“Today, medical data is not portable across all systems. That’s the big problem we’re ultimately trying to fix.”
Fueled by advancing technology and the unprecedented infusion of federal funding, the United States is speeding toward a digital evolution in healthcare information. The promise holds that better use of technology will improve patient care and save the system billions of dollars. It’s a massive transformation, affecting myriad individuals and institutions, and Michael Gagnon ’81 and John Janas ’79 are just two WPI alumni who are leading the change at both ends of the spectrum.
It’s easy to imagine: A guy from Detroit is vacationing on Michigan’s upper peninsula and falls off his all-terrain vehicle, breaking his leg and suffering a concussion. He is rushed to the local emergency room, unconscious, and with a few key strokes his entire medical history is displayed on a screen to help guide the ER team.
What’s easy to imagine in our digital age, however, is not yet possible in practice. Making it so is the latest challenge for Mike Gagnon. “Today, medical data is not portable across all systems. That’s the big problem we’re ultimately trying to fix,” he says. “I like to fix big, messy problems, and this is a big one.” Gagnon is the technical architect for the Michigan Health Information Network (MiHIN), the public-private partnership working to link healthcare providers across the state into a single network. Their goal is to have the medical records for each of Michigan’s 10 million residents accessible whenever, and wherever, they’re needed. He’s taken on the challenge in Michigan after helping the states of New York and Vermont design and launch various elements of their health information networks.
Getting an entire state healthcare system working on one network is a massive undertaking. Beyond the complexities of making incompatible systems talk to each other, details such as ensuring that a patient’s identity is correct across the network are not as straightforward as one might imagine. It’s very common for a person to be identified in different ways by different healthcare providers, Gagnon says. A patient may use her full name at her primary care doctor, but drop her middle initial when registering with a specialist. A lab report with blood sugar results may list a patient as Bob instead of Robert. So when our fictional tourist is on the bed in the ER, a networked health information system needs to know which records are really his
In Michigan, Gagnon leads a multifaceted team to conceptualize the design of a workable network for the state. “Right now, we’re at the very-high-level design stage of the system,” he says. “We’re evaluating the status of our providers, looking at what core technologies we need, and starting to develop standards for interoperability, privacy, and security that we will embed in the system. Every state in the country will be doing this eventually.”
Crafting the big picture for healthcare information technology was not on Gagnon’s radar screen growing up in Hopedale, Mass. He knew he wanted to be an engineer, but he was not focused on any particular area. When WPI offered a scholarship, his father suggested studying computer science because, as his dad presciently told him back in the 1970s, “this computer thing is going to be big.”
“My father worked for the state department of employment security, so he saw where people were getting laid off and where the job opportunities were good,” Gagnon says. “His advice to me was right on target.”
After earning a degree in computer science, Gagnon went to work for a defense contractor—now part of BAE Systems— where he developed a networking algorithm for the Patriot Missile training system that allowed a battalion commander a unified view of the battlefield so he could direct each missile battery from a single location. In 1990 Gagnon moved to Wisconsin, following his future wife, Heidi, an engineer trained at UMass Lowell. He landed an IT job in the department of laboratory medicine at the Mayo Clinic, which set him on a new career path. “Working at Mayo was an amazing educational experience,” Gagnon says. “I learned a lot about the business of healthcare.”
At Mayo he developed the clinic’s first electronic system for sending test results to hospital-based laboratories. He also designed Mayo’s electronic clinical trial control system. In 1997, after the family had moved back to New England, Gagnon became the director of IT infrastructure at the Fletcher Allen Medical Center in Burlington, Vt.,where he led the development of several new health information systems, and helped set the standards for Vermont’s nascent health information network.
Now as a consultant and president of Health Information Exchange Partners, LLC, Gagnon sees no turning back on the digital evolution in healthcare systems in the United States. “The technology is definitely there—it’s ready,” he says. “I think we’re about five years away from seeing the core elements of these large health exchanges in place and starting to have meaningful use.”
“The electronic medical records (EMR) system not only made us moreefficient, it improved patient satisfaction.”
Spend any time on the Internet and you’ll see them—annoying pop-ups or artfully integrated displays specifically aimed at you, based on your demographics and your web-surfing history.
But long before this idea of selling soap through personalized information delivery became commonplace, John Janas saw the potential of using digital tools to deliver personalized medical information to help doctors take better care of their patients. “What we’re trying to do,” he says, “is take the best of evidenced-based medicine and integrate the relevant data into the doctor-patient encounter.”
A medical doctor turned software engineer, Janas developed a novel system to link established medical information, like guidelines for managing diabetes, with a patient’s electronic chart. In 2006 General Electric bought his patented software and it’s now embedded in GE’s Centricity® Physician Office system. “We want the technology to allow physicians to spend less time worrying about paperwork, and more time assessing their patients and developing treatment plans based on the best relevant information,” he says.
Growing up in Lowell, Mass., where his father practiced family medicine, Janas knew early on that he, too, wanted to be a doctor—even though his father was becoming disillusioned by the non-medical burdens placed on physicians. “My father actually tried to talk me out of becoming a doctor because he was concerned with the direction medicine was taking,” he says. Janas chose WPI because of its strength in the sciences and its project-enriched curriculum. His MQP work optimized techniques for isolating immune-system cells known as lymphocytes from human blood samples. [Lymphocytes help the body identify and fight off infections.] “This was the late 1970s, before people understood what was unfolding with HIV and AIDS, so my project turned out to be in a very important field,” says Janas.
Upon receiving his MD from Creighton University Medical School, Janas completed a combined internal medicine/ pediatrics residency at Bay State Medical Center in Springfield, Mass., then joined a family practice in Bar Harbor, Maine. After nearly four years on the island, he moved to the Dartmouth- Hitchcock clinic in Concord, N.H., where, in addition to seeing patients, he served as assistant director for managed care, focusing on improving the efficiency and quality of care.
During those years in New Hampshire, some of his father’s forebodings were realized. “The demands of the insurance companies and the government were hitting physicians with hours and hours of paperwork,” Janas recalls. “Paperwork can become overwhelming and it cuts into the time you spend with patients.”
Janas made a fateful decision. He left Dartmouth- Hitchcock to build a private practice, one with an electronic medical records (EMR) system. “We had an advantage because we were small and starting from scratch,” he says “We decided to do things differently and we became the first private practice in New Hampshire to implement EMR.”
Using such a system yielded benefits right away. It savedphysician, nurse, and staff time by having patient records always available. No more chasing down charts. Janas could communicate with patients by secure email, instead of returning phone calls from messages that piled up all day, or all weekend. The system handled reminders for visits and prescription renewals, cutting down on incoming phone calls. “It not only made us more efficient,” he says, “it improved patient satisfaction.” As helpful as the early EMR was, Janas saw a gap and an opportunity that ultimately led to his patented software. Until then, the growing amount of evidence-based clinical information on best treatment practices was available only by reading reams of medical literature. “And the reality is, not every physician can take the time to read all the literature,” Janas says.
So he began tinkering with computer code and developed applications for his EMR system that aggregated medical information from respected sources, and then brought that data into a patient’s record, as appropriate. When he saw a patient with high cholesterol, for example, the latest peer-reviewed guidelines for treating high cholesterol would pop up on the screen alongside that patient’s medical history and recent lab results.
With a colleague, he founded Clinical Content Consultants, which continues to develop new software tools to make the doctor-patient encounter more effective. He also consults with hospitals and physicians groups to help them effectively implement the GE system and to use the technology to drive better quality of care. “The software is important, but if they put only existing processes on the screen, it will fail,” Janas says. “What’s more important is training physicians and adapting their processes to use the technology.”Maintained by firstname.lastname@example.org
Last modified: July 13, 2010 08:15:49