In a wide-ranging opening keynote address, Christopher A. Longhurst, M.D., CIO at UC San Diego Health, offered his perspectives on the healthcare IT-facilitated clinical transformation beginning to take place now in earnest across U.S. patient care organizations, on the first day of the Health IT Summit in San Diego, sponsored by Healthcare Informatics. Dr. Longhurst, a pediatrician who had been CMIO at Stanford Children’s Health before coming to UC San Diego Health as CIO a little over a year ago, told attendees gathered at the Omni Hotel San Diego on Tuesday morning, that now is absolutely the time for healthcare IT leaders to help their patient care organizations turn the corner from the immediate post-electronic health record (EHR) implementation phase, to the vital work of improving patient care quality and outcomes through EHR implementation and clinical transformation.
Longhurst began his keynote address by framing the context of the current moment in clinical informatics in U.S. healthcare. He reviewed what happened when a December 2005 article, “Unexpected Increased Mortality after Implementation of a commercially Sold Computerized Physician Order Entry System,” appeared in the journal Pediatrics, summarizing a documented increase in mortality at Children’s Hospital of Pittsburgh, after EHR implementation there. As Longhurst noted of the article’s core finding, “It was a bombshell result. We gave a lot of thought to this,” he said, “and I wrote a letter to Pediatrics, along with Dr. Classen”—David Classen, M.D. of the University of Utah Health Science Center. Looking at the immediate result of increased mortality at Children’s Hospital of Pittsburgh following EHR go-live, he said, speaking of the analysis of it that he and Dr. Classen undertook, “We thought it was inadequate preparation along with bad order sets.”
Christopher Longhurst, M.D.
As a result of the heightened awareness of the potential for unanticipated negative impacts on patient outcomes in the immediate aftermath of EHR go-live, Longhurst talked about how he and his colleagues at Stanford Children’s Health (at that time still known as Lucile Packard Children’s Hospital) engaged in very careful, thoughtful analysis of outcomes as they were going live with their EHR implementation, and in its immediate aftermath. Indeed, as CMIO, he had asked the hospital’s chief quality officer to monitor very closely all mortality trends in their facility, as they moved forward through post-go-live. As it turned out, their implementation revealed a dramatic decrease in patient mortality: mean monthly adjusted mortality rate for the hospital overall decreased by 20 percent in the 18 months after EHR go-live, with an estimated 36 children’s lives saved during that time, based on an analysis of their outcomes. In an article that he and his colleagues from Lucile Packard published in the May 2010 issue of Pediatrics, entitled “Decrease in Hospital-wide Mortality Rate After Implementation of a Commercially Sold Computerized Physician Order Entry System,” Longhurst and his co-authors attributed the difference between the outcomes at their organization and those years earlier at Children’s of Pittsburgh, to differing implementation strategies, and offered that he and his colleagues had learned a great deal from what their peers at Children’s of Pittsburgh had discovered in their post-implementation; and that a well-executed EHR implementation is indeed fully capable of reducing mortality rates among pediatric patients.
Longhurst also referenced an April 2010 article by Jane Metzger et al in Health Affairs, “Mixed Results In The Safety Performance Of Computerized Physician Order Entry,” which found that, among hospitals implementing six different commercial EHR products, patient safety impacts from EHR implementations varied across every vendor solution as implemented by every hospital, to make the point that the relative success of EHR-fueled patient safety work will depend on what goes on in every patient care organization that attempts such work, not on the commercial EHR product used. In the Metzger study, he noted, “Six different vendors were the safest of six different vendors. So what does that tell us? It’s not the software that you buy. It’s about us. It’s about implementation. Less than 20 percent of outcome was based on the vendor, 80 percent was the implementation,” he said of that study.
Moving into a new era in clinical transformation, Longhurst emphasized, will require some enterprising ingenuity, and above all, leadership and a passion for leveraging health IT effectively to improve clinical outcomes. He spent some time recounting a clinical case at Stanford Children’s Health that broke new ground in that regard, and which was recounted in an article entitled “Evidence-Based Medicine in the Clinical Era,” in the Nov. 2, 2011 edition of New England Journal of Medicine, with Jennifer Frankovich, MD., the lead author, and Dr. Longhurst and Scott M. Sutherland, M.D., as coauthors.
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