record can easily travel with the patient, regardless of where in the world they seek care. We’re currently a long way from realizing this vision in the U.S., which can create some communication and treatment issues whenever a patient needs to be seen outside of their regular care network. Luckily, outside of patients that relocate or get sick or injured while on vacation, most patients aren’t excessively mobile. Most tend to seek care from multiple providers in their local community. However, what if the tables were turned? What if the vast majority of your patient population was made up of world travelers? What if your patients regularly sought care in different cities, states, countries, and even continents? What if transporting a medical record in a timely manner was considerably more complex than couriering a paper file across town to a local specialist’s office? Well, this “what-if” scenario is a reality for the United States Olympic Committee (USOC).
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Thanks to an EHR implementation in 2012, the United States Olympic Committee has improved medical documentation, health data access, and overall patient care.
One of the ultimate goals of EHR adoption is the creation of a global infrastructure where the medical record can easily travel with the patient, regardless of where in the world they seek care. We’re currently a long way from realizing this vision in the U.S., which can create some communication and treatment issues whenever a patient needs to be seen outside of their regular care network. Luckily, outside of patients that relocate or get sick or injured while on vacation, most patients aren’t excessively mobile. Most tend to seek care from multiple providers in their local community. However, what if the tables were turned? What if the vast majority of your patient population was made up of world travelers? What if your patients regularly sought care in different cities, states, countries, and even continents? What if transporting a medical record in a timely manner was considerably more complex than couriering a paper file across town to a local specialist’s office? Well, this “what-if” scenario is a reality for the United States Olympic Committee (USOC).
MOBILE PATIENTS CREATE CARE COORDINATION CHALLENGES
The USOC provides healthcare services to all U.S. Olympic athletes and operates three clinics — one in Lake Placid, NY; another in Colorado Springs, CO, and another in Chula Vista, CA. These clinics handle approximately 30,000 patient encounters per year and house a wide variety of health providers (e.g. traditional PCPs, sports doctors, chiropractors, physical therapists, dieticians, strength and conditioning trainers, psychologists, etc.).
“There’s probably no other organization — outside of the Department of Defense — that has a more highly mobile patient population than the USOC,” says Bill Moreau, DC, DACBSP, and managing director of sports medicine at USOC. “It’s not uncommon for me to have a patient encounter on Monday, follow up with them on Friday, and they’ll have been to two continents in between.”
The typical USOC patient also has at least seven providers involved in their care and regularly receives treatment at all three USOC clinics (the clinics are adjacent to the Olympic Training Centers). All of these factors made traditional paper medical records an inefficient medium for recording and transmitting patient health information.
“Maintaining paper medical records was an absolute nightmare for USOC,” says Moreau. “We typically had three different versions of a patient chart at each of our clinics, plus additional copies with each patient’s individual health providers and consultants. There was no central repository. Furthermore, we had no ability to track or analyze patient data in an effort to keep our patients well.”
Paper medical records became even more problematic when it came to treating patients onsite at the Olympic games. For instance, during the 2008 Summer Olympics in Beijing, U.S. athletes would be treated at one of several sports medicine clinics established at the event. The paper medical records that were created as a result of these encounters were put into a box. That box, in turn, was placed on a pallet that was ultimately packed into a shipping container that eventually boarded a freighter and made the long journey back to the U.S. by sea. Once the freighter reached the Port of San Francisco, the shipping container was unloaded and the boxes of patient records were transported back to each USOC clinic by truck.
“It sometimes took three to five months for those boxes of patient charts to finally make their way back to our clinics,” says Moreau. “At that point, they’re almost irrelevant. Don’t get me wrong, those charts are still valuable for historical purposes, but they fail to provide physicians with the most-up-to-date information on a patient that they often need to make an effective diagnosis or treatment plan. In this technological age, a health provider shouldn’t have to put up with this level of inefficiency.”
AN EHR & ANALYTICS PROVE CRITICAL TO OLYMPIAN CARE
In 2012, the USOC deployed Centricity, an EHR solution from GE Healthcare, in an effort to improve charting, data exchange, and record access. USOC leveraged its EHR solution for the first time at the 2012 Summer Olympics in London.
The technology performed as expected, allowing providers to record patient encounters electronically into a central repository that is shared by all three USOC clinics. Moreover, electronic capture and transmission of patient data meant no more shipping containers and freighters full of paper charts. All USOC providers —whether at the games or at the clinics — can now gain simultaneous access to a patient record via Centricity. This capability gives providers up-to-date medical information on each patient, which improves diagnosis, treatment, and coordination of care.
The EHR has indeed had a profound impact on patient documentation and data transport, but Moreau states the ability to perform in-depth analysis on electronic patient data has been even more rewarding. “We are now able to apply analytics technology to EHR data to identify injury and illness trends,” says Moreau. “In some instances, we’ve been able to take proactive measures to prevent future injuries and illnesses from occurring. This has been a huge improvement in the care of our Olympians.”
For example, thanks to the EHR and data analytics, USOC was able to identify that approximately 50% of the women on the U.S. synchronized swimming team sustained a concussion over a two-week period. With this data, the USOC was able to intercede and determine not only what was causing the concussions, but also work with coaches and trainers to prevent the concussions going forward.
The USOC also identified abnormally high occurrences in ACL tears among its female wrestlers. Once it identified the issue, the USOC put protective measures in place to help prevent ACL injuries. As a result, the USOC reduced its ACL surgery rates over the past two years by nearly 60%.
“Prior to the EHR, we would have thousands of separate encounters with multiple patients and there was no easy way to collectively analyze trends that were occurring in specific patient populations,” says Moreau. “It turns out this data can tell you a lot. And, when you’re armed with it, you can make huge improvements in patient care.”
ENHANCING THE VALUE OF AN EHR
While few healthcare facilities would envy USOC’s highly mobile patient base, there are some other unique characteristics of the organization that many providers would find desirable. For example, the USOC is an independent organization funded by sponsorships, donations, marketing rights, etc. As such, the USOC doesn’t deal with payers and doesn’t process insurance claims. Furthermore, the organization is tax-exempt, and they aren’t required by law to comply with HIPAA and other industry regulations. Finally, for good or bad, the USOC is not eligible for the Meaningful Use (MU) incentive funds offered as part of the HITECH Act, nor will it be affected by the Medicare penalties that are imposed on providers that fail to achieve MU.
This final detail is intriguing to me. The USOC was not goaded into adopting EHR technology because of the stimulus. It genuinely viewed the technology as a solution to an operational problem it was experiencing, and the organization deployed the EHR in a manner that addressed its specific pain points. The result? The USOC genuinely values its EHR solution and views it as a critical tool in care delivery. Wouldn’t it be nice if more healthcare providers felt that way about their EHR solutions?
In fact, the USOC continuously seeks out ways to leverage its EHR (and the data it harvests) in new and innovative ways. For example, the USOC is looking for new ways to apply analytics and mobile technologies to extend the value of the EHR. Furthermore, the USOC is currently working with the United States Anti-Doping Agency (USADA) to integrate its EHR with the USADA drug reference database.
“Obviously, there are several medications that are banned in sport, and our athletes are tested for these substances regularly” says Moreau. “It’s difficult for a physician to keep tabs on all of these banned medications. For instance, what might appear to be a benign medication for sinusitis may actually be banned in some events. If a physician were to prescribe this drug to one of her Olympic patients, she could be jeopardizing that athlete’s career and reputation. By cross-referencing our EHR orders with the USADA drug registry, we can be immediately alerted as to whether or not the drugs we prescribe are allowed by the rules of sport.”