Have you ever settled onto your couch on a cold winter’s night, well into an enjoyable Netflix binge, but then get a phone call and need to pause the program with the remote nowhere to be found? Without it, the program continues, you distractedly finish your call, the treasure/murderer/true love has been found – and you missed all of it.
Can you even pause a program on Netflix without the remote? I hope you never have to find out because the remote is as much of the experience as scrolling through 450 new movies and then deciding to watch your favorite episode of Friends.
In everyday life, we use interoperable devices and apps that are built to seamlessly work together to make our lives easier all the time, from the remote to the iPhone. Unfortunately healthcare, one of the most important issues of our time, lags behind. But change is coming.
How Interoperability Applies to Healthcare
Imagine Netflix with commercials or a shopping cart with one bad wheel, but instead of just being annoying or distracting, it could affect the healthcare delivered to your family and contribute to clinician burnout.
These scenarios are analogous to the challenges inherent with interoperable data and technology in healthcare. Electronic health records (EHRs), for instance, offer a comprehensive view of a patient’s history reflective of multiple provider inputs. Following the patient’s journey, EHRs were designed to link the entire healthcare ecosystem. However, while incredibly useful, many EHRs currently operate under locked systems that restrict the use of data beyond their platform. In many cases, they do not yet speak to other EHR systems without a fee to build the functionality. While EHRs are working to evolve with real-time patient and provider needs, the devil is in the details as the task at hand is a massive undertaking that will take time, as well as a modernization to federal regulations that, in part, created the locked approach in the first place.
Meanwhile, providers get placed in a tough spot, where the tools they use to input and connect data get in the way of the work being done. This has created a new misery for those engaging in “pajama time” after work hours as they take time from their families to finish the work of the day. Oftentimes, this game of catch up leads to uninformed decisions that could delay or interrupt the quality of care.
The industry’s move to value-based, clinically integrated care means that as providers seek to provide affordable, high-quality care beyond the four walls of the hospital, they need access to interoperable and actionable support technologies that allow them to focus on patient care.
In today’s digital era, there is an urgent need for interoperable healthcare technology solutions to ensure the effectiveness of care coordination and improve patient outcomes. Unable to fight this need any longer, some progressive EHR players have recently taken steps to deliver a more interoperable platform and reduce their fees to do so. In addition to these commendable efforts, in the coming months The Department of Health and Human Services is queuing up regulations to address information blocking, and the challenges patients and providers face with opaque and inaccessible data.
To raise care above the level of restricted tools and chisel away at the clinicians’ to-do list, Premier recently acquired Stanson Health, a software-as-a-service-based provider of clinical decision support (CDS) tools that are integrated directly into the EHR workflow, providing real-time, patient-specific best practices at the point of care. These new capabilities will further:
• Save providers and payers time and expense while enhancing patient and provider satisfaction, improving clinical excellence and reducing variation in care.
• Reduce administrative burden and costs each year through an automated prior authorization solution, which, once finalized, is expected to provide near real-time prior authorization decisions for medical and pharmacy benefits.
• Drive evidence-based care and compliance with advanced imaging reimbursement requirements.
How Does CDS Help?
In short, Stanson’s clinical team reviews available evidence (including Choosing Wisely guidelines along with many other sources of information), makes it machine-readable and houses it in a content management system where it can be mapped to all the different data elements in an organization’s EHR (the major EHRs are integrated with Stanson). The technology uses both the native rules engine of the EHR to link the guidelines to the relevant patients while guidelines are also being deployed into a cloud-based rules engine that notifies physicians when new evidence is available, finally delivering proactive, actionable care not just reliant upon the providers’ latest article review.
Similar to the “You might be interested in this item” function of a retail ecommerce site, Stanson’s guidelines appear in the physician workflow as they input tests and treatment paths for patients. If a physician prescribes an adult insomnia patient an antipsychotic, for instance, as a first-line intervention, the system will prompt the physician to evaluate an alternative based on available guidelines. The physician then has the option to accept, override or ignore the prompt.
• Cedars Sinai Medical Center (CSMC) implemented 92 alert-based CDS interventions from ABIM Foundations’ Choosing Wisely campaign of more than 400 medical society recommendations into their inpatient and ambulatory EHR. In an observational study of 26,424 patient encounters and 18 of the highest-volume alerts, CSMC analyzed providers who were either always adherent to the alerts in the treatment group or never adherent in the control group. Encounters in the treatment group – in which providers followed all of the CDS guidelines – demonstrated significantly better outcomes compared to the control group, including lower readmissions rates, shorter lengths of stay, lower complication rates and lower costs.
• AdventHealth of Altamonte Springs, Fla. set out to enhance the way care was delivered across its 46-hospital enterprise in its aim to become a high reliability organization. This meant removing unwarranted care variation to provide exceptional care for all patients. Beginning at Florida Hospital, its system flagship, the team used Stanson’s CDS technology to roll out 10 specific rules in the inpatient EHR. Initially Florida Hospital intended to bring the rules live in production but have them run silently in the background to see how often they were firing. They would then begin physician education. But a simple accident turned into a big realization. The rules were unintentionally turned on for providers without change management or physician training – very unusual in a system where new software generally requires weeks of training. They were amazed to find out that, even without education, training or change management, physicians began changing their behavior. The Stanson technology observes the decisions providers are making and when it sees something that does not align with the guidelines in the system, it can alert the provider within their workflow and enable the provider to immediately change the action they were going to take. By year’s end, AdventHealth will be live system-wide in both its inpatient and ambulatory EHRs.
Ultimately, as healthcare delivery grows more complex and pushes providers to assume greater risk for total costs and quality outcomes, healthcare organizations need solutions to help them make the best possible healthcare decisions. Interoperable data across EHRs can allow CDS tools to reach their full potential, and further enable providers to standardize care delivery around optimal and evidence-based healthcare processes.
To learn more about the need for interoperable patient data, click here or contact us.