Blog from October, 2018

Kate Monica

The regional health information exchange leveraged funding to engage more providers in health data exchange.

More than 60 healthcare providers throughout the greater Rochester area are contributing patient EHRs to Rochester RHIO after receiving grants from a New York grant program, according to the Monroe County Post.

The grant from the Data Exchange Incentive Program (DEIP) is being used to offset setup costs for enrolling additional providers and patient health records into the regional health information exchange (HIE).

The DEIP was established in 2017 by the New York State Department of Health (DOH), with support from CMS. The grant program was launched to increase HIE adoption across the state. The New York eHealth Collaborative coordinates the programs and awards incentive payments on behalf of DOH.

“Hundreds of health care organizations were already sharing patient information, but as extensive as that data was, records were still not complete in many instances,” said Rochester RHIO President and CEO Jill Eisenstein. “With the help of DEIP, we’ve expanded our data sources to include groups such as skilled nursing facilities and diagnostic treatment centers.”

Rochester RHIO is one of eight qualified entities (QEs) part of the Statewide Health Information Network for New York (SHIN-NY). Organizations can add patient health data such as medications, lab test results, care plans, procedures, and other health information to offer providers a more comprehensive view of patient health spanning multiple care settings, facilities, and care teams through RHIO’s Contribute service.

Contribute allows providers to share patient data in the form of C-CDAs through provider EHR systems. Utilizing the Contribute service to add new patient health information to the exchange helps to enable better-informed clinical decision-making and improve care coordination.

Hospitals, healthcare organizations, private practices, and ambulatory care sites can gain access to this data with patient consent.

“By having a more complete digital record of care for each patient, health care providers can make more informed decisions,” Eisenstein said. “We’re looking forward to helping even more health care organizations connect, especially with the financial assistance from New York state.“

Increasing the number of providers contributing patient EHRs to the regional HIE will allow Rochester RHIO to provide a more complete view of patient health to each patient’s treating physician and care team. The grant supports the HIE’s mission to support high quality patient care across the community through the use of clinical data.

Grants from the DEIP can be used to build EHR interfaces that connect with QEs to increase the quantity and quality of data in SHIN-NY. The grant program was designed to help offset the costs of connecting to QEs for healthcare organizations by offering incentivizes to healthcare organizations that share a pre-defined set of data elements with other providers.

Two other New York-based HIEs part of SHIN-NY recently entered into a strategic partnership to boost HIE use among area providers.

HealthlinkNY and HealtheConnections partnered earlier this month after months of collaboration. HealthlinkNY first announced its decision to seek a strategic partner in 2017. Together, the two QEs cover 43 percent of providers across New York.

Prior to announcing its strategic partnership, HealthLinkNY stated its disapproval for another SHIN-NY QE that planned to expand its HIE services into HealthlinkNY’s territory.

Hixny planned to extend into nine additional counties over an 18 month period, stating health data exchange in those areas “historically lags.”

Several medical centers and clinics in regions covered by HealthlinkNY signed participation agreements with Hixny.

According to HealthlinkNY Executive Director Staci Romeo, Hixny’s expansion into territories covered by HealthlinkNY were the result of a “case of sour grapes after being passed over during our search for a strategic partner.”

HealthlinkNY covers 13 counties in the Hudson Valley, Catskills, and the Southern Tier.

Jennifer Bresnick

Cutting costs doesn't mean sacrificing on quality of care if hospitals focus on reducing unnecessary care variations and trimming down on wasteful testing.

High quality and lower costs can indeed go hand-in-hand for hospitals, according to new data from Advisory Board, if healthcare organizations can successfully reduce unnecessary variations in care.

An analysis of more than 460 hospitals revealed that the highest quality facilities delivered lower-cost care for 82 percent of diagnoses included in the study, indicating that investments in patient safety, standardized care delivery methods, and enhanced health IT tools may be worth the effort.

“Care variation reduction (CVR) is one of the few avenues for generating the level of savings needed to withstand downward pressures on hospital revenues without negatively impacting care, and hopefully improving it,” said Steven Berkow, Executive Director, Research at Advisory Board, an Optum, Inc. business.

Hospitals that follow the lead of their highest-quality, lowest-cost peers could save up to $29 million each year, the report added.

Advisory Board researchers derived the potential savings goal from analyzing cost and quality data from more than 20 million patients across 468 hospitals.  They found that the average hospital spends up to 30 percent more to deliver the same care than a hospital in the highest-performing group.

“Our high-performer benchmark is based on high-quality care, not low cost,” explained Veena Lanka, MD, Senior Director, Research at Advisory Board. 

The team explored variations in common quality metrics, such as rates of complications, to assess hospital performance.

“Closing just a quarter of the cost gap for less than 10 percent of the conditions we analyzed could net over $4 million in annual savings for a typical hospital and over $40 million for 10-hospital system—without compromising quality,” Lanka stressed.

However, Berkow pointed out, “Achieving a realistic chunk of this savings opportunity…will require most health systems to rethink how they prioritize, set and embed care standards.”

Reducing variations in care requires a collaborative effort that involves standardizing provider training, carefully choosing the appropriate settings for care, and fostering a greater reliance on meaningful health IT tools.

Reducing emergency room use by redirecting non-emergency cases to urgent care facilities can help to conserve resources in more expensive settings – as long as the urgent care clinics adhere to best practices for antibiotic stewardship and maintain high quality in other areas of care.

To ensure less variation in how services are applied, organizations may wish to consider clinical decision support (CDS) technologies that can ensure that providers are aware of the latest clinical guidelines for treating specific conditions. 

CDS tools may help to reduce unnecessary testing or imaging, and can help providers react more quickly to high-risk conditions such as sepsis.

Trimming down on repetitious or low-value imaging and lab testing can help to prevent billions in wasteful spending that lead to high costs without producing better outcomes. 

In a 2017 study from Health Affairsresearchers found that low-value testing and imaging contributed to more than half a billion dollars in spending per month in Virginia alone. 

Nationally, wasteful spending accounts for nearly a third of all healthcare dollars each year.

At Methodist Le Bonheur Healthcare, tacking the problem of variation in care and high spending involved significant investment in data analytics and health IT tools, explained Arthur Townsend IV, MD, MBA, Chief Clinical Transformation Officer for Methodist Le Bonheur Healthcare.

“Embarking on a journey to reduce care variation can be challenging, but our success is due to dedicated teams of physicians, nurses and administrators, all working toward the common goal of improving every life touched at Methodist Le Bonheur Healthcare,” he said.

The Tennessee-based health system initially targeted unnecessary laboratory utilization and blood transfusions, using data analytics tools to identify opportunities for improvement that would not negatively affect patient care.

The health system then moved on to develop standards of care for stroke and sepsis, creating Clinical Consensus Groups packed with subject matter experts to define guidelines for treating patients with these conditions. 

The experts, including administrative and clinical champions, took a close look at how to improve clinical documentation and standardize care delivery and infuse new best practices into the daily routines of care providers.

As a result of both efforts, the health system saw more than $800,000 in cost savings and revenue enhancements in a single quarter.  Atrial fibrillation is next on the list, promising even more gains in quality and cost.

“We see care variation initiative as the next frontier in improving overall quality and significant cost reduction across the system through physician leadership,” said Michael Ugwueke, president for Methodist Le Bonheur Healthcare.

While Advisory Board’s Lanka noted that it is not likely that hospitals will be able to stamp out all care variation due to differences in patient demographics, clinical severity, and other underlying socioeconomic issues, most hospitals will have some opportunities to reexamine care delivery and the costs associated with unnecessary utilization or discrepancies in delivery.

The goal is a very high priority for hospitals and health system, according to an accompanying survey of C-suite executives, with “preparing the enterprise for sustainable cost control” taking the top spot on their checklists for the remainder of 2018.

Organizations that hope to achieve that objective will benefit from assessing their current clinical processes for high-cost conditions, considering new technologies to support adherence to clinical guidelines, and investing in innovative initiatives to engage providers in quality improvements that simultaneously lower costs.

Brita Hansen

The medical world has declared zero tolerance for healthcare-associated infections (HAIs), but it is a massive problem to address. 

Seven out of every 100 hospitalized patients at any time and about 30% of patients in intensive care units will acquire at least one HAI, according to the World Health Organization.

HAIs such as Clostridium difficile (C. diff) and catheter-associated urinary tract infections (CAUTIs) take a heavy toll on patient outcomes and length of hospital stay. They are also expensive. The most common infection is CAUTI, accounting for more than 30% of HAIs, costing health systems about $500 million annually in the direct cost of treating patients. 

Making matters worse, Medicare does not reimburse for certain HAIs, and a portion of reimbursements are withheld for the quartile of hospitals with the most HAIs. When Medicare penalties and lost revenues are included, the cost likely exceeds $1 billion annually. 

Thankfully, health systems already have a powerful weapon that can make a major dent in infection rates: electronic health records. For true progress to be made toward zero HAIs, healthcare needs a greater focus on using this tool along with key clinical processes to guide the delivery of care.

Here are five specific areas where health systems can and must improve:

  1. Streamline workflows. Hospitals are reducing infection rates by using EHR systems to streamline workflows by making the right thing to do the easiest thing for clinicians to do. The idea is to remove unnecessary variation in the way care is delivered to ensure clinicians follow the best clinical practices. For example, it was once routine to place catheters in many hospitalized patients, but now catheters should only be used when the patients meet specific clinical criteria. Once inserted, EHR systems can be leveraged to remind clinical staff that a patient has a catheter and suggest they remove it or document why it is still indicated. Up to 69% of CAUTI cases can be prevented by following these and other evidence-based strategies.
  2. Stop overtesting. Hospital staff too often overtest for infections when there are not strong clinical reasons to expect an infection. For example, hospitals overtest for C. diff, the most common infectious cause of healthcare-associated diarrhea and a significant factor leading to morbidity, mortality and increased length of stay among hospitalized patients. This inappropriate C. diff testing leads to false positives and overdiagnosis. Using EHR systems to ensure care processes are aligned with current testing guidelines and workflow best practices can produce even bigger improvements. One hospital following this approach had a 50% reduction in C. diff infections.
  3. Focus on best practices. Getting CAUTI rates to zero means clinicians should set strict rules for testing and focus on the correct insertion, maintenance and removal of catheters. A study published in Infection Control & Hospital Epidemiology found that when ICUs at the Cleveland Clinic improved their catheter protocols that CAUTIs decreased from three per 1,000 catheter days to 1.9. Similar improvements can be made by ensuring clinicians focus on best practices throughout the care-delivery continuum.
  4. Minimize patient risk of infection. Whether it’s overuse of catheters or antibiotics, more rigorous hospital workflows can minimize infection risk. That was among the topics discussed in June at the Association for Professionals in Infection Control and Epidemiology (APIC) conference, where more than 4,500 infection prevention professionals gathered to discuss strategies to lower infection rates. The conference revealed that many hospitals and health systems still have multidisciplinary teams performing retroactive chart reviews of HAI cases to look for things that could have been done differently to mitigate the risk of infection. However, such retroactive assessments can never find the type of consistent process improvements that can be identified by a well-organized EHR, where you can look at and sort large data sets to find patterns. Rather than reviewing past cases, EHRs can even be set up to proactively make recommendations for clinicians. 
  5. Improve infection controls. Once an infection is identified in a timely fashion, hospitals need consistent procedures to stop it from spreading. Those should include isolating the patient, clinicians wearing special gowns and gloves, special hand-washing procedures and, crucially, communicating those standards to staff.

It’s not uncommon in American hospitals for nurses to attempt to manage catheter hours by physically walking around wards, seeking out patients with catheters to assess whether proper care was performed and which catheters can be removed. 

In an age when we use technology for everything from better navigation to movie recommendations, hospitals should use modern information technology available to them to push their HAI rates to zero as quickly as possible.