Electronic Health Records

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Maximizing EHR Investments through Clinical Surveillance

EHRs are a first step but not the end game. As the value-based landscape unfolds, healthcare organizations must get serious about fully leveraging the data that is available to them.

By Steve Riddle of Wolters Kluwer

- As the timeline for value-based care marches forward, hospitals and health systems increasingly need access to the wealth of patient data that exists within EHR technology and other clinical systems. Success hinges on the ability of technical infrastructures to work together to unlock critical information and deliver it to clinicians in a meaningful, actionable way.

Return on investment for EHR technology

Data integrity, access and exchange is also taking on greater urgency as the Department of Health and Human Services (HHS) continues to raise the bar on its quality-based care initiatives. Earlier this year, HHS announced its intentions to tie 85% of all Medicare fee-for-service payments to quality or value by 2016, and 90% by 2018. Piggybacking on this effort, the Health Care Transformation Task Force — comprising some of the largest U.S. health systems and insurers — announced the goal of shifting 75% of their business to risk-bearing models by January 2020.

The most appropriate and effective responses for hospitals and health systems is to give clinicians a line of sight into comprehensive real-time patient information that enables early identification of potential issues to circumvent  avoidable events and ensure successful therapeutic outcomes. EHRs are great repositories of data and can accomplish some low-level data aggregation, but these systems were never designed to address the level of data analytics needed to advance care delivery from reactive to proactive.

Bridging this data integration gap requires advanced clinical surveillance technology capable of aggregating critical data across disparate systems and formatting it into intelligent, accurate and actionable patient information for delivery at the point of encounter. When implemented and utilized properly, these systems can help hospitals nationwide fully maximize EHR investments and align performance with national quality initiatives. 

Healthcare’s data integration conundrum

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The convergence of health IT advancements with risk-bearing care delivery models has resulted in the emergences of a number of business trends as healthcare organizations respond to both opportunity and economic pressure. Incentives associated with the development of accountable care organizations have spurred a substantial uptick in health systems’ acquisition of primary care and specialty practices, while the need to consolidate resources and costs has made the multi-hospital model increasingly attractive.

These models offer opportunities to increase scale and collaborative care. However, they also create significant challenges to technological integration and a health system’s ability to standardize industry best practices. The merging of multiple disparate data streams and EHR systems creates roadblocks to real-time aggregation of key patient data and the kind of proactive decision-making needed to move the needle on outcomes performance.

Actionable information is key to minimizing patient risk. Clinicians must have access to the full patient picture that pulls from all of a hospital’s data sources, including admissions/discharge/transfer, laboratories, radiology, surgery, pharmacy, vital signs and medical records, to make informed decisions. Data must also be presented in a way that is meaningful to a particular patient’s care. In other words, if a patient is at risk for developing sepsis, systems need to collect and present clinical indicators specific to that patient’s status in real-time such as trending of WBCs, temperature and blood pressure data along with microbiology results.

Rules-based electronic surveillance solutions accomplish this goal by serving as an extension of the EHR system and integrating with other clinical systems to collect and analyze needed information. Through real-time clinical decision support applications, data is aggregated to identify at-risk patients in need of immediate clinical intervention. The most advanced surveillance systems also provide clinicians with access to a dynamic dashboard to quickly see trends and emerging issues, and to take action to prevent complications.

Alignment with national quality initiatives

When clinicians are equipped with critical information made available through ongoing patient surveillance, time associated with manual data collection is recouped to focus on higher-level clinical initiatives. Consider how these hospitals are addressing national quality initiatives by streamlining operations and making use of existing data through use of clinical surveillance technology.

Infection prevention

Reduction of healthcare-associated infections (HAIs) are focal points of national performance-based initiatives.  HAIs are included in several aspects of the Value-Based Purchasing (VBP) and the Hospital-Acquired Conditions (HAC) Reduction Program. They also impact performance on the Hospital Readmissions Reduction Program (HRRP). Specifically, a  2012 CMS report details the “strong relationship” between HAI/HAC and the increased chance of readmission within 30 days. Electronic surveillance speeds identification of HAIs by targeting specific organisms of interest and flagging patients who should potentially be isolated on admission.

One community hospital in New York realized a 56 percent decrease in Infection preventionists at UnityPoint Health – Trinity in Illinois have also recouped approximately two hours per day into their workflows, enabling more proactive response to potential patient issues and staff education.

Antimicrobial stewardship

A national priority following the signing of a presidential executive order to combat the growth of antibiotic-resistant bacteria, antimicrobial stewardship is a critical strategy for all health systems today. Formal hospital programs specifically addressing this area have demonstrated reduced treatment failures and complications, improved care quality and safety, advanced evidence-based prescribing and lowered costs.

Three years after implementing an antimicrobial stewardship program built on a foundation of electronic surveillance technology, the 300-bed Arlington Memorial Hospital in Texas saw a 750% increase in antimicrobial related activities and a 35% decrease in antibiotic costs per patient day. Texas Health Presbyterian Hospital of Dallas leveraged a surveillance infrastructure to support antimicrobial stewardship strategies and decreased targeted broad-spectrum antimicrobial use by 15 percent, equating to a cost savings of $1,621,730 from 2010 to 2012.

Top-of-license approach to clinical resources

The new focus on quality outcomes while controlling costs requires a well-connected and activated clinical team.  Interestingly, many of the measures found in current quality programs are directly related to medication use, infection management and infection prevention. It is in the best interests of the health system to leverage their expert resources of pharmacists and infection preventionists by supporting them with both the time and tools to optimize care delivery.  

Carteret General Hospital, 135-bed hospital in North Carolina, realized an overall increase in pharmacist’s clinical activities from hundreds to thousands within the first seven weeks of using a surveillance solution. Reinforced by the monthly report data, this showed a range of $3 million to $4 million monthly in clinical cost avoidance (ie, risk reduction). Saint Barnabas Health Systems documented direct cost savings of $6,169,593 over six years using a web-based surveillance tool.


EHRs are a first step but not the end game. As the value-based landscape unfolds, healthcare organizations must get serious about fully leveraging the data that is available to them. Electronic surveillance technology holds great promise as an extension of EHR investments and a means for unlocking patient information needed to optimize outcomes.

Steve Riddle, PharmD, BCPS, FASHP, serves as Director of Clinical Development at Wolters Kluwer.



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