Blog from November, 2018

Case Western Reserve University

Electronic health records (EHRs) produce savings for hospitals by reducing the average length of patient stays—but only in facilities meeting the highest federal standards for implementing the technology, according to new research from Case Western Reserve University.

The findings are significant for a health-care industry with growing levels of spending—now roughly 18 percent of the nation’s gross domestic product.

In hospitals meeting the federal government’s measure of “meaningful use” of electronic health records, patients are discharged nearly four hours earlier—approximately a 3 percent reduction of the average five-day hospital stay.

For sicker patients, the benefit was even greater: Those with complex or multiple chronic conditions see up to an additional 0.5 percent reduction in their hospital stays.

What’s more, researchers found that these shortened stays did not come with an increase in re-admissions. With prolonged patient stays costing hospitals an average of $600 a day, the use of electronic records could help contain growing costs, especially amid a trend of reduced reimbursements from insurance companies and entitlement programs.

“Longer hospitals stays cost more money for all involved,” said Manoj Malhotra, dean of the Weatherhead School of Management at Case Western Reserve and co-author of the research.

“Electronic health records, when meaningfully implemented help patients go home sooner, reducing their exposure to germs in the hospital and likelihood of having to come back," he said.

Hospitals that did not fully engage in meaningful use of electronic records showed no significant reductions in length of patient stays, according to the study, which was published in the  Journal of Operations Management.

“Any efficiencies, even small improvements, can produce significant savings when adopted in a large health-care system—and are certainly preferable to the alternative,” said Malhotra, who is also the Albert J. Weatherhead, III Professor of Management at the university.

Health-care savings, thanks to federal perks (and penalties)

While electronic records are touted for their potential to reduce hospital errors and inefficiencies, their adoption had been slow among U.S. hospitals.

In 2010, a $27 billion package included in the Health Information Technology for Economic and Clinical Health (HITECH) Act encouraged hospitals to adopt and meaningfully use the technology—and established penalties for failing to do so, such as negative adjustments to Medicare and Medicaid reimbursement.

The approach has been successful in pushing increased adoption of electronic records: By 2015, the level of adoption had reached 80 percent of hospitals nationally. But a more proactive approach that meaningfully uses the technology beyond mere adoption may be needed to see more progress, researchers conclude.

The researchers categorized hospitals into one of three categories—partial adoption of EHRs, full adoption of EHRs and “meaningful assimilation” of EHRs.

“Whereas partial or full adoption showed no benefits for reducing patient stays, meeting the government’s highest standard of meaningful use reduced length of stay without any adverse impact on readmissions,” said Malhotra. “Results from this study indicate that meaningful assimilation of technology is likely to help free-up clinicians and other valuable resources –this approach is preferable to making additional investments in facilities or hiring additional employees as more people seek hospital services.”

The study

The research—co-conducted with Deepa Wani, an assistant professor of management science and statistics at the University of Texas at San Antonio—used four years of detailed patient-level data from all acute-care hospitals in California, in addition to as data reported by the Centers for Medicare & Medicaid Services (part of the U.S. Department of Health and Human Services) on hospitals that successfully attested to meaningful use criteria stated in HITECH.

Austin Fitzgerald / U. of Missouri

Nursing homes that adopt more sophisticated information technologies are seeing specific improvements in the quality of care, a new study shows.

These improvements include significant decreases in urinary tract infections, patients reporting moderate to severe pain, and patients with new or worsened pressure ulcers.

Health care providers in hospitals and ambulatory care are currently incentivized with federal funds to adopt health information technology (IT). Nursing homes, however, have been largely left out of these incentive programs, although this health care sector is beginning to see some benefits. For example, IT systems support health information exchange and access to electronic health records by care providers across settings, enabling them to address patients’ needs better.

Now, a new study has linked more sophisticated nursing home information technology, including electronic medical records and other digital data systems in resident care, clinical support, and administrative activities with specific improvements in quality.

“We already knew that information technology can help create better care outcomes, but this study helped us see which technologies improve which elements of care,” says Gregory Alexander, a professor of clinical informatics at Missouri University. “As IT capabilities and extent of IT use improved in nursing homes, we saw an associated decline in urinary tract infections, among other correlations.”

Alexander and his colleagues collected surveys once per year for two years from nursing homes nationwide. The researchers compared the responses, which rated the sophistication of a given facility’s information technology, against federal data describing 18 quality measures in those same facilities, and technology had positive affects on quality of care. For example:

  • Facilities reporting greater IT capabilities in administrative activities were associated with a lower percentage of residents reporting moderate to severe pain.
  • Increased use of clinical support technologies, which include laboratory systems, was associated with lower percentages of residents with urinary incontinence.
  • Increases in technology use in resident care were associated with lower percentages of residents with new or worsened pressure ulcers.

The researchers also observed that while the overall trend was an increase in IT adoption, some nursing homes actually lost capabilities between years one and two. Though these facilities were outliers, Alexander says they reflect the challenges nursing homes face when adopting new technology.

“Federal incentive funds are going into hospitals and ambulatory care, not nursing homes,” Alexander says. “Many homes don’t have a trained expert to manage the technology, so even if they do decide to upgrade their IT capabilities, they may abandon certain ones because they are too difficult or expensive to manage. If they aren’t being reimbursed for investing in information technology, they may decide it isn’t worth the time and money.”

Alexander says that because the study detailed the impacts of a variety of specific IT factors on different aspects of quality of care, the data could help inform nursing home administrators about which features of an IT system are important to adopt to improve quality of care. This information could be very helpful to administrators and other leaders in making decisions about how to design and implement information systems.

The study appears in the Journal of Nursing Care Quality. A grant from the Department of Health and Human Services’ Agency for Healthcare Research and Quality supported this research.

Rosy Matheson

Artificial intelligence looks set to transform nursing over the coming years.

If you think the digitisation of nursing is just about nurses filling out scores on a mobile device, it’s time to think again because artificial intelligence (AI) could be about to revolutionise the way nurses do their jobs. Recent digital developments include bottles which automatically issue reminders to drink, diapers that sound an alert when wet and sensor-equipped stoma pouches.  

Heiko Mania, NursIT CEO, and a former nurse, believes AI will change the focus of nursing care: “Modern nursing expert software not only streamlines nursing documentation, it will automate it using AI, sensors and smart nursing aids. At the same time, professional nursing care will change from reactive to predictive, preventive nursing care.”

Mania said they had developed a nursing care expert system, CareIT Pro, which supports automation in nursing. He explained that smart algorithms and AI could reduce the need for information to be entered and could link content, so that further workflows and tasks could be automatically initiated at the right time. He added that the software automatically recognised patterns, evaluated the planned nursing goals and recommended necessary adaptations.

He said sensors, wearables and smart devices were also enabling increased automation: “Intelligent tools automatically deliver data on the patient to the nursing expert software and thus allow automated documentation. Alarms, nursing tasks and digital processes can be generated and started independently. Nursing staff not only receive digital to-do lists, but can also see the current status and quality of the nursing processes at all times and react to them at an early stage.

An intelligent drinking cup can automatically fill the drinking protocols and remind the patient to drink regularly or the stoma pouch sensor generates an automatic care task for changing the bag when it is almost full. We are currently developing an intelligent nursing mattress with a partner company that can detect not only the patient’s movement, breathing, position, pressure and sleep, but also incontinence.” 

Improved quality of care and patient safety

If the Internet of Things (IoT) is set to transform nursing, it is also starting to change the way nursing is taught. Widener University in Pennsylvania has introduced a range of simulation training from programming intravenous pumps and pumps for medication to updating electronic health records.  It also runs disaster simulation training as Widener, in line with other nursing schools, has recognised the need to prepare nurses for such incidents in the wake of 9/11.

Nancy Laplante, Associate Professor of Nursing at Widener University, has recently published a paper arguing the case for introducing IoT in disaster training. Laplante believes this would highlight the application of these technologies in a meaningful way and enhance the experience for nursing students. She would like to teach the students to use mobile apps to track patients, triage them and track them to different hospitals, rather than using, for example, old-school paper-tagging of victims.   

She said that downloading simple drawings, like Rich Pictures and Use Case Diagrams, which show all the participants in the disaster scene at a glance, can also improve understanding: “We were looking at what we call this rich picture for disaster scenarios and it was one way to help visualise all the interactions that would occur.  What we wanted to do was to give students an understanding of how complex communication is in a mass casualty disaster scenario. It is not just nurses talking to patients; they are going to have to deal with fire fighters, police officers, bystanders and health providers that are off site.” 

Laplante said students had to get to grips with new technology as it was a growth area. She said that nursing students had to understand, embrace and help develop new solutions as they could transform their practice. However, she pointed out that while IT was an important aspect of nursing, it could never take the place of nurses: “I don’t personally believe that nurses can ever be replaced because you always need that human touch. My hope and my feeling for technology is that it can help enhance our care.” 

It is likely that technology will fundamentally change nursing over the coming years and, provided it is used correctly, it seems it really could improve the quality of care and lead to increased patient safety.  

Jessica Kent 

With more than $3 million in funding, the Center will use big data analytics to advance precision medicine worldwide.

Duke University Pratt School of Engineering has established a new big data analytics center that will support global research to advance precision medicine.

Launched last month, the Sherry and John Woo Center for Big Data and Precision Health will receive more than $3 million in funding over the next three years from philanthropist and biotech industry executive John Woo. The Center will help Duke faculty and students develop innovative methods for turning big data into actionable clinical insights.

Investigators will have new opportunities to work with hospitals, government agencies, and biotech companies worldwide to advance data-driven health research.

“Big data, analytics, and machine learning are changing our world significantly, and nowhere will the change be more significant and meaningful than in healthcare,” said Ravi V. Bellamkonda, Vinik Dean of Engineering at Duke.

“Duke Engineering and Duke Health are collaboratively leading this change, and the Woo Center will help catalyze this further by coordinating new partnerships, expanding access to diverse, well-curated datasets and fueling transformative research ideas in this space.”

The center already has research efforts under way in China, where a team is developing a national network of health data parks to improve rural care delivery.

The new facility will also award annual pilot grants of up to $150,000 to Duke faculty so they can explore new ideas for collaborative projects.

In addition, the center will hold a yearly symposium to highlight significant findings to further build a global community of researchers. Leaders plan to sponsor global internships and exchanges for Duke students, as well as business plan and pitch competitions.

“Big data and precision medicine have the potential to vastly improve human health, and Duke has a special role to play with its unique combination of strengths in data science and machine learning, biomedical engineering and medicine—our faculty are world leaders in each of these areas,” said Larry Carin, Vice Provost for Research at Duke.

“Through new partnerships in China and around the world, we hope to address pressing medical issues in emerging markets and reduce disparities to improve global health.”

Duke University expects that the new Woo Center will add to its existing research efforts and will help foster the study of healthcare big data analytics

“Duke is already at the forefront of bringing big data and precision medicine into clinical practice,” said Xiling Shen, the Hawkins Family Associate Professor of Biomedical Engineering, and director of the new center. 

“We’re excited about the opportunities this new center will open for our faculty and students to build productive new collaborations with clinicians and biotech companies to make an impact for patients.”

Other organizations have established similar facilities to improve care delivery.

In September 2018, the New Jersey Hospital Association launched a big data analytics center to identify and address gaps in care. Researchers plan to use predictive modeling and other analytics strategies to extract meaningful insights from big data.

“So many of the problems we see in healthcare today – racial and ethnic disparities, access to care barriers, variations in use of healthcare services, variables in access and funding of prevention and wellness – require a deeper dive intowhy,” said NJHA President and CEO Cathy Bennett.

“One of the ways we get closer to answering that question is to have solid data that shows us the root causes of these problems. We can then support design of solutions that address the foundation of the problem, rather than the symptoms.”

The University of California, Irvine (UCI), also recently launched an artificial intelligence center to help researchers develop deep learning tools and apply them to big data. The new center will allow researchers and faculty to collaborate and translate AI-based concepts into clinical tools that will improve patient health.

Additionally, Dell Medical School at the University of Texas at Austin has established a big data analytics center, called the Biomedical Data Science Hub. The facility will use big data analytics to enhance population health research, showing how both clinical and non-clinical factors affect health outcomes.

“To increase the pace of innovation in health, high-quality data needs to be ubiquitous and analysis much richer, and that’s what we’re trying to achieve with the data hub,” said Clay Johnston, MD, PhD, Dean of the Medical School.

“UT already has so much strength in this area, and now it’s about directing that toward the key questions in health including addressing health inequities in our community.”