Saturday, July 5, 2008

How this started for me

In 1999, I moved from the faculty at Washington University in St. Louis to the University of Vermont. Among my colleagues, I found Charles D. MacLean. Charlie is a top-notch General Internist who teaches medical students and residents and has a busy practice in Essex, Vermont. Charlie believes in flow sheets to manage his patients with chronic problems. Lots of doctors love having a current, legible, well-organized flow sheet to keep track of vital signs, lab results, clinical findings and all the details of chronic care, but we all hate to keep them up to date.

Charlie was fed up with keeping track of the lab results of his patients with diabetes. So, he asked the hospital computer guys to create an automatic laboratory data flow sheet. Instead of reporting just the latest result for, say, the cholesterol test, the new flow sheets showed the last 4 results for the whole cholesterol profile, the hemoglobin A1C test, the serum creatinine, the urine protein and other information basic to the management of adults with diabetes.

The flow sheets were a big success. The other providers (mostly primary care internists and nurse practitioners) loved them and they soon became an integral part of the Primary Care Internal Medicine practice at Fletcher Allen Health Care and the University of Vermont.

Although I also practice and teach Primary Care Internal Medicine, my main focus has always been on research, especially Technology Assessment: the rigorous evaluation of clinical practices. So, Charlie and I pulled the laboratory data from before the new flowsheets were available and compared them to the results seen after the flow sheets had been in place a while.

What we saw was wonderful: the A1C test (the main measure of blood sugar control) was down a full 0.5%! (This is a very big deal for this kind of test. To put it in perspective, that's about how much you can get from prescribing a second daily pill for a poorly controlled diabetic adult.)

We were thrilled. It felt like a kind of alchemy: take something of little apparent value (old lab results), reformat and reorganize them, present them to the provider at the right time and in the right way, and you get clinical gold: a tangible improvement in the health of an entire population!

Since then, Charlie and I, and our computer wizard partner Michael L. Gagnon, CPHIMS, from Fletcher Allen Health Care Information Systems, have expanded the system to tens of thousands of patients in three states, added lots and lots of additional features, discovered things it could do that we didn't even imagine, built other information systems for other clinical areas, filed patents, started a business, and tried to keep up with the many different ways that individual clinical data can be used to improve the health of both individuals and the population at large.

We're hoping this blog will give us an opportunity to tell the story, excite others to get involved, and contribute to the spread of these powerful new ideas across the country and around the world.

More to follow....

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