Blog from January, 2018

Kate Monica

 

Improved patient outcomes are tied to sharing diagnostic EHR data within health systems.

A recent study ties hospital and health system sharing of diagnostic EHR data to lower patient mortality rates and improve health outcomes.

Researchers studying CMS and AHA data published their findings in the American Journal of Managed Care. Specifically, Deyo et al. scrutinized information about patient mortality and readmission rates for heart failure and pneumonia in 2012 and 2013.

The AHA Annual Information Technology supplement gathered information from providers about their hospital’s health data sharing behaviors. Providers submitted responses about how frequently their hospital exchanged data between providers in their own health system, as well as with providers at outside health systems. AHA collected separate responses from providers about hospital sharing of radiology reports and lab results.

Researchers linked AHA survey data from 3,113 distinct hospitals to each hospital’s corresponding CMS Hospital Compare scores.

Ultimately, study results showed diagnostic EHR data sharing within health systems was associated with better health outcomes.

“Hospitals sharing diagnostic data through their EHRs with other hospitals and physicians within their system were associated with significant reductions in 30-day patient mortality scores,” stated researchers in the report.

Comparatively, sharing diagnostic EHR data with hospitals part of other health systems was associated with higher patient mortality scores – particularly for patients with heart failure.

Several factors may contribute to the correlation between EHR data sharing between health systems and higher patient mortality scores, researchers wrote.

“It is possible that hospitals within a system share EHR data more effectively due to team dynamics,” they suggested. “Further, as hospitals in different systems may have different EHR systems, there may be unique difficulties with sharing data across systems.”

Furthermore, the exchange of radiology reports may be limited by the fact that many patient health records do not contain radiology images.

“This may partially account for the differential between sharing with providers within and outside of systems because physicians within the system may be able to access the source images through other means when necessary,” wrote researchers. “Hospitals that solve the communication challenges associated with EHR data may be able to significantly reduce patient readmissions and mortality.”

Researchers also found communication between providers across EHR systems was generally lower than communication between providers using the same system. Seventy-two percent of hospitals shared radiology reports with hospitals within their system while only 36 percent shared radiology reports with hospitals outside their system.

Researchers observed a similar gap in the exchange of lab results within health systems as compared to between health systems.

Without significant improvements in EHR interoperability, the effectiveness of data sharing between hospitals will continue to lag behind data sharing within hospitals.

“If hospital sharing is limited by communication or compatibility among different EHR systems, the ability of EHRs to improve patient outcomes or access to care may be limited in the long run,” wrote researchers.

A lack of effective health data exchange between health systems may pose a significant threat to patient safety.

 “Our study found some evidence that when hospitals do share EHR data with hospitals outside their system, patient mortality has the potential to increase,” researchers explained. “Therefore, although there may be benefits to sharing EHR data, it may be that hospitals are not yet able to effectively use EHR data from other hospitals as well as would be desired.”

Given the low rate of diagnostic EHR data sharing between health systems, researchers suggested policymakers develop improved common standards for health data exchange between EHR systems.

“Thus, best approach for increasing patient outcomes through better provider communication of diagnostic information may not be simply expanding the degree of EHR data sharing among providers, but rather developing common standards when using different EHR systems to ensure that providers can share diagnostic information in ways that are easy for other providers to access and accurately interpret,” they concluded. 

Jessica Kent

 

Organizations can use EHR timestamp data to improve clinical workflows by approximating the time it takes to complete common tasks. The data may be able to help providers with refining scheduling methods, analyzing EHR use, and quantifying how trainees interact with health IT systems, according to a study published in JAMIA.

In order to better understand how this dataset could help optimize interactions with the EHR, Researchers observed and collected workflow data from four ophthalmologists within Oregon Health and Science University’s (OHSU) Epic EHR system.

They compared the observations of workflows to timestamp data generated within the EHR, and found that EHR timestamps provided a reasonable approximation of workflow.

For three of the four physicians, the EHR timestamp measurements were within one minute of the observed reference exam times on average.

Additionally, 84.3 percent of the EHR calculated exam times were within three minutes of the observed times, indicating that this dataset could offer providers an accurate substitute for manual observation.

“There are many possible uses of this large set of timing data available from all EHRs,” the researchers wrote.  

The team applied their findings to three different studies. The first used simulation models to test staff and exam room allocations and scheduling strategies that would prevent long wait times.

The models showed that adding staff and exam rooms didn’t reduce patient wait times, but scheduling patients who need more time toward the end of the day did help to control wait times throughout the day.

In addition to reducing patient satisfaction, long patient wait times can threaten healthcare revenue. This is especially true as the industry increasingly turns to value-based reimbursement models, in which clinicians are rewarded for providing timely access to quality care.

Researchers also applied their findings to a study on daily EHR use, and found that ophthalmologists use their EHR for an average of 3.7 hours per day. They also found that clinic volume and appointment complexity are two major factors that affect EHR use.

In general, researchers found that as patient volume increases, EHR use time decreases. However, they also found that when appointment complexity increases, so does EHR use time.

Since physicians with the highest clinic volume tend to see less complex patients, and vice versa, these findings suggest that patient volume is limited by the work required during exams. EHR use makes up a significant part of that work.

In fact, a 2017 study found that clinicians spend approximately 5.9 hours of an 11.4-hour workday on EHR documentation. This excessive amount of time spent on data entry has led to a spike in physician burnout, which negatively affects quality and cost of care.

Researchers also applied their findings to a third study that examined the impact of trainees on workflow. They found that trainees were associated with significantly longer appointment times for both fellows and residents.

While there are programs in medical schools that allow students to interact with EHR data before entering residency, the researchers write that these results show the effects trainees have on the “efficiency, productivity, and financial viability of academic medical centers.”

The application of EHR timestamp data to studies like this can lead to better planning and reimbursement models for clinics’ training activities, the researchers state.

Using this type of metadata can help justify EHR improvements. EHR optimization requires technology experts to assess the current system in place, and to examine how users interact with the EHR.

Knowing the factors that significantly impact EHR use can help experts decide where to make improvements, and ultimately increase EHR efficiency.  

Studying clinical workflow is a key way to gain insight for improving physician productivity. Providers are currently under pressure to see more patients in less time, and many believe that EHRs have only added to time pressure.

However, as the researchers indicate, workflow studies often require observational data that is too resource-intensive. The results of this study show that existing EHR timestamp data can help organizations boost physician productivity and increase patient satisfaction.

“These applications show the power of using existing EHR timing data for clinical workflow studies that would not have been possible otherwise and the possibilities for applying these methods to studies in other clinical settings,” the researchers concluded.

Evan Sweeney

 

The Centers for Disease Control and Prevention (CDC) has formed a new initiative focused on leveraging technology to get clinical guidelines in front of healthcare providers.

Through the initiative known as “Adapting Clinical Guidelines for the Digital Age,” CDC officials are looking for feedback from clinicians, EHR and third-party app developers and public health agencies about the best ways to disseminate clinical guidelines. The agency plans to hold a public meeting with stakeholders the week of February 5, according to a notice (PDF) posted this week to the Federal Register.

The CDC plans to use information from that meeting to pilot test new processes for guideline development and implementation.

“Because there are multiple roles in developing and disseminating clinical guidelines, it is important to get a comprehensive understanding of the current challenges in translating guidelines in order to develop a standardized process for the future,” the notice stated.

CDC spokesperson Melissa Brower told FierceHealthcare the initiative is "a natural extension" of an agencywide working group formed in 2016 looking at ways to ensure CDC guidance is used in practice. 

Using technology to quickly get information to clinicians, particularly during public health emergencies, is an issue the CDC has highlighted as an ongoing challenge. At a December meeting hosted by the Office of the National Coordinator for Health IT, the CDC’s Chesley Richards, M.D., who directs the Office of Public Health Scientific Service, said the Ebola outbreak led to “some soul-searching” about how the agency can improve clinical decision support.

Richards added that the CDC is especially interested in extracting data from EHRs to quickly identify outbreaks, while also limiting the reporting burden for physicians.

Eric Wicklund

 

Harvard Pilgrim Health Care is financing expansion of the eConsult telemedicine platform to two new Connecticut health systems, improving access to specialist services for patients and their doctors.

 

One of New England’s largest health plans is investing in a telemedicine platform that enables patients and their primary care providers to access specialty consults.

Harvard Pilgrim Health Care has awarded $32,000 in grants to two Connecticut health systems to expand the eConsult program, an innovative telemedicine program launched in 2015 by Middletown, Conn.-based Community Health Center (CHC) and now being used in about a dozen states across the country, including New York, Delaware and California.

Harvard Pilgrim has awarded $20,000 to Community eConsult Network to launch a year-long pilot through the Value Care Alliance (VCA). The pilot began last month at Middlesex Hospital Primary Care in Middletown nad is expected to expand soon to other VCA member organizations.

“The goal of this pilot program is to make it easier for patients to get the care they need by helping their primary care physicians obtain timely specialty consultations,” Russell Munson, MD, Harvard Pilgrim’s Connecticut Medical Director, said in a press release issued last November, when the grant was made. “In many cases, it will eliminate the need for additional appointments as well as time and travel by using technology to access prompt, high quality specialty care for patients. eConsults will help with access to specialist medical opinions, prescribing, ordering tests and the maintenance of patient medical records, bringing ease and efficiency to patients.”

In addition, the health plan has issued a $12,000 grant to help CeCN launch the telemedicine platform for the new Haven-based Community Medical Group. CMG’s Independent Practice Association serves New Haven, Shoreline and Fairfield counties with a network of some 900 primary care practitioners.

Working with the Weitzman Institute – CHC’s research and innovation arm - and Safety Net Connect, a California-based developer of online care coordination services, CHC launched its eConnect pilot in 2015. Working at first with cardiac care patients, the program routed all specialist referrals from CHC providers through an online system that allows the specialist to review the case online. This includes access to the patient’s medical record and any questions the primary care doctor may have about his/her diagnosis and treatment so far.

The model was originally developed to help federally-qualified health centers coordinate and improve care for the hard-to-reach Medicaid population.

CeCN officials say between 60 percent and 90 percent of the specialty consults have been resolved by the eConsult service since its launch, eliminating costly and unnecessary specialist appointments. More than 14 specialties are now available through the telemedicine platform, including cardiology, dermatology, gastroenterology, pediatric cardiology, orthopedics and pain management.

“Our work has clearly shown what a significant difference eConsults can make for primary care providers and their patients,” says Daren Anderson, MD, CHC’s vice president and chief quality officer and director of the Weitzman Institute. “They help to ensure that patients get access to the best care quickly and efficiently. Harvard Pilgrim is helping us to spread this work across Connecticut, helping build a stronger and more effective primary care system.”

Based on the 2015 pilot’s success, CHC and the Weitzman Institute created CeCN, a non-profit to manage and run the program. Shortly thereafter, the Centers for Medicare & Medicaid Services approved the program for Medicaid reimbursement.

“With limited specialty providers available to treat Medicaid patients, appointment wait times can be as long as a year, leading to healthcare disparities, higher rates of disability and complications in chronic diseases,” CMS officials said in a 2016 press release. “SNC’s eConsult system has been proven to increase access to timely, cost-effective specialty services for underinsured and underserved patients, many of whom live in rural areas with limited access to specialty care.”

John Donohue

 

Associate Vice President John Donohue divulges the system’s approach to telemedicine and videoconferencing, including the tech and governance components hospitals need to succeed.

While there is nothing really new about video-based collaboration — or even telemedicine for that matter — a technology ecosystem is emerging to make next-generation medical visits and business interactions mainstream. That means it should be a core component of hospital’s IT planning process. 

Video technology and clinical integration capabilities have reached a maturity level that makes enhanced collaboration a reality, and potentially a competitive differentiator.

Recently, we developed a three-tier video strategy for collaboration and telemedicine. Our strategy addresses a wide range of clinical visit types and business scenarios. Yet it is dynamic and agile enough to scale and handle future state requirements.  For example, our new patient bed tower will be opening in 2021 and we are preparing to include types of video technologies that might be built in to the core requirements of this acute care facility.

Additionally, our strategy addresses the legacy video technologies already in place across the enterprise with a transformation plan. Lastly, this scheme fits into our planning tenant of common systems, centrally managed and collaboratively implemented. 

The first component of our plan addresses clinical grade video technology. This offering is designed for more clinically oriented requirements. Examples of this type include video technology within our OR suites for grand rounds and physician education.  Additionally, this is the platform used for connected health (such as remote patient monitoring) and telemedicine solutions that touch patient care. This platform is designed with high resilience for maximum availability and has been integrated with our EHR for billing purposes. The collaboration required to design and build an integrated EHR/telemedicine capability is significant — but it paves the way for some game changing telemedicine offerings to your patient community.

Room-based video conferencing is another offering designed as a standards based collaboration technology to use throughout our health system which has grown exponentially in size and geographical footprint. Picking the right technology partner and a solution that is both easy to use and scales appropriately is instrumental in our success. We are also able to collaborate more easily outside the organization communicating with U.S. and even overseas business relationships. Interoperability is the name of the game when it comes to bridging outside your organization. This interoperability should include other industry leading room service providers and cloud service providers. For our room based video conferencing, we have templates that help guide new implementations and budget estimates for upcoming construction projects. These include one for senior executive/trustee level rooms, one with a higher level of technology for specific requirements and one for basic audio/visual needs. All of our rooms are tied back to a central control center for monitoring, support and troubleshooting.

Lastly, the mobile and desktop video conferencing is the most flexible of our tiers and is used for collaboration among staff level folks across the organization. Here we leverage our network infrastructure across to deliver unified communications capabilities. Cost is low and it’s easy to implement. The technology is already paying dividends for collaboration.

Most recently, we are piloting a concept called “VC in a Box”.  This concept includes the capability to have a mobile video conferencing configuration that can be moved around the organization for special events that don’t occur in a previously designed video conferencing room. The early success in this pilot leads me to believe that we may wind up with several of these setups as a new offering.

When rolling out video technology like this across a broad, diverse and complex organization, communication becomes paramount. How you explain these offerings (via a service catalog) and make it easy for the user community to select the right technology at the right time is key to acceptance and driving the benefits of its use. We created a video technology governance committee that steers the direction and becomes a set of champions. This group ultimately helps us with communications and the development of an effective portal for how to engage the services and maybe most importantly how to get a session scheduled and get the support that is needed. 

Our portal offers white glove support and even addresses things like re-arranging the room for an event and having food and beverages delivered. Lastly, the portal allows for calendar synchronization so that it is tightly integrated with the scheduling of the room itself.

Ultimately, having an effective and easy to use video technology ecosystem can allow a growing organization to drive down travel costs, increase collaboration and ultimately provide better patient care to drive enhanced outcomes.