ay in herOutcomes
The HPH had a 20% increase of attributed lives without adding any PCPs, which accommodated future growth and fewer PCPs. By the end of the first year, HPH performance improved to 90th percentile benchmarks from a subpar ranking at or below the 50th percentile in most of these areas. HPH improved access to primary care services and achieved their four goals of the Clinical Guidance and Quality programs through the use of IT data analytics transparency and technological automation.
HPH improved their ambulatory quality metrics to the 90th percentile nationally, which resulted in a reduction to Medical Cost Trends and an accumulation of six million dollars in monthly downstream net patient revenue. HPH avoidable ED percentages resulted in a decline to less than 36%. This result was due to the 23% monitoring and maintaining of same day availability of patient slot reservations and the building of various urgent access locations with modified location, hours and coverage.
HPH length of stay (LOS) improved for all sepsis patients from 11.32 days in 2012 to 9.74 days in 2016. From these results, 275 people survived a sepsis event due to the improvements that were implemented. HPH resulted in 39.8% of all glucose values in the ICU setting being above the recommended limit (Glucose 180 mg/dl) with usual care, due to the adoption of the Computer Directed Insulin Dosing System (CDIDS). Utilization increased to greater than 90% of titratable IV insulin infusions. By using the CDIS for intravenous insulin, the hyperglycemia rate was much lower representing just 16.6% of all glucose values.
Reflection
HPH has met the intent of the Davies award by having again, for the second time, utilized information technology and teamwork to accomplish the following:
• Achieved improved patient access and population management by using data analytics transparency and technological automation.
• Achieved the goal of reducing the patient average length of stay through improving sepsis identification and treatment through order sets and algorithms.
• Achieved the goal of reducing the patient average length of stay of diabetic patients through the use a system wide hypoglycemia management protocol and the use of Computer Directed Insulin Dosing System (CDIDS).
A. The HIMSS Value Suite page includes a tab titled “Value STEPS”. The short video below includes a section that demonstrates how to navigate the STEPS tab. Determine what attributes were illustrated in your case study that would indicate the EHR use was patient centered.
Treatment/Clinical:
“ValueSTEPS” tabs showed this two links for HPH:
1) Treatment/Clinical > Quality of Care > Overall improved quality of care > Perfect compliance with Asthma.
HPH used every clinical improvement effort with EHR information analytic technologies to ensure collaboration between Quality Management and Medical Records in order to resolve quality and clinical documentation issues. This “ValueSTEPS” Treatment/Clinical effort resulted in prolong perfect compliance with children’s asthma and long periods of failure free care in adult hospitals, as it relates to heart attack and heart failure.
2) Treatment/Clinical > Quality of Care > Reduction in hospital acquired infections > Clinical Improvements with Health IT.
HPH’s clinical improvement was entirely enabled by Health IT. Emergency Medical Records (EMR) information and the collaboration between Quality Management and Medical Records were used to create queues, alerts, dashboards, and registries, to resolve clinical documentation questions. This clinical database ensured flexible accurate reporting and clinical surveillance. HPH’s Health IT also empowered patients with a portal to be able to view their own lab results, scheduling/reminders, and provide education materials. Patient communication with health care providers was also supported through computers or phones. This “ValueSTEPS” Treatment/Clinical effort resulted in more than 25,000 patients now regularly communicating through this portal, averaging 650 logons per day. All HPH’s hospitals and primary care clinics reported improvements in reducing catheter associated urinary tract infection (CAUTI) ranging from 9 to 79 percent with improvements.
Electronic Secure Data:
“ValueSTEPS” tabs showed this link for HPH: Electronic Secure Data > Enhanced Communication > Increased use of patient portal > Patient engagement through change management.
HPH improved patient engagement by providing a portal for patients to access their medication, health maintenance and schedules online. By allowing patients to schedule their own appointments online, clinicians received more business from patients, which promoted rapid adoption of the improved process. This “ValueSTEPS” Electronic Secure Data effort resulted in nearly 500,000 transactions that were processed during 2011 through the patient portal which then had 25,000 users. On average there are 650 patient logons each day, and there are approximately 1,000 new users each month.
Savings:
“ValueSTEPS” tabs showed this two links for HPH:
1) Savings > Financial/Business > Improved claims management > ROI from a Focus on Avoidable Write-Offs.
HPH’s EHR were able to identify problems and tools which could be used to build permanent repairs to avoidable write-offs, which in turn improved their ROI. This “ValueSTEPS” Savings effort resulted in $13.7 M avoided in net revenue losses since 2008.
2) Savings > Financial/Business > Other financial/business benefits > ROI of 9%
HPH collaborated integration of all revenue cycle functions, which improved financial and clinical performance through transparency and accountability. This “ValueSTEPS” Savings effort resulted in an annual return on investment from their EHR of 9.0% over ten years.
B. If you were the administrator for this organization, what would your strategy be to build upon what you have done with this project and move your organization to the next level utilizing IT?
The strategy I would use as the hypothetical health care administrator of HPH would be to use clinical governance and physician engagement in supporting the two committees: Primary Care Redesign Steering and Primary Care IT Clinical Workgroup, which resulted in achieving our EHR goals. As the HPH administrator, I would support our committees in their research and innovative measures to take HPH to the next level of IT and beyond.
This collaborative effort performed by these two committees would maintain the same four focus areas but with more innovative exploration. The three areas of focus: 1) Review and determine all patient access and national benchmark research, 2) Research and determine current physician and patient data benchmarks, and 3) Recommend which technologies and automations will accomplish benchmark goals.
By maintaining this strategy with the collaborative efforts of these two committees, HPH would have a clearer futuristic picture of our organization and the committees would be able to make educated decisions regarding how to proceed with improving access. The process would remain sustainable due to the standardized use of discrete fields in our EHR and using those fields to build our databases. This would in turn allow reporting and monitoring to remain effective and efficient. This strategy would also work to alleviate issues associated with the downstream demand of rapid growth and collateral impact of our improved access, which would force our operations team to expand. This strategy would allow IT to not only expanded HPH’s data infrastructure needs and define specialty benchmarks and access metrics, but assist in taking HPH’s IT to a whole new level of longevity.
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