North Shore LIJ (Manhasset, N.Y.), Baystate Health (Springfield, Mass.) and Care at Home Community Healthcare (Campbell, Calif.) were all recognized as semifinalists in the Healthcare Informatics Innovator Awards program. The three semifinalists reveal the details of their projects below.
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 Orlando on Feb. 24 at the annual HIMSS conference.
North Shore LIJ
Michael Oppenheim, M.D., CMIO at North Shore-LIJ
Interoperable comprehensive prenatal care record with data derived from multiple outpatient EHRs and prenatal imaging centers.
Why did you focus on high risk pregnancies?
North Shore-LIJ Health System had a very active perinatal safety and quality taskforce focusing on reducing morbidity and mortality for both mothers and babies. It is always most effective to apply healthcare IT solutions when there is an active clinical partner who can assure that the process and workflow changes can be effectively operationalized. This choice was also spurred by the opportunity to secure grant funding through the New York State Health Care Efficiency and Affordability Law (HEAL). The HEAL 10 Program sought to fund projects that applied Patient Centered Medical Home Models supported by interoperable health IT to drive clinical improvements. Given the number of different specialists involved in the care of the high-risk mother, and the importance of communication between those providers in the prenatal period the criticality of that information to support the patient during Labor and Delivery, High Risk Pregnancy was the ideal clinical entity to focus on.
Why was interoperability between systems so important for high risk pregnancies?
There are multiple coordination points and care transitions during the care of a woman with a high risk pregnancy and the care of the child who is born. During the prenatal period, the high-risk obstetrician may be referring to the patient to adult subspecialists to care for the mother, or to pediatric specialists to care for the fetus or to plan for care of the newborn. Communication among these providers is not only critical during the prenatal period, but this information must be available in the hospital environment to manage the Labor and Delivery period as well as to optimally care for both the mother and baby. Finally, both mother and baby will be seen and cared for after discharge from the hospital. Building a comprehensive clinical record and making this information available through the continuum of prenatal care, Labor and Delivery, and postpartum/newborn care is expected to improve the care and outcomes for both mothers and babies, as well as decrease the administrative burden on hospital and office staff that would otherwise have to seek and collate this information manually.
How can this project be replicated across the industry?
Technology is not the barrier: all interoperability was achieved using industry standards, including the representation of the OB data in a CCD as well as using SNOMED as a normalizing vocabulary where needed. The primary element which needs to be carefully understood and addressed at the local level is around documentation practices and workflows to assure that the documents are exchanged after they are complete and contain the maximum data but not too late to be useful to a downstream recipient.
What’s next for the project?
A critical pre-requisite for the exchange of discrete data is the charting of discrete data. We need continued focus on optimizing the design and use of our office EMR so that as much data as possible is charged discretely and can be shared as discrete data to maximize the value of the data sharing.
Andrew Healy, M.D., medical director of obstetrics at Baystate Health.
Perinatal-specific EHR to successfully institute a hard-stop policy eliminating the procedures of elective deliveries prior to 39 weeks of gestation and elective inductions of labor in patients at increased risk for cesarean deliveries
What made you go down the path of limiting elective labor induction?
This happened for a couple of reasons.
First of all, we recognized that there was a national trend toward increased elective labor induction. Many of these deliveries were happening prior to 39 weeks of gestation.
There is compelling evidence that all babies born at term do not necessarily do as well as once thought. Babies delivered between 37 and 39 weeks are increased risk for complications compared to those delivered at or beyond 39 weeks. For this reason we need to make sure that delivery is delayed until at least 39 weeks in the absence of medical indication.
We also know that many patients who are electively induced face an increased risk for cesarean section. This places the mother to increased risk for surgical and postoperative complications compared to women who have a vaginal delivery. Women who are delivered by cesarean section are also at increased risk for future cesarean sections and complications related to abnormal placentation compared to women who have vaginal deliveries.