Blessing Hospital: Decision Support

Order sets are created to be as user-friendly as possible, Duke says. Medications, for example, are grouped in the most common types of practices, she says. Physicians are given prompts for certain medications to determine whether or not the physician wants to continue, she explains. “When a patient comes out of surgery and the physician is doing his post-ops, the system allows them to be prompted for the orders they want. By doing that, they have their documentation built and their orders sent,” she says. She adds that the prompts result in more complete documentation, which allows the hospital to code more appropriately for reimbursements.

Blessing uses sophisticated alerts, called medical logic modules, which are embedded in the electronic record. “We set some rules up from the very beginning of the design of our informatics system that we felt were high patient safety issues, and that we were going to put the alert in front of the practitioners or the providers,” Kahn says. Other conditions are monitored behind the scenes to minimize alert fatigue, she says. “We want to make sure that when we put an alert in front of a physician, there is meaning to it,” she says. Kahn adds that other programs are running in the background, such as a pharmacy monitoring system to help monitor dosing of medications and potential side effects, based on the medications that are being ordered, with data shared with the physicians.

Kahn maintains that the human connection remains important as a resource for physicians. Clinician documentation  experts are stationed on patient floors to provide guidance to physicians. “These are nursing experts who are talking with physicians, are reading their notes, and who want to make sure that the [care] plan is well defined,” she says.

GETTING STAKEHOLDER INPUT
According to Duke, all groups of stakeholders were consulted in developing the system. The IT team brought in groups of physicians, pharmacists and nurses, each of which presented its perspective, she says, noting that Debra Phillips, M.D., the hospital’s CMIO, was heavily involved in the rollout. “We made sure we had all of the stakeholders involved, and looked at ways to gain wins,” she says.

That stakeholder involvement has been important, Kahn says, adding that the hospital has not been perfect in designing some of its processes. “It has been the feedback of clinicians and providers that have made us go back and revise a process, revise the software, and get it to the best way it works for the people in this organization,” she says.Core users are clinicians and other care providers, but the system also has benefits in the business sense as well, Khan says. “As we start to look at Medicare’s bundled payments, we will need this data to understand our business,” she says.

The IS and informatics team that led the implementation. Photo: Blessing Hospital

Kahn maintains that its physicians have embraced the system enthusiastically. She notes that Blessing never used the word “mandatory” when it rolled out its CPOE, yet 90 percent of orders were electronically entered within three months. The hospital’s informatics team trained the physicians at their convenience, “morning, noon, or night—whatever worked for them,” Kahn says. After the system went live, “super-users” were assigned to physicians to coach them as they did their rounding and put their orders in.

The decision support activity and function are truly driven from the clinical documentation system, Kahn says. “We identify in the documentation system the key elements that we know we are going to want to abstract, or we know we are going to want to search on patients. And we designed our system to make sure that we will be able to pull data and be able to abstract. As we developed this sophisticated documentation system, decision support becomes a byproduct of all of our work of putting this information in the system.”

The metrics have been impressive. Examples of additional gains include: a 29-percent cost-per-case decrease in septicemia, saving $64,600 annually; a 7-percent decrease in cost-per-case digestive disorders, saving $10,400 annually; and a 13-percent decrease in cost-per-case pneumonia, saving $19,200 annually.

Blessing Hospital has recently been recognized by the Illinois Hospital Association for its improvement in preventing deep vein thrombosis (DVT), which dropped 37 percent over the course of one year. “It was the physicians and nurses working together on a new process; and they used the computer system to leverage it, to improve the screening of patients who are potentially at risk, and developing those rules and alerts to make sure that we are providing the patients with evidence-based interventions to decrease their potential risk of developing DVT,” Kahn says.

For other hospitals interested in implementing an aCDS system, Kahn offers this advice: work toward getting relevant information that can drive change. It’s a good idea, she says, to work with a well-defined, step-by-step process and “not try to cure everything in one fell swoop.”