In his July 24 testimony before the U.S. Senate Committee on Finance, Colin Banas, M.D., chief medical information officer of the Virginia Commonwealth University Health System, made a strong case for how data ubiquity lays the groundwork for subsequent clinical innovation and improved outcomes.
Banas, who helped create a dashboard embedded in the organization's commercial EHR system that monitors the status of vulnerable patients and gives clinicians an early warning of major problems, noted that all the gains that VCU has made in clinical decision support, transitions of care and innovations first relied on ubiquitous access to data. “Only after processes were refined did technology become the secret sauce to improving outcomes,” he said. It is the triad of people, process and technology that leads to success, added Banas, who heads up the VCU Health System’s Office of Clinical Transformation, overseeing a group of physician informaticists, nursing informaticists and clinical trainers.
He credited the meaningful use program with pushing organizations like VCU on their portal initiatives. “A portal was always a vision on our roadmap, but it was the meaningful use program that gave it the much-needed activation energy directional framework for success,” he said.
VCU launched its patient portal in December 2012 and in just seven months it has already enrolled 11,000 patients who now have access to core elements of their medical records. “Inefficient phone tag has been replaced by an e-exchange between patients and providers,” Banas said, “and we have only started to scratch the surface of this technology.
VCU has created innovative and custom dashboards to augment its patient population management strategy by repainting large sums of data into easy to consume, graphical and interactive formats. The health system seeks to help providers deal with the information overload that has become common as the data stored in the EMR grows. “One of the most exciting examples is our homegrown medical early warning system dashboard,” Banas said. “This gives our rapid response team a real-time monitoring system that continuously measures patient acuity and severity. The dashboard has been adopted by the team as their compass to guide them to the bedsides of our sickest patients.” The team no longer waits for a call from a nurse or doctor about a patient in distress, he explained. Instead they are accessing the dashboard on mobile devices and arriving at the bedside to assess and intervene, sometimes ahead of the primary team and nurse. “Since launching this dashboard, our analysis has shown a 5 percent reduction in in-house mortality and a significant reduction in cardio-pulmonary arrest outside of the intensive care unit,” he added.
But Banas also told the senators that like other institutions, VCU is grappling with the pace of change. “We are drowning in a sea of competing priorities and clinical needs to ensure that the EMR remains usable and meaningful,” he said. “The combined tsunami of the ICD-10 mandate collides precisely with the medical center’s need to attest for the first year of meaningful use, Stage 2.” He suggested that ONC and HHS might consider creative solutions to providing more flexibility on the timelines and potential penalties while preserving the momentum of the program.