We at Healthcare Informatics were once again delighted by the exceptional quality of the submissions we received from innovating teams from across the country, this year. Below, please find descriptions of the initiatives of the eight teams whom we have awarded semifinalist status in this year’s program.
Also, 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 Las Vegas on March 1 at the annual HIMSS conference.
Allina Health: Intensive clinical and operational gains
As an organization participating in the federal Pioneer Accountable Care Organization program, Allina Health, based in Minneapolis, has a natural incentive to improve clinical performance. Even so, the decision on the part of senior leaders at the 13-hospital, 90-clinic, 26,000-employee Allina to commit to achieving exceptional outcomes—senior executives strove to be in the top decile of performance on every meaningful, measurable quality metric—was ambitious.
Specifically, Allina team members aggregated clinical, financial, operational, patient satisfaction, and other data into its enterprise-wide data warehouse (EDW), to create consistent views of the data. They then decided to use analytics to identify the clinical programs in greatest need of optimization and waste reduction, focusing initially on congestive heart failure (CHF) readmissions, spine care, length of stay, and venous thromboembolism (VTE) care. They chose to drill down particularly intensively on reducing CHF-related 30-day readmissions.
In the readmissions arena, Allina clinicians and care managers have achieved a 17-percent 30-day CHF readmissions rate reduction in 10 of the 11 hospitals doing cardiac care, along with a 30-percent increase in patient participation in the system’s heart failure program, a 36-percent reduction in CHF patient ED visits, and a 20-percent reduction in length of stay for CHF patients. In the spine care arena, the health system has been involved in a full initiative to deliver care that supports the Triple Aim in the treatment of spine disorders and lower back pain. Among other achievements, Allina has implemented a collaborative spine care coordination program; achieved a 16-pecent reduction in length of stay for spine care procedures; achieved a 36-percent reduction in post-operative complications; and achieved a projected $2.7 million in savings through supply standardization.
Allina leaders continue to work forward across the CHF, spine care, and VTE clinical areas, and continue to show ongoing significant clinical and financial outcomes progress.
Unity Point-Meriter: Transforming bundled payment-driven joint replacement
In 2012, in preparation to begin participating in the bundled-payment program for joint replacement procedures under the Centers for Medicare & Medicare Services (CMS), leaders at UnityPoint Health-Meriter, a one-hospital health system in Madison, Wisconsin, performed financial analysis on the organization’s efficiency in that arena, with the goal to launch a high-quality, efficient joint replacement bundle by January 2014. A multidisciplinary project team worked to redesign care delivery, lower costs, and automate some of the administrative burden. Standardization and cost reduction began with re-negotiating implant contracts and tackling surgeon pick lists for surgical pathways and supplies in materials management.
Among other actions, Meriter leaders implemented a claims data-analysis and modeling tool to better understand claims reconciliation, and provide detailed performance data. They soon discovered high variability in post-acute care utilization. They also developed a set of clinical pathways to ensure standardized, best practice-driven care across clinicians. The results have been significant, including, between 2013 and 2015, a 12-percent reduction in length of stay; a 23-percent decrease in the use of skilled nursing facilities; and a 68-percent reduction in readmissions, even as 55 percent of all joint replacements performed at Meriter are done so under bundled payment.
Yale-New Haven: Engaging physicians intensively in performance improvement
At Yale-New Haven (Conn.) Health System, a focus on quality is at the center of the organization’s multi-year, $125 million cost savings initiative. As part of the execution of the initiative, Yale-New Haven leaders created a customized set of quality metrics called QVIs (quality variance indicators), and a sophisticated cost accounting systems, to better collaborate with clinicians on quality improvement and cost reduction. As a result, organizational leaders were able to overcome typical physician skepticism about performance data, thus opening the doors to full collaboration with the health system’s affiliated physicians.
Among numerous other examples, the organization was able to increase overall appropriate use of the drug bivalirudin (used as an anticoagulant in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty) by nearly 30 percent, contributing to a reduction in direct cost per case among those patients, through sharing data related to costs associated with variations in care. Yale-New Haven senior leaders report that, because they have leveraged data and information systems, along with strategy, to fully engage physicians, both physicians and non-clinicians are now fully invested in working collaboratively, in a data-facilitated way, to look at costs across the health system.
Hackensack University Medical Center: Using IT to monitor blood loss in real time
The research team at New Jersey-based Hackensack University Medical Center (HackensackUMC) has refined the concept of quantified blood loss (QBL) as a new vital sign as important in preventing morbidity and mortality, and improving patient outcomes. The team encountered a QBL calculating system called Triton, a mobile platform for real-time monitoring of surgical blood loss, created by the Los Altos, Calif.-based Gauss Surgical Company. At HackensackUMC, healthcare providers use iPad cameras in real time in the operating room to take pictures of surgical sponges and blood canisters. These images are uploaded to a cloud-based system which processes them using a colormetric algorithm that determines the amount of blood contained in the sponge and canister and differentiates it from other body fluids and irrigation.
The chief technology officer and founder of Gauss Surgical, Siddarth Satish, and the HackensackUMC researcher team met with Shafiq Rab, M.D., CIO for HackensackUMC, to review the Triton system and how it might best be implemented into the electronic medical record (EMR) system for real-time clinical use. Rab and the team were able to incorporate and interface the Triton systems’ results into HackensackUMC’s Epic EMR, resulting in real-time reporting of blood loss to the obstetrical team.
This two-way integration with mobile devices and cloud technology allows the obstetrical surgical team to monitor blood loss in real time, the same way a patient’s heart rate, oxygen saturation and blood pressure are monitored. The result of these efforts is a clinical system deemed Accurate Display of Postpartum Hemorrhage using Triton (ADOPT) for the Modified Early Obstetric Warning System (MEOWS). HackensackUMC officials say that it has become the first organization to accurately calculate true and total quantified blood loss in obstetrics.
Geisinger Health System: Saving lives using data
Not too long ago, Gregory Moore, M.D., Ph.D., neuroradiologist and chief emerging technology and informatics officer at the Danville, Pa.-based Geisinger Health System, suspected that Abdominal Aortic Aneurysm (AAA) patients may not have been receiving their necessary follow-up care. While radiologists identify AAA in diagnostic reports, the potential exists for the report to file in the ordering physician’s EMR with the message regarding needed follow-up missed, or at least not digitally actionable.
As such, Geisinger convened a multi-disciplinary team to implement an end-to-end process that provides a safety net and improves follow-up care for patients with this life-threatening condition. The team reviewed industry best practices, including the Society of Vascular Surgery practice guidelines for the care of patients with AAA. To address the challenge of identifying essential AAA information in unstructured radiology reports, Geisinger introduced a new technology, natural language processing (NLP), allowing the Geisinger team to identify those cases where the information only exists in the narrative radiology report. The finalized Geisinger guidelines were used to develop the clinical decision support necessary to identify, classify and facilitate reliable follow-up care.
In its first year, the AAA Close the Loop Program completed its retrospective review of two million radiology reports to identify AAA cases and stratify patients by clinical risk. Using EMR and scheduling data, Geisinger targeted the outreach contact for 3,400 patients to ensure appropriate AAA follow-up occurred. Twelve patients received life-saving surgical AAA repair due to the Close the Loop Program, according to officials.
Stanford Medicine & Stanford Health Care: A virtual primary care clinic
ClickWell Care (CWC), a telemedicine primary care delivery model, was developed and implemented to better address the needs of Stanford Medicine’s current population of accountable care organization (ACO) patients, many of whom choose emergency services and urgent care instead of engaging in traditional primary care. ClickWell Care is a team-based primary care medical home model staffed by physicians, wellness coaches, and medical assistants. Key features include convenience, extended and same-day access, and integrated wellness coaching into the primary care team, all leveraging telemedicine and mobile technologies to support each patient’s overall health and well-being. The care team provides integrated primary care and wellness services, including preventive, urgent, and chronic care services through virtual modalities, including video and phone visits and brick-and-mortar interactions when clinically appropriate.
CWC directly engages patients through convenient access to personalized medical and wellness care services. Compared to the traditional brick-and-mortar office setting, this model deepens the primary care relationship through telemedicine and personalized wellness coaching tailored to each patients’ needs. What’s more, the clinic engages patients through mobile technologies integrated into daily clinical workflow, including the customized Stanford Health Care MyHealth app and website, which are integrated with the Epic EMR, Withings connected devices, and the Apple HealthKit. Physicians may prescribe device and application usage, enabling patients to collect vital ambulatory data in partnership with their wellness coach and primary care physician when implementing a personalized health and wellness care plan. In the first 10 months of implementation, ClickWell Care has provided more than 2,000 physician visits.
Florida Hospital: Improving OR patient flow through RTLS-based visual analytics
The leaders at Florida Hospital Celebration Health (Celebration, Fla.), a member of the Adventist Health System, have been involved in an initiative to leverage Real Time Locating System (RTLS) visual analytics technology to improve operating room (OR) patient flow. The hospital’s general surgery teams treat nearly 10,000 cases annually in 11 operating suites and 12 post-anesthesia care unit (PACU) bays, and project leaders identified a simple yet compelling goal—continuous visibility into the surgical patient experience.
To meet that goal, Celebration leveraged its RTLS technology, and now patient flow infrastructure and visual dashboards are in use across Celebration Health’s Surgical Services, with every surgical patient wearing an RTLS badge to monitor location, status and interactions. The dashboards enable staff to look “upstream” and “downstream” in real time to streamline case preparation, advance patient throughput and expedite room turnover.
Since implementing the solution, Celebration Health has achieved a reduction of six to 16 minutes in hold times in the PACU between when a patient meets release criteria to when they are moved to an acute care unit. The hospital also has achieved a reduction of 10 to 24 minutes in the total time in recovery for patients in the OR, and total recovery times are now significantly more predictable, with 20 percent less variation on average.
Multicare Health System: Clinical collaboratives project
At Tacoma, Wash.-based MultiCare Health System, a six-hospital integrated healthcare delivery system, physician-led, multidisciplinary teams, called Collaboratives, are developing and deploying system-wide improvement strategies that have resulted in some stunning clinical outcome improvements and measureable financial benefits. Even more impressive is the fact that MultiCare has successfully implemented a sustainable approach for standardizing best-practice, value-based care across not just a health system, but also across its commercial accountable care organization (ACO) and clinically integrated network. MultiCare leadership credit the Collaborative project’s success to strong physician leadership in partnership with other clinicians and the fact that the project delivers on three key areas—it standardizes best practices, optimizes the use of technology and analytics and transforms the culture of the organization through extensive change management.
In 2011, MultiCare created the two initial Collaboratives focused on improving outcomes for sepsis and heart failure. The significant outcomes from this initiative—a 65 percent reduction in sepsis mortality rate—prompted the health system leadership to accelerate its investment in the Collaboratives and there are now six Collaboratives across the system focused on critical care, medicine, surgery, cardiac, women’s services and pediatrics. Here are a few results—within the Women’s Collaborative, a 71 percent reduction in C-section deliveries with length of stay greater than six days and within the Surgery Collaborative, the 30-day readmission rate for total joint surgery patients is 0.5 percent, an 80 percent improvement from 2014. Regarding financial results, the Collaboratives structure has contributed to a system-wide cost reduction trajectory of greater than $100 million over the last three years.
