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Show Us the Evidence

December 31, 2009
by Mark Hagland
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With a solid IT foundation in place, hospitals are leveraging data to establish new clinical guidelines and change the face of patient care.

The folks at Children's Hospital of Pittsburgh don't just parrot the party line about using actionable data to optimize patient care; they live the creed. Not only do executives - including Vice President and CIO Jacqueline Dailey - regularly participate in executive patient-safety rounds across the hospital's units, but years after implementing core EMR and CPOE systems, they're using data from Children's itself, as well as from the national clinical literature, to modify care processes and establish clinical guidelines.

“We've leveraged the children's hospital national database in order to create and advance our antibiotic stewardship process,” says CMIO James Levin, M.D., Ph.D. “We found that we had been using more of a particular antifungal, AmBisome, than any other children's hospital in the country.” (The medication is used to treat unusual fungal infections, such as mold in the bloodstream, that can afflict immuno-compromised patients.) But new evidence emerged in clinical literature indicating that a different antifungal, Caspofungin, demonstrated the same efficacy, with fewer side effects.

So, using their robust data warehouse and reporting tools, Levin's colleagues in the pharmacy produced daily reports on antifungal use that went to pharmacists and to a clinician steering committee. Ultimately, they created a guideline that made Caspofungin the preferred medication (and the default in the hospital's CPOE system for that scenario), and led to a dramatic drop in side effects. The guideline has also saved the hospital tens of thousands of dollars in pharmacy costs per quarter.

This type of evidence-based care, however, would not have been possible had Children's not spent years laying the IT foundation. Not only was the hospital live with CPOE back in 2001, but that implementation had been preceded by a multidisciplinary effort to develop consensus-based order sets.

“We've done a lot of work here in terms of design, and in terms of the IT team spending a lot of time in clinical areas watching how people work,” says Dailey. “Really observing practice, and figuring out how we can have the biggest impact in terms of supporting physicians in the right way, supporting care at the bedside,” are the keys to making patient care safer, better and more cost-effective, she notes. Incidentally, Children's Hospital of Pittsburgh was one of seven pediatric hospitals in the country to earn “top hospital” ranking for patient safety in 2008 from the Washington-based Leapfrog Group. Dailey also credits support from senior leadership at Children's as well as its parent health system, the University of Pittsburgh Medical Center, with helping to facilitate the organization's success on the evidence-based care journey.
(from left) the executive team at children's hospital of pittsburgh: jacqueline dailey, vp and cio; steven docimo, m.d., vp of medical affairs and cmo; christopher gessner, president; and james levin, m.d., ph.d., cmio

(from left) The executive team at Children's Hospital of Pittsburgh: Jacqueline Dailey, VP and CIO; Steven Docimo, M.D., VP of Medical Affairs and CMO; Christopher Gessner, President; and James Levin, M.D., Ph.D., CMIO

Children's hospital of pittsburgh, part of the 20-hospital upmc health system

Children's Hospital of Pittsburgh, part of the 20-hospital UPMC Health System

Across the nation, a revolution

Richard bankowitz

Richard Bankowitz

The effort underway at Pittsburgh Children's is indicative of where industry experts believe healthcare is moving and must move. And that, many agree, means implementing EMR, CPOE, eMAR, advanced pharmacy, and other core clinical information systems, and leveraging those systems to drive improvements in quality, patient safety, efficiency, and cost-effectiveness. This is best accomplished through examining both clinical literature and hospitals' own clinical databases, and then creating a continuous loop of data reporting and data-driven process change in care delivery. In fact, there are several critical elements involved in using data to support improvements in care, among them, the creation of a culture of objectivity (see “Critical Success Factors,” p. 37).

And industry leaders say now is the time to move forward. One initiative pushing quality and safety of care forward is the CMS/Premier HQID demonstration program, which has combined data-driven quality improvement and pay-for-performance goals at more than 250 hospitals. According to Richard Bankowitz, M.D., vice president and medical director at Charlotte, N.C.-based Premier Inc., HQID hospitals have raised their overall quality by an average of 17.2 percent over four years, based on delivery of more than 30 care measures in five clinical areas.

Paul browne

Paul Browne