Quality and Safety

New York City-based Hospital for Special Surgery, the first specialty hospital to win a HIMSS Davies Award for Excellence. has found a way to use teamwork and health IT to improve processes and care outcomes. With nearly 19,000 annual inpatient surgeries, requiring close bed utilization monitoring, HSS leadership used to receive operational reports four times a day using manual data collection, but this posed significant operational challenges, and length of stay adherence was also lacking. To remedy the situation, HSS instituted clinical pathways – procedure-specific, post-op order sets. These pathways established best practices, by coordinating and standardizing care, according to HSS. The pathways are made up of time-based goals and milestones for the interdisciplinary care of defined patient groups, ensuring standardized care across these groups. The pathways also include LOS adherence as part of the performance goals. WHY IT MATTERS Many healthcare organizations wrestle with patient volume challenges on a regular basis, requiring close monitoring of bed utilization. Once HSS began to address bed management and LOS through a multipronged approach that included EHR enhancements and new reporting capabilities – including a capacity management dashboard – capacity improved significantly, hospital officials say. THE LARGER TREND There are a variety of care coordination technologies on the health IT marketplace. Vendors include Cipherhealth, eQHealth, GSI Health, Imprivata, Microsoft, Optum and pMD. We reported last month, for instance, that Penn Medicine used care coordination tech, TrekIT, to reduce LOS and readmissions. According to preliminary findings by TrekIT, the company’s care coordination technology helped Penn Medicine achieve a 50 percent reduction in pneumonia readmissions, a 7 percent reduction in risk-adjusted length of stay, and a 9 percent improvement in HCAHPS scores. Groups using the technology during clinical rounds were able to access real-time data on their patients 50 percent more often than teams that didn't, while spending 25 percent less time logging into their devices. Another success story, is Cedar View Rehabilitation and Healthcare Center, a skilled nursing facility in Methuen, Massachusetts, that shifted from piecing together a patient’s encounter history from discharge records and verbal summaries from patients and their families to PatientPing, a technology which provides real-time alerts from hospitals, emergency departments and post-acute care providers every time a patient goes through a transition of care. The vendor also supplies key clinical data that is valuable for placing a patient’s situation in context, as well as contact information for their healthcare providers. The technology allowed Cedar View to trim LOS for the average Medicare Advantage patient by three to five days. Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.  Twitter: @Diana_Manos Email the writer: dnewsprovider@gmail.com  Healthcare IT News is a HIMSS Media publication. 

Their automated identity proofing process helps providers to adhere to looming government-mandated EPCS verification standards, enabling them to approve or deny prescriptions remotely.

In the book Affordable Excellence: The Singapore Healthcare System by William A. Haseltine published in 2013, the author noted that Singapore “ranks sixth in the world” in terms of healthcare outcomes, while “spend[ing] less on healthcare than any other high-income country”. When compared with other countries, Singapore ranks high on value-based indices - A 2014 EIU white paper that looked at health outcomes and costs across 166 countries ranked Singapore second after Japan, noting that it had achieved similar outcomes to Japan’s but with a significantly lower investment. One of the key pillars behind Singapore’s remarkable success in delivering affordable and high-quality healthcare since its independence in 1965 is the government’s approach to healthcare improvement and care as an integral and inseparable part of the overall development planning for the country, Haseltine explains in the first chapter of his book. In November 2017, the Ministry of Health introduced the ‘3 Beyonds Strategy’ to keep healthcare in Singapore good and affordable. They are: (i) Beyond Healthcare to Health (ii) Beyond Hospital to Community (iii) Beyond Quality to Value With an aging population and increasing costs and burden of healthcare in Singapore, the “Beyond Quality to Value” strategy becomes essential to retain or increase quality of care while ensuring value for money. The Agency for Care Effectiveness (ACE) was set up in 2015 to research treatments that provide the best value for money. For instance, three drugs may offer the same results, but have very different prices. Or a drug may be more expensive, but offer outcomes that are far better than cheaper alternative drugs. Webinar: Compliance as code: Automate compliance using open source technology In the long run, the conventional method of fee for service-based care that works on a basis of volume and treating illnesses and injuries as they occur is also not tenable – hospitals and healthcare organisations cannot expand their capacities indefinitely and there is already an existing manpower crunch of qualified professionals in the healthcare sector.   Treating illnesses and diseases when they occur is often expensive and unpleasant for patients – therefore, the proverb, “prevention is better than cure” is especially relevant. The “Beyond Healthcare to Health” strategy has seen the Health Promotion Board (HPB) ramping up efforts for people to become healthier and more active, through initiatives such as the National Steps Challenge (currently in its forth season) and Healthier Dining Programme. Value-based care prioritises health outcomes that matter to patients relative to the cost of achieving those outcomes. This is also related to “Beyond Hospital to Community” strategy in which patients can receive appropriate care community or at home so they can stay well and avoid frequent hospital admissions. This is better for them in terms of health and convenience, and for the healthcare system too, as hospital care is very expensive. The transition from a fee for service-based to a value-based healthcare system may not be an easy journey for many healthcare providers and organisations but it also presents many opportunities to relook existing approaches to healthcare, not just in the delivery of patient-centric care but also in aspects such as financing models and leveraging technologies such as AI to provide value to both patients and clinicians while reducing costs. With the theme of “Disruptive innovation for Value-based healthcare”, the HIMSS Singapore eHealth & Health 2.0 Summit held from 23-24 April 2019 at Marina Mandarin Singapore will feature six main topics related to achieving value-based healthcare: (i) Population health (ii) Healthcare revenue cycle (iii) Patient outcomes (iv) Acute-to-community (v) Cybersecurity; and (vi) Artificial intelligence The HIMSS Singapore eHealth & Health 2.0 Summit will be a great opportunity for like-minded healthcare leaders and professionals in Singapore and abroad to come together to tackle some of the major challenges and opportunities in moving towards a value-based healthcare system.

The U.S. Department of Health and Human Services has announced the winners of a new challenge to develop software for identifying and reporting safety and usability issues in EHRs in a way that doesn’t disrupt clinical workflow. The winning tools aim to make it easy to report IT issues within the healthcare workflow: giving feedback to developers and guiding the formation of best practices. The hope is to targeting usability challenges before they become major problems. Three winners were announced: The James Madison Advisory Group came in first, with a hotkey that allows a clinician to document an issue without leaving their EHR and which simplifies the process of reporting issues. Pegwin, in second place, developed an intuitive reporting system that allows a user to document an issue “in as few as three clicks.” Jared Schwartz and team came in third with a Google Chrome plugin which integrates with common IT ticketing platforms, making it easy to work into existing systems. The winners received $45,000, $25,000, and $10,000 respectively. WHY IT MATTERS Like any software, EHRs sometimes have flaws or malfunctions. An already busy clinician who is trying to manage a full patient load, perform diagnostic work and enter data usually doesn’t have time to document and report safety or usability issues to his or her IT department. Webinar: Improving Patient Matching in your EHR: A Case Study Finding a way to work tools into the care workflow that allow practitioners to capture and share potential safety and usage concerns results in greater efficiency without disrupting a clinical workflow. "Improving the safety of health IT remains an important priority," said Dr. Andy Gettinger, ONC chief clinical officer. "We believe that making it easier for end users to report will help in that goal." THE LARGER TREND EHRs have the potential to be the first point of data capture in a new landscape of precision care. First, though, they need to win over physicians who see them as cumbersome and byzantine replacements to the old pen and paper methods. Some healthcare systems are focusing on identifying those problems and addressing them to enhance the value of their EHR systems. Practitioners are experiencing EHR burnout – something ONC has also recently been working to help combat – where poor usability or other IT safety concerns can have a detrimental impact on effective patient care. ON THE RECORD "Helping reduce the burden of health IT continues to be a key area of focus at the Office of the National Coordinator for Health Information Technology, and we anticipate the winning submissions to the Easy EHR Issue Reporting Challenge will help with those efforts," said ONC chief Dr. Don Rucker. Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media. Twitter: @BenzoHarris.

The Centers for Medicare and Medicaid Services will kick off 2019 looking to reward new ways artificial intelligence can be safely leveraged to for improved quality of care.

At a two-day event to learn about the ethics and consumer implications of artificial intelligence, an ONC official and tech developer offered the healthcare perspective.

As Watson has undergone close scrutiny over the past year, leader Deborah DiSanzo is moving to IBM Cognitive Solutions' strategy team.

KLAS sees health system decision makers wanting vendors to give them needed functionalities: point of care access to PDMPs, specific clinical decision support and more.

Expanding from hospital assessments, the patient safety group will publish a national report by this time next year, with data on individual ASCs available by 2020.