Universal Health Services
King of Prussia, Penn.

Universal Health Services wanted to improve patient care by enhancing its EMR usability and efficiency. The organization rolled out its EMR to all 25 acute care facilities where 97 percent of the 6,000 physicians are independent.

During the support process, the organization learned that users wanted better communications delivered in a no ndisruptive way, says Ori Lotan, MD, associate CMIO. For example, a physician might be in the system working on information about one patient when an alert fires about another patient. “That can be a nuisance.”

Lotan and his colleague, Ehab Hanna, MD, another UHS CMIO, developed an inpatient notification system designed to display pressing patient concerns face up in the tool with one-click renewal. Communications from nursing, pharmacy and ancillary staff as well as clinical alerts (such as sepsis) are posted and can be viewed and acknowledged by any provider caring for the patient.

The system works in the physicians’ favor, says Hanna, because it covers issues they have to address anyway. The system ties these “pain points” to each patient so there aren’t problems such as inpatient medications and orders for restraints inadvertently expiring.

UHS has a development license from its EMR vendor so the tool was custom developed in-house by its own staff. “We’re trying to innovate in a manner that is accelerated compared with the 18 to 24 months we see on the vendor side for enhancements they agree to do.”

Lotan calls the system the next generation of clinical decision support because it is “a little more intelligent than just something that fires that a user can dismiss.”

UHS plans to expand the notification system with more physician-to-physician communication, enabling, for example, correspondence between hospitalists and cardiologists. Feedback also has helped Lotan and Hanna direct other enhancements such as an option to view what medications and orders qualify for renewing but have not yet been renewed.

VCU Medical Center
Richmond, VA.

VCU Medical Center has a goal of being the safest health system in the U.S. and its homegrown dashboard is a big part of that mission.

The organization developed the Medical Early Warning System and Pediatric Early Warning System (MEWS/PEWS) and first deployed the tool in 2012, says CMIO Colin Banas, MD.

“After a poor outcome for a pediatric patient, we recognized a need to give our front-line clinicians and rapid response team (RRT) a real-time monitoring system that continuously measures patient acuity and severity,” Banas says. “Looking back through the record and the data it was clear that there were subtle hints and trends that were portending a decline, yet we all missed it.”

Development started in 2010 after this event and employed a multi-disciplinary team including experts from multiple fields including respiratory therapy, critical care, nursing and pediatrics. “It was a long and iterative process, but we are very proud of the final product and the results to date,” says Banas.

Color-coded and interactive, the dashboard identifies the most ill and trending ill patients so the RRT can use that information to intervene before their decline. The dashboard is accessed more than 100 times a day and the RRT accesses it on mobile devices, sometimes arriving at the bedside before the primary team.

The tool calculates the patient illness level using physiological data that is already inherent in the EMR. The MEWS/PEWS scoring algorithm is based on evidence-based protocols that have been in use on paper for many years. In the first year of MEWS/PEWS, the hospital experienced a 10 percent reduction in code blues in the ICU and a 20 percent reduction in code blues outside of the ICU. VCU also realized a 5 percent reduction in in-house mortality.

Looking ahead, Banas says the organization will expand the tool to other service areas and address the many custom dashboard requests. “Users are really starting to see the power of the EMR and are asking for new and innovative ways to improve the outcomes of their patients,” Banas says.

Penn State Hershey Medical Center
Hershey, Penn.

Penn State Hershey Medical Center was looking for a way to improve its quality improvement efforts with more efficient quality indicator review. Because the measures are reviewed retrospectively, clinicians were missing the opportunity to improve care as it’s provided.

The organization developed a quality indicators (QI) dashboard to turn data into actionable information, says Darla Marks, MSN, RN, manager of nursing informatics. An interdisciplinary team of clinicians collaborated with nursing informatics and IT resources to create clinical decision support tools to provide real-time information about quality indicators.

The QI dashboard was deployed hospital-wide in March 2013 and since then, Penn State Hershey has improved numerous quality measures including infection rates, use of restraints, vaccines and falls. The dashboard within the EMR provides immediate, actionable information for use during provider and nurse rounds, hand-off communications and nurse-to-nurse communications. The dashboard provides a “quick view” of the quality indicators and allows charting directly from the dashboard. Links from key indicators allow staff access to orders and documentation improving the efficiency of identifying missing elements related to each indicator.

The neuroscience critical care unit reduced catheter device utilization by 21 percent and the catheter-acquired urinary tract infection rate decreased by 86 percent, says Marks. The hospital also has saved money by avoiding penalties related to compliance measures and decreasing extended hospital stays due to hospital-acquired infections.

The QI dashboard has strengthened day-to-day operations of the clinical workflow, improving hospital efficiency by taking less time to find the quality indicators within the EMR and has brought more value to how and what kind of data/information is being documented, she adds.

Mike Ward, BSBA, lead analyst, develop the dashboard which includes color, icons and links. The charge nurses started to use it first and “once they saw the value, use of the tool skyrocketed to all staff,” says Marks.

The tool is constantly being enhanced by recommendations from the unit level quality teams, he says. The organization is now working on a similar tool for outpatient and disease management. Matt Loser, BBA, also worked on the tool.

Butler Health System
Butler, Penn.

Butler Health System was looking for ways to enhance patient engagement for patients undergoing joint replacement and bariatric surgery.

Most patients just come into the hospital for the surgery or testing. But, the hospital can provide a lot of education, reminders and follow-through with care in conjunction with primary care providers, says Cynthia Esser, director of emerging technologies. “We wanted to better engage patients by having them acquainted with us way in the beginning when they are making the decision to have surgery.” That makes them feel more welcome and less anxious, she adds.

Because of the long lead time for bariatric surgery—up to one year—patients have a lot of information to manage. Joint replacement surgery patients typically sign up for surgery 6 to 8 weeks in advance. They are more likely to be older but indicated they were interested in online support, says Esser.

BHS worked with a vendor to design Guided CarePaths for its BHS Total Care, which was designed to blend online technology with in-clinic support. Patients can access the care paths online at their convenience for online education, family involvement, checklists and reminders, outcomes surveys, satisfaction surveys along with opportunities to submit needed information, like home assessments and discharge planning forms. “We identified every entity that would touch the patient from the time the patient decided to do the surgery,” says Esser, including therapists, nutritionists, social groups and psychiatry.

The company hosts the product online so there have been no technical challenges, she says. Patients can access the information at any time and the hospital contacts them when it’s time for the next step of surgery preparation. Enrolled patients have reported better satisfaction with the overall experience and the program has provided cost savings related to patients being better prepared, improved quality measures, improved patient satisfaction scores and improved staff efficiency in the collection of information and feedback from patients.

The program also has helped improved compliance with the important six-week follow-up appointment that serves as a chance to check for problems such as depression and infection.

BHS plans to expand this program to other service lines including cardiology and more orthopedics, says Esser. “Patients have more choices and can decide if they want to come here or there. If you are engaged with patients, you will have more of a relationship and that’s important.”

Michigan Urological Surgery Improvement Collaborative
Michigan

Michigan Urological Surgery Improvement Collaborative (MUSIC) was launched in 2012 with the ultimate goal to improve quality and cost efficiency in prostate cancer care.

Through the creation of a state-wide clinical registry, MUSIC collects statewide data on patient demographics, cancer severity, utilization and outcomes for radiographic staging studies and patterns of care.

MUSIC’s infrastructure brings together evidence-based medicine with clinical experience and collaborative physician learning, says Susan Linsell, BS, MHSA, senior program manager. Blue Shield Blue Cross of Michigan covers the cost of the program and MUSIC also works with a vendor’s cloud-based analytics platform to identify best practices and disseminate the information across the state.

With 90 percent of the urologists in Michigan participating in MUSIC on a voluntary basis, the program has led to quality improvements including statewide reductions in the utilization of radiographic imaging for staging patients with low-risk prostate cancer and reductions in the frequency of biopsy-related infectious complications.

MUSIC uses innovative approaches in three areas: data analysis and feedback; quality improvement; and assessment of the impact of quality improvement efforts, says Linsell.

The data are analyzed to determine the performance of each MUSIC practice and urologist in comparison to their peers. Metrics related to prostate biopsy, radiographic staging, radical prostatectomy outcomes, and patient-centered decision making are shared among the participants.

Looking ahead, MUSIC plans to create a tool that expands the ability of patients to play a role in their treatment decisions and “continue to identify opportunities for improvement while tracking those we have implemented in the past,” says Linsell.