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Dome - Leadership Speaks: A case for clinical integration

December 2011

Leadership Speaks: A case for clinical integration

Date: December 16, 2011

Ron Peterson

When I talk about why we are restructuring Johns Hopkins Medicine, I first focus on how it will strengthen our brand, how it will support our tripartite mission and how it is going to make a difference in the way we provide health care to our patients.

To the latter point, achieving clinical integration throughout our health care delivery network is important—and perhaps the most challenging. It is also the way of the future, because we need to better coordinate the care that we provide. Clinical integration is making sure that across the health care system we are communicating effectively with each other, and practicing the same quality care standards and protocols.

What is particularly essential, yet difficult, is the interface between the faculty located in East Baltimore and at the Johns Hopkins Bayview Medical Center, with our community doctors, whether they are a part of Johns Hopkins Community Physicians or the private physicians and practices that are associated with our hospitals.

We are thinking a great deal about how we engage with the variety of physicians interacting with us. As we looked at the operational restructuring of Hopkins Medicine, we kept this in mind, and this has led to the creation of the Office of Johns Hopkins Physicians.

This office is working closely with the Community Division, headed by Brian Gragnolati, to address our community physicians’ needs, whether they are those that a community hospital president might perceive or those of a private practice physician wanting to become more aligned with Hopkins Medicine. We believe this alignment will promote true clinical integration.

How? If a patient is being treated by a community-based physician, but at some point needs to be seen by one of our faculty specialists or enters our system through one of our hospitals, we foresee a seamless way to facilitate that. With this better alignment among our physicians, we bring ourselves one step closer to an integrated, more effective and patient-friendly system.

Another way that we are moving toward the goal can be seen in the efforts of both Bill Baumgartner, senior vice president in charge of the Office of Johns Hopkins Physicians, and his deputy, Steve Kravet, president of Johns Hopkins Community Physicians, who are developing a medical service organization. The concept is to offer community physicians a set of services by which they can align themselves with Hopkins in ways other than being employed by us, such as our billing services, our medical malpractice insurance, our continuing medical education courses and our protocols for patient safety and quality care.

It is fair to say that in a complex system such as ours where you have large number of faculty specialists, private practice doctors and a primary care group, the communication piece can be challenging. However, if we do it right, it will help us to achieve true clinical integration. Of course, when we fully implement the Epic electronic medical record system, all providers employed by us or practicing in our community hospitals will have access to it, as will our patients.

I should also mention one of the most effective models for clinical integration. Julie Freischlag, director of the Department of Surgery, and Brian Gragnolati came up with the idea to create the role of regional director of surgery for the National Capital Region and recruited Michael Zenilman. He’ll establish a high bar for quality surgery in these three hospitals.

Finally, I view clinical integration not as a finite endpoint but as an ongoing objective. I hate to venture a guess on exactly where we are in that continuum, except that we’re relatively early in the process. But we will get there. We have to. In the health care environment that is taking shape, where the government is not going to be paying as well for the services providers deliver, we will need to be smarter in the way that we do our business. Part of the idea is having a more highly coordinated approach to caring for our patients.