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As CMIO of United Hospital System in Wisconsin, I try to make it easy for our physicians to get the information they need to make the best clinical decision. Recently we deployed a Medical Logic Module (MLM) for all 40 of our employed physicians so they can do just that. Using the MLM, they can view, with one click in their Sunrise Ambulatory EHR, everything they need to manage a patient with chronic disease – and they can do it in less time, with improved accuracy and better outcomes.
Before I go on, though, a little history might be in order. If you’re not familiar with MLMs, you should be. An MLM is a bit of computer wizardry that’s designed to find all the information within an EHR database pertinent to a single question and alert doctors when the right conditions are met. For instance, you can write an MLM that keeps watch for renal failure and is triggered when a Creatinine result is recorded in the EHR.
The idea is to make it relatively easy for healthcare organizations to implement advanced clinical decision support with minimal help from their EHR vendor.
But MLMs can do far more than trigger alerts in an EHR. Our new chronic disease MLM, for instance, improves documentation, helps us meet performance measures, saves time and, we believe, will help our physicians improve patient care by ensuring they meet quality measures.
Let’s say I’m seeing a diabetic patient. Before we deployed the MLM, I would have had to check a few different places within our EHR and possibly the hospital’s Sunrise Acute Care EHR (which is on the same database) to confirm the last foot exam, last eye exam, last blood glucose result, and several other key pieces of information. But today that’s not necessary. The beauty of the new MLM is that, like a web spider, it pulls in with one click all the information I want, so I have more time to spend with the patient, make a good decision and talk with the patient about it.
It’s like somebody handing you a summary sheet when you walk into the room. Then you just add some of the information obtained in the interview and you’re done. It both improves documentation and saves me easily 5 minutes on a 15-minute visit, which adds up over the course of a day. But more importantly, it helps us ensure we meet quality measures when caring for chronic disease patients because all the information is right there in front of us, including any results that are missing or need to be updated.
I call that “EHR happiness” – when you actually look forward to seeing a patient with a chronic disease because you know you have this tool that will make the process easier and you know you’ll get better outcomes.
Here’s a screenshot that shows what the MLM produces with one click in a patient with Diabetes and Hyperlipidemia.
Using the Allscripts Client Connect portal, I’ve shared the MLM with other hospitals and doctor’s groups who seem to agree. That reciprocal exchange of MLMs is exactly what we need to be doing to take good care of patients. At a time when more and more quality guidelines are being disseminated by payers and the government, an MLM is the perfect way to help doctors meet the guidelines simply by using the everyday workflow of their EHR.
Just one caveat. It’s wonderful to have a vendor who provides MLMs like this one created by Allscripts CMO Dr. Rick Mansour. But most organizations will still need a full-time MLM writer to adjust the MLM for their own Sunrise environment. We have only a part-time writer, which slowed down the process.
I’m interested in hearing whether you’re using MLMs to improve decision making in your organization, and whether you share them with other organizations. I’ll do my best to respond to comments in a timely manner.