If a clinician at Sparrow Health System in Lansing, Mich., wants an opinion from Mayo Clinic specialists on a specific issue with a patient, that patient's electronic records are uploaded to Mayo's clinical information system through a portal. The consultation is sent back electronically.
In addition, a repository of medical information developed and vetted at Mayo, originally for internal use, has "succinct answers about literally thousands of medical issues," says David Hayes, M.D., medical director of the Mayo Clinic Care Network. The service, called Ask Mayo Expert, also provides access to Mayo-developed care pathways that guide courses of treatment as well as to patient education materials.
Knowledge transfer is the centerpiece of clinical arrangements between renowned centers of medicine and community hospitals. "Very candidly from the get-go, what we were looking for in the Mayo Clinic Care Network connection is really about access to the human and intellectual capital," says Dennis Swan, Sparrow's president and CEO. "Physically we're out there often, physically they're here often, but in between we're also connected electronically, so that we can have Mayo experts involved with physicians here in the treatment of our patients."
Sometimes the side-by-side synergy of doctors trading insights leads to action at community hospitals ahead of the medical curve. At a meeting of physicians from Hartford (Conn.) HealthCare and Memorial Sloan Kettering Cancer Center, a discussion got started on a new approach called "sentinel lymph node mapping" for endometrial cancer. It led to a trip within weeks to the New York cancer organization, time in the operating room observing the procedure, and then porting the concept to the Hospital of Central Connecticut, a Hartford HealthCare member facility, says Wendy Perchick, MSK's senior vice president of strategy and innovation.
Within a month of instituting sentinel node mapping at Hartford HealthCare, the National Comprehensive Cancer Network declared it the standard of treatment, Perchick says. "Rapid adoption through collaboration in the disease management team is really powerful."
The transfer of team management concepts is a high priority in itself. At MSK, 17 different multidisciplinary groups are in operation, comprising surgeons, medical oncologists, radiation therapy oncologists, radiologists, pathologists and more, says John Gunn, executive vice president. The coordinated teams, structured into these groups about 25 years ago, have become very adept in the different kinds of cancers. For Hartford physicians, depending on their areas of expertise, "they will become part and parcel of these disease teams here," Gunn says. They'll be in on how-to meetings, and they will have access to the latest treatments.
The consulting extends to administrative, operational and cultural aspects of delivering health care, says Jonathan Raven, an emeritus board member who served during the Mayo-connection decision. One basic goal set by the board is to "create a gentle environment where there is openness and trust among all providers, which is in fact the Mayo way," he says. "You get an environment where there's this passionate communication, doing sacred work with mutual respect for all professionals."
In sum, the know-how at Mayo is valuable to others. "Over the years, there aren't many problems or issues or new things in medicine that Mayo hasn't tackled," Hayes says. "Every time we either work on an improvement process or develop a new initiative. … we always have as part of our team a system process engineer. As a result of that, every time we approach a new process or improve an old process, we really emerge with a blueprint, if you will, that covers all the details." Those practices can be shared but tweaked for community systems such as Sparrow, which don't have to start from square one and can progress faster and less expensively, he says.
At M.D. Anderson Cancer Center in Houston, leaders spent 10 years capturing all it does and structuring it "into one transferrable body of knowledge," says Melanie Wong, vice president of strategy and business development for the M.D. Anderson Physicians Network. The aim is to develop the body of knowledge into a program that shares information with organizations seeking to improve clinical care in their community, she says.
Multidisciplinary care is a complicated concept, and that's why M.D. Anderson worked through a process to explain and implement the way it does team care. Cancer can't be overcome through individual effort, Wong says. And leveraging the promising paths that others have forged and documented is the way to preserve patient lives. "In no other disease is there this standardized approach to the whole cycle of a patient treatment process," she says.
Besides packaging their knowledge for the benefit of communities, the eminent medical centers are conceiving with their community partners new configurations of health care that focus on delivering complex care where people live. "We have seen people stay here for care — care-coordinated by Mayo and Sparrow physicians working together — who otherwise without question would have traveled to Rochester," Swan says.
"They subscribe, and we subscribe, that the best care is oftentimes the care that's delivered as close to home as possible," Swan explains. "Doing things in a coordinated way we think ultimately gets you to a better-and-quicker proper diagnosis, but also gets you on to your course of treatment quicker as well, and everything doesn't have to be done in one location."
Hospital care is being de-emphasized and population health coming on fast, but Hartford President and CEO Elliot Joseph says the consequence is "not the disappearance of America's hospitals, it's the transformation of these important institutions in our community." Instead of "trying to keep our hospitals full," initiatives such as Hartford's elevation of cancer care are "building the capacity to manage these patients in their access to acute care, through clinical trials, and long-term chronic disease management — in their neighborhoods, but based on a standard of excellence."
Many of the people who stand to benefit "don't even know they will be the beneficiaries because they haven't been diagnosed yet," Joseph says. "Unfortunately the incidence of cancer is going to continue to increase, and over the next 2-3 years our job is to provide the very best care and the very best support systems, so that we can spread this excellence amongst more and more patients who are in need."
"I'm a survivor myself, I had cancer, I know what it's like to go through it," Joseph says. "And the fear and anxiety that you as a patient and your family go through searching for the right answers can be overwhelming. Our position in this market is to be that expert that people can come to — most trusted, and nationally recognized."
For more on alliances between nationally known organizations and community hospitals, read our cover story, "Partners in Clinical Excellence."
John Morrissey is a freelance writer in Mount Prospect, Ill.