North Shore LIJ (Manhasset, N.Y.), Baystate Health (Springfield, Mass.) and Care at Home Community Healthcare (Campbell, Calif.) were all recognized as semifinalists in the Healthcare Informatics Innovator Awards program. The three semifinalists reveal the details of their projects below.
To learn more, leaders of these teams along with leaders of the four finalist teams, will be recognized at the Healthcare Informatics Innovator Awards Reception, to be held in Orlando on Feb. 24 at the annual HIMSS conference.
North Shore LIJ
Michael Oppenheim, M.D., CMIO at North Shore-LIJ
Interoperable comprehensive prenatal care record with data derived from multiple outpatient EHRs and prenatal imaging centers.
Why did you focus on high risk pregnancies?
North Shore-LIJ Health System had a very active perinatal safety and quality taskforce focusing on reducing morbidity and mortality for both mothers and babies. It is always most effective to apply healthcare IT solutions when there is an active clinical partner who can assure that the process and workflow changes can be effectively operationalized. This choice was also spurred by the opportunity to secure grant funding through the New York State Health Care Efficiency and Affordability Law (HEAL). The HEAL 10 Program sought to fund projects that applied Patient Centered Medical Home Models supported by interoperable health IT to drive clinical improvements. Given the number of different specialists involved in the care of the high-risk mother, and the importance of communication between those providers in the prenatal period the criticality of that information to support the patient during Labor and Delivery, High Risk Pregnancy was the ideal clinical entity to focus on.
Why was interoperability between systems so important for high risk pregnancies?
There are multiple coordination points and care transitions during the care of a woman with a high risk pregnancy and the care of the child who is born. During the prenatal period, the high-risk obstetrician may be referring to the patient to adult subspecialists to care for the mother, or to pediatric specialists to care for the fetus or to plan for care of the newborn. Communication among these providers is not only critical during the prenatal period, but this information must be available in the hospital environment to manage the Labor and Delivery period as well as to optimally care for both the mother and baby. Finally, both mother and baby will be seen and cared for after discharge from the hospital. Building a comprehensive clinical record and making this information available through the continuum of prenatal care, Labor and Delivery, and postpartum/newborn care is expected to improve the care and outcomes for both mothers and babies, as well as decrease the administrative burden on hospital and office staff that would otherwise have to seek and collate this information manually.
How can this project be replicated across the industry?
Technology is not the barrier: all interoperability was achieved using industry standards, including the representation of the OB data in a CCD as well as using SNOMED as a normalizing vocabulary where needed. The primary element which needs to be carefully understood and addressed at the local level is around documentation practices and workflows to assure that the documents are exchanged after they are complete and contain the maximum data but not too late to be useful to a downstream recipient.
What’s next for the project?
A critical pre-requisite for the exchange of discrete data is the charting of discrete data. We need continued focus on optimizing the design and use of our office EMR so that as much data as possible is charged discretely and can be shared as discrete data to maximize the value of the data sharing.
Baystate Health
Andrew Healy, M.D., medical director of obstetrics at Baystate Health.
Perinatal-specific EHR to successfully institute a hard-stop policy eliminating the procedures of elective deliveries prior to 39 weeks of gestation and elective inductions of labor in patients at increased risk for cesarean deliveries
What made you go down the path of limiting elective labor induction?
This happened for a couple of reasons.
First of all, we recognized that there was a national trend toward increased elective labor induction. Many of these deliveries were happening prior to 39 weeks of gestation.
There is compelling evidence that all babies born at term do not necessarily do as well as once thought. Babies delivered between 37 and 39 weeks are increased risk for complications compared to those delivered at or beyond 39 weeks. For this reason we need to make sure that delivery is delayed until at least 39 weeks in the absence of medical indication.
We also know that many patients who are electively induced face an increased risk for cesarean section. This places the mother to increased risk for surgical and postoperative complications compared to women who have a vaginal delivery. Women who are delivered by cesarean section are also at increased risk for future cesarean sections and complications related to abnormal placentation compared to women who have vaginal deliveries.
In the new healthcare environment, there has been a push to decrease the length of stay. Patients undergoing prolonged elective inductions often have longer hospital stays than their counterparts who are admitted in spontaneous labor. Furthermore, a significant percentage of patients who undergo elective induction of labor wind up requiring a cesarean section which further increases length of stay.
Therefore, because of these issues we thought it was important to limit the practice of elective labor induction at our institution. Utilizing our EHR, were able to measure the impact of our new policy fairly easily.
How can this project be replicated across the industry?
Any hospital that has an obstetric unit can introduce a policy limiting elective induction of labor. We are happy to share our policy. The fact that we have a strong electronic health record enables us to continuously monitor the impact of our policy which has been crucial to our success. We are able to generate monthly reports detailing the frequency of labor induction, elective labor induction, cesarean section rate in additional to numerous other outcomes/variables.
What's next for this project at Baystate?
Our labor and delivery unit is continuously monitoring numerous variables with respect to patient care in the effort to keep us at the top of the curve.
Care at Home
Jason Grinstead, president at Care at Home.
Mobile application that supports caregiver safety.
Explain how the mobile app works?
The AtHoc mobile app enables our mobile, distributed workforce to efficiently communicate with our home office in multiple scenarios such as safety/security events, checking in and out of home visits, or responding to staffing opportunities posted by our administrators.
- It also enables our staff to report events, submit photos of suspicious activities, and activate a geo -locational tracker to increase their security if they are concerned.
- All communications with the mobile app are encrypted and no data resides on the users' phones or tablets, making it a very secure way to communicate with our virtual workforce.
- We have found the AtHoc mobile app to be very simple and intuitive to use, making end-user training relatively simple:
- Users can quickly alert us of concerns using the big red button prominently displayed on the app’s screen.
- Users can easily start safety geo-tracking or locate themselves on a map using standard, easily recognizable icons.
Why the home health market is important for this kind of platform?
Home healthcare is a rapidly growing, $100-plus billion market, but care provision poses significant communication and care coordination challenges: instead of working in the physical confines of a hospital or outpatient facility, home healthcare clinicians are mobile and distributed over large geographies. Because of this, the AtHoc platform provides an effective solution to unique challenges:
- Care coordination. It is critical to establish a secure, efficient communication platform to ensure that care is effectively staffed and coordinated across this mobile, distributed workforce; well-coordinated care is shown to improve patient health outcomes.
- Safety. Home health clinicians often make community visits in unfamiliar surroundings and are more likely to be exposed to safety concerns than within the controlled confines of a hospital. The AtHoc platform provides a scalable, effective way to promote coordinated care and instant communication to solve these pressing needs.
What is the major need that has to be addressed in terms of care coordination?
Home health care is a cornerstone of healthcare reform because it is a significantly lower cost venue of care that drives patient health outcomes similar to those of other more costly venues such as hospitals, specialty clinics and skilled nursing facilities.
- Efficient coordinated care management across the healthcare continuum of doctors, hospitals and other healthcare venues that care for the same patient is key to ensuring successful patient care.
- Historically, this coordination has broken down due to poor communication tools that reinforce communication silos, such as handwritten paper-based documentation and heavy reliance on faxes.
- The AtHoc communication platform enables us to push secure, efficient communication all the way to the edge of the healthcare continuum by extending sophisticated communication mechanisms to the front-lines of community healthcare. This is critical because nurses who make home visits often are the early warning sirens of adverse patient health events and can prevent traumatic and expensive hospitalizations.
How can this project be replicated across the industry?
The home health market is large and growing rapidly, yet is highly fragmented with many providers.
- Most providers are using older communication tools that fail to institutionalize knowledge and disrupt effective care coordination.
- Our work with AtHoc will provide AtHoc and the home care industry with the expertise, ROI solutions, and compliance policies and procedures to quickly and efficiently implement this program.
- Although it is highly innovative and at a relatively early stage, we are finding good traction with the
AtHoc solution and believe it will provide great value for others in the home care industry too.
What’s next for the project?
We are in the process of scaling the project within our organization and are exploring the AtHoc platform for other healthcare industry use cases such as staffing, remote visit compliance, secure integration with electronic health records, etc. As a truly innovative project, we are excited to be utilizing this very effective safety tool that is trusted by the U.S. government and many national, campus-based organizations. We are determined to push the AtHoc platform’s technological limits into compliant high value virtual workforce applications.
