2014 Accelerator Awards

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coverstory.jpg - 2014 Accelerator Awards

Recognizing Innovative Projects Working Toward the Triple Aim

We asked for innovative projects that are helping healthcare providers achieve the triple aim and you delivered. We selected the top five entries for our first annual CIT Accelerator Awards. From improving care coordination and streamlining clinicians’ workflow to better engaging patients and using data to address declining patients, these projects are the most impressive of this year’s submissions. Congratulations to the winners!

WINNER: CARE COORDINATION

Universal Health Services
King of Prussia, Penn.

Universal Health Services wanted to improve patient care by enhancing its EMR usability and efficiency. The organization rolled out its EMR to all 25 acute care facilities where 97 percent of the 6,000 physicians are independent.

During the support process, the organization learned that users wanted better communications delivered in a no ndisruptive way, says Ori Lotan, MD, associate CMIO. For example, a physician might be in the system working on information about one patient when an alert fires about another patient. “That can be a nuisance.”

Lotan and his colleague, Ehab Hanna, MD, another UHS CMIO, developed an inpatient notification system designed to display pressing patient concerns face up in the tool with one-click renewal. Communications from nursing, pharmacy and ancillary staff as well as clinical alerts (such as sepsis) are posted and can be viewed and acknowledged by any provider caring for the patient.

The system works in the physicians’ favor, says Hanna, because it covers issues they have to address anyway. The system ties these “pain points” to each patient so there aren’t problems such as inpatient medications and orders for restraints inadvertently expiring.

UHS has a development license from its EMR vendor so the tool was custom developed in-house by its own staff. “We’re trying to innovate in a manner that is accelerated compared with the 18 to 24 months we see on the vendor side for enhancements they agree to do.”

Lotan calls the system the next generation of clinical decision support because it is “a little more intelligent than just something that fires that a user can dismiss.”

UHS plans to expand the notification system with more physician-to-physician communication, enabling, for example, correspondence between hospitalists and cardiologists. Feedback also has helped Lotan and Hanna direct other enhancements such as an option to view what medications and orders qualify for renewing but have not yet been renewed.

WINNER: PATIENT SAFETY

VCU Medical Center
Richmond, VA.

VCU Medical Center has a goal of being the safest health system in the U.S. and its homegrown dashboard is a big part of that mission.

The organization developed the Medical Early Warning System and Pediatric Early Warning System (MEWS/PEWS) and first deployed the tool in 2012, says CMIO Colin Banas, MD.

“After a poor outcome for a pediatric patient, we recognized a need to give our front-line clinicians and rapid response team (RRT) a real-time monitoring system that continuously measures patient acuity and severity,” Banas says. “Looking back through the record and the data it was clear that there were subtle hints and trends that were portending a decline, yet we all missed it.”

Development started in 2010 after this event and employed a multi-disciplinary team including experts from multiple fields including respiratory therapy, critical care, nursing and pediatrics. “It was a long and iterative process, but we are very proud of the final product and the results to date,” says Banas.

Color-coded and interactive, the dashboard identifies the most ill and trending ill patients so the RRT can use that information to intervene before their decline. The dashboard is accessed more than 100 times a day and the RRT accesses it on mobile devices, sometimes arriving at the bedside before the primary team.

The tool calculates the patient illness level using physiological data that is already inherent in the EMR. The MEWS/PEWS scoring algorithm is based on evidence-based protocols that have been in use on paper for many years. In the first year of MEWS/PEWS, the hospital experienced a 10 percent reduction in code blues in the ICU and a 20 percent reduction in code blues outside of the ICU. VCU also realized a 5 percent reduction in in-house mortality.

Looking ahead, Banas says the organization will expand the tool to other service areas and address the many custom dashboard