Over the past several years, Carle Foundation Hospital has undertaken a clinical initiative to improve safety and patient care. Carle physicians now have high usage of clinical decision support, plus the Urbana, Ill., hospital has automated review of inpatient Centers for Medicare & Medicaid Services' quality indicators.

"We wanted to put tools into physicians' and nurses' hands to provide the right information at the right time," says William Schuh, M.D., Carle's chief medical information officer. To do this, Carle installed an inpatient, emergency department and pharmacy electronic medical record, achieving HIMSS Stage 6 in the process.

From greater adoption of electronic clinical tools to better financial performance, executives at Carle and other hospitals on the Most Wired Survey's 2010 Most Improved list find that a little extra attention and hard work pay off.

The effort at Carle was managed as a clinical transformation initiative rather than an IT project, which greatly improved physician adoption, particularly in the tenuous area of computerized provider order entry. Physicians, nurses and pharmacists lead clinical development. "As a result, our medical staff viewed the build and install as a means to improve care, rather than as a means to improve facility efficiency," Schuh says.

Clinical decision support tools were implemented with best-practice advisories on key performance areas, core measures and other quality improvement projects, generating discrete data for reporting. Specialty tools were developed for key areas like the stroke unit, preoperative risk assessment and obstructive sleep apnea screening. "Our projects were successful because we involved the medical staff and physician leadership in every step of the process, from vendor selection through implementation and ongoing support," Schuh says.

Virginia Mason Medical Center, Seattle, applied a multidisciplinary approach to streamline and automate such areas as contract management, charge capture and electronic funds transfer and remittance. In 2002, Virginia Mason embarked on a program to improve patient care and quality by adopting the tenets of the Toyota Production System, calling it the Virginia Mason Production System. "We systematically applied VMPS to improve revenue cycle bottom-line results over the past eight to 10 years," says Steve Schaefer, vice president of finance.

A Japanese improvement philosophy called kaizen coupled with a desire to eliminate inefficiencies and all nonvalue-added activity have led to marked improvements. For instance: accounts receivable DRO (days revenue outstanding) dropped from more than 74 days in 1999 to fewer than 30 days in 2009; accounts receivable bad debt declined from 2.74 percent in 2004 to 1.64 percent in 2009; and cash on hand grew from $471 million in 2003 to $735 million in 2009.

"For kaizen to truly work, it must start at the top, with engagement and commitment across the executive team," Schaefer says. At Virginia Mason, all hospital executives must be certified in VMPS and must annually lead and sponsor VMPS in their areas in order to maintain certification."Change, defined as the elimination of waste, has begun to become the cultural norm, not the exception," Schaefer says.

At Sisters of Mercy Health System, Chesterfield, Mo., physician compliance with CPOE jumped from 13 to 70 percent. "We achieved these gains by understanding and communicating that the electronic medical record is our clinical engine for delivering, documenting, billing and researching safe, effective, efficient, timely, equitable and patient-centered health care," says Chief Medical Officer Glenn Mitchell, M.D. Mitchell says technology implementations already have reduced medication harm events to 5-Sigma performance level (233 defects/errors per million). The EMR also allows automated performance reports to track meaningful use.

"We also track clinical outcome measures such as readmission rates for specific conditions and issue alerts when treatment milestones are in danger of being missed," Mitchell says.

He advises that hospital leadership needs to be 100 percent behind these efforts and that all clinicians must be in all implementation, upgrade and enhancement loops.

Douglas Page is a freelance writer in Pine Mountain, Calif.