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17. Building Consensus: Quality Improvement at Vesalius Health System 175represents a fixed amount a physician is compensated for in caring for a particulartype of patient. Capitation is intended to reduce costs by putting the physician at financialrisk for caring for a group of patients classified by a diagnosis or condition, suchas diabetes.)Three months ago, a chart audit of the diabetic patients seen at the Baltimore VSDclinic showed poor performance in achieving standard clinical goals set for treatingsuch patients. Performance on a number of outcome measures for diabetic patients waswell below national target goals. As a result of this chart audit, the VSD director, JessLockhart, worked with the newly developed internal information technology (IT) andVHP staff on a plan to improve the quality of care provided to these patients.After considerable research on the subject, Lockhart’s team developed a comprehensivediabetes management program that utilized a third-party diabetes managementmodule for the Limited Medical Systems EMR system. Seeking to help defraythe cost of this software module, VSD decided to look for partners across the VHSorganization. At a recent LUG meeting, attended by Dr. Lawler and key members ofthe other VHS ambulatory care divisions, Lockhart outlined the VSD plan and proposedthe partnership idea.While his presentation was well received by some, others rejected the proposal. Dr.Banting, the VMG medical director made a surprise counterproposal, announcing thatVMG’s IT department had already begun internal development of a diabetes registryand other related add-ons (forms, alerts, etc.) for Limited Medical Systems. He suggestedthat with added financial support from the other divisions and/or the corporateoffice, they could expand their effort. Other voices of dissent came from Med Edand the corporate-level disease management group, who were both noticeably upsetbecause they had not been consulted in the development of either plan.Witnessing this clear lack of coordination among the various VHS groups interestedin diabetes management, Dr. Lawler recognized a problem that would require his attention.In fact, it might be his first true test as the new CMIO at VHS. Here was an opportunityto enhance the ROI of the Limited Medical Systems EMR implementation.Enhancing the existing EMR to support the new diabetes disease management programcould generate new revenue. How could a strategy be developed that would workfor all stakeholders?Vesalius Corporate IT DivisionThe information system infrastructure at VHS is based on a predominantly decentralizedmodel, with each clinical division retaining the responsibility for managing its ownsystems operations. Hardware and software support, as well as policy administration,are handled at the local level. In contrast, the corporate information technology division(CITD) focuses on the IT needs of the health system as a whole. Among otherroles, CITD supports the systemwide network architecture, provides Web services, andcoordinates the implementation of core clinical and administrative applications.Under the direction of Allen Shmitt, chief information officer (CIO) for more thana decade, CITD established VHS as a relative leader in healthcare IT. Shmitt waslargely responsible for selection and implementation of the Limited Medical SystemEMR in each of the clinical divisions. At that time, in the mid-1990s, successful ambulatoryEMR implementations were still relatively uncommon. With the support ofsenior management, CITD was able to provide substantial assistance to the VMG,VSD,and Med Ed clinics during the Limited Medical Systems rollout. Considerable CITD