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HAI — A High Visibility Problem

December 1, 2008
by Daphne Lawrence
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Recent studies show that hospitals with low HAI rates rely heavily on IT, but the jury is still out on where a CIO should begin

Lynn eckendorf

Lynn Eckendorf

The Washington-based Government Accountability Office (GAO), an independent, nonpartisan agency that keeps an eye on Congress's spending, recently released a report, ‘Healthcare Associated Infections in Hospitals: An Overview of State Reporting Programs and Individual Hospital Initiatives to Reduce Certain Infections,’ outlining how hospitals, which rely heavily on IT are able to prevent infections and save money in the process. No big surprise there for healthcare CIOs. What state and hospital association officials told the GAO, however, highlights the real issue CIOs often face in the hospital-acquired infection (HAI) arena: most hospitals face challenges with implementing and funding HAI technology — and that can limit the scope of systems and the timing of implementations.

“I believe as more and more imperatives come for infection control, (health) systems like mine are going to say ‘I only have so much money, I have all these things I'm supposed to be doing, and I need to have a thoughtful and relatively objective strategy for looking at where am I going to11 get the best bang for my buck,” says Mark Wheeler, director of clinical informatics at PeaceHealth, a nine-hospital system headquartered in Bellevue, Wash.

So when it comes to the IT solutions that can address the Oct. 1, 2008 reimbursement changes from the Centers for Medicare and Medicaid stipulating that it will no longer pay hospitals for treating HAIs, CIOs may need to be more creative than ever.

The Centers for Disease Control and Prevention (CDC, Atlanta) estimates that HAIs affect more than 2 million patients a year, and cost the nation more than $4.5 billion annually. In addition to the serious safety issues for patients, the cost of treating HAIs exceeds most payer reimbursement, resulting in hospital net loss. Since the CMS reimbursement changes were first announced, hospitals have been scrambling to implement solutions.

Ensuring compliance for HAI regulations is high on every CIO's to-do list. But should CIOs wait for their infection or quality control departments to drive the solution? “The CIO has to have an HAI strategy that is in alliance with the enterprise strategy because it's not simply a one-topic issue,” says Lynn Eckendorf, a consultant at Falls Church, Va.-based Noblis Center for Health Innovation. “HAI is a great example of using technology to enable strategies to reduce infection.”

As exposure to multi-drug resistant organisms, or ‘superbugs,’ becomes more common, one of the most common resulting infections in hospitals is MRSA (methicillin-resistant Staphylococcus aureus). For Tom Smith, CIO of Evanston Northwestern Healthcare, a three-hospital system in Evanston, Ill. (that recently changed its name to NorthShore University HealthSystem — NSUH), MRSA screening was part of the enterprise strategy. “MRSA is the way we decided we want to practice medicine,” Smith says, in regard to screening.

NSUH was one of two health systems the GAO visited in preparing its study (the other was the University of Pittsburgh Medical Center). NSUH, which is on an Epic (Verona, Wis.) EMR, added an orange banner on the medical record screen that highlighted any patient who had yet to undergo a MRSA test. “You need some kind of clinical-record keeping at point of care, otherwise you're putting something into a piece of paper and looking at it,” Smith says. “You can do that if you have enough people — but it takes a lot of people.”

Another MRSA initiative is currently going on at PeaceHealth, and Wheeler says the system is performing a cost benefit analysis of MRSA screening. “When you look at infections, there are many strategies you can take,” he says. “What you really need to do is ask what is the cost and benefit of any intervention.”

To determine numbers for MRSA, Wheeler says he plans to use his enterprise data warehouse from U.K.-based GE Centricity for a multiple regression analysis to pick the best predictors for any patient being a MRSA carrier. “You can screen everybody, but it depends on the MRSA carrier rate,” he says. “It's all locally driven.”

Wheeler says if hospitals have a carrier rate of five percent, it doesn't make sense to screen everybody — particularly when keeping the budget in mind. “If we can screen a third of our patients, that's a big change in the cost,” he says. “We'll miss some, but if there's competition for that money for other things like hand-washing, the combination might turn out to be a more efficacious strategy.”

Lindsey jarrell

Lindsey Jarrell

Saving staff for other important functions around HAI is cited by many as one of the big benefits of automating. “If you are reducing the need to put resources in one area, you can deploy them in other areas,” Eckendorf says. That includes monitoring and reporting any infection patterns to the CDC.

At BayCare Health System, a Tampa, Fla.-based nine-hospital system, CIO Lindsey Jarrell was using two infection control systems. They were interfaced into his Kansas City, Mo.-based Cerner EMR and automatically monitored clinical data to alert the hospital of any types of infection patterns within the hospital. He says his quality officer began taking a look at HAIs about 18 months ago. “Knowing what was coming, and knowing that we needed to get better in the management of HAI, we said ‘this is not going to do.’”