15. Partners HealthCare System

Thomas H. Davenport

Partners HealthCare System was in 2012 the single largest provider of health care in the Boston area. It consisted of 12 hospitals with over 7,000 affiliated physicians. It had 4 million outpatient visits and 160,000 inpatient admissions a year. Partners was a nonprofit organization with almost $8 billion in revenues, and it spent over $1 billion per year on biomedical research. It was a major teaching affiliate of Harvard Medical School.

Partners was known as a “system,” but it maintained substantial autonomy at each of its member hospitals. Although some information systems (the outpatient electronic medical record, for example) were standardized across Partners, other systems and data, such as patient scheduling, were specific to particular hospitals. Analytical activities also took place at both the centralized Partners level and individual hospitals such as Massachusetts General Hospital (MGH) and Brigham & Women’s Hospital (usually called “the Brigham”). This chapter describes both centralized and hospital-specific analytical resources. The focus for hospital-specific analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although other Partners hospitals also have their own analytical capabilities and systems.

Centralized Data and Systems at Partners

The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s. Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s Chief Information Officer, initiated an outpatient electronic medical record (EMR) at the Brigham in 1989.¹ This EMR contributed outpatient data to the clinical data repository. The hospital was one of the first to embark upon an EMR, although MGH had begun to develop one of the first full-function EMRs as early as 1976.

A clinical data repository provides basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient EMR, the Brigham—and Partners after 1994, when Glaser became its first CIO—needed facilities for doctors to input online orders for drugs, tests, and other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would solve the time-honored problem of interpreting poor physician handwriting. If endowed with a bit of intelligence, CPOE also could check whether a particular order made sense for a particular patient. Did a prescribed drug comply with best-known medical practices? Did the patient have any adverse reactions to it in the past? Had the same test been prescribed six times before with no apparent benefit? Was the specialist to whom the patient was being referred covered by her health plan? With this type of medical and administrative knowledge built into the system, dangerous and time-consuming errors could be prevented. The Brigham embarked upon its CPOE system in 1989.

Nesson and Glaser knew that there were approaches other than CPOE to reducing medical errors. Some provider institutions, such as InterMountain Health Care in Utah, were focused on close adherence by physicians to well-established medical protocols. Others, like Kaiser Permanente in California and the Cleveland Clinic, combined insurance and medical practices in ways that incented all providers to work jointly on behalf of patients. Nesson and Glaser admired those approaches but felt that their impact would be less in an academic medical center such as Partners, where physicians were somewhat autonomous, and departments prided themselves on their individual reputations for research and practice innovations. Common, intelligent systems seemed like the best way to improve patient care at Partners.

In 1994, when the Brigham and Mass General combined as Partners HealthCare System, there was still considerable autonomy for individual hospitals in the combined organization. However, from the onset of the merger, the two hospitals agreed to use a common outpatient EMR called the longitudinal medical record (LMR) and a CPOE system, both of which were developed at the Brigham. This was powerful testimony in favor of the LMR and CPOE systems because there was considerable rivalry between the two hospitals, and Mass General had its own EMR.

Perhaps the greatest challenge was educating the extended network of Partners-affiliated physicians about the LMR and CPOE. The physician network of over 6,000 practicing generalist and specialist physician groups was scattered around the Boston metropolitan area and often operated out of their own private offices. Many lacked the IT or telecom infrastructures to implement the systems on their own, and implementation of an outpatient EMR cost about $25,000 per physician. Yet full use of the system across Partners-affiliated providers was critical to a seamless patient experience across the organization.

Glaser and the Partners Information Systems (IS) organization worked diligently to spread the LMR and CPOE to the growing number of Partners hospitals and to Partners-affiliated physicians and medical practices. To assist in bringing physicians outside the hospitals on board, Partners negotiated payment schedules with insurance companies that rewarded physicians for supplying the kind of information available from the LMR and CPOE. By 2007, 90% of Partners-affiliated physicians were using the systems, and by 2009, 100% were. By 2009, over 1,000 orders per hour were being entered through the CPOE system across Partners.

The combination of the LMR and CPOE proved to be a powerful one in helping avoid medical errors. Adverse drug events—the use of the wrong drug for a condition or a drug that caused an allergic reaction—typically were encountered by about 14 of every 1,000 inpatients across the U.S. At the Brigham before the LMR and CPOE, the number was about 11. After the widespread implementation of these systems at Brigham and Women’s, a little more than five adverse drug events occurred per 1,000 inpatients—a 55% reduction.

In 2012 Partners announced that it was considering replacing its homegrown EMR system with one from Epic Systems Corp. The move was driven in part by Dr. David Blumenthal, who was named the first national coordinator for health information technology under the Obama administration. Blumenthal returned to Partners in 2011 as chief health information and innovation officer—the first person to hold such a role. He commented in a news story on the disparate systems at Partners that led the organization to consider a commercial EMR:

“The result is, when patients move from one place to another, their information often does not follow them in a complete form or as promptly as we’d like,” said Dr. David Blumenthal, Partners chief health information and innovation officer. Under the new system, data for a patient who is referred from a primary care office to an orthopedist, has surgery, and later is discharged with home care would be contained “all in the same record and all available in real time,” he said. The change would make it easier to update the system as the technology evolves and to apply quality control tools—such as prompts about appropriate tests or warnings of possible drug interactions—uniformly across all Partners practices, Blumenthal said.²

Managing Clinical Informatics and Knowledge at Partners

The Clinical Informatics Research and Development (CIRD) group, headed by Blackford Middleton, was one of the key centralized resources for health care analytics at Partners. Many of CIRD’s staff, like Middleton, had multiple advanced degrees. Middleton had an MD, a Master of Public Health degree, and a Master of Science in Health Services Research. CIRD’s mission was

...to improve the quality and efficiency of care for patients at Partners HealthCare System by assuring that the most advanced current knowledge about medical informatics (clinical computing) is incorporated into clinical information systems at Partners HealthCare.³

CIRD was part of the Partners IS organization.

It was CIRD’s role to help create the strategy for how Partners used information systems in patient care, and to develop production systems capabilities and pilot projects that employ informatics and analytics. CIRD’s work had played a substantial role in making Partners a worldwide leader in the use of data, analysis, and computerized knowledge to improve patient care. CIRD also had several projects funded by U.S. government health agencies to adapt some of the same tools and approaches it developed for Partners to the broader health care system.

One key function of CIRD was to manage clinical knowledge and translate health care research findings into daily medical practice at Partners. In addition to facilitating adoption of the LMR and CPOE, Partners faced a major challenge in getting control of the clinical knowledge that was made available to care providers through these and other systems. The “intelligent CPOE” strategy demanded that knowledge be online, accessible, and easily updated so that it could be referenced by and presented to care providers in real-time interactions with patients. Of course, a variety of other online knowledge tools, such as medical literature searching, were available to Partners personnel; in total they were referred to as the Partners Handbook. At one point after use of the CPOE had become widespread at Brigham and Women’s, a comparison was made between online usage of the Handbook and usage of the knowledge base from order entry. There were more than 13,000 daily accesses through the CPOE system at the Brigham alone, and only 3,000 daily accesses of the Handbook by all Partners personnel at all hospitals. Therefore, there was an ongoing effort to ensure that as much high-quality knowledge as possible made it into the CPOE.

The problem with knowledge at Partners wasn’t that there wasn’t enough of it; indeed, the various hospitals, labs, departments, and individuals were overflowing with knowledge. The problem was how to manage it. At one point, Tonya Hongsermeier, a physician with an MBA degree who was charged with managing knowledge at Partners, counted the number of places around Partners where some form of rules-based knowledge about clinical practice was not centrally managed. She found about 23,000 of them. The knowledge was contained in a variety of formats: paper documents, computer screen shots, process flow diagrams, references, and data or reports on clinical outcomes—all in a variety of locations, and only rarely shared.

Hongsermeier set out to create a “knowledge engineering and management” factory that would capture the knowledge at Partners, put it in a common format and central repository, and make it available for CPOE and other online systems. This required not only a new computer system for holding the thousands of rules that constituted the knowledge, but an extensive human system for gathering, certifying, and maintaining the knowledge. It consisted of the following roles and organizations:

• A set of committees of senior physicians who oversaw clinical practice in various areas, such as the Partners Drug Therapy Committee, that reviewed and sanctioned the knowledge as correct or best-known practice

• A group of subject matter experts who, using online collaboration systems, debated and refined knowledge such as the best drug for treating high cholesterol under various conditions, or the best treatment protocol for diabetes patients

• A cadre of “knowledge editors” who took the approved knowledge from these groups and put it into a rules-based form that would be accepted by the online knowledge repository

High-Performance Medicine at Partners

Glaser and Partners IS had always had the support of senior Partners executives. But for the most part their involvement in the activities designed to build Partners’ informatics and analytics capabilities was limited to some of the hospitals and physician practices that wanted to be on the leading edge. Then Jim Mongan moved from being President of MGH (a role he had occupied since 1996, shortly after the creation of Partners) to being CEO of Partners overall in January 2003. Not since Dick Nesson had Glaser had such a strong partner in the executive suite.

Mongan had come to appreciate the value of the LMR and CPOE, and other clinical systems, while he headed Mass General. But when he came into the Partners CEO role, with responsibility for a variety of diverse and autonomous institutions, he began to view it differently.

So when I was preparing to make the move to Partners, I began to think about what makes a health system. One of the keys that would unite us was the electronic record. I saw it as the connective tissue, the thing we had in common, that could help us get a handle on utilization, quality, and other issues.⁴

Together Mongan and Glaser agreed that although Partners already had strong clinical systems and knowledge management compared to other institutions, a number of weaknesses still needed to be addressed (most importantly, that the systems were not universally used across Partners care settings). Steps needed to be taken to get to the next level of capability. Working with other clinical leaders at Partners, they began to flesh out the vision for what came to be known as the High-Performance Medicine (HPM) initiative, which took place between 2003 and 2009.

Glaser commented on the process the team followed to specify the details of the HPM initiative:

Shortly after he took the reins at Partners, however, Jim had a clear idea on where he wanted this to go. To help refine that vision, several of us went on a road trip, to learn from other highly integrated health systems such as Kaiser, Intermountain Health Care, and the Veterans Administration about ways we might bring the components of our system closer together.

Mongan concluded:

We also were working with a core team of 15 to 20 clinical leaders and eventually came up with a list of seven or eight initiatives, which then needed to be prioritized. We did a Survivor -style voting process to determine which initiatives to “kick off the island.” That narrowed down the list to five Signature Initiatives.

The five initiatives consisted of the following specific programs, each of which was addressed by its own team:

• Creating an IT infrastructure. Much of the initial work of this program had already been done. It consisted of the LMR and CPOE, which was extended to the other hospitals and physician practices in the Partners network and maintained. This project also addressed patient data quality reporting, further enhancement of knowledge management processes, and a patient data portal to give patients access to their own health information.

• Enhancing patient safety. The team addressing patient safety issues focused on four specific projects:

• Providing decision support about what medications to administer in several key areas, including renal and geriatric dosing

• Communicating “clinically significant test results,” particularly to physicians after their patients have left the hospital

• Ensuring effective flow of information during patient care transitions and handoffs in hospitals and after discharge

• Providing better decision support, patient education, best practices, and metrics for anticoagulation management

• Uniform high quality. This team addressed quality improvement in the specific domains of hospital-based cardiac care, pneumonia, diabetes care, and smoking cessation. It employed both registries and decision support tools to do so. This team also took the lead in incorporating aspects of the SmartForms project into the LMR and CPOE systems.

• Chronic disease management. The team addressing disease management focused on preventing hospital admissions by identifying Partners patients who were at highest risk for hospitalization. Then they developed health coaching programs to address patients with high levels of need, such as heart failure patients. The team also pulled together a new database of information about patient wishes concerning end-of-life decisions.

• Clinical resource management. At Mongan’s suggestion, the team focused on how to lower the usage of high-cost drugs and high-cost imaging services. It employed both “low-tech” methods (such as chart reviews) and “high-tech” approaches (such as a data warehouse making transparent physician’s imaging behaviors relative to peers) to begin making use of scarce resources more efficient.

Overall, Partners spent about $100 million on HPM and related clinical systems initiatives, most of which were ultimately paid for by the Partners hospitals and physician practices that used them. To track progress, a Partners-wide report, called the HPM Close, was developed that shows current and trend performance on the achievement of quality, efficiency, and structural goals. The report was published quarterly to ensure timely feedback for measuring performance and supporting accountability across Partners.

New Analytical Challenges for Partners

Partners had made substantial progress on many of the basic approaches to clinical analytics, but there were many other areas at the intersection of health and analytics that it could still address. One was the area of “personalized genetic medicine”—the idea that patients would someday receive specific therapies based on their genomic, proteomic, and metabolic information. Partners had created i2b2 (Informatics for Integrating Biology and the Bedside), a “National Center for Biomedical Computing,” that was funded by the National Institutes of Health. Glaser was codirector of i2b2 and developed the IT infrastructure for the Partners Center for Personalized Genetic Medicine. One of the many issues these efforts addressed in personalized genetic medicine was how relevant genetic information would be included in the LMR.

Partners was also attempting to use clinical information for “post-market surveillance”—identifying problems with drugs and medical devices after they have been released to the market. Some Partners researchers had identified dangerous side effects from certain drugs through analysis of LMR data. Specifically, Research Scientist John Brownstein’s analyses suggested that the baseline expected level of heart attack admissions to Mass General and the Brigham had increased 18 percent beginning in 2001 and returned to its baseline level in 2004. This increase coincided with the time frame for the beginning and end of Vioxx prescriptions. Thus far the identification of problems had taken place only after researchers from other institutions had identified them, but Partners executives believed they could identify the problems at an earlier stage. The institution collaborated with the Food and Drug Administration and the Department of Defense to accelerate the surveillance process. Glaser noted:

I don’t know that we’ll get as much specificity as might be needed to really challenge whether a drug ought to be in a market, but I also think it’s fairly clear that you can be much faster and involve much fewer funds, frankly, to do what we would call the “canary in the mine” approach.⁵

Partners was also focused on the use of communications technologies to improve patient care. Its Center for Connected Health, headed by Dr. Joe Kvedar, developed one of the first physician-to-physician online consultation services in an academic medical setting. The Center also explored combinations of remote monitoring technologies, sensors (for example, pill boxes that know whether today’s dosage has been taken), and online communications and intelligence to improve patient adherence to medication regimes, engagement in personal health, and clinical outcomes.

In the clinical knowledge management area, Partners had done an impressive job of organizing and maintaining the many rules and knowledge bases that informed its “intelligent” CPOE system. However, it was apparent to Glaser, Blackford Middleton, and Tonya Hongsermeier—and her successor as head of knowledge management, Roberto Rocha—that it made little sense for each medical institution to develop its own knowledge base. Therefore, Partners was actively engaged in helping other institutions manage clinical knowledge. Middleton (the principal investigator), Hongsermeier, Rocha, and at least 13 other Partners employees were involved in a major Clinical Decision Support Consortium project funded by the U.S. Agency for Healthcare Research and Quality. The consortium involved a variety of other research institutions and health care companies. It focused primarily on finding ways to make clinical knowledge widely available to health care providers through EMR and CPOE systems furnished by leading vendors.

Despite all these advances, not all Partners executives and physicians had fully bought into the vision of using smart information systems to improve patient care. For example, some believed the LMR and CPOE were invasive in the relationship between doctor and patient. A senior cardiologist at Brigham and Women’s, for example, stated the following in an interview:

I have a problem with the algorithmic approach to medicine. People end up making rote decisions that don’t fit the patient, and it can also be medically quite wasteful. I don’t have any choice here if I want to write prescriptions—virtually all of them are done online. But I must say that I am getting alert fatigue. Every time I write a prescription for nitroglycerine, I am given an alert that asks me to ensure that my patient isn’t on Viagra. Don’t you think I know that at this point? As for online treatment guidelines, I believe in them up to a point. But once something is in computerized guidelines it’s sacrosanct, whether or not the data are legitimate. Recommendations should be given with notification of how certain we are about them.... Maybe these things are more useful to some doctors than others. If you’re in a subspecialty like cardiology, you know it very well. But if you are an internist, you may have shallow knowledge, because you have to cover a wide variety of medical issues.

Many of the people involved in developing computer systems for patient care at Partners regarded these as valid concerns. “Alert fatigue,” for example, had been recognized as a problem within Middleton’s group for several years. They had tried to eliminate the more obvious alerts and make changes in the system to allow physicians to modify the types of alerts they received. There was a difficult line to draw, however, between keeping physician attention and saving lives.

Centralized Business Analytics at Partners

Much of the centralized analytical activity at Partners had been on the clinical side, but the organization also was making progress on business analytics. The primary focus of these efforts was financial reporting and analysis.

For several years, for example, Partners employed an external “software as a service” tool to provide reporting on the organization’s revenue cycle. It had also developed several customized analytics applications in the areas of cash management, underpayments, bad debt reserves, and charge capture. These activities took place primarily in the Partners Revenue Finance function.

The Partners Information Systems organization was also increasing its focus on administrative and financial analytics. It was putting in place Compass, a common billing and administrative system, at all Partners hospitals. At the same time, Partners had created a set of standard processes for collecting, defining, and modifying financial and administrative data. Furthermore, as one article put it:

At Partners, John Stone, corporate director for financial and administrative systems, is developing a corporate center of business analytics and business intelligence. Some 12 to 14 financial executives will oversee the center, define Partners’ strategy for data management, and determine data-related budget priorities. “Our analysts spend the majority of their time gathering, cleaning, and scrubbing administrative data and less time providing value-added analytics and insight into what the data is saying,” says Stone. “We want to flip that equation so our analysts are spending more time producing a story that goes along with the data.”⁶

Hospital-Specific Analytical Activities: Massachusetts General Hospital

MGH, because it was a highly research-driven institution, had long focused primarily on clinical research and the resulting clinical informatics and analytics. In addition to the LMR and CPOE systems used by Partners overall, MGH researchers and staff had developed a number of IT tools to analyze and search clinical data, including a tool that searched across multiple enterprise clinical systems, including the LMR.

Historically, the research, clinical, information systems, and analytics-focused business arms of MGH tended to operate in narrow and rigidly defined roles. However, the challenges of an evolving health care landscape forced a change in that paradigm. For instance, a strong focus at MGH in 2011 was on how to achieve federal “meaningful-use” reimbursement for the organization’s expenditures on EMR. Because achieving meaningful-use objectives is predicated on a high level of coordination among information systems, the physicians and business intelligence people were beginning to collaborate extensively. These were people like David Y. Ting, the Associate Medical Director for Information Systems for MGH and Massachusetts General Physicians Organization, and Chris Hutchins, Director of Finance Systems and Deputy CIO.

The HITECH/ARRA criteria for Stage 1 EMR meaningful use prescribed 25 specific objectives to give providers incentives to adopt and use electronic health records.⁷ The incentive from the federal government is up to $44,000 for each eligible provider who fulfilled the meaningful-use criteria. MGH had examined the objectives and broken them into ten major pieces of patient data that physicians need to record in the EMR. However, many are not relevant for all its physicians. For example, a primary care physician would logically enter such data as demographics, vital signs, and smoking status, but these would be less relevant for certain specialists to enter.

In order to raise the level of EMR use by all its providers, as well as to provide resources for the work needed to achieve that level, MGH arrived at a novel funds distribution model. They determined that the physicians organization would reserve a portion of the pool of $44,000 per physician toward IT and analytics infrastructure. Then it would distribute the remaining incentive payment across all providers, proportional to the amount of data a particular physician is charged with entering. An internal quality incentive program would serve as the distribution mechanism. For example, if a physician recorded demographics, vital signs, and smoking status for the requisite number of patients, he would receive 30% of the per-physician payment from the pool. If he fulfilled all 10 quality measures, he would receive 100% of the payment. This encouraged all physicians to contribute to the meaningful-use program, but it also meant that no physicians would receive the full amount of $44,000.

Clearly, such a complex quality incentive model required an unprecedented level of analytics. Currently, Ting, Hutchins, and others at MGH are working to map the myriad clinical and finance data sources that are scattered among individual departments, exist at a hospital site level, or exist at the Partners enterprise level. Simultaneously, they must negotiate data governance agreements even among other Partners entities. This ensures that the requisite data feeds from sources within Partners and pertaining to MGH, but stored outside MGH’s physical data warehouses, were available for MGH analytics purposes.

MGH has some experience with reimbursement metrics based on physician behaviors, having used them in Partners Community HealthCare, Inc. (PCHI), its physician network in the Boston area. PCHI has provided physician incentives on the basis of admission rates, cost-effective use of pharmacy and imaging services, and screening for particular diseases and conditions, such as diabetes. This was also the mechanism used to encourage physicians to adopt the LMR and CPOE systems. But MGH, like other providers, struggled with developing clear and transparent metrics across the institution that could help drive awareness and new behaviors. If MGH could create broadly accessible metrics on individual physicians’ frequency of prescribing generic drugs, for example, it would undoubtedly drive MGH’s competitive physicians to excel in the rankings.

On the business side, MGH was trying to develop a broad set of capabilities in business intelligence and analytics. A Business Intel-ligence/Performance Management group had recently been created under the direction of Chris Hutchins, Deputy CIO and Director of Finance Systems for the Mass General Physicians Organization. The group was generating reports on certain financial and administrative topics:

• Billing efficiency, claims adjudication, rejection rates, and times to resolve billing accounts, both at MGH overall and across practices

• Improving patient access, average wait times to see a physician, cancellation and no-show rates

• Employer attrition as an MGH customer

MGH was also working with the CMS (Centers for Medicare and Medicaid Services) on the Physician Quality Reporting Initiative. To combine all these measures in a meaningful fashion, the Massachusetts General Physicians Organization was also working on a balanced scorecard.⁸ At the moment, however, Hutchins felt that the scorecard was still early in its development, so current efforts focused on identifying leading indicators.

Although the current analytical activity largely concerned reporting, Hutchins planned to develop more capabilities around alerts, exception reporting, and predictive models. The MGH Physicians Organization was implementing capabilities for statistical and predictive analytics that would be applied to several topics. For example, one key area in which better prediction would be useful involved patient volume. They were also pursuing more general models that would predict shifts in business over time.

Hospital-Specific Analytical Activities: Brigham & Women’s Hospital

Like MGH, the Brigham’s analytical activities in the past had been largely focused on clinical research. Now, however, it was also addressing much of the same business, operational, and meaningful-use issues as MGH. Many of the analytical activities at the Brigham were pursued by the Center for Clinical Excellence, which was founded by Dr. Michael Gustafson in 2001. The center had five functionally interrelated sections:

• Quality programs

• Patient safety

• Performance improvement

• Decision support systems (including all internal and external data management and reporting activities)

• Analysis and planning (which oversees business plan development, ROI assessments for major investments, cost benchmarking, asset utilization reporting, and support for strategic planning)

The CCE had close working relationships with the Brigham’s CFO and Finance organizations, the Brigham’s Information Systems organization, the Partners Business Development and Planning function, and other centers and medical departments at the Brigham.

One major difference between the Brigham and MGH (and most other hospitals, for that matter) was that the Brigham established a balanced scorecard beginning in 2000. It was based on a well-established cultural orientation to operational and quality metrics throughout the hospital. Richard Nesson, the Brigham CEO who had partnered with CIO John Glaser to introduce the LMR and CPOE systems, was also a strong advocate of information-driven decision-making on both the clinical and business sides of the hospital. The original systems that Nesson and Glaser had established also incorporated a reporting tool called EX and a data warehouse called CHASE (Computerized Hospital Analysis System for Efficiency). The analyses and data from these systems formed the core of the Brigham’s balanced scorecard.

Before an effective scorecard could be developed, the Brigham had to undertake considerable work on data definitions and management. One analysis discovered, for example, that five different definitions of the length of a patient stay were circulating in 11 different reports. The Chief Medical Officer at the time, Dr. Andy Whitte-more, and the CCE’s Dr. Gustafson, a surgeon who had just taken on quality measurement issues at the Brigham, addressed these data issues with a senior executive steering committee. They decided to present the data in an easy-to-digest scorecard.

Under the ongoing management of the CCE, the scorecard contained a variety of financial, operational, and clinical metrics from across the hospital. The choice of metrics was driven by a “strategy map”⁹ specifying the relationships between key variables that drove the hospital’s performance (see Figure 15.1). Unlike most corporate strategy maps, financial performance variables were at the bottom of the map rather than the top. The hospital-wide scorecard had more than 50 specific measures, and departments such as Nursing and Surgery had more detailed scorecards. The scorecard also had been extended to Faulkner Hospital, a Partners institution that was managed jointly with Brigham.

Figure 15.1. Strategy map for Brigham & Women’s balanced scorecard.

Dr. Gary Gottlieb, the Brigham president from 1992 to 2009, was the most aggressive user of the scorecard. He noted the following: I review the balanced scorecard on a regular basis because there is specific data that is of interest to me. There are key metrics I examine for trends and if they develop, then I analyze the data to better understand what is going right or wrong. It is one view, but an important one of our hospital. I can look at the balanced scorecard and get information in another way, from a different perspective than I can when I’m making rounds on a hospital unit, or sitting in the meeting with chiefs.

Gottlieb left the Brigham CEO role to become the CEO of Partners overall in 2010. One of the primary initiatives in his new Partners role was to expand the degree of common systems throughout Partners so that there could be common data and analytics throughout the organization. Perhaps one day, he speculated, all of Partners Health-Care System would be managed through one scorecard.

Endnotes

1. This and other details of the Partners LMR/CPOE systems are derived from Richard Kesner, “Partners Healthcare System: Transforming Health Care Services Delivery Through Information Management,” Ivey School of Business Case study, 2009.

2. Chelsea Conaboy, “Partners HealthCare in Talks to Buy New Electronic Records System,” Boston Globe, May 17, 2012.

3. www.partners.org/cird/.

4. “HPM and IT: A Successful Working Partnership: Q&A with James Mongan and John Glaser,” Partners IS Newsletter, Winter 2010, p. 1.

5. PricewaterhouseCoopers, “Partners HealthCare: Using EHR data for post-market surveillance of drugs,” 2009.

6. Healthcare Financial Management Association, “Developing a Meaningful EHR,” www.hfma.org/Publications/Leadership-Publication/Archives/Special-Reports/Spring-2010/Developing-a-Meaningful-EHR/, Part 3 of “Leadership Spring-Summer 2010 Report: Collaborating for Results.”

7. The 25 meaningful-use criteria are described in www.healthcareitnews.com/news/eligible-provider-meaningful-use-criteria.

8. Kaplan, Robert S. and Norton, David P. “The Balanced Scorecard: Measures that Drive Performance,” Harvard Business Review, January–February 1992.

9. Kaplan, Robert S. and Norton, David P. “Having Trouble With Your Strategy? Then Map It,” Harvard Business Review, September–October 2000.