Running Head: CLEVELAND CLINIC

Amanda Bryant
The Cleveland Clinic
Siena Heights University

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The Cleveland Clinic

According to Shehadi, Tohme, and Baker (2012) with its slogan every life deserves
world-class care, the Cleveland Clinic in Ohio has staked out a distinctive role in consumercentric, innovative healthcare including the development and use of medical information
technology (p. 1). The ability to use computers as a part of the information systems in business
has been put into service since the early 1960s. The first applications mainly targeted the
mechanization of existing tasks. Once the computer systems have evolved, applications were
designed with a view to support the organization management (Tole & Matei, 2016, p. 1).
Benefits of an electronic medical record (EMR) system includes easy, quick, and accurate access
to records. The benefits outweigh the risks. Our goal is to protect a patients health information,
even if health information is received through a text message. According to Bromwich and
Bromwich (2016) there are risks associated with using smart phones. These risks include privacy
breaches, insecure data storage and physician or institution liability for failure to obtain patient
consent. According to Ethics in Medicine (2016) informed consent is the process by which the
treating health care provider discloses appropriate information to a competent patient so that the
patient may make a voluntary choice to accept or refuse treatment (p. 1).
Health Information Technology (HIT) contributes to patient satisfaction through
Cleveland Clinics information systems initiatives. According to Alego Health (2016), Cleveland
Clinic, is a nonprofit, multi-specialty academic medical center that integrates clinical and
hospital care with research and education (p. 1). According to Rowe (2013), Cleveland Clinic
focuses on patient experience through their EMR system. At the present time, David Levin of
Cleveland Clinic has pointed out five key changes in how patients interact with Cleveland Clinic.
These changes include: open access to scheduling, patient education, open medical records

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policy, two-way messaging via patient portal, and patient reported outcomes. With open access
scheduling patients have the ability to log on and schedule their own appointments. Patients want
and needs to be made aware of their current condition. Cleveland Clinic has educational material
available online. Since October 2012, Cleveland Clinic has had an open medical records policy,
including increased access to electronic patient information; such as lab results. With ongoing
healthcare reform two-way messaging via patient portals is something that has eliminated
unnecessary office visits. Feedback from patients is important, as it increases patient
engagement. With patient reported outcomes patients have the ability to enter notes into their
own record.
According to IBM (2016) new technology is continuously being unveiled at Cleveland
Clinic. Research today unveiled two new Watson-related cognitive technologies that are
expected to help physicians make more informed and accurate decisions faster and to cull new
insights from electronic medical records (EMR) (p. 1). Cleveland Clinic in collaboration with
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University have
developed systems known as WatsonPaths and Watson EMR Assistant. According to IBM (2016)
the Watson Assistant has helped improve quality of care at Cleveland Clinic. Medical domain
experts have the ability to interact easily, allowing the ability to understand structured data
sources. Improved health information technology assists in continuity, communication,
coordination, and accountability of patient care.
Braley (2016) states problems during the installation of a new computer system are
described at great length in the literature and at professional meetings (p. 2). During
professional meetings and during the selection process a Request for Proposal (RFP) should be
utilized. In this RFP, according to RFP Writing Guide (2016) professionals must specify the

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outcome targets, minimal performance standards expected from the contractor, and methods for
monitoring performance and process for implementing corrective actions (p. 1). According to
McCormack (2013), after implementation of the new electronic health record (EHR) system
doctors were amazed at the systems ability to assist in continuity, communication, coordination,
and accountability of patient care. Doctors have the added ability to log in from home after
having dinner with their family instead of staying at the office to finish paperwork
(McCormack, 2013, p. 2). According to Health Information Management Body of Knowledge
(2016) a successful transition from paper-based charts to EHRs in the physician practice or
clinic requires careful coordination of many moving parts (p. 1). Without proper transition
doctors at Cleveland Clinic would have a hard time accessing and updating patient information at
home. Improvement of information systems is high priority within Cleveland Clinic as a result of
the ever changing healthcare field. According to Rowe (2013), David Levin, MD, chief medical
information officer at the Cleveland Clinic states, a few years ago leadership took a
comprehensive look at how patients engaged its services, focusing on the impacts patient
experience had on care outcomes (p. 1).
According to HHS.gov (2016) the Patient Protection and Affordable Care Act puts
consumers back in charge of their health care. Americans have the added ability to make
informed decisions about their health. To add, The Health Information Technology for
Economic and Clinical Health Act (HITECH Act) legislation was created in 2009 to stimulate the
adoption of electronic health records (EHR) and supporting technology in the United States
(TechTarget, 2016, p. 1). According to Gentili, Harati, and Serban (2016), several policy
interventions have been implemented and evaluated to improve health care access, most recently
the provisions outlined in the Patient Protection and Affordable Care Act (p. 1). However,

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many states are still considering whether to expand Medicaid under

the Affordable Care Act and whether to pursue alternative models for coverage expansion
(Nguyen & Sommers, 2016, p. 1). According to Johnson and Marrero (2016), the EMR decreases
the risk of medical error through improved health care data storage, access and sharing,
enhanced communication between providers, and greater provider adherence to evidence-based
standards of care (p. 1).
Information system technology has affected healthcare and the delivery of healthcare in
in Cleveland Clinic in a positive manner. According to Columbus (2016), Cleveland Clinic was
named by Forbes as one of the most admired companies making IT a competitive advantage.
Cleveland Clinic was recognized for being customer-driven in IT, and not underestimating the
disruptive power of cloud computing and mobility to completely re-order enterprise systems
quickly. According to Columbus (2016), its imperative for CIOs to keep challenging their
organizations to stay intensely focused on new developments, seeking out how they can be used
to strengthen business strategies (p. 1). According to Healthcare Informatics (2016) it is an
interesting phenomenon to think that consumers are beginning to use the internet for medical
diagnostic purposes (p. 1). According to Patient Safety Primer (2016) diagnostic error has
received comparatively less attention, despite the fact that landmark patient safety studies have
consistently found that diagnostic error is common (p. 1). In contrast, according to Gittlen
(2016):

Diagnostic errors are under the microscope at many healthcare organizations

following a report from the National Academies of Sciences, Engineering, and
MedicineHealth and Medicine Division that found that 5% of U.S. adults who
seek outpatient care each year experience a diagnostic error (p. 1).

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According to Gittlen (2016), our brains are prone to bias when we are thinking fast.
Gittlen states this and other cognitive biases can lead to diagnostic errors and delays. For this
reason investing in data warehouses, clinical data repositories, data mining, and data analytics
capabilities is necessary. According to McKinney (2010) for all the progress weve made in the
last 30 years, we are still a long way from getting the most out of what we have wrought (p. 2).
Furthermore, data warehouse is a central data source that combines data from various
Institute administrative systems (Information Systems and Technology, 2016, p. 1). In large
organizations such as Cleveland Clinic it is imperative to incorporate data analytics into daily
operations. According to Palmer (2013) the need for more advanced data visualization and
analytics capabilities increases with the introduction of big data (p. 1). Another is data mining.
According to UCLA.edu (2016), generally, data mining is the process of analyzing data from
different perspectives and summarizing it into useful information. Data mining software is one of
a number of analytical tools for analyzing data (p. 1). According to Campbell (2016) a clinical
data repository consolidates data from various clinical sources, such as an EMR or a lab system,
to provide a full picture of the care a patient has received (p. 1). According to IBM (2016),
IBM and Cleveland Clinic are used Watson EMR Assistant to explore how to navigate and
process electronic medical records with the goal of helping physicians make more informed and
accurate decisions about patient care (p. 2).
Historically, the potential of EMRs has not been realized due to the discrepancies of how
the data is recorded, collected and organized across healthcare systems and organizations. The
massive amount of health data within EMRs alone presents tremendous value in transforming
clinical decision making, but can also be difficult to absorb. For example, analyzing a single
patients EMR can be the equivalent of going through up to 100MB of structured and
unstructured data, in the form of plain text that can span a lifetime of clinical notes, lab results

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and medication history. McCormack (2013) states for an organization at the early stages of
planning to implement an EHR, whats the best way to get started is to choose vendors wisely.
McCormack suggests smaller practices choose vendors who work with affiliate hospitals that
way staff and patients will not have to wait for electronic health information. According to Alego
Health (2016):
The first regional facility to Go-Live with CPOE was Euclid Hospital, a 371bed facility with a full continuum of care from emergency services to a renowned
rehabilitation center. Physician opposition to the change was vocal and visible,
with physicians opting out of training sessions and vowing to find ways to work
around CPOE. To address physician concerns, another implementation services
provider had created a SWAT Team of support personnel posted in a computer
laboratory ready to provide additional assistance and training during the activation
(p. 1).
According to HHS.gov (2016), to improve the effectiveness of the health care
system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
included Administrative Simplification provisions that required HHS to adopt national
standards for electronic health care transactions and code sets (p. 1). Furthermore, while
choosing a vendor it is best to review the business associate agreement for gaps. The
business associate is a subcontractor that creates, receives, maintains, or transmits
protected health information on behalf of another business associate (HHS, 2016, p. 2).
With a BAA being a written contract between a covered entity and a business associate
the following applies:

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Establish the permitted and required uses and disclosures of protected health

information by the business associate

Provide that the business associate will not use or further disclose the information
other than as permitted or required by the contract or as required by law (HHS,
2016).

Data Resource Management helps improve quality of care. According to Brackett (2001)
data administration has not been an effective way to manage an organizations data resource.
People have tried to administer the data with an orientation toward the data, rather than towards
support of the business (p. 1). According to HHS.gov (2016) effective quality improvement
requires valid and reliable data. The Quality & Safety Institutes Data Department creates overall
quality measurement tools and reporting plans. Database design, data collection, and reporting
findings are key activities (p. 3). According to Harrison (2016), patients benefit from
coordination among doctors offices, hospitals, procedural suites and operating rooms across a
variety of specialties, and as it is kept current, the data in the EMR makes things safer for
patients. For example, when a clinician prescribes a medicine, the EMR is used to ensure correct
dosage by checking it against the patients weight. The medicine is compared with the patients
list of drug allergies and cross-checked for interactions with other medicines.
Cleveland Clinic utilizes an information system called MyChart. According to Harrison
(2016), MyChart is a secure, online health management tool that connects Cleveland Clinic
patients to portions of their electronic medical record, 24/7, allowing you to:

Receive test results, including labs, radiology, procedures, and pathology

Schedule, request, and cancel appointments

Securely message your providers office

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View ambulatory progress notes

View current health issues

Renew prescriptions

Review past appointment information

Track immunizations

According to Harrison (2016) As a result of Watson EMR Assistant, MyChart users have
additional options to schedule their appointments. With all the good an electronic health system
can provide to an organization, there is always the possibility of being hacked. According to
Health Data Management (2016), there are five things that should be done when a system is
hacked. These things include: pulling the plug to prevent any further attacks, wiping the slate
clean by restoring a backup, diagnose compromised systems by finding out who got in, why, and
what information was compromised. The next step is to notify affected users by being
transparent. The last step is to take corrective action taking note of gaps to ensure the break-in
can never happen again.
According to Cleveland Clinic (2016), the healthcare landscape is changing rapidly.
Institutional consolidations, global footprints, treatment breakthroughs, expanded use of
technology, and an increasing focus on outcomes, cost pressures: all are having an impact.
According to Rowe (2013) some of the initiatives began as experiments, Levin said, but they're
all part of a very deliberate strategy. It seems very clear to us that part of how we're going to get
to better outcomes is through this kind of collaboration with patients (p. 1). To add, insurance
companies have an impact on the care patients receive, even if it is technology that can better
enhance their way of life. Such technology can get pretty expensive resulting in self pay patients

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being the only patients receiving such technological care. It is my belief that as price of
technology drops fairly quickly, quality of care will increase. Something like this could help us
show how benefits outweigh the risks in healthcare; and how technology can increase patient
volume in private practice and overall help eliminate waste. According to Gardner (2016) in the
current political climate, the Affordable Care Act (ACA) is cast either as a positive change for
the health care system or as a total disaster. Thus, regardless of one's perspective, it has changed
how insurance is purchased and how health care is delivered. I do think it is wrong that the best
thing for the patient is trumped by expenses and ultimately what insurance will pay for.
According to Jagger, Siala, and Sloan (2016), the take up of technology as a method for
communicating and networking has been responsible for an evolution in learning styles (p. 1).
However, technology in healthcare helps create a balance. To add, America is built on business. I
think most patients seek the least expensive alternative method. I must say the 3D cast looks
pretty cool, and I feel there is a market for it; just may not be the best alternative for patients
looking to purchase through their insurance.

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