The nation's top hospitals continue to reach new heights in pursuit of the next creative information technology solution to address pressing issues of patient safety and efficient delivery of care. This year, Hospitals & Health Networks recognizes six organizations with Innovator Awards, three winners and three finalists. A panel of 14 hospital and information technology leaders evaluated essays describing a specific IT project. Essays were judged on the achievement of the stated business objective, creativity and uniqueness of concept, scope of solution and impact on the organization.
Winner | Avera, Sioux Falls, S.D.
The ePharmacy service lets pharmacists at a central hub remotely review and approve medication orders for the mostly rural hospitals in the Avera network. That helps reduce or prevent potential errors and takes the sting out of the shortage of pharmacists in those communities. So far, Avera has implemented the system in more than 20 of its 29 hospitals in four Midwestern states.
The service uses a combination of existing infrastructure, new technologies and pooled resources, making it possible for every medication order to be reviewed and approved in inpatient settings.
Senior Vice President and Chief Information Officer Jim Veline says ePharmacy has become a critical vehicle in Avera's meaningful use journey. "It's an invaluable resource for our rural health care providers," he says. The system provides around-the-clock access to remote pharmacy support, which translates into safer medication practices.
Veline says during a 12-month period, more than 75,000 scans representing approximately 300,000 orders were processed by ePharmacy. "Utilizing intervention tracking, ePharmacists have performed over 5,000 interventions, including dosing issues, therapeutic duplication avoidance, inappropriate abbreviations, drug-drug interactions, allergy and anticoagulation issues," he says.
The hardware and software behind ePhar-macy includes an integrated electronic health record and order scanning devices. The system also supports automated medication dispensing at remote facilities and bedside medication verification. When clinicians from various hospitals write orders, the prescriptions are sent to the ePharmacy hub, where they are prioritized and reviewed manually. ePharmacists use the EHR to check patient treatment and medication histories.
Once approved, the order is electronically sent to the appropriate dispensing unit, devices that resemble automated vending machines. These units unlock and release specific medications to caregivers. "With ePharmacy, a remote pharmacist can virtually ‘hand' the medication to hospital staff, delivering the correct dosage and medication for each patient," Veline says.
Avera says initial capital equipment costs were $2,073,542 plus another $844,347 so the implementation team could get the initial 14 pilot sites installed and operational in the first 12 months. Front-line services staff and five full-time pharmacists to provide 24-hour service came to $896,347.
Implementing ePharmacy in more than 20 facilities meant working with dozens of individuals and legacy systems. "We had to carefully watch and eliminate work-around as we moved front-line staff from an environment with little or no pharmacy review to a process that may require a short wait for order approval," Veline says.
The organization now is partnering with other hospitals within and outside the Avera system. Through secure networks connecting the nonsystem sites, Avera is able to focus expansion on rural, independent hospitals that also have a need for ePharmacy services.
Winner | Baptist Health South Florida, Coral Gables
A Hotline to Health Care
South Florida patients no longer have to wonder where the nearest urgent care center is. There's an app for that. Baptist Health South Florida earned an Innovator Award after introducing a free iPhone, iPad and Android application called PineApp that quickly locates the nearest BHSF emergency room or urgent care center based on the user's location. The name comes from the pineapple logo associated with BHSF's brand.
When initialized on a 3G, 4G or Wi-Fi device, PineApp lists all eight BHSF emergency departments and 13 urgent care facilities in the Miami-South Florida area, sorted by proximity, along with a building photo, address, phone number, distance, map and driving directions. An iPod Touch can be used but, because this device has no GPS, no driving distance can be calculated.
"One unique feature PineApp provides is genuine door-to-doctor wait times at each facility," says Wayne Brackin, BHSF executive vice president and chief operating officer. Wait times are given in 30-minute increments for urgent care (e.g., under 30 minutes, under one hour) and one-hour intervals for EDs (under one hour, under two hours). The times are updated manually every 30 minutes by designated staff, but BHSF plans to automate that by calculating wait times using data from an existing clinical system used to track patients.
Since its launch in October 2010, PineApp has been downloaded more than 5,000 times.
PineApp exploits mobile computing technology to help confront the challenge of emergency departments overcrowded with nonemergent patients seeking routine health care. BHSF previously addressed that issue by opening several after-hours urgent care centers to treat minor illness and injury. PineApp was the next step in this process.
Brackin says BHSF physicians initially were concerned that an emphasis on short wait times might create the appearance that speed was more important than quality of care. "Also, our doctors and nurses wanted to be sure we were providing legitimate wait times, not just a marketing ploy," Brackin says.
In the end, BHSF opted for door-to-doctor wait times, which might be longer compared with other EDs that promise patients will be seen within 30 minutes. That often means they'll be seen by a triage nurse or other staff member, not necessarily by a physician. BHSF leaders believe consumers want to know how long it will take to see a doctor, not a nurse and not the inside of a treatment room.
The wait-time feature actually created an interesting intramural rivalry between BHSF facilities. "The emergency departments and urgent care centers began to compare wait times with each other," Brackin says. "That fact alone lowered some wait times."
BHSF spent about $170,000 to develop and publicize the app, including $23,700 for initial vendor contracts, $31,000 for ongoing development and $115,000 for advertising.
Winner | University of Pittsburgh Medical Center
The University of Pittsburgh Medical Center leveraged its electronic medical record to offer nonurgent patients an online means to avoid office visits or emergency department waits altogether. A system called eVisits is the result.
With the secure eVisits portal, registered patients who have an existing relationship with a UPMC physician complete a detailed questionnaire similar to triage interviews covering more than 25 common complaints, ranging from back pain, bronchitis and sunburn to shingles, sinus conditions and strep throat. Forms can be submitted at any time from any Internet-enabled device.
After submitting the forms, patients receive physician responses, often within minutes, more typically within 4 hours and always within 24 hours. Some physicians have conducted eVisits while traveling. If treatment includes medication, the physician uses the prescribing function and the order is sent electronically to the patient's pharmacy of choice.
An early challenge was physician adoption, which got a boost when a reimbursement model was designed. Approximately 1,000 UPMC physicians now participate.
eVisits now has more than 54,000 registered patients. Since 2009, when eVisits became reimbursable, more than 1,700 eVisits have been submitted. Figures show patients between ages 34 and 49 use the system most frequently, followed by the 50–64 age group. Women tend to use eVisits more than men. The service is offered from 8 a.m. to 8 p.m. daily. During off-hours a medical call center handles eVisits submissions and contacts the on-call physician.
The program began as an effort to develop new service models to manage both chronic and episodic illness, particularly for those patients with limited mobility. Other objectives were to increase patient access to their physicians while reducing wait times in physician offices. Now, patients who use eVisits do not sit in a waiting room. Appointment slots in busy clinician offices thereby are made available as more patients are served online, increasing the convenience for patients who prefer or require a personal appointment.
"This tool allows UPMC to provide convenient and cost-effective care for patients and is part of our broader effort to expand access to care that includes urgent care and after-hours primary care centers," says Jody Cervenak, CIO of UPMC's physician services division. Cervenak believes eVisits also will improve patient safety because the system is integrated into the UPMC electronic health record.'
The largest expense associated with eVisits is the licensing fee for the patient portal module from the hospital's vendor partner, which is $2.40 per year per registered patient, or about $125,000. This cost is recovered, however, as long as patients have at least one reimbursable encounter during the year. Trends show most users have more than that.
Douglas Page is a freelance writer in Pine Mountain, Calif.
Texas Health Resources, Arlington
VTE Risk Assessment
Texas Health Resources' interactive venous thromboembolism risk assessment application automatically identifies at-risk patients and then suggests appropriate interventions. The Web-based system is integrated in THR's electronic health record; when a clinician clicks the right button, a routine is triggered that queries the EHR for diagnosis, procedures, labs and other information. A score is automatically calculated and an intervention regime suggested. Ferdinand Velasco, chief medical information officer, says pulmonary embolism-deep vein thrombosis has been reduced 20 percent and utilization of VTE prophylaxis has increased. "Prior to this implementation, VTE prophylaxis could be overlooked," Velasco says. "Now, clinicians either use the order set or must document the reason it wasn't used."
Lehigh Valley Health Network, Allentown, Pa.
Lehigh Valley Health Network was a dual finalist with both innovations related to burn injuries.
The first innovation, TeleBurn, allows remote physicians to photograph burn injuries, then upload the high-resoution images online so specialists at Lehigh's Burn Center can decide whether patient transport is indicated, thereby preserving precious bed space for the most severe burn patients. Previously, these consultations were done by phone, and patients who could have been treated at their local hospital sometimes were transported to the center. TeleBurn delivers images to any Internet-enabled device, including smart phones, allowing consultation to be carried out wherever the burn specialist happens to be. "It's amazing how a relatively simple process can provide such a large impact," says Randy Bankes, an associate director of Lehigh's information services.
LVHN's second innovation is Snow World, a "cool" virtual reality, pain management alternative for burn patients who must endure sometimes unbearable intrusive daily dressing changes, wound debridement and physical therapy. Most burn patient pain management solutions involve opioids and sedatives, with negative side effects. "Our nontraditional approach reduces or eliminates the need for these medications," says David Pucklavage, manager of clinical applications in information services. Lehigh enlisted a virtual reality helmet company to design a device with a head-mounted, overlapping dual display that provides 90-degree visibility. The device is suspended from an articulating arm on a mobile tripod. Once Snow World is activated, the patient is fully immersed in a fun-filled, snowlike VR environment.