Innovation is everywhere in U.S. healthcare these days, and many leaders in patient care organizations nationwide are pursuing initiatives that are leveraging health information technology to improve patient care quality, patient safety, clinician and staff effectiveness, efficiency, cost-effectiveness, and more.
Indeed, we at Healthcare Informatics were delighted by the exceptional quality of the submissions we received from innovating teams from across the country, this year. Below, please find descriptions of the initiatives of the six teams whom we have awarded semifinalist status in this year’s program.
To learn more, leaders of these teams, along with leaders of the four finalist teams, will be recognized at the Healthcare Informatics Innovator Awards Reception, to be held in Chicago on April 13 at the annual HIMSS conference.
Independence Blue Cross: Supporting the PCMH Model
For more than six years, the Philadelphia-based Independence Blue Cross has actively supported and promoted the medical home model; to date, more than 300 primary care practices in Independence’s network are recognized by NCQA as medical homes, and those practices serve nearly 45 percent of Independence members. Independence’s senior leaders recognize that true PCMH capability is only possible through intense IT and analytics facilitation.
Within the context of its ongoing support for the PCMH model, Independence’s chief informatics officer, Somesh Nigam, and its director of advanced analytics, Ravi Chawla, led the organization’s informatics team in conducting a series of studies from 2009 to 2011 in order to evaluate the success of the medical home model and further prove its value in helping to deliver high-quality, coordinated patient care while helping to lower costs. The results of those studies were published in peer-reviewed policy journals.
Among the key findings: that the patients cared for in practices recognized as PCMHs had 10.8 percent fewer hospital admissions than control patients in 2009; 8.6 percent fewer in 2010; and 16.6 percent fewer in 2011. In addition, in 2009 and 2010, there was a savings in total medical costs of 11.2 percent and 7.9 percent, respectively, for patients treated in PMCH-organized practices.
Independence is moving ahead with further initiatives to support research into PCMH-based care models, and is collaborating with Penn Medicine on research initiatives looking into some of today’s most pressing issues, including how to improve medication adherence for heart attack survivors.
Children’s Hospital of San Antonio: Optimizing Pediatric Dosing in Texas
The leaders at Children’s Hospital of San Antonio (Tex.), a member of the CHRISTUS Health System, have been involved in a broad initiative to optimize provider ordering, particularly around pediatric medications, and especially with regard to pediatric dosing, long a historical problem in pediatric care. Project leaders worked intensively over a multi-year period with pediatric clinicians to create the following standardized content: over 170 pediatric-specific order sets with evidence-based recommendations where available; over 1,800 dosing sets associated with 372 medication profiles, providing clinicians with over 1,800 weight-based medication dosing strings; development of a pediatric medication dosing policy that provides ordering clinicians and pharmacists with defined guidelines for medication dos standardization/rounding, to ensure the dispensing and administration of practice and accurately measured medication doses based on weight; and development of an approved list of pediatric and neonatal ICU standard concentrations including associated dosing guidelines, maximum dosing, and rounding information to support the building of clinical content within the electronic health record.
All of these supports have been transforming pediatric ordering not only within the inpatient space, but in the outpatient space as well. Children’s leaders note that 50 percent of pediatric care delivery within their health system occurs outside the walls of the hospital itself. Now, the clinicians, who may or may not have pediatric expertise, to quickly determine dosage for the medications for their youngest parents.
Blanchard Valley Health System: Population Health Management Powers Medical Home
For the past four years, Blanchard Valley Health System in Findlay, Ohio, and a large home appliance manufacturer have teamed up to tackle the healthcare value challenge. Together, these organizations established a technology-enabled patient-centered medical home (PCMH) initiative to get more value from providers and to encourage employees to better manage their health. Serving more than 4,000 combined employees, the medical home is driving better management of high-risk and high-cost patients, an increase in preventive care compliance, a drop in unnecessary ER utilization, and a return of $2.44 for every dollar invested in the program.
Critical to the success of the initiative is an end-to-end technology solution for population health management delivered by the Alpharetta, Ga.-based Wellcentive. The solution not only aggregates data about the medical home’s population; it also empowers caregivers to take strategic action to improve outcomes, says Pat Beham, director, managed care, Blanchard Valley Health System. “With our Blanchard enrollees, we noticed three changes in the usage patterns,” Beham says. “An increase in physician office visits and preventive visits; a 22 percent decrease in inpatient admissions (excluding deliveries), and an 8 percent decrease in ER visits. This initiative is a prime example of a forward-thinking local provider and employer working hand in hand to align incentives appropriately to tackle the value equation,” Beham says.
NextLevel Health: Virtual Health for Community-Based Care
In March 2014, the Chicago-based NextLevel Health Partners (NLHP) was awarded a contract with the Illinois Department of Healthcare and Family Services to provide care coordination services to seniors, people with disabilities, and those newly eligible under the expansion of Medicaid under the Affordable Care Act. A vital piece of this contract award was the utilization of health IT to support NLHP’s community-based care model. As such, NLHP partnered with the Ney York City-based Virtual Health to implement a cloud-based care coordination system providing a high-tech solution to support NLHP’s high-touch care coordination strategy.
NLHP’s care teams are equipped with tablets and mobile phones, giving them the ability to have the full breadth of the technology platform’s capabilities while accessing members at their homes, at providers’ offices, at hospitals, and at various community-based sites, including homeless shelters, food banks and employment offices. Through a successful implementation and continuous partnership between NLHP and Virtual Health, NLHP care teams and in-network providers are able to enhance efficiency, carefully track and monitor members’ health status in real-time and leverage the data to provide actionable interventions across the entire member population, resulting in improved health outcomes, enhanced quality, and higher efficiency, according to NLHP officials. As a result, to date, NLHP has been able to actionably engage with more than 50 percent of its member population in a matter of months, a statistic that is a far outlier among care coordination given the transient nature of the member population, its officials say.
Penn Medicine: Real-Time Data via a Mobile Patient Dashboard App
A Penn Medicine team has developed, and put into wide internal use, a mobile patient dashboard application that consolidates real-time patient data from nine clinical information systems at Penn. These include three electronic medical records (inpatient, outpatient, and emergency department) and six specialized systems (including lab, radiology, and admissions). The app— designed by a practicing Penn Medicine physician—offers physicians, nurses, therapists, pharmacists, dieticians, and lab and radiology professionals a faster, more convenient way to monitor patients, prioritize needs, and make treatment decisions, according to Penn officials.
Through the app, users can check real-time vital signs via easily viewable graphs that convey the patient’s current and trended conditions. Other important clinical data that are available include allergies, medication with administration history (including home-based medications), radiology studies, and lab results. Unlike conventional EMRs, the Penn Medicine app presents these data in a display that is intuitive and designed to compliment provider workflow, say Penn officials. During the pilot phase for the Penn mobile app, care teams using the app were compared to a control group. Users accessed patient data from the EMR more frequently than control teams (12 vs. eight times per patient round). Penn leaders also found that the average login time for the EMR on a desktop is 53 seconds, but only 2.5 seconds on a mobile device, or 22 times faster. Based on an average of 40 log-ins daily, this translates into caregivers saving 33 minutes every day.
Military Health System: Tri-Service Workflow: Bringing Team Care to Patient Care
Tri-Service Workflow (TSWF) innovation is a multi-disciplinary approach for the integration of IT systems into the clinical environment. The goal of TSWF is to improve overall quality of care across the Army, Navy, and Air Force Medical Services that together make up the Military Health Services (MHS). Prior to TSWF, clinicians in the MHS were frustrated with documenting and reviewing patient encounter notes in the electronic health record. There was no standardized workflow within an individual care team nor between patient care teams; the usability and performance of AHLTA was so poor, it led to profound provider dissatisfaction and became a barrier to the military being able to retain physicians.
To this end, an organic coalition of practicing providers known as the Tri-Service Workflow team came together. It employed a new methodology for organizational change management that integrated healthcare, policy/business, and IT communities together in the development of workflow solutions. Representatives from each service were then able to develop standardized tools and workflows for all three services that were sensitive to service-specific considerations. To support the workflow, every clinical team member was utilized to their highest level of training to promote team documentation. TSWF provided an analysis of the current technology systems impacting clinical end users.
One of the most significant accomplishments of TSWF is the standardization of the Army, Navy, and Air Force patient screening and intake process, officials say. This has strengthened the joint environment and moreover has decreased training times and staff downtime after permanent change of station while increasing interoperability. TSWF products are the standard documentation method for patient centered medical home (PCMH) in family medicine, internal medicine, and pediatrics for the entire MHS with products being used over 500,000 times each week.