Dr. Brent James, executive director of the Intermountain Health Care's Institute for Health Care Delivery Research, held a meeting with several staff members which included physicians, nurses, and clinical leaders. Dr. James discussed the institute's policies regarding delivery to the patients and how these policies could improve the quality of patient care. "Anytime I get physicians to use them, I'm basically tracking them into an evidenced-based, standardized line of clinical thought." (Bohmer and Edmondson, 2003). One nurse that was involved in the meeting, wanted to make a point that each patient's case is treated uniquely and to expect that each patient's care was managed the same manner was inappropriate. This nurse referred to patients not being treated as if they were an assembly line. The nurse stated that "we're not making widgets here!" (Bohmer and Edmondosn, 2003). Dr. James disagreed and felt that the comparison could be done.
Health care staff from different levels within the organization had access to patient records that were stored in a centralized database. The staff utilizing this database is employed by Intermountain Health Care's Institute for Health Care Delivery Research. As this EMR held pertinent information, non-employed physicians from other locations of the Institute did not want to follow the policies regarding the use of the EMR. One of the challenges Dr. James faced was how to get the non-employees "on-board" and utilize the system.
In 1975, Intermountain Health Care consisted of fifteen hospitals in Utah. "In 1983, Intermountain Health Care transitioned from being exclusively a hospital company and became an insurer. The provider arm was known as IHC Health Services. By 2002, IHC Health Services comprised more than 150 facilities, including 22 hospitals, 25 health centers and over 70 outpatient clinics, counseling centers, and group practice offices." (Bohmer and Edmondosn, 2003). As you can see, many different businesses make up the foundation in which the Research Institute is able to view health care quality and cost. Like any organization or company, outcomes are important and need to be viewed by all of the providers within their network of services.
Dr. James stated "We just started to add cost outcomes to our traditional clinical trials and proved it true within a few months." (Bohmer and Edmondosn, 2003). This is proof that higher quality can lead to lower cost. "James was able to attach costs to individual clinical activities and then build a cost profile of different strategies for managing a particular clinical condition." (Bohmer and Edmondosn, 2003). A challenge Dr. James faces is how to get all of the physicians, managers and staff engaged with this strategy.