Show Us the Evidence

“We've found that the best performers in HQID have a few characteristics in common,” says Bankowitz. “First, all of them have created a culture of quality, in which everyone in the organization considers quality to be part of his or her job. Second, these organizations have a data-driven culture; they review data, figure out what works and doesn't, do small tests, and are very transparent in their use of data. And third, there is a culture of accountability, in which people take responsibility for the results of their unit or group team.”

The results that pioneering organizations have achieved in leveraging EMR, CPOE and other clinical IS to create evidence-based care processes are demonstrating quite clearly that there is tremendous potential to raise the standard of care. Examples include the following:

• Leaders at Cincinnati Children's Hospital Medical Center have created a Center for Health Policy and Clinical Effectiveness to generate and coordinate evidence-based care practices for children's hospital and outpatient care. With the support of that office, clinicians have created more than 500 evidence-based order sets, and have achieved 95 percent compliance, says Uma Kotagal, M.D., senior vice president of quality and transformation, and Marianne James, vice president and CIO. James says her clinicians and IT professionals used an iterative process to continuously improve how IT can support evidence-based care-driven improvement.

• At 44-hospital, Novi, Mich.-based Trinity Health, clinicians created hundreds of clinical order sets, 300 of which are evidence-based, say Vice President and CMIO J. Michael Kramer, M.D., and Senior Vice President and CIO Paul Browne. Kramer says Trinity's leaders created a multidisciplinary, evidence-based practice team that both examines the national clinical literature, and draws data out of the organization's database for use in developing the order sets. Once an order set has been piloted in one or more hospitals, the team helps implement it system-wide. “In addition to reaching a new level of transparency and accountability, we're headed towards a new age of discovery,” Browne says. “We can now compare thousands of patients who have had hip replacements at Trinity, see every step taken by every nurse and doctor caring for them, and discover what works and what doesn't, in a way we couldn't before. That's going to lead to a lot of improvements in the quality, consistency, and efficiency of care, and to advance the industry in ways we can't really conceive of today.” Trinity Health was named one of 10 top health system performers in the 2009 “Top 100 Hospitals: Health System Quality/Efficiency Benchmarks” study by Thomson Reuters.
  

  Gregory Husk

• At the Continuum Health System in New York City, which includes Beth Israel Medical Center and three other hospitals, Gregory Husk, M.D., CMIO, and Colleen Lyons, corporate director of IT, have found that improving care quality requires continuous data analysis and modifications to order sets based on the analysis. For example, Beth Israel clinicians recently realized that having a single order set for the ordering of low-molecular-weight heparin was creating problems because of differences in the clinical appropriateness between patients who were undergoing hip replacement and those undergoing knee replacement. As a result, two separate order sets - or “nests,” in Continuum Health terminology - have been created for deep vein thrombosis prophylaxis for hip and knee replacement patients. Making such refinements is critical to leveraging the advantages of EMR, CPOE, and data warehouse implementation for care improvement, Husk says.
  

  Patty Lavely

• At Memorial Health University Medical Center in Savannah, Ga., clinician leaders have been working to leverage data to analyze patient safety issues and improve the hospital's safety record. Clinicians at the 538-bed teaching hospital have used a program called “Create a Safe Day” to reduce serious patient safety events by 70 percent between 2007 and 2008, say Marty Scott, M.D., vice president for quality and patient safety. The number of events decreased from 12 in 2007 to four in 2008 and only one in 2009, he says. As for the IT facilitation of this work, the difference often comes from simple steps like making sure all necessary hardware is available to ensure universal clinician adoption on a day-to-day basis, says Patty Lavely, senior vice president and CIO. Memorial has been a solid performer in terms of its outcomes to date in the HQID demonstration project.

• Aurora Health Care, a 15-hospital system based in Milwaukee, was the top performer of all 250 participating HQID hospitals in terms of clinical outcomes in both in 2008 and 2009. Philip Loftus, CIO and vice president of information services, cites the organization's commitment to improving core clinical outcomes, as well as its use of clinical information systems to support that work, as key factors in its success. In 2009, Aurora hospitals were top performers in 23 of 47 quality areas measured, and received 68 incentive payments, the most of any system in the country.