Connections: January 2025 - 10

Clinical
Integration at
Dartmouth Health
Seeing value in
collaboration
F
or Dartmouth Health chief medical
officer Ed Merrens, MD, clinical
integration is all about matching the
needs of our patient population to
the medical infrastructure that spans the two
states of New Hampshire and Vermont.
Dartmouth Health is unique because it
serves primarily unique populations from rural
New Hampshire and Vermont at the Canadian
border to the Boston region, and includes an
academic medical center that can treat the
most challenging patients' needs. Merrens'
work in clinically integrating the Dartmouth
Health system is focused on enhancing
the capabilities of all of Dartmouth Health's
member hospitals. As Merrens describes it,
these efforts will result in " enhanced care,
brought to the community, tied to our
academic medical center, and done really well. "
Connecting with clinical and administrative
leaders across the system, Merrens is working
with member hospitals in order to better serve
patients by providing access to complex care
throughout our communities. This includes
implementing a system perioperative approach,
through teleheath and capacity coordination,
looking at each member's care environment to
see how each could be enhanced to serve both
patients and the system overall.
Examples include collaborative
ophthalmology services at Mt. Ascutney
Hospital and Health Center, providing
tele-ICU and nephrology services at Cheshire
Medical Center, hiring new providers to
expand community General Surgery at
Alice Peck Day Memorial Hospital,
increasing access to care at Dartmouth Cancer
Center's radiation/oncology care at Dartmouth
Hitchcock Clinics Manchester, and providing
highly rated emergency care and telemedicine
services across our system of Critical
Access community and PPS hospitals.
It also requires a complex and strategic
view of how to develop, coordinate and
enhance clinical operations and care across the
system. For example, when Valley Regional
Hospital joined Dartmouth Health in July 2024,
the Clinical Integration team realized a great
opportunity to coordinate care, develop a new
site for surgery and more highly integrate with
Mt. Ascutney Hospital and Health Center.
Merrens aims to bring complex care and more
integrated services to more communities and
believes that Dartmouth Health's member
hospitals like Valley Regional are a means
to achieve that. The system Strategic Plan
includes a lot of work focused on continued
collaboration to provide services across our
service area. Leaders such as Samuel Shields,
MBA, MHCDS, system vice president of
Strategic Planning and Operational Excellence
and Lillian Powell, MBA, MPH, senior director
of System Strategy and Business Development
have also played a significant role in helping
shape strategy around clinical integration.
Merrens feels that " What really knits us
together is our IT (information technology)
approach with EPIC. That changes everything.
We can work on one shared electronic record,
share imaging and coordinate care across
sites-it makes things much easier. " EPIC is
the electronic health records system used by
Dartmouth Health. The Dartmouth Health
team has worked to modify and develop EPIC
under the leadership of Peter Solberg, MD,
chief health information officer and
Martin Purcell, MBA, chief information officer
and has made improvements so that it now
serves as a unique, individualized system that
supports broad integration efforts.
Other examples of how Dartmouth Health
is becoming more integrated include the
Dartmouth Health Chief Medical Officer
Ed Merrens, MD
expansion of telehealth services under
Kevin Curtis, MD, emergency medicine,
and Katelyn Darling, operations director
of connected care, creating a system-wide
network of medical specialists. The Capacity
Coordination Center, led by Jessica Ryan, RN,
system vice president of care coordination,
and Colin Stack, MD, emergency medicine,
enables patients to be moved across the
system to the most appropriate hospital for
care, and is supported by Care Management,
Nurse staffing, Utilization management and
coordinated transportation. Increasingly
the system is working towards a " One call
does it all " model of coordinated care and
moving patients from one acute setting to
another, often closer to home for continued
inpatient care. Merrens says, " We are working
to collaboratively enhance everything from
emergency care, triage and telehealth to
create a system hospital medicine group as
well as share protocols and care paradigms to
extend the team model. "
Integrating a system like Dartmouth Health
to maximize its infrastructure potential is a
challenging proposal, but is one that Merrens
feels can be achieved through collaboration,
connecting people, and taking advantage
of all the resources available, including local
expertise and ingenuity.
" We want to utilize all the aspects of our
system in order to provide timely patient care
and increase access, " he says. " Patients want
efficient care and we want to always frame our
efforts around the patient experience. "
Next Month: How the
Capacity Coordination Center
places patients at the right location
for the level of care they need.
Connections: January 2025

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