Three Winning Ways Improve Patient Care With IT

The rapid evolution of health information technology challenges hospitals to keep up, to understand IT’s clinical potential and to experiment with it to boost quality and safety. This year’s Most Wired Innovator Award honorees have tackled a variety of issues, from monitoring employees’ handwashing to giving younger clinicians clinical apps for their ever-present smartphones to more quickly treating patients with atrial fibrillation by creating a mobile ECG. — Geri Aston

WINNER |St. Joseph Mercy Oakland

As leaders at St. Joseph Mercy Oakland planned a new patient tower, they saw the undertaking as more than a construction project; it was an opportunity to build in new processes to improve patient care, patient experience and staff job satisfaction.

They focused on two issues that face all hospitals — preventing health care-acquired infections and falls. And they saw technology as a tool to support those clinical goals.

A medical-surgical unit with a very engaged staff served as a pilot site to test new technologies that are now in use throughout the patient tower, which opened in May 2014. From the start, the initiative was viewed as a clinical project, not an IT project, says Robert Jones, director of information technology at the 443-bed community teaching hospital in Pontiac, Mich. The IT people became clinical experts and the pilot site’s clinicians became IT experts, he says.

One part of the project is to use a real-time locating system to track hand-hygiene compliance. Clinical staff members wear RTLS badges behind their hospital identification badges. Sensors at hand sanitizers and sinks indicate whether personnel have washed upon both entry and exit from patient rooms.

Nurses were given time to get accustomed to the RTLS badges before hand-hygiene performance data were shared — first at the unit level, lastly at the shift level, and now down to the individual level.

The system resulted in a 300 percent improvement in hand-hygiene compliance, and the HAI rate fell to zero in the pilot’s first quarter, says Fabian Fregoli, M.D., vice president of clinical quality and patient safety and chief medical informatics officer for St. Joseph Mercy Health System’s east market. These results cemented nurse buy-in to the project.

The RTLS integrates into the tower’s nurse call system with employee locator features, including a staff assist button that nurses can press when they need help with a patient. The nurse call monitor also has buttons for Code Blue and for rapid response.

The system links with specially configured iPhones so alerts for assistance, Code Blue and rapid response are sent via iPhone to the appropriate team members. All alerts have a specific sound and include the room number.

Nurses requested a button on the monitor that the dietary staff can press when a diabetic patient’s meal is delivered. The patient’s nurse is notified via iPhone so the nurse can administer insulin if needed to better manage the patient’s blood sugar level.

Pillow speakers enable patients to press a button for help in using the toilet, and a message with room context is sent via phone to that patient’s care assistant. When a patient presses the pain button, his or her nurse receives a message on an iPhone and can use it to communicate with the patient directly. The nurse can get the pain medication on the way to the room and address that patient’s needs more quickly.

New patient beds also are tied into the nurse call system. When a patient is identified as a high risk for falls, a bed exit alarm is set. If the patient tries to get out of bed without assistance, the dome light outside the room flashes and staff members receive a room-specific priority alert on their iPhones. Information on a patient’s weight and head-of-bed angle can be documented directly in the electronic health record via the smart beds.

The team took special care to work with the nurses on the phone alerts to avoid alarm fatigue, Jones says. Only eight alerts deemed as critical are included in the system, and they are directed to the correct care team members.

One challenge early on was getting the vendors of the different technologies to work together, Fregoli says. Nurses and other front-line staff accompanied the team to vendor meetings and site visits. The team had to explain the common vision and make it clear that the hospital was leading the project, not being dictated to by the vendors, he says. Once vendors understood that, they began to cooperate with one another. 

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WINNER |Penn Medicine

Penn Medicine, a four-hospital system, has a strong, well-deployed electronic health record accessible via desktop computers, as well as a rich data warehouse. As an academic medical center system, it also has many residents and hospitalists who often are 35 or younger.

“The question was how do we get this rich patient data to them in a manner that is always accessible,” says Michael Restuccia, Penn Medicine vice president and chief information officer. “They’re not tethered to desktops, but they are tethered to their smartphones.”

The solution was an internally developed mobile Web application that enables clinicians to access important patient information on their smartphones.

Corporate information services, a physician champion, and a Web designer collaborated to build the tool. That combination of technical, content and visualization talent produced a product so intuitive that within two months it went viral among clinicians without formal rollout or training, Restuccia says.

An initial challenge was figuring out how to fit all the data physicians wanted onto a mobile device in an easy-to-use format. The original assumption was that the app would be used on a tablet, says Glenn Fala, senior director of software development. But there was no budget for purchasing enough tablets.

So the design team started working on prototypes that could be used on clinicians’ hospital-issued smartphones and quickly came to the conclusion that it would work. Within two weeks, the first iteration was in the hands of the physician champion, hospitalist Subha Airan-Javia, M.D., who got feedback from a core group of colleagues. The app was released for voluntary use by the full clinical staff in August 2014.

The team still produces a new iteration of the app every two weeks, although now changes are released en masse about once a month.

“Our key to success is having daily interaction with end users and steering the ship based on feedback from our physicians,” Fala says. “User ideas are not the exception; it’s how we operate.”

Clinician input was especially helpful in determining how to visually present information, Restuccia says. For example, the app could present lab results just in numeric form, but graphed data give clinicians a clear idea of how a patient’s results are trending.

Because the app calls up patient data much faster than the desktop (2.5 seconds vs. 53 seconds), clinicians access data more frequently via their phones. That means they’re viewing their patients’ most current labs, vitals, medications and more while moving around the hospital doing their jobs, Fala says. Feedback indicates that clinicians feel the app enables them to make faster decisions and makes them more efficient.

For example, many physicians use the app before they arrive at the hospital to look up patient information and prepare for the day, Fala notes. The app also has enabled smoother handoffs at shift changes.

Penn Medicine estimates that the project cost about $150,000, primarily in application development and project management, expansion of its Wi-Fi, and dissemination of smartphones. Continual enhancements to the app cost an estimated $12,000 a month.

The app was built with industry standard, nonproprietary technology. Other health care organizations could undertake a similar effort, Restuccia says. “It was a small team that generated a big result.” 

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WINNER |St. Luke’s Cornwall Hospital

Hospital executives seldom feel as if they’ve saved a patient’s life, but no one can blame Cletis Earle if he does.

After being inspired by a presentation on mobile electrocardiograms at a technology conference, Earle decided to bring the idea of using the devices to cardiologists practicing at St. Luke’s Cornwall Hospital in Newburgh, N.Y., where he is vice president and chief information officer. Several cardiology practices signed onto the project because they immediately saw the potential of the devices, which connect to smartphones, to speed the time between a patient’s atrial fibrillation to medical intervention.

When the hospital took the idea to Capital District Physicians’ Health Plan, the New York health insurance company was “all in” because of the device’s potential to prevent costly admissions. The insurer paid for a block of $200 mobile ECGs, and the hospital distributed them to participating cardiology practices.

Earle found a physician champion in cardiologist Mehul Patel, M.D. The mobile ECG paid off the first time Patel trained a patient and sent him home with the device. The patient, Frank Lippolis, felt unwell that day, used the device to get a 30-second heart rhythm reading, and emailed the results to Patel.

Sure enough, Lippolis was in atrial fibrillation. Patel arranged to meet him at the cardiac catheterization lab and shocked his heart back into rhythm with an electrical cardioversion procedure. The mobile ECG not only averted a hospital admission, it also prevented a potentially deadly blood clot from forming in Lippolis’ heart — a major complication for patients who remain in AFib. An estimated 15 percent of strokes are the result of untreated atrial fibrillation, according to the American Stroke Association.

Earle, who is not a medical professional, can draw a straight line from his idea of introducing the device at St. Luke’s Cornwall to Lippolis’ care. “It’s the first time I felt as though I saved someone’s life,” he says.

Since the program began in early 2014, mobile ECGs have been distributed to about 100 patients, not all of whom are covered by CDPHP. The devices paid for themselves the first day by preventing Lippolis’ hospitalization, Earle says.

The number of admissions avoided thanks to the device hasn’t been quantified. That’s because a relatively small number of patients use them and because the cardiologists are in independent practice and the hospital would have to rely on them to report every use, Earle says.

Some cardiologists have privileges at other facilities, so even though they received the mobile ECGs from St. Luke’s Cornwall, they could use another facility’s cath lab to treat patients in AFib.

Together the mobile ECGs and a larger care transitions and follow-up program for cardiac patients have reduced readmissions by an estimated 17 percent. The devices also have strengthened the doctor-patient relationship and put patients more in charge of their health, Earle says.

However, another reality is that the combination of avoided hospitalizations and physicians’ freedom to use the devices outside cath labs reduces income for St. Luke’s Cornwall. The contract with CDPHP is not risk-based. The challenge with population health management is that often payment models haven’t kept pace with changes in practice.

But, Earle says: “We will do the right thing for the patient.” 

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Finalists

Middlesex Hospital

Middlesex Hospital in Middletown, Conn., set its sights on reducing patient falls, but the technology it could afford didn’t provide an accurate location of the patient who triggered a bed-exit alarm. The solution: The 215-bed hospital created a program to extract the alarm data from a wireless bed exit system and announce the room number in the hallway so all staff would immediately know which patient was at risk of falling. Since the program’s implementation, the 15-bed telemetry unit where it was installed has had no reported patient falls. The system cost the hospital $6,000, plus $3,000 in internal labor costs to build the software. The program’s patient safety benefit and staff acceptance led to the creation of an initiative to put the solution in other departments. 

Ohio State University Wexner Medical Center

In December 2014, Ohio State University Wexner Medical Center opened a 306-bed cancer hospital. Included in the hospital’s array of technology is Internet Protocol television. IPTV saved $2 million compared with coaxial cable. It offers TV programming and on-demand movies, and the hospital can stream educational videos to patients about their disease. The cancer center also features an interactive display in its pediatric waiting area and radiation bays. In the waiting room, a digital friend — a squirrel or other small animal — joins children via a video wall. Children can play games with the virtual creatures, who follow them to the exam and induction rooms. When medically appropriate, cancer center patients are offered a tablet computer at admission. They can use it to access their health information, connect to the Internet, order food, send notes and requests to their care team, view their daily schedule, take notes on physician directions or jot down questions, and review educational materials. 

St. Joseph Mercy Oakland

In addition to its winning project described on Page 45, St. Joseph Mercy Oakland’s Integrated Accountability System was named a Most Wired Innovator Award finalist. To help to improve quality, safety and patient satisfaction, a real-time dashboard was created for key performance indicators and adherence levels. Dashboards were placed throughout the hospital so clinical and ancillary staff, physicians, the leadership team, and patients and visitors could view the real-time data. Dashboard metrics include emergency department door-to-doctor time, such department-specific quality metrics as falls and hand-hygiene compliance, and department-specific patient satisfaction scores. The transparency created incentive among staff to excel at their performance and strive to meet integrated organizational goals.