Health information technology is still in its adolescence, and its potential, while seemingly unlimited, remains largely untapped. However, the winners of this year’s Most Wired Innovator Awards harnessed IT to tackle three very different challenges, from clinical care to price transparency to physician orders.
Winner: Holy Name Medical Center
One of the mysteries of modern health care is the fact that approximately 75 percent of the 3.5 million Americans currently infected with hepatitis C virus are baby boomers — those born between 1945 and 1965.
No one can say if or when that mystery will be solved. But in February, Holy Name Medical Center in Teaneck, N.J., began offering free HCV screening to patients within the high-risk cohort who present to the hospital's emergency department.
To ensure that this service is offered on an equal basis to all eligible patients, Holy Name's information services department automated as much of the process as possible. The department developed processes to screen patients for eligibility, provide eligible patients with HCV education, link clinical documentation to laboratory orders, notify patients of HCV results and track follow-up communication and care.
“I designed a process that started a tracking mechanism when a hepatitis screening order was entered into the system," says Mike Skvarenina, Holy Name's chief information officer and solution architect. "If the result was positive, then the process continued looking for the RNA test [the follow-up test to confirm the findings of the screening] and the result for the patient."
Other innovations devised by Skvarenina included a data entry screen for the patients who were found to be HCV-positive and needed additional follow-up.
By placing the responsibility to identify eligible patients on the programming staff rather than the ED staff, the processes were made less susceptible to human error, thereby increasing the number of patients screened and maximizing the community benefit.
The programming offers the user an intuitive layout to determine key performance indicators such as the number of patients with positive results. Forty-seven percent of eligible patients have agreed to and received the screening, and 3 percent of those screened have tested positive for HCV.
In May, Holy Name's HCV screening efforts were recognized by the Department of Health and Human Services when the hospital received the Viral Hepatitis Recognition Award.
Approximately 160 hours were required to develop the testing program, at an approximate cost of $7,700. Anticipated costs for related laboratory testing are estimated at approximately $200,000 for a three-year period.
With a self-directed health information system and an in-house development team, building add-on features for the project required no additional staff and incurred no additional expense.
Holy Name leaders acknowledge that without such resources, its model may be difficult to replicate without additional expenses. However, the processes themselves are transportable to other organizations or constituencies.
Winner: St. Clair Hospital
In an age when consumers are shouldering more responsibility for their health care costs, the leaders of St. Clair Hospital in Pittsburgh knew it was time to provide their patients with greater price transparency.
To make that happen, the hospital partnered with Experian Health to create an online Patient Estimates Tool that went live in February. The tool is designed to determine, in advance, a patient's out-of-pocket costs (deductibles, copays and coinsurance) for services at St. Clair based on his or her insurance coverage.
"We knew that patients appreciated knowing the cost prior to service," says Richard Chesnos, senior vice president and chief financial officer. "We wanted to leverage our leadership in quality, patient safety and patient satisfaction to transparency and value for our patients."
St. Clair for several years had offered patients phone-based cost estimates, but those interactions could only occur during hospital business hours. So in late 2014 and early 2015, discussions about how to take cost information online were held by Experian Health officials; Chesnos; John DeZulovich, St. Clair director of patient financial services; and Kandi Housley, St. Clair manager of patient access.
Valuable input for the Patient Estimates Tool was obtained from a patient focus group. "They didn't want to see the charges; that's rather irrelevant to them," Chesnos says. "They wanted to see what the insured allowed amount is, what their copay is, what the remaining deductible is, and the composition of what their final out-of-pocket cost would be."
Formulating the tool required a great deal of testing. "The total for all of our testing was over 1,000 hours," says Sarah White, St. Clair supervisor of patient accounting. "That was really critical in making sure we were providing patients with accurate estimates they could trust."
The initial rollout of the Patient Estimates Tool cost considerably less than $100,000, and the project did not require additional employees.
Chenos says the tool is generating an average of 100 estimates every week on the hospital's website. "That's a 535 percent increase from our prior process of pricing requests that were done via phone," he says.
The Patient Estimates Tool has generated positive feedback from patients and groups such as the Pittsburgh Business Group on Health, the Allegheny County Schools Health Insurance Consortium, the Pittsburgh Regional Health Initiative and the Greater Pittsburgh Chamber of Commerce.
Richard Schaeffer, St. Clair's vice president and chief information officer, says the "most dramatic outcome we had was just the ability to demonstrate to the industry that transparency is doable."
Winner: Texas Hospital Association
Research has long shown that there’s no correlation between health care spending and health care quality. Inefficiencies and unnecessary treatments can inflate costs and sometimes harm patients.
This disparity is especially challenging at a time when hospitals are assuming more financial risk in the care of patients.
Significantly, 87 percent of variable hospital expenses stem from orders submitted by physicians who typically do not know the cost of each item they order. Yet, many studies have demonstrated that informing physicians about treatment costs and/or the risk of patient harm — at the time and place they are about to write an order — prompts them to order fewer and less expensive tests and medications.
To help physicians make better-informed ordering decisions, the Texas Hospital Association teamed with Alabama-based IllumiCare Inc. to create a solution known as the Smart Ribbon. The patent-pending, nonintrusive ribbon of information hovers over a hospital's electronic health record and gives physicians real-time, patient-specific hospital costs [as opposed to charges] and iatrogenic-risk data.
"As Texas health care leaders, we understand the importance of adopting smart, innovative and cost-effective technology to improve care," says Ted Shaw, the association's CEO. "The Texas Hospital Association has taken on the challenge by helping hospitals to identify ways to obtain the latest innovations through partnerships that also provide savings and clinical value."
Mukul Mehra, M.D., IllumiCare co-founder, says the technology "doesn't tell physicians what to do or not do" but provides them with actual cost data and probabilities of iatrogenic risks such as cancer from medical radiation.
For all of Texas' short-term, acute care hospitals, the THA projects savings of $143.9 million (including a $77.9 million reduction in medication spending) on an investment of $21.5 million, for a 567 percent return on investment.
Harvey Nix, THA hospital liaison, says 23 THA hospitals are looking at adopting the Smart Ribbon. “The intent was to find 10 hospitals in different geographic locations with different electronic health record systems so we could prove that it could be installed and adopted and used in that fashion. It looks like we will end up with three different systems and 23 hospitals in total participating in this first phase of the initiative."
The second phase of the project will include hospital collaboration on next-generation Smart Ribbons. Early interest has been expressed in areas such as statewide radiation tracking, antimicrobial stewardship, pharmacogenomics data and an ED ribbon with access to state drug databases.
Finalists
Baptist Health South Florida
The Affordable Care Act was expected to reduce emergency department visits, but, so far, that has not happened. As a result, it is more important than ever for hospitals to reduce expenses and improve health care quality and access. To that end, Coral Gables-based Baptist Health South Florida launched its TeleTriage program Dec. 5. The collaboration between the hospital and the ED physician group uses the latest telehealth technologies to improve door-to-disposition times in the ED when it is near or at surge capacity. A review performed in March found that diagnoses in which a TeleTriage patient experienced time savings comprised 33 percent of all ED visits since the launch. Each minute saved amounts to approximately $6 in possible additional revenue, or $540 per average patient.
St. Joseph Mercy Oakland
To improve patient safety and reduce costs related to missing medications and medication waste, St. Joseph Mercy Oakland in Pontiac, Mich., created an integrated medication tracking system that was launched in March 2015. The medication tracking board comprises three integrated technologies: a dashboard that displays all medication requests (Medication Board), an iPhone-based communication platform (Voalte) and Cerner's PowerChart (electronic health record). When the pharmacy receives an order from the electronic health system, it is recorded on the medication board. The dashboard presentation of information such as patient name, drug name, category, medication history and room destination increases efficiency, patient safety and staff satisfaction. The cost of the integrated medication board is $21,420 plus maintenance costs. Since implementation, the hospital has experienced a significant reduction in missing medications and in wasted product.
St. Joseph Mercy Oakland
Another initiative by St. Joseph Mercy Oakland is also recognized as a finalist for the Most Wired Innovator Award. Two population health initiatives are designed to more effectively manage recently discharged patients and high-risk patients in their homes. The first initiative is a grant-funded partnership pilot program between the hospital and a local fire department. Patients participating in the program receive additional support as they transition to home recovery, including visits from a paramedic who performs a health assessment and a home safety check. The paramedic then uses swyMed Telehealth technology to conduct a two-way virtual consultation with an emergency medicine physician. In the second initiative, the hospital utilizes a new home monitoring tool provided by Vivify Health to manage high-risk patients through customized care plans and virtual visits and other means. Early intervention data have shown a decrease in readmissions and ED visits through effective transitions of care.
