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Like many other health care delivery organizations, Methodist Le Bonheur Healthcare, an integrated health care delivery system based in Memphis, Tennessee, invested early in health care information technology and enhanced those capabilities in part through funding partly as a result of funding provided by the Health Information Technology for Economic and Clinical Health Act of 2009. Those EHRs now contain quantitative data (eg, laboratory values), qualitative data (eg, text-based documents and demographics), and transactional data (eg, a record of medication delivery). The big benefit with the electronic medical record is the aggregation of patient data over the long term.
“Agreement in relation to goals is important to ensure that the optimization efforts of stakeholders are aligned”
With the foundation in place, this phase of care innovations enabled by technology now allows for a transformation of health care by delivering information directly to patients and empowering them to play a more active role in their care. We are now exchanging data, not just for meaningful use, but also to improve patient health. We ensure that we connect with Methodist partners and also the community, including providers who serve underinsured and self-pay patients. This connection includes mobile applications and programs to text patient’s disease specific education reminders care reminders and open notes. We also have cutting-edge initiatives underway including joint projects with Cerner, big data work with the University of Tennessee, precision medicine and population health programs — all of which are aimed at serving its unique patient population.
To this end, a patient-and family-centered culture led to the development of a life-saving alert system based on Cerner tools. With 90 percent of its doctors using iPhone, iPads or Apple Watches, the IT shop created an algorithm that sits on top of its Cerner electronic health record platform that sits on top of patient records in the EHR to continuously monitor changes and alert clinicians accordingly.
This algorithm has already saved thousands of lives by shrinking the time – it takes to notify a physician when a patient is diagnosed with severe sepsis – from six hours to fewer than five minutes. It also alerts doctors when a patient is at risk of fall or readmissions, and users can hover over the alert for clinical decision intelligence that explains steps they should take to avoid a readmission. Cerner, in turn, has added that algorithm to its EHR for other hospitals to use as well. We are seeing innovations like this take hold and improve health outcomes.
Some key take aways to enable patient centered innovations are:
1. Maintain organizational leadership and develop blue chip focused support structures
At present, many organizations are trying to manage enormous numbers of requests for IT changes, and if these are not actively addressed, value is not likely to be achieved, with the consequence that “sharp end” providers may become discouraged. The systems that vendors offer tend to be “bare-bones.” The implicit assumption being made is that organizations will use the system tools offered to make care improvements, but achieving this requires organizations to continuously develop local human resource and governance structures and a focus on key blue chips and priorities for patients and families.
2. Improve the basic care and business process first
Before taking on new initiatives, focus on improving today’s business or clinical problems. Success breeds success. Agreement in relation to goals is important to ensure that the optimization efforts of stakeholders are aligned.
3. Promote transparency as a cultural norm
If we don’t promote transparency of results, outside regulators or payor’s will do so and not very gently. We have the data in our EMRs. Leaders who promote this will find the benefits outweigh the risk. The more the data is used, the better it will get.
4. Create a top down vision and stimulate bottom up innovation
Actively managing the process of change is essential because all organizations have difficulty in navigating major organizational change. Effective organizational transformations require long periods of time and constant effort.
5. Set specific benefits driven approach
Focus start with a benefit-driven method approach. Our approach begins with the identification of a specific aim (For example, 5 percent reduction in hospital readmissions within 12 months), followed by an assessment of current and future states. After these important preliminary steps, relevant data items are identified and specified, which allows monitoring of progress toward this goal.