ABOUT THE AWARD
The Most Wired Innovator Award honors hospitals that apply technology in innovative ways, finding creative solutions to serve their patients, staff and communities. A panel of chief information officers and others evaluate submissions on a variety of criteria, including universality and achievement of business objectives, creativity and uniqueness of concept, impact on the organization, scope of the solution, stage of implementation, and technical creativity. Visit www.hhnmostwired.com.
ABOUT HEALTH CARE’S MOST WIRED
H&HN’s Most Wired Survey and Benchmarking Study is made possible through a partnership of the American Hospital Association, the College of Healthcare Information Management Executives, AT&T and McKesson Corp.
WINNER | University of Pittsburgh Medical Center
Like doctors elsewhere, physicians at the University of Pittsburgh Medical Center were frustrated by the amount of time they spent pulling patient data needed at the bedside from various clinical information systems. So UPMC set about designing a better way for physicians to interact with and view clinical data.
The result was Convergence, a touch application for Windows 8 tablets that extracts patient data from a variety of clinical information systems and presents them to physicians in an easy-to-navigate, visually meaningful way. Clinical pathways are built into the application to guide physicians in using evidence-based practices.
“What electronic health records in their silos are not good at doing is looking across longitudinal records and bringing together the patient’s story or looking at clinical care pathways across multiple care teams,” says Rasu Shrestha, M.D., UPMC vice president of medical information technology. “We’ve built all of that into Convergence. Convergence is an overlay layer that sits on top of the EHR, and it ties it all together.”
Cardiologists at UPMC Presbyterian are testing the Convergence platform. They access it at the bedside using tablets that can be docked in a desktop computer. In Convergence, physicians are able to move back and forth through various applications with the correct patient record displayed in each.
“One of the big themes that we push forward in Convergence is contextualization and how we can present the right information to the right clinicians at the right time in the context of their clinical subspecialty, the legacy electronic health record systems they need to access, and the specific workflow they’re in,” Shrestha says.
He uses the example of a cardiologist seeing a patient who was just transferred to the cardiac intensive care unit after a procedure for a heart attack. The physician would log into Convergence on the tablet and immediately see that person on his or her patient list. When the cardiologist touches the patient’s name, “the patient’s chart comes to life on the Convergence screen across a longitudinal record, but highlighting specific aspects in the context of the physician as the subspecialist cardiologist,” Shrestha explains. The physician can swipe into the clinical pathways module and see what parts of the care pathway have been taken and see if any care gaps exist.
If a test needs to be performed, the cardiologist can swipe to the order entry screen, where all the necessary patient information is populated automatically, order the test and swipe out of order entry into whichever application meets the cardiologist’s needs given the workflow, Shrestha says.
Although the pilot project is so new that no outcomes results are available, Convergence has been well-received by cardiologists. “They’re getting a lot of time back in terms of being able to focus on their patients,” Shrestha says.
UPMC, which operates 20 hospitals, plans to spread cardiology use of Convergence to other hospitals in its system and to expand its application to internal medicine physicians and hospitalists, says Rebecca Kaul, president of the UPMC Technology Development Center. By the end of 2014, UPMC wants to launch Convergence in the commercial market.
The product was built with external sales in mind. It works with multiple electronic systems. “UPMC is a small microcosm of the industry because we have 21 hospitals, and those hospitals have been a product of acquisition, so we’ve essentially had to work with a plethora of different source systems and different electronic records,” Kaul says. “Our goal is to provide a lot of great value to our patients internally, which will make us be able to more effectively market this externally.”
WINNER |Baptist Health South Florida
Sometimes all it takes is one person with an idea to spark change. Leslee Gross, R.N., assistant vice president for operations at Baptist Health South Florida, oversees several disparate departments — home health, the e-ICU, telemedicine and the transfer center.
Having a hand in so many areas gave Gross a unique perspective that allowed her to see an unfilled need and come up with a solution. She leveraged her knowledge of telemedicine, home health and the e-ICU to develop a program that allows e-pharmacists to conduct medication reconciliation visits with home health patients by computer.
At the time, speech therapists, though not trained in pharmacology, were handling medication reconciliation during their home health visits. Meanwhile, the e-ICU had e-pharmacists on staff. “I thought it would be great if we could tap that resource into the home,” Gross explains.
Baptist already had the needed software through its telestroke program. The addition of cameras on home health nurses’ laptops rounded out the necessary components for an e-pharmacy medication reconciliation program for home health patients.
The home health team decided to test the idea on one patient. That patient needed three medication interventions, Gross says. “We said, ‘Let’s do another one and see what happens.’ Patient 2 had three interventions.”
Since the program was piloted in June 2013, every patient involved has needed some type of intervention with medications, Gross says. Examples include a patient who hadn’t filled a medication because it was too expensive, and patients who weren’t taking blood thinners despite being discharged after having a stroke or deep vein thrombosis.
The program focuses on home health patients with congestive heart failure, but the nurses also organize e-pharmacy medication reconciliation sessions for home health patients who take many medications, for patients who have fallen at home, when a medication is unfamiliar to a nurse, when a patient is on a high-risk medication, or when a nurse has questions about a patient’s medication.
A review of the pilot in late October 2013 found that the 17 participating patients with heart failure required an average of five interventions per patient, for a total of 74 interventions during the program’s first five months. The interventions included education, correction of duplicate medication orders, medication compatibility issues, drug omissions and adverse drug reactions. Thanks to the interventions, the readmission rate for those patients was 11.6 percent, well below the 24 percent national readmission rate for Medicare patients.
Because the home health nurses and e-pharmacists already had the necessary equipment, most of the program costs come from licensing fees. Those costs are far outpaced by the savings the program generates by preventing complications and readmissions.
The home health e-pharmacy program helps the six-hospital Baptist system prepare as it moves toward more care outside of the hospital walls and toward pay for quality. “With all of the clinically integrated networks and trying to keep people at home, we know that pharmacy is a big part of that,” Gross says. “Patients don’t know how to take their medications, they don’t understand why they need to take them, and some patients don’t have access to them.”
WINNER |Citizens Memorial Hospital
A fixture in virtually every hospital, dry-erase boards in patient rooms hardly get a second thought. But at Citizens Memorial Hospital, nurses’ dissatisfaction with them prompted a project that increased patient engagement, satisfaction and communication with providers.
Nurses thought the dry-erase boards, which just listed their names and numbers and weren’t consistently updated, didn’t provide patients and caregivers with enough useful information, says Chief Information Officer Denni McColm. The rural hospital in Bolivar, Mo., decided to replace the boards with electronic white boards that would feature pertinent information.
Financial constraints ruled out buying technology from a vendor. So the staff had to get creative and design a solution itself. A small team built the white boards using existing software and inexpensive, off-the-shelf hardware. The system pulls data from the EHR and nurse call system into custom tables. Specific information is pulled from those tables onto each board based on the bed.
The price tag for creating the system and installing 53 electronic white boards in the hospital’s medical-surgical, ICU, telemetry and emergency department beds was just under $50,000.
One of the biggest challenges was finding where the information for the electronic boards was stored in the data repository and then fine-tuning the software so each data query called up just the information needed, not thousands of results, says Network Administrator Jon Moores.
The team sweated the details. Moores and Webmaster Lauren Fraser used empty patient beds to get the patient perspective. From that vantage point, they looked at whether the boards were the right size, whether they felt invasive, whether the background was too bright or too dim, and whether the text was easy to read. The legal department made sure the data posted on the boards didn’t violate HIPAA and that the boards weren’t visible from the hall.
Initially, the boards included room and bed number, care team names and numbers, the room and other phone numbers, diet, fall risk, the patient’s pain level and pain goal, the date, time, and patient number. The boards, installed in 2013, were so well-liked that staff asked for more information to be posted. At the request of rehab, patient activity level and weight-bearing status were added. Discharge planners got the anticipated discharge date on the boards. To support the nurse rounding program, the last four rounding times were displayed.
Feedback from patients has been very positive. The electronic boards contributed to an increase in patient satisfaction, McColm says. Patients and their families have become more engaged in care. Communication among providers and between providers and patients has improved, McColm adds. “Just having the anticipated discharge date on there, we were amazed at how much conversation that starts.”
The electronic boards also enhance quality and patient safety because the patient’s diet, activity level, weight-bearing status, fall risk and pain level are clearly communicated to the care team, patients and their families.
Citizens Memorial plans to install the boards in the obstetrics department down the road and is exploring other uses. Ideas include creating patient self-check-in kiosks for certain types of visits and electronic staffing boards that would display in real time who is assigned to which bed. The staffing boards eventually would list in real time which physician is responsible for each patient.
• St. Joseph Mercy Oakland
St. Joseph Mercy Oakland aimed to improve patient safety and reduce mortality rates when the 443-bed hospital in Pontiac, Mich., installed a patient early-warning detection system in a medical-surgical unit and a neuro unit, neither of which had continuous monitoring. The system tracks patients’ blood pressure, pulse rate, respiratory rate, pulse oximetry and body temperature and is able to detect signs that a patient might be deteriorating. Monitors in patient rooms and at nursing stations display the detection system’s assessment of patients’ status with color coding — red for patients who could be deteriorating, green for patients whose metrics are in range, and yellow for patients with one or more metrics outside the normal range. The system has reduced mortality by 34.5 percent, the code blue rate by 50 percent and average length of stay in those units by 5.3 percent, all the while increasing the rapid-response team activation rate by 21 percent and ICU up-transfers by nearly 73 percent.
• Texas Health Resources
Medicare rules adopted in 2013 that require physician certification of the medical necessity of inpatient hospital services prompted Texas Health Resources to create new processes to comply and optimize reimbursement. The project included new patient lists for case managers that automatically populate with patients who meet the two-midnight rule; changes that make it easier for physicians to certify medical necessity for inpatient services; and best-practice alerts that prompt physicians to complete the certification form when an admission order is placed or when a discharge order is made but certification hasn’t been completed for a patient who falls under the requirements. The health care system used electronic collaboration tools that allowed clinicians to provide input or test new workflows without having to travel to a central location.
• Broward Health
To increase efficiencies in its radiology department, 716-bed Broward Health Medical Center, Fort Lauderdale, Fla., embarked on a multidisciplinary workflow improvement project that included re-engineering standard operating practices and innovative use of wireless technology. One component of the initiative reworked the way portable ultrasound results are uploaded. Wireless technology that transfers images directly into the electronic image archive system replaced the old process that required a technologist to physically return to the radiology department to upload each study into the system. The change saves an average of six hours a day. Another arm of the project reduced STAT radiology report times in the ED from an hour to less than 15 minutes. Because of the initiative’s success, it was implemented in Broward Health’s other hospitals.