Quality Improvement & Value-based Care: Actionable Data Required
By Brita Hansen, MD, Chief Medical Officer, LogicStream Health
At HIMSS18: Visit LogicStream Health at #HIMSS18 in Booth 1473 this year in Las Vegas.
The intense focus on higher quality and greater value in healthcare is perhaps the greatest cultural change the industry has experienced in the past decade. It is also the most daunting. While provider organizations have made great strides in improving outcomes for numerous quality metrics, building on (or even sustaining) the success presents major challenges. Clinical processes and electronic health records (EHR) influence nearly every aspect of patient care. As medical knowledge continues expanding exponentially every year, best practices will change in response, rendering current processes and EHR content obsolete. The problem—identifying and updating outdated processes and content is incredibly time consuming and resource intensive. Further, most initiatives have a narrow focus and aren’t scalable to other specialties or clinical departments.
A strategy of continuous clinical process improvement and control is the deciding factor between conducting a one-off quality initiative and generating sustainable, scalable improvements in the reliability and value of care. Think of your EHR and clinical processes like a person —to maintain a healthy life, people need to eat a balanced diet and exercise regularly. In this analogy, a quality initiative focusing on a single issue is comparable to a fad diet—the dieter might lose weight after a few months, but without a change their lifestyle they will very likely gain all the weight back, or even more. Conversely, implementing quality strategies scalable throughout an entire facility is the equivalent of a person who overhauls her life, changes her eating habits and makes the time to exercise.
To develop an effective clinical process improvement and control strategy, provider organizations need the ability to generate actionable data in near-real-time to address three key pillars: 1) clinician engagement, 2) patient safety and quality and 3) appropriate utilization.
Meeting Patient Safety and Quality Objectives
In a value-based environment, patient safety and quality care initiatives are paramount. Yet, healthcare organizations and hospitals often lack the capabilities to obtain instant, actionable insights into electronic health record (EHR) data to meet these goals. To overcome this challenge, providers are increasingly leveraging advanced IT solutions that provide all authorized members of the care team with access to the self-service information needed to analyze critical content in near-real-time and identify areas of variation, such as the ineffective ordering of labs, medications and procedures.
With these rapid insights, organizations can also specifically distinguish which individuals, departments and groups of clinicians may be ordering outside of best-practice protocols. These assessments also shed light into areas where organizations can enhance standardizing efforts for various conditions, such as healthcare-associated infections, that often result in extended length of stay, steep costs and increased risk of mortality. In turn, providers gain a true understanding of key processes and the steps required to improve, monitor and control them in a timely manner.
Maximizing the Benefits of Appropriate Utilization
To truly achieve appropriate utilization and realize the quality and cost containment benefits that ensue, healthcare organizations must have the ability to align both EHR content and clinical workflows. Armed with the right solutions, clinical teams can identify and then fix care processes that are inadvertently driving unnecessary utilization such as the use of medications, tests and treatments that are frequently ordered, yet provide little -if any- benefits, repeated unnecessarily or outdated.
By targeting inappropriate medication utilization, a multi-state health system on the U.S. west coast implemented clinical process improvement and control software that identified the prescribing trends for its most frequently used high-cost and high-volume medications. Once the organization assessed the frequency of use and implemented standard protocols, adoption was tracked to identify areas that continued to exemplify ongoing variability. Through this process, the organization was able to identify and improve care processes around the ordering of five targeted medications ultimately saving the organization $4 million per year.
Improving and Maintaining Clinician Engagement
Too often, the EHR feels like something that is happening to clinicians rather than acting as a clinical tool to help them. This feeling often diminishes clinician engagement in clinical process improvement. To address this issue, provider organizations must have the capability to address “EHR bloat” – things such as alert fatigue reduction, order set management and documentation streamlining. With the typical health system averaging 24 million alert firings per year, clinicians become accustomed to “tuning out” alerts, which increases the risk of missing key notifications. To overcome the challenge of alert fatigue, leading IT solutions ensure alert processes align with the Five Rights of Clinical Decision Support by ensuring the 1) right information is delivered 2) to the right person 3) in the right format 4) through the right channel 5) at the right time in the workflow.
For instance, a leading hospital set out to standardize and improve sepsis care. Although EHR-generated alerts targeting potential cases of sepsis are imperative to initiate evidence-based treatment protocol, the hospital’s clinicians often ignored the alerts. Clinical process improvement and control software revealed the alerts lacked sensitivity, which led to the over-firing of alerts. After fine-tuning the alerts and adjusting the clinician workflow, the hospital was able to achieve and maintain nearly full engagement and compliance. The hospital was also able to reduce length of stay in intensive care units as early detection and treatment of sepsis increased.
The modern healthcare environment requires dynamic solutions that provide actionable insights to truly achieve value and quality outcomes. By leveraging clinical process improvement and control software, organizations can overcome barriers to clinician engagement, patient safety and quality, and appropriate utilization, and become better prepared to adapt to future changes in the healthcare environment.