Healthcare providers’ response to the opioid crisis has been hampered in part by the lack of information sharing between organizations. Opioid treatment centers and primary care providers often have no idea that their patients have had multiple recent emergency room visits.
A dashboard tool created for nurse care managers by the Rhode Island Quality Institute (RIQI) is changing that dynamic in the Ocean State. Users of its Care Management Dashboard (CMD) have seen their patients’ emergency department return visits within 30 days reduced by 16 percent. For this effort, RIQI has been named a winner of one of Healthcare Informatics’ Innovator Awards for 2018, Providers Division.
Starting in 2015, RIQI set out to create a tool to deliver information in a timely and organized way to help nurse care managers with transitions of care, explains Elaine Fontaine, RIQI’s director of data quality and analytics. “We thought that we would help them be more efficient and reduce patients’ likelihood of being readmitted or return to the ER, but the dashboards’ full potential is actually bigger than we had imagined.”
The dashboards allow nurse care managers to see— in real time— who among their patients has just been admitted to or discharged from any emergency department or acute care hospital in Rhode Island. They know who is in the ED or is hospitalized, their reason for admission, and such critical details as the patient’s room number, which nurse care managers can spend inordinate amounts of time tracking down.
Hospitals were already sending some of this information via fax, but there were many ways in which this data was falling through the cracks, Fontaine says.
Nurse care managers were surveyed in October 2016 before implementation and again in October 2017 after CMD was in use. “We were stunned by how much time nurse care managers spent hunting for data as opposed to taking care of patients,” Fontaine says. “Before the dashboard was implemented, more than 50 percent of respondents said they spent 10 or more hours per week hunting for information. After the dashboard, not one was spending more than 10 hours per week. They reported that their satisfaction in their work significantly increased. That was phenomenal.”
Today all of the community mental health organizations and opioid treatment programs in Rhode Island as well as a large number of primary care practices are using the dashboard, which is offered as a subscription service.
Linda Hurley, president and CEO of CODAC, a Cranston, R.I.-based nonprofit provider of treatment, recovery and prevention services, says the dashboard enhances communication between behavioral providers and those in other care settings. Coordinating with other medical service facilities is critical to safe and effective care, she adds, yet before the dashboard was in use, nine out of 10 times that one of CODAC’s patients was in the ED or admitted to the hospital, CODAC did not get that information in a timely fashion. The institutions are busy and the methods of communication were not effective, she says.
“The dashboard really is a solid step in changing our culture so we are not operating in silos and so that mental health and substance use disorders are not something tucked aside,” Hurley says. The enhanced communication actually serves to educate providers, she adds. “We learn more about the needs of those providing the medical care, and they learn more about our needs in providing behavioral health so we can provide optimal care for the individual who is receiving care from both of us.”
Laura Adams, RIQI’s president and CEO, recalls a primary care physician’s response to the initial installation of CMD in his practice. “He was watching the data come up and said, ‘Wait a minute — that patient is 28 years old. Why are there so many hospital admissions in six months? What is going on?’ His office reached out to that person, who was definitely experiencing problems with opioids. They were able to get that young man into treatment. Here is a primary care doctor who had no knowledge of anything going on with their patient until he was able to see a pattern of admissions that came in real time in our dashboard,” Adams says. “You not only get real-time information, but you get the history over the last six to 12 months.”
Opioid treatment centers and community mental health centers often find that patients have a “window of willingness” to reconnect with providers right after an overdose. “They have a new opportunity to intervene if they can get connected with them,” Adams says. But sometimes they wouldn’t find out about an overdose or even multiple overdoses. They were particularly interested to know when that was happening so they could do an immediate outreach.
The tool also allows patients to designate a person to be contacted if they are admitted, discharged, or seen in an ED, and that could be a family member, peer counselor or provider. “You have the opportunity to influence who is part of your care team,” Fontaine says, “and that is really exciting.”
When RIQI did a return on investment analysis on its portfolio of products and services in November 2017, it demonstrated a $13.3 million savings on $6.3 million in spending, with the CMDs and alerts contributing the lion’s share of the savings, despite having been built for only a little over $500,000. Also, RIQI stresses that the dashboards’ value isn’t limited to caring for those with addiction disorders. They also are used in the care of children with asthma, people with diabetes, and elderly patients with multiple co-morbidities. Nurses can get alerts for admissions and discharges from long-term care and nursing homes, as well as hospitals and EDs.
In enhancing the dashboard in 2017, RIQI added real-time risk score adjustments for patients, because there is often lag time before providers get risk score updates from insurers. The organization also wants to provide relevant social determinant information. “When you are prescribing a medication, a patient may not be able to afford it or have transportation to pick it up,” Adams says. “We want to be able to bring them that actionable information.”
For government and health system leaders grappling with the opioid crisis, RIQI’s contribution is much appreciated. “Rhode Island Quality Institute is once again leading the nation in healthcare innovation with a tool to help people struggling with addiction get their lives back on track,” said Rhode Island Sen. Sheldon Whitehouse in a statement e-mailed to Healthcare Informatics. Sen. Whitehouse, who helped launch RIQI when he was Rhode Island’s attorney general, added that “the Institute’s Dashboard allows healthcare providers to respond immediately when a patient has been treated for an overdose in an emergency room or hospital, giving the patient the best possible chance of getting the treatment they need to begin the path to recovery.”
Adams says the success of RIQI’s HIE (health information exchange) depends on providing more than just access to lots of data. She recalls one physician saying to her: “When I am in the midst of treating a patient, I am looking for a needle in a haystack, and you keep adding more hay.” She says RIQI recognized it needed to build “sift-and-serve” technologies. “We want to give providers information that otherwise would take time to synthesize and sift through and instead give it to them right now when it is actionable to them.”