Clinical

Electronic health records are typically touted as providing two primary and vital services: readily accessible patient records and protection against contraindicated medications. But Intermountain Healthcare is benefiting from a growing and transformative versatility in the application of its EHRs.

Patient care teams at Yale-New Haven Hospital, looking for a faster, more efficient and more secure way to communicate with each other in the emergency room, have adopted smartphone applications to speed up workflows. The changeover from stilted clinician communications and responsiveness as a result of the hospital’s emergency room reconstruction. At certain times, different areas of the department would be closed creating confusion and making it difficult to locate personnel. In addition, the way the pediatric emergency department was logistically set up, the clinicians working there had no line of sight, making it hard for them to communicate with one another. [Also: Intermountain deploys ReadyPoint for audit compliance] Eventually, the hospital bucked its traditional methods, which included a public address system and a VOIP wireless phone system, turned to MH-CURE – for Clinical Urgent Response – a smartphone application from Waltham, Massachusetts-based Mobile Heartbeat. MH-CURE offers care teams secure, single smartphone access to all clinical communications, pertinent patient information and lab data. Care team members have a choice of using their own smartphone or sharing hospital-supplied devices. It consolidates clinical communications, including alarms and notifications, pertinent patient information, lab data, texting, voice and photography. Allen Hsiao, chief medical information officer and associate professor of pediatrics and of emergency medicine at Yale-New Haven, said adoption was easy and the staff realized early the power of having everyone on one platform. [Also: OhioHealth taps Epic's MyChart Bedside] "We choose the ED because it's as a self-contained a unit as you're going to find in a hospital," said Hsiao. "We certainly have the dynamic need of trying to find the right nurse, the right physician, at the right time, they are often in different rooms out of sight." So far, he said, the impact has been positive. "We're saving a lot of time. We used to play phone tag, used to get interrupted taking care of patients, having to step out to take a call or answering an overhead page. It's giving us back time with the patient at the bedside." Hsiao said that if a doctor or nurse gets a text, they can glance at it very quickly without leaving the patient and they can decide whether or not they need to step away or if it can wait and continue to do what they were doing with the patient. In addition, their train of thought and conversation with the patient is not interrupted. "Unlike a traditional text message I can see if another physician or nurse has read my text or not – they can tell if I read it or if it’s been delivered and not read yet," he said. "That helps a great deal. Then I know if they haven't read it and it's urgent, I can escalate with a phone call." Hsiao said that with traditional text or pager you have no way of knowing if the receiving person read a text or not. For example, if a lab sends critical lab alerts, instead of playing phone tag the alert is automated – so when something is critical, needs intervention right away, as soon as the result is back the text gets triggered right to a smartphone. Hsiao said the effect on patient care has been positive. "It cuts down on the delays between awareness of information and actual treatment." Hsiao said adoption has been driven by the flexibility of the platform, such as the ability to use an Android or iPhone device, and integration with the electronic health record. "All these features add to the functionality and the importance of the technology so it becomes a secure HIPAA-compliant ecosystem for clinical tools, that is the wave of the future," he said. According to a Mobile Heartbeat, an outside consulting firm conducted a study, before and after the MH-CURE implementation, to determine how long it took for the clinicians in the emergency departments to communicate with one another. Results revealed that the amount of time required for clinicians to locate and transmit information to one another was greatly reduced, allowing staff to spend more time with patients and thus provide better patient care. In a poll of clinicians, 75 percent said they now found it easy or very easy to communicate with colleagues with MH-Cure; just 24 percent felt that way prior to using it. Nearly 75 percent, meanwhile, reported that MH-CURE has improved patient workflow and patient safety. [Like Healthcare IT News on Facebook] James Webb, vice president of strategic accounts for Mobile Heartbeat, said that the market for this smartphone technology is growing because secure texting is a major driver. "What we're seeing at MobileHeart beat is that people do not want to lock in to just a secure text solution, they want a full communications package, clinical workflows and inputs and alerts from various systems in the hospital," said Webb. "We see a lot of sites looking at their mobility strategy and really the major thing for their apps is they have to be able to play well together." Hsiao said that in addition to the adult and pediatric ED the smartphone app is now being deployed in its medical and surgical departments – and recently in intensive care units and emergency departments – at all of Yale's other hospital campuses, including the main campus in New Haven. Twitter: @HealthITNews

Analytics functionality has improved measurably in recent years, according to Chilmark Research, but  workflow integration remains a key hurdle.

VisualDx will debut a new version of its clinical decision support system at HIMSS16. The company is growing its image- and graphics-oriented software from supporting skin, eye and oral care decision-making to include more chief medical complaints.

MidMichigan Health, a nonprofit health system affiliated with the University of Michigan Health System, is ready to replace a mixed bag of technology with an electronic health record from Epic Systems, which will provide the clinical, administrative and billing software. The goal: to connect its hospitals, physician practices and outpatient care facilities on one platform for medical records, registration, scheduling and billing. Contract cost: $55 million. MidMichigan Health executives say they expect to recoup that investment within six years through efficiencies gained. They've named the endeavor the One Person, One Record project. [See also: 11 Epic stories worth reading again.] The health system's leaders announced the decision in a January 26 post on the MidMichigan Health website. The EHR rollout is one of several initiatives the health system is undertaking to put patients and their families at the center of care while enhancing safety and quality, patient experience, employee and provider engagement and financial stability, officials noted. Project team members have already begun traveling to Wisconsin for Epic training and will begin configuring the system in early 2016. MidMichigan anticipates the system will be fully operational at its hospitals and doctors' offices in April 2017. A second phase of the project in late 2017 will connect MidMichigan Home Care and other newly owned subsidiaries to the rest of the health system. "Our current state of multiple vendor systems requires us to maintain a large number of custom interfaces," said Dan Waltz, CIO. "This has simply become unsustainable, both in terms of the cost to maintain those systems and the potential risk and confusion that it introduces." [See also: Epic scores EHR contract from Vanderbilt University Medical Center, beats Cerner.] There is more to the project than setting up new technology. "As part of the process, we will be evaluating all of our workflows, comparing them to industry best practices and making improvements," said Pankaj Jandwani, MD, MidMichigan Health's CMIO, in the news release. "It's an opportunity for us to think differently about how we work and to design our tools and our processes around what patients and their families need. Jandwani added the changes would also help improve productivity and satisfaction, with tasks and roles "dramatically transformed." As a result of the project, patients will be able to schedule appointments online and self-check-in from home or at on-site kiosks. The health system will also offer virtual care options such as telemedicine and e-visits, and the ability to view and pay MidMichigan Health bills from one account.

The Patient-Centered Outcomes Research Institute has approved $70 million for nine new patient-centered research projects. The new studies will focus on conditions ranging from a type of very early-stage, localized breast cancer to diabetes, chronic lung disease and migraines. [Also: PCORI adds $142M for big data research] With these latest awards, PCORI has now approved or awarded more than $1.2 billion for research. The new studies will compare: active surveillance to traditional treatments, effectiveness of two common medications for chronic obstructive pulmonary disease, varying approaches to smoking cessation among adults with mental illness, competing approaches to managing chronic migraines and the use of inhaled corticosteroid versus symptom-based use in treating asthma exacerbations.  PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research to provide patients, their caregivers, and clinicians with evidence-based information needed to make better-informed healthcare decisions. [Like Healthcare IT News on Facebook] PCORI also awarded $6.7 million to three members of PCORnet as part of its ongoing work to establish a national patient-centered clinical research network. That money will go toward studying population health policies and interventions for type II diabetes. The agency awarded another $5.2 million to researching the effectiveness of wellness coaches for African Americans with uncontrolled diabetes. And PCORI allocated $3.8 million for a study to determine the optimal dose of aspirin for preventing heart attacks and strokes. Twitter: @HealthITNews

The new software aims to help researchers, molecular pathologists and clinicians work together more easily to improve care.

More than two-thirds of non-academic health institutions say precision medicine will play an "average, small or non-existent" role in their plans over the next several years, according to a recent Health Catalyst survey. But it's already making big waves in academic medical centers, which are fast adopting new technologies and integrating genomics into their therapies.

Health Level 7 and the Office of the National Coordinator for Health IT kicked off a new challenge that aims to alleviate provider frustrations with the usability of HL7's consolidated clinical document architecture standard. 

President Barack Obama laid out some aggressive healthcare goals in his final State of the Union address on Tuesday night, including a broader focus on precision medicine and the appointment of Vice President Joe Biden to lead what he called a “moonshot” effort to cure cancer.