Blog from February, 2019

With fewer than half of HHC clinicians having the ability to view patient data in an EHR, new research finds giving them the option could reduce medical errors. 

Nathan Eddy



Major gaps in communication exist between hospital and home health care (HHC) clinicians, which could lead to potentially deadly medical errors, a University of Colorado Anschutz Medical Campus study found.


WHY IT MATTERS


The study that concluded providing electronic health record access for HHC clinicians would be a promising solution to improve the quality of communication.


Although almost all (96 percent) indicated that internet-based access to a patient's hospital record would be at least somewhat useful, fewer than half reported having access to EHRs for referring hospitals or clinics.


Among respondents of the study, which surveyed 50 HHC nurses, managers, administrators and quality assurance clinicians, 60 percent reported receiving insufficient information to guide patient management in HHC, and 44 percent reported encountering problems related to inadequate patient information.


More than half of respondents (52 percent) indicated patient preparation to receive HHC was inadequate, with patient expectations frequently including extended-hours caregiving, housekeeping, and transportation--beyond the scope of HHC.


Respondents with EHR access for referring providers were less likely to encounter problems related to a lack of information (27 percent versus 57 percent without EHR access).


"We have heard of medication errors occurring between hospitals and home health care providers," the study's lead author Christine Jones, an assistant professor at the University of Colorado, said in a statement. "As a result, patients can receive the wrong medication or the wrong dose. Some home health providers don't get accurate information about how long to leave a urinary catheter or intravenous line in."



Nearly six in 10 (58 percent) of respondents said the recommendation of additional tests by hospital clinicians was the communication domain most frequently identified as insufficient.



Jones also noted additional studies have found extremely high rates of medication discrepancies (94 percent – 100 percent) when referring provider and HHC medications lists are compared, noting that if these issues are arising in Colorado, they could signify a national problem.


ON THE RECORD


"For hospitals and HHC agencies seeking strategies to improve communication, this study can provide targets for improvement," Jones said. "Future interventions to improve communication between the hospital and HHC should aim to improve preparation of patients and caregivers to ensure they know what to expect from HHC and to provide access to EHR information for HHC agencies.”


The study, published in the Journal of the American Medical Directors Association, suggested targeted education of hospital staff about what home health clinicians actually provide to patients and caregivers to avoid frustration.


Just 12 percent of respondents reported positive experiences when accessing the Colorado Regional Health Information Organization (CORHIO) about hospital admissions.



Bill Siwicki


Chicago's Rush University has been earned the HIMSS Davies Award Of Excellence for its work using health IT to treat veterans with post-traumatic stress disorder, more commonly known as PTSD.

The provider organization recognized that approximately 23 percent of U.S. veterans who served in Afghanistan and Iraq suffer from PTSD. Despite the availability of effective evidence-based treatments for PTSD, research has suggested that less than 20 percent of these veterans actually receive these interventions, HIMSS reported.

Furthermore, of the veterans who receive evidence-based PTSD treatments, close to 40 percent do not complete them and therefore do not receive adequate therapeutic doses. Consequently, it is important to identify ways to increase access to evidence-based PTSD treatments and to help veterans stay engaged in treatment so that they can complete their course of therapy, HIMSS said.

To address these critical needs, the "Road Home Program: Center for Veterans and Their Families" at Rush University Medical Center developed an intensive treatment program for veterans with PTSD. The three-week-long program offers a combination of evidence-based PTSD treatments and adjunctive services. Rush is one of the first health systems in the country to offer intensive PTSD treatment, so it was important to ensure that this novel PTSD treatment delivery method was effective, HIMSS explained.

Innovating with clinical data

The Road Home Program worked to address veterans not receiving adequate amounts of therapy by systematically capturing clinical data, including but not limited to PTSD and depression symptom severity at various time points.

This was performed while using existing technology available through the electronic medical records and survey tools. All data capture tools were designed with input from clinicians, researchers and system administrators to ensure that the collection of program data could be completed in short amounts of time to minimize any potential burden on clinicians. Moreover, the systems were designed so that captured data could be easily extracted and analyzed to assist with program evaluation, HIMSS said.

As a result, the Road Home Program was able to improve access to evidence-based treatments for veterans with PTSD. Ongoing, data-driven program evaluation led to continuous improvements in program effectiveness.

According to research published by Road Home clinicians, clinical outcomes from the three-week-long intensive program demonstrate that the intensive program is highly effective and that participation in the program leads to large reductions in PTSD symptoms. In addition, program completion rates are much higher (91.5 percent) compared to standard outpatient PTSD treatment. Veterans also report very high satisfaction with the program and would recommend it to their veteran peers, HIMSS reported.

The organization was able to standardize the Road Home Program data-capture system and share it with other academic medical centers who offer similar programs for veterans with PTSD. As a result, PTSD programs and clinical outcomes can be directly compared to ensure that the veterans served receive the highest quality care possible, HIMSS explained.

Since it first began to offer intensive treatment services in 2015, the Road Home Program has closely tracked clinical outcomes and patient satisfaction through custom flowsheets in the electronic medical records and external survey tools. By continuously analyzing its program-based data – such as veterans' PTSD symptom improvement over the course of the program and at short, medium and long-term follow-up time points – the Road Home Program has been able to make changes to further increase effectiveness, HIMSS said.

The Davies Award

The HIMSS Davies Award of Excellence recognizes outstanding achievement of organizations that have used health information technology to substantially improve patient outcomes and value. The HIMSS Davies Award of Excellence is the pinnacle of the HIMSS Value Recognition Program and highlights organizations promoting health information and technology-enabled improvements in patient and business outcomes through sharing evidence-driven best practices on implementation strategies, workflow design, change management and patient engagement.

"Rush is proud to receive the HIMSS Davies Award of Excellence, as striving for excellence is the bedrock of everything we do at Rush," said Dr. Larry Goodman, CEO of Rush University Medical Center and the Rush System. "While this award symbolizes information technology achievement and expertise, we are especially proud that it also reflects the collective efforts by clinical, operational, and business teams to drive technology-enabled improvements for our patients."



Jeff Lagasse


How an interdisciplinary kaizen group within CDC is charting a roadmap for future metrics to improve population health and provider satisfaction.


Addressing global infectious diseases has been an ongoing challenge. To tackle the issue, in 2018 the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention put together a Kaizen group consisting of an interdisciplinary collection of healthcare and IT professionals.

The group worked collaboratively to develop a roadmap and metrics for the future of clinical guidelines as they apply to electronic health records and infectious diseases.

Such an approach has several advantages — and a handful of drawbacks. That’s what attracted the attention of Steph Hoelscher, chief clinical analyst for the Office of Clinical Transformation at Texas Tech University Health Sciences Center’s School of Medicine in Lubbock, Texas.

Digitalizing these guidelines and algorithms would consist of creating them in a way that an EHR could accept them quickly from an outside source with minimum modification needed to the system.

“The goal of this would be to decrease guideline adoption time as well as improve both provider and informaticist satisfaction, not to mention improve overall population health,” said Hoelscher. “The process is still in its early stages and hopefully will move to larger scale testing within the next year.”

For the project, Hoelscher and her team looked to align their facilities with the CDC’s initiative, the Quadruple Aim, as well as the 21st Century Cures Act, in regards to clinician documentation burden.

She’ll discuss the implementation in more depth at the upcoming HIMSS19 annual conference in Orlando, Florida -- focusing on preparing an EHR for the future of clinical decision support, and bridging the gap until they get there.

“The process can be as complicated or simple as your development team allows for,” said Hoelscher. “Proper CDS development takes time, patience, evidence, subject matter experts committed to the project, and executive support.”

Facilities often lack the time and resources to properly develop a new process -- one that involves testing, reevaluation and maintenance. But for it to truly succeed, it has to be designed to stand the test of time, said Hoelscher.

That takes commitment, and with the constant changes of both medicine and technology, having CDS design that’s evidence-based, usable and safe can be a challenge.

“If you push hard for a strong CDS foundation, maintenance later on can be made much simpler,” said Hoelscher.

There are, of course, both pros and cons of clinical support in EHRs. First, the cons.

The limits of current technology and education are a big one. As fast as technology often moves, sometimes it’s just not fast enough; EHRs are often just not ready for the changes an organization may want to make today, and there have to be temporary bridges built in order to make it across the chasm.

And then there’s making a complex concept understandable to multiple levels of healthcare professionals.

“As with any maintenance cycle of a CDS project, quality education and often re-education needs to be a top priority,” said Hoelscher. “Staff and providers that do not ‘understand’ changes or new workflows, often succumb to frustration, and that’s what we are trying to avoid.”

Yet there are some pros as well. Hoelscher’s organization has integrated the potential for local disease detection into its EHR. With diseases like measles popping with some frequency as of late, it’s not enough to simply concentrate on Ebola and Zika.

“With that being said, an improved CDS process can possibly help you recognize the next Virus ‘X’ as well,” she said. “We are at the point where it’s not a matter of if, but when. If our systems can be enhanced enough to accept digitized algorithms from agencies such as the CDC in the future, the improvement in quicker detection and treatment of impacted patients could be profound, even life-saving.”

Hoelscher will share these thoughts and more at HIMSS19 annual conference in Orlando in a session entitled “Clinician Satisfaction: Digitalizing ID Clinical Guidelines,” at 3 p.m. on Tuesday, Feb. 12 in room W311E.