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In Michigan, Lakeland Health’s Newfound Focus on Patient Monitoring and Safety

December 7, 2017
by Rajiv Leventhal
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At Lakeland Health, the three hospital-based community-owned health system in St. Joseph, Mich., “patient safety with zero harm” is the number one goal enterprise-wide. But as senior clinical and informatics leaders at Lakeland quickly realized a few years back, some 40 percent of unanticipated hospital deaths happen on the general ward, where it's hard to predict which patients to watch closely.

Due to this challenge, coupled with government regulations increasingly focusing on safety and compliance, Lakeland C-suite executives knew the pressure was on to ramp up their protocols so that they could reach their goal of either very minimal errors or best of all, zero patient safety issues. To start, a newfound emphasis was placed on collecting patients’ vital signs, says Arthur Bairagee, chief nursing informatics officer, Lakeland Health.

“When a patient comes in and he or doesn’t feel good, the first thing we will do is take the vital signs. And the vital signs are called just that because we are taking information from the vital organs. So our goal was to get that accurate patient data into the EHR [electronic health record],” Bairagee explains. “We have found throughout my years as a nurse on the floor that transcription errors can happen. So when I am documenting respiration [rates], a normal rate might be 17 or 18 [breaths per minute], but accidently if I record that number as 60, that changes everything. And the same thing goes for blood pressure and the other vital data that goes in. We needed to get the right data into the [Epic] EHR so that we could have a better decision making process for clinicians,” he says.

As Bairagee explains, the approach around vital sign collection at Lakeland had been that the nurse’s assistant would go into every patient room with the vital sign monitor, ask the patient’s name, collect the vital signs, and then write that information down on a piece of paper, while later on going into the EHR to transcribe it. But with that process, since paper was being used, sometimes the patient’s room number or name would get switched, misplaced, or forgotten. Also, just one nurse assistant would collect this information for seven or eight patients, which would take over an hour alone, and then he or she would sit down at the computer to enter in the data. This means that clinicians wouldn’t get that important data until an hour-and-a-half after the collection of the vital signs, rather than immediately. “And one keystroke mishap changes everything,” Bairagee says.

This archaic approach needed to evolve, and that’s why Lakeland clinical and IT leaders decided to deploy the Philips IntelliVue Guardian Solution with automated early warning scoring (EWS) at all three of its hospitals. The solution contains software and clinical decision algorithms, allowing caregivers to accurately obtain vital signs and integrate the validated patient data directly to the EHR. Last year the hospitals did two pilots with the technology and then the entire organization went live with it this past August.

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Arthur Bairagee

Now, explains Bairagee, when the nursing assistant goes into the patient’s room, he or she is using the system to scan his or her own ID badge barcode, as well as the patient’s arm band barcode, collects the patient’s vital signs, validates the data, and then hits “send.” The data is calculated by the software and then wirelessly uploads into the Guardian system while also giving the nurse assistant a patient “score” back on the screen.

The scoring system assigns a number to each patient, from 1 to 8. A score of 1 to 3 means that the patient is doing OK; a score from 3 to 5 leads to a decision being made by the nurse and nurse assistant on if the vital signs should be taken every two hours going forward; and a score of 6 to 8 is when the nurse could call in a rapid response team, if needed.

This entirely new and improved process has “completely changed the organization’s culture,” attests Bairagee. The nurse assistants feel empowered and engaged, he says, and they are also communicating that data to the nurses, whereas previously they were just entering it into the computer. “And that also has led to complete awareness; before the patient crashes, if he or she does, the nurse is more engaged. And the physicians also come in right away, addressing the patient’s issue early, so that part of the culture has changed as well.”

As a result of this system, Bairagee points to the amount of rapid responses having increased significantly, with the number of cardiac and respiratory arrests decreasing by approximately 56 percent. He adds that while deploying the vital signs system and having the algorithm in the back to display the score certainly has helped, that alone will not save lives. “It does make people aware to do something about it because it’s pointing out where attention should be placed, but you still have to act on it. That culture change doesn’t come in one day, but it will come once you show that data. And here at Lakeland we want to keep up this effort and move toward our goal of zero codes.”


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LabCorp Joins Apple Health Records Project

November 5, 2018
by Rajiv Leventhal, Managing Editor
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LabCorp, a provider of clinical laboratory and end-to-end drug development services, has announced that it has enabled Apple’s Health Records feature for its patients.

This iPhone feature aims to make it easier for LabCorp patients to access their LabCorp laboratory test results, along with other available medical data from multiple providers, whenever they choose, according to officials.

In January, Apple announced that it would be testing the Health Records feature out with 12 hospitals, inclusive of some of the most prominent healthcare institutions in the U.S. Since that time, more than 100 new organizations have joined the project,  according to Apple.

LabCorp test results are viewable in the Apple Health app for LabCorp patients who have an account with the company, and enable integration with the Health Records app. In addition to their LabCorp test results, patients will have information from participating healthcare institutions organized into one view, covering allergies, medical conditions, immunizations, lab results, medications, procedures and vitals.

Patients will receive notifications when their data is updated, and the Health Records data is encrypted and protected with the user’s iPhone passcode, Touch ID or Face ID, according to officials.

“LabCorp on Health Records will help provide healthcare consumers with a more holistic view of their health. Laboratory test results are central to medical decision making, and broadening access to this information will help patients take charge of their health and wellness, and lead to more informed dialogues between patients and their healthcare providers,” David P. King, chairman and CEO of LabCorp, said in a statement.

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HIMSS Analytics Introduces Infrastructure Adoption Model for Health Systems

October 25, 2018
by Rajiv Leventhal, Managing Editor
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HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society, announced the introduction of the Infrastructure Adoption Model, or INFRAM, which is designed to measure the technical infrastructure used within a health system.

The INFRAM focuses on five technical subdomains, allowing organizations to benchmark how their infrastructure operates within the following areas: mobility; security; collaboration; transport; and data center.

Similar to HIMSS Analytics’ well-known Electronic Medical Record Adoption Model, or, EMRAM, the INFRAM is an eight-stage model (0 – 7) that allows healthcare IT leaders to map the technology infrastructure capabilities required to reach their facility’s clinical and operational goals, while meeting industry benchmarks and standards.  The final stage, Stage 7, guides organizations towards optimized information integration, contextualization and orchestration essential for the delivery of higher order local and virtualized care processes.

For reference purposes, Stage 0 on the model represents that an organization does not have a VPN, intrusion detection/prevention, security policy, data center or compute architecture. Stage 3 signifies that an organization has an advanced intrusion prevention system, while Stage 5 represents having video on mobile devices, location-based messaging, firewall with advanced malware protection, and real-time scanning of email hyperlinks.

HIMSS officials note that by identifying specific benchmarks for organizations to reach before they go live with EMR, systems, the INFRAM aims to ensure that a health system’s infrastructure is stable, manageable and extensible. Through this, organizations can ideally improve care delivery and create a pathway for infrastructure development tied to business and clinical outcomes.

 “The INFRAM is a welcome addition to our maturity model suite and addresses a longstanding need – guiding healthcare organizations in securely implementing the infrastructure with which their EMRs are built upon,” Blain Newton, executive vice president, HIMSS Analytics, said in a statement. “We have seen health systems engage with advanced clinical applications, only for them to ‘glitch’ under infrastructure that isn't powerful enough to support their tools. With the INFRAM, healthcare providers can develop a detailed, strategic technology plan that defines their organization's current state, desired future state, and each stage in between to achieve their clinical and operational goals.”

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Eisenhower Health, a west coast-based Magnet Hospital, implemented an enterprise-wide solution enabling mobile communications and collaboration across all care teams, linking the entire enterprise, advancing its communications capabilities, creating access to an enterprise directory, and improving care team response and turnaround times.

Additionally, the system provided extensive and comprehensive reporting with data analytics showing where and to what extent response improvements were made, but also providing the information the hospital needed to better utilize the system and make adjustments to improve results.

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