Eliminating Care Variation

One of AdventHealth’s top imperatives is to continually improve quality and safety. AdventHealth, based in Altamonte Springs, Florida, has been pursuing avenues to reduce care variation across its health system. We discussed how the team at AdventHealth launched their program and what they’ve learned, with Dr. Qammer Bokhari, the system’s Vice President and Chief Medical Information Officer.

What prompted you to introduce clinical decision support (CDS) to clinicians using your inpatient electronic health record (EHR)?

QB: The team at AdventHealth is focused on preventing medical errors to keep people safe. Medical errors can commonly be categorized as acts of omission – whereby a provider fails to do something that should be done – as well as acts of commission – whereby a provider could order an intervention that could harm the patient. We determined that the best way to prevent these would be by engaging Stanson Health, Premier’s CDS solution, to implement specific and targeted rules in the inpatient EHR. It was our belief that intelligent CDS could help our organization maintain a low frequency of both error types.

Using Choosing Wisely® and evidence-based practice guidelines, Stanson evaluates the decisions providers are making in real time. When it recognizes something that does not align with the most up-to-date guidelines, it can alert the clinician within their workflow, allowing them to take a more appropriate course of action.

How did the roll out go?

QB: We anticipated that change management and training would be necessary for our providers to adopt the new CDS alerts into their workflow. However, as we activated the rules across 44 hospitals and 854 providers in 424 physician practices, we found that providers began changing their ordering behavior and utilizing the CDS recommendations before they even received their training!

How do the Stanson CDS alerts work?

QB: When triggered, a Stanson alert contains several pieces of information for the provider:

1. The reason the alert was triggered
2. A recommended course of action, typically suggesting that an order be cancelled
3. A link to the latest clinical evidence behind the recommendation
4. An option to accept, ignore, or override the advice
   

Similar to the “you might be interested in this item” function when shopping online, Stanson’s guidelines appear in the provider workflow as they input tests and treatment paths for patients. For example, if a provider prescribes an adult insomnia patient an antipsychotic as a first-line intervention, the system will prompt the physician to not order medication that may be harmful to this subset of patients.

Through our work with the Stanson clinical team, we learned that they constantly scan and review the most current evidence available, make it machine-readable, and house it in a content management system where it can be mapped to different data elements in an organization’s EHR. Ultimately, it delivers efficient, targeted, and actionable information to our providers.

What are you learning from implementing CDS across your network?

QB: Because the Stanson CDS solution interfaces with our EHRs, we can run analytics to understand how providers respond to the recommendations. The Stanson analytics dashboard helps our team identify cases where additional training is needed.

We have found that intelligent, targeted alerts within the workflow can change provider behavior enough that – over time – there are fewer unnecessary orders resulting in alerts, reducing the possibility of alert fatigue. For example, we have seen a nearly fifty percent reduction in the number of alerts recommending not to order CK-MB, a test commonly used when a heart attack is suspected.

As we gather data to quantify the tool’s success in our organization, we believe that Stanson can:

• Improve patient safety and quality
• Save our health system time and avoid costs associated with patient harm
• Reduce variation in care across our health system
• Drive evidence-based care and compliance

The results have been promising and we are eager to continue to partner with Premier’s Stanson CDS team as they innovate into their next generation of technologies and help transform the way care is delivered.

To learn more about Premier's Stanson CDS team, visit stansonhealth.com.

Story originally featured in Modern Healthcare.