Clinical surveillance systems reduce risks that thrive in information gaps

The data that clinicians and their teams must wade through in caring for hospitalized patients can be overwhelming. Premier data shows that an average of 168 data transactions occur per patient per day, adding up to about 59,000 total daily clinical transactions for a typical hospital. Managing these data transactions without surveillance tools presents the potential risk that something might be missed by front-line caregivers, leading to patient harm, increased costs, and damage to a hospital’s reputation.

It is this reality that spurred development of the first clinical surveillance system in 2001. The purpose? To track large volumes of patient data from a variety of sources, analyze that data in real time, and alert front-line caregivers to potential problems and gaps in care. To be successful, real-time data needed to be made available to clinicians, alerts had to be timely, and the technology had to be easily customizable for an ever-changing patient population. The resulting technology has demonstrated significant improvements in the identification of healthcare-associated infections (HAIs), improved medication safety and stewardship, and reduced length of stay and cost of care.

More than 15 years later, delivery of care has evolved due to healthcare technology. Most organizations have implemented electronic health records (EHRs), and many also have adopted clinical surveillance systems. Specialized clinical surveillance systems have continued to demonstrate their ability to help clinicians improve the quality of care, increase efficiency, comply with regulatory pressures, and reduce costs. These systems have a unique ability to integrate, transform, and help data make sense to front-line caregivers—all in real time. Providing clinical analytics at the point of care, clinical surveillance solutions perfectly complement EHRs. In addition, as more organizations merge and partner, multiple EHRs may be in place. Because clinical surveillance technology is vendor neutral, it overlays disparate EHRs and allows for standardization across the organization.

Clinical surveillance—as a complementary workflow or integrated into the EHR—will be a key part of the external technology that enhances EHR usability.

Making sense of data

In this period of big data, healthcare leaders are working hard to harness all the clinical data associated with patient care, most of which remains in silos, even after the implementation of EHRs. Acting on this clinical data has become a priority as part of the movement toward a more consumer-centric and accountable care delivery system amid ongoing efforts to control costs.

These concepts were reinforced in a Premier survey, which showed that healthcare leaders are focused on:

• Managing costs, including the rising cost of drug spending;
• moving from meaningful use to meaningful insights;
• engaging and satisfying customers;
• shifting toward value-based care, risk, and scale; and
• continuing differentiation on quality and costs.

Critical to addressing these priorities is transforming raw data into meaningful information, providing the insights to inform decision-making and close gaps in care—all with the goal of reducing risk to patients and hospitals, improving quality, and decreasing costs.

EHRs—transactional data

EHRs are transactional systems that were originally designed for billing purposes. Today’s EHR systems have evolved to include basic alerting and analytic capabilities, as EHR vendors have worked with provider clinical teams to create alerts and surveillance lists, as well as reports to address clinical and regulatory needs. However, any changes to clinical initiatives, patient population, or regulatory guidelines must be met through the requisition process within hospital IT departments or the EHR vendor, which can be labor intensive and time consuming.

Since the implementation of EHRs, hospital labor costs outside direct patient care have increased by up to two-thirds. Two areas that have experienced a 44% increase in labor are data mining and clinical decision support departments¹. In this world of reimbursement constraints and essentially “no new money” in healthcare, organizations cannot afford to increase nonpatient care labor expenses.

Clinical surveillance technology vendors with clinical in-house expertise can help ensure that technology supports the unique clinical workflows of a healthcare organization.

Clinical surveillance systems—clinical insights

Clinical surveillance systems have evolved to meet the surveillance, data analysis, and reporting needs of hospitals. They eliminate the labor-intensive and inexact process of piecing together and manually reviewing data from EHRs and other hospital information systems. Continuously monitoring disparate data, clinical surveillance systems analyze and track laboratory and microbiology results, pharmacy data, patient demographics, ADT (admission, discharge, transfer) data, vital signs, radiology, surgery, clinical notes, and device data (i.e., central lines, ventilators, and Foley catheters), allowing clinicians to identify at-risk patients, prioritize care, improve clinical services, and reduce costs.

An effective clinical surveillance solution supports efficient clinical workflow through customizable user interfaces that present the information needed by individual clinicians and teams according to their roles. Customizable reporting capabilities provide patient population views and trend data, helping to ensure that resources are targeted toward patient populations at risk for the outcomes of greatest importance. They also facilitate state and federal regulatory reporting requirements, including HAI reporting and antimicrobial use (AU) and antimicrobial resistance (AR) data submission to the National Healthcare Safety Network (NHSN).

Clinical surveillance systems—clinical results

More than 15 years of use have demonstrated the value of clinical surveillance systems in areas aligned with the priorities of healthcare executives, including the need for meaningful insights that help address risk to patients, manage costs (including medication expenditures), and efficiently handle the growing challenge of regulatory reporting. A sampling of the results achieved by Premier members shows benefits across a range of clinical issues for hospitals of all types and sizes.

Reducing costs

Hospitals have seen significant cost savings directly related to the use of clinical surveillance technology:

• Good Shepherd Medical Center achieved nearly $1.5 million in incremental savings in the first year using clinical surveillance technology².
• CHRISTUS Health realized nearly $2.5 million in intervention savings in one year after implementing a clinical surveillance system ³.
• Detroit Medical Center reduced average LOS by 2 days in one year after adopting clinical surveillance technology ⁴.

HAIs

Clinical surveillance technology helps streamline infection surveillance through quicker identification of HAIs and time to isolation, allowing infection preventionists to spend more time in patient care areas educating and observing practice.

• At Memorial Hospital Miramar, automating data collection and report creation led to more timely removal of Foley and central venous catheters, and a decrease in urinary tract and central line-associated bloodstream infections ⁵.
• Hahnemann University Hospital reported 67% faster confirmation of HAIs with fewer errors using a clinical surveillance system, and it reduced by half the time it took to identify patients with MDROs for isolation ^6,7.

Comprehensive medication management

Clinical surveillance systems that provide comprehensive pharmacy management tools help ensure the appropriate use of medications, improve stewardship (antibiotics, opioids, etc.), save time, and reduce costs. In fact, a study looking at clinical surveillance use in primary care showed a 32% reduction in inappropriate antibiotic use.⁸

• Henry Ford Health System reduced antimicrobial use by 20% and lowered C. difficile infection rates after adopting clinical surveillance technology⁹.
• Ellis Medicine achieved a 286% improvement in the appropriate prescription of antibiotics with the aid of a clinical surveillance system¹⁰.
• A clinical surveillance system contributed to the prevention of 261 adverse drug events at a Veterans Affairs medical center¹¹.
• Detroit Medical Center saw a 76% reduction in the odds of infection-related mortality after implementing alerts to support its stewardship program⁴.

Regulatory compliance

Federal and state reporting requirements are a significant burden—a study by Robert Wood Johnson University Hospital showed that infection preventionists spent an average of 5 hours and 8 minutes per day completing NHSN reporting tasks¹².

• Warren Hospital found that clinical surveillance technology led to 10 times faster NHSN reporting¹³.
• Hahnemann University Hospital reduced time spent on NHSN reporting from 6 minutes per case to 2 minutes using a clinical surveillance system⁶.

Value-based care: Here to stay

Clinical surveillance systems help healthcare leaders better understand a variety of issues and trends impacting patients and their facilities, reduce clinical variation, and expand team structures to include care coordinators, clinical pharmacists, nurse practitioners, and others, as well as arm patient care teams with tools to deliver efficient, quality care. Features including full medication management tools, mobile delivery of alerts, patient-specific clinical data, and the ability to expand surveillance to outpatient care for medication management enhance communication and improve patient care¹⁴.

Advanced integration: The future is here

The future of clinical surveillance involves the integration of advanced capabilities into the workflow of EHRs. Premier has led this effort through its clinical surveillance technology, providing features and capabilities such as medication utilization reports, real-time alert engines, and antibiogram analytics to be seamlessly integrated into EHRs. The goal is to ensure that front-line caregivers have the technology and insights at their fingertips to deliver the best care possible, while adhering to clinical initiatives and reducing the cost of care.

Managing risk with confidence

With EHRs in use by about 95% of U.S. hospitals, the key now is to turn meaningful use into meaningful insights through an ecosystem of technologies.

The enormous repositories of data in hospital EHR systems must be leveraged in an efficient and focused way that allows healthcare leaders and clinicians to take actionable steps to improve patient care and organizational performance. Significant progress has been made possible by clinical surveillance systems—well established drivers of healthcare quality improvement that uniquely complement EHRs.

Clinical surveillance systems provide technology and analytics that help healthcare organizations make sense of raw data contained in EHRs and other hospital systems to move toward more consumer-centric and accountable care delivery systems, as well as better control costs. Used together, the technologies help address the information gaps that increase risk to patients and hospitals.

References

1. All In: Moving from EHR Adoption to Optimization. 2017. https://www.nuance.com/content/dam/nuance/en_us/collateral/healthcare/brochure/nc_049976.pdf.
2. Calloway S, Akilo H, Bierman K. Impact of a clinical decision support system on pharmacy clinical interventions, documentation efforts, and costs. Hosp Pharm. 2013;48(9):744-752.
3. Udeani G, Evans J, Payne A, Shanks J. Clinical and economic impact of a data mining computer application at CHRISTUS Spohn. Texas Society of Health-system Pharmacists 2014 Annual Seminar; April 11-13, 2014; Houston, TX.
4. Pogue J, Mynatt R, Marchaim D, et al. Automated alerts coupled with antimicrobial stewardship intervention lead to decreases in length of stay in patients with gram-negative bacteremia. Infect Control Hosp Epidemiol. 2014;35(2):132-138.
5. Chavez A. Clinical decision support technology streamlines documentation of infection control interventions for timely removal of Foley and central venous catheters. Am J Infect Control. 2010;38(5):E62-E63.
6. Sarvareddi P, Fry-Arrighy B, Ciolko T, McAllister M. Does an Automated Infection Surveillance System Benefit a Hospital with Limited Information System Resources? : Association for Professionals in Infection Control and Epidemiology (APIC);2010.
7. Ciolko T, Fry-Arrighy B, Sarvareddi P, McAllister M. Can automated surveillance software asssist with cohorting patients with multidrug-resistant organisms? Association of Professionals in Infection Control and Prevention (APIC); 2010; New Orleans.
8. Samore M, Bateman K, Alder S, et al. Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA. 2005;294:2305–2314.
9. Hospira Reinforces Importance of Clinical Surveillance Technology in Line With World Health Day Focus on Antimicrobial Resistance. [press release]. April 7, 2011.
10. Bassi S, PharmD. Antibiotic Stewardship Program Supported by Clinical Surveillance Increases Pharmacy Interventions and Reduces Costs. Poster presented at ASHP Annual Meeting; Dec. 3-7, 2017; Orlando, Florida.
11. Echevarria K, Smith G, Tierney C, Patterson J, Cadena-Zuluaga J. Utility of an electronic clinical surveillance system to facilitate tracking of multidrug-resistant organisms (MDRO) and antimicrobial stewardship in a VA medical centre. ElectronicHealthcare. 2011;10(2):e30-e37.
12. Parrillo S. The burden of national healthcare safety network (NHSN) reporting on the infection preventionist: a community hospital perspective. Am J Infect Control. 2015;43(6):S17.
13. McSorley L. Email ed. Phillipsburg, NJ Warren Hospital 2011.
    Sobnosky J. Expanding Antimicrobial Stewardship to Outpatient Settings Using Clinical Surveillance Technology. ASHP Annual Meeting; Dec. 3-7, 2017; Orlando, Florida.