|Daniel A Handel, M.D. , Chief Medical Officer|
The MUSC Medical Center has named Daniel A. Handel, M.D., MPH, MAS, an Associate Professor of Emergency Medicine and Vice Chair for Clinical Affairs for Emergency Medicine at Oregon Health & Science University (OHSU), as Executive Medical Director/Chief Medical Officer, effective March 3. Dr. Handel received his medical degree and a Master of Public Health from Northwestern University, a Master of Aeronautical Science degree from Embry Riddle University, and will complete a Master of Business Administration from OHSU in June 2014. He completed his Emergency Medicine (EM) residency at the University of Cincinnati Medical Center. At OHSU, he held a series of medical leadership roles in which he addressed key hospital management issues that include many of the same issues that MUSC faces: electronic health record implementation, access to ambulatory facilities, capacity and patient flow, and quality and safety. Progressnotes spoke with him to learn more about his background and how he will apply that experience to advance the strategic goals of the institution.
PN: You’ve said that Oregon Health & Science University has been able to improve patient flow in recent years. Can you tell us how that was accomplished?
DH: One of the things I feel most proud of is the transparency we brought to patient flow throughout the institution. We made people realize the importance of ensuring that patients got timely care and transition on to the next phase of care. We created discharge appointments that enabled us to produce an inpatient capacity dashboard to help the hospital be proactive in patient flow management. At 5:45 a.m. every day, the capacity report is e-mailed to hospital leadership and unit managers. The other thing we did was build a data infrastructure to be able to truly understand where the patient flow bottlenecks were.
This emphasis on improving patient flow is one of the things that appealed to me about the position at MUSC. The challenge is not only how to serve the needs of patients in our hospital but also the needs of patients throughout the state who need to transfer in. My first goal is to truly understand the bottlenecks. What are the data telling us? Are certain days of the week consistently better or worse than others? What does that tell us about how we schedule elective admissions and accept transfers?
There are several things we can look at regarding the completion of a patient’s hospital course. How long does it take from when the discharge order is written to when the patient leaves the hospital? What barriers does he or she face? A ride home? Nursing home placement? An hour delay here and there that we can eliminate can have a significant impact across the population and increase our capacity to provide care.
PN: Another issue that all large medical centers face is ensuring ambulatory patients’ access to clinics. What are some of the methods you’ve found to be effective for improving access?
DH: This is always an ongoing process. The goal is to standardize the intake for the various clinics. I would like to take time to learn how the clinics operate and work with the leaders to streamline the appointment process. We’ll also be looking at how to make it as easy as possible for community providers to get their patients referred to the appropriate specialist.
PN: What have you learned from rolling out electronic health records at OHSU and what are your plans for sharing that experience with MUSC as our rollout unfolds?
DH: OHSU went live with the outpatient ambulatory module in 2005 and then the inpatient module in 2008. It’s important to realize that going live is just the start of a process. It requires a continuous iterative optimization to truly harness the potential of the system. People get bogged down in how perfect it has to be before it goes live. The most important thing is to make sure that clinicians are able to get into the system and deliver care. But we must also be sure to know how to use the data to measure the level of care we’re providing.
PN: Electronic records provide reams of data.
DH: The challenge is: How do you filter the data in a way that’s meaningful not only for making the institutionally strategic decisions but also for meeting the providers’ needs? We all want to do better, but we need the data to tell us where we can improve.
PN: Does your professional training as an emergency physician give you any particular insight or skill that has prepared you for your new position?
DH: Emergency physicians are trained to be problem solvers, to not just look at the patient in front of us but to understand the whole continuum of care. I believe I have a background of understanding not only episodic health care, but also long-term solutions to population health. It’s the chronic illnesses, not Emergency Department (ED) visits, that are driving the true cost of health care. How do we as an institution spearhead that work to address the health care needs of our state? Dr. Cawley, as CEO of the medical center, will be leading that conversation. I think it’s critically important that our CEO is a clinician. For me, being a practicing clinician will continue to be important. Working in the ED is a good barometer of the overall operations of the hospital. If the ED is running well, then patients are flowing well through the system. It’s also important to work during different times of the week to see the different challenges. You always discover things at 3:00 a.m. that no one tells you about.