The Cleveland Clinic was recognized as a semifinalist in the 2013 Healthcare Informatics Innovator Awards program. Leaders of this team, along with leaders of the four finalist teams, will be recognized at the Healthcare Informatics Innovator Awards Reception, to be held in Orlando on Feb. 24 at the annual HIMSS conference.
Leaders at the Cleveland Clinic, the integrated health system in northern Ohio, have long believed in leveraging their investment into its electronic health record (EHR). According to Beth Meese, manager, clinical solutions center at the Clinic, the organization knew that it could push the application further by simply taking advantage of existing features and functions, but also by thinking beyond what comes in the box.
“Our health system has been using a traditional patient-entered data solution that exists outside of the integrated medical record,” Meese says. “We were challenged to understand if we could bring this solution into the record, therefore giving physicians the power to not only see data, but also see useful clinical information supporting clinical decisions. We were also challenged to build this out as a mobile solution to free patients to enter their response.”
While Meese knew this would not be an easy task, it was worth trying, she says. “Our first step was understanding how we wanted this solution to be different—not different technically, but different for the clinicians and different for our patients. We did not want to rebuild the same thing, but [instead] build a solution utilizing the tools within Epic,” Meese continues. “Once we defined our new clinical and technical requirements, we worked to build a solution that would not work only for this particular use case, but for patient-entered data solutions throughout the enterprise. A scalable solution is what we were after.”
The end result was WellQ, an EHR integrated patient-entered data solution that allows patients to answer simple questions about their overall health and well-being in wellness realms: COPD (chronic obstructive pulmonary disease)/smoking; sleep; depression; nutrition; exercise; and stress. These questions are tied to weighted scores that generate an overall score of relative risk in that particular category, explains Meese. The risk score is integrated into the EHR and allows for clinical decision support such as flexing orders for physicians, customized information for patients, and clinical trending of results against physiological factors, says Meese.
The scope of the project was one family health center at Cleveland Clinic, five physician providers, and all patients scheduled with a new patient appointment, follow-up appointment, or same-day visit, explains Meese. The patient-entered data component was delivered to patients via an iPad application at the point of check-in, and the data was reviewed by the physician during the patient visit. A satisfaction survey was also delivered to the patients at the time of data entry. The average completion time for the patient-entered data component was four minutes and did not require any additional pre-visit appointments or extended wait time for patients, or a delay in physician schedules, Meese says.
According to Meese, the solution is unique because the data is integrated into the clinical workflow. Physiological data is tied to patient-entered data driving intervention recommendations, she says. “This is done through a unique clinical integration engine called the common service layer (CSL). This integration engine uses custom web services to set the patient-entered data discretely into the medical record through a common protected, secure application programming interface (API) web service layer,” she explains. “The industry is accustomed to patient-entered data solutions. However, these solutions store data in an external database, and if integrated into the medical record, are done so in an interface that either does not make the information available immediately to act upon during the existing medical appointment, or in a manner that does not allow for discrete use of the information,” she says.
The pilot ran for an initial 90 days with an agreement to continue due to pilot success, says Meese. In the initial 90 days, out of 1,423 eligible patients, 1,130 participated in the pilot. Ninety-nine percent of the patients who participated reported the data entry to be easy, and more than 90 percent found the questions would at least be “of somewhat help” to the state of their health, Meese notes.
“By capturing clinical questionnaires, information can be leveraged to give the best, most personalized patient experience,” Meese says. “In addition, this data tracks important outcome metrics. We can leverage this data to drive the best quality of care for the best cost.”
And operationally, a patient can take important clinical questionnaires, update demographics, or even check in, all from the convenience of an application, continues Meese. “We feel the concept of a ‘waiting room’ is a relic of the old practice model. Do it at home and do it on your own time,” she says. “Leveraging technology to support clinical and patient workflow might someday change the phrase, ‘the doctor will see you now’ to ‘the patient will see you now.’”
The results of the pilot were reviewed by section to understand the risk ratio to intervention prescribed. The most notable outcomes were related to COPD and smoking, says Meese. For smoking/COPD patients, smoking history was considered against three nationally recognized questions related to COPD diagnosis—cough, phlegm/sputum, and activity level. Of the patient respondents for these questions, 14 percent were found to be of high-risk for COPD, she says.
Upon review of the high-risk patients, 55 percent were consulted to smoking cessation and 46 percent were ordered testing for spirometry, a common pulmonary function test. These are patients who had previously gone unrecognized for combined symptoms of COPD and are now undergoing evaluation leading to treatment, says Meese. “This solution is changing people’s lives,” she says.