Doctors’ Patient Software Pays Off

Milwaukee Journal Sentinel

May 29, 2014

An idea developed by three Wisconsin doctors to build a better application to ensure that patients receive the appropriate tests for a certain type of heart disease has been awarded a $15.9 million federal grant.

If implemented nationwide, the application could save from $1 billion to more than $3 billion in its first year by reducing the number of unneeded stress tests and diagnostic catheterizations, based on a study done by Milliman Inc.

"You can improve the quality of care and save money," said Tim Bartholow, the former chief medical officer of the Wisconsin Medical Society and now chief medical officer of WEA Trust in Madison.

One feature, for example, would help primary care physicians determine when they should order a stress test.

Bartholow and two other doctors—Tom Lewandowski, a cardiologist with ThedaCare in Appleton, and Anthony DeFranco, a cardiologist with Aurora Health Care—have been working on the idea, which they named SMARTCare, since 2010.

"We really just drew on our own experience: What do we need from technology to be better doctors," DeFranco said.

The grant is from money allocated under the Affordable Care Act to test new ways of improving care and lowering costs. The $15.9 million grant was among 12, ranging from $2 million to $18 million over a three-year period. The grant was to the American College of Cardiology Foundation. Lewandowski, who is credited with the original idea, will oversee the project.

SMARTCare will put existing software into a package that can become part of an electronic health record. The work will be done by a contractor.

The most immediate result could be wider adoption of software that provides practice guidelines.

"This is the ACC (American College of Cardiology) guidelines put in a convenient electronic format," DeFranco said.

The guidelines could help prevent the overuse—and the underuse—of tests and treatments.

"This ensures we do the tests that are truly appropriate," DeFranco said. It also helps doctors keep up with the flood of new information.

There can be six or seven major changes every few years in any one of the 30 to 40 sets of cardiology guidelines, DeFranco said. And all of the changes affect the way he treats patients.

"It's impossible for an individual physician to keep up," he said.

Shared decision making

Another component will include software for shared decision making—helping patients make the best decisions for themselves on the care they want.

A patient may want to treat his or her heart disease, for instance, with medication rather than angioplasty.

Another component will track outcomes to help researchers determine which treatments are the most effective. Patients' names will be removed from the data.

"This is all about improving best practice in health care," said Dianne Kiehl, executive director of the Business Health Care Group, an employer coalition, which wrote a letter in support of the grant. The long-term goal is to help make it easier for health systems to accept a fixed payment for patients who have heart disease.

Health economists and policy experts across the political spectrum agree that developing new ways of paying hospitals and doctors will be essential in slowing the rise in health care spending.

Patient concerns

But one concern is that patients may be wary that payment reform could lead to doctors skimping on care.

"We know there is a lot of overtreatment, but you don't want to go too far in the other direction," said Harold Miller, president and chief executive of the Center for Healthcare Quality and Payment Reform. Miller was a strong supporter of SMARTCare. He and others noted that it could become a model for other medical specialties.

Lewandowski, DeFranco and Bartholow refined the idea over several years, eventually partnering with two cardiologists in Florida and talking to people like Miller at health systems, businesses and a long list of organizations involved in health policy.

The organizations included the Robert Wood Johnson Foundation, Consumers Union, National Business Coalition for Health, and National Partnership for Women and Families.

Several wrote letters supporting the grant application. Ten members of the Wisconsin congressional delegation did the same.

Aurora helped with the legal fees and gave advice on the design and information technology requirements. The Wisconsin Medical Society, the Alliance, an employer coalition based in Madison, and other groups also backed the idea.

The biggest commitment, though, was the time put into the proposal by Lewandowski, DeFranco and Bartholow.

"We need this level of physician leadership," Kiehl said. "Physicians can make a difference. This is a project that demonstrates this."

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