Northwestern Memorial Hospital (Chicago) is one of six national participants in a pilot study that will test whether operable lung cancer patients and their families have a smoother care experience and better outcomes by hardwiring data systems to reduce medical error and to reliably adhere to best practice standards. The 18-month trial co-sponsored by the Chicago-based Commission on Cancer and the Society of Thoracic Surgeons (STS) will study clinician consistency in delivering 38 evidence-based best practice elements of care from the time of referral through their surgical admission and concluding with a plan for follow-up and continued cancer surveillance. Monitored care elements include appropriate pre-surgical imaging, medication choice, dose and timing, patient counseling regarding smoking cessation and defining expectations of a patient's involvement in their own care. Malcolm DeCamp, MD, Northwestern's chief of the division of thoracic surgery, says the study's novelty centers on assessing whether better outcomes and fewer complications can be achieved by applying systems engineering principles to our plan of care and then leveraging our electronic health record to provide rapid feedback regarding how well we did.
ProvenCare, the evidenced based program by Danville, Penn.-based Geisinger, calls attention to such possible errors by tracking the documentation already performed by medical staff in the electronic health record. For example post-operative pain is assessed on a 0 to 10 scale by the nursing staff at least every 4 hours. These pain scores are recorded in the vital signs area of the record and any score greater than 3 mandates an intervention (change in medication and/or dose) with a follow-up pain assessment in the next hour. As the record is electronic, the original pain score, the intervention and reassessment are date and time stamped when entered.
At Northwestern, its Enterprise Data Warehouse (EDW) is able to generate a ProvenCare "electronic report card" combining and analyzing both out-patient and in-patient records. The EDW verifies when and how often each care element was completed and more importantly flags episodes where the best-practice standard was not met. This tally, which can be updated daily, is often a wake-up call for clinicians about consistency in routine.