Becker's Hospital Review

25 Executive Briefing Allscripts is a global leader in healthcare technology that connects communities for smarter care. Built on an open platform, its EHR, financial management, population health and precision medicine solutions drive innovation in workflows, care delivery and patient behavior. With the right data turned into actionable information, small and midsized hospitals can take better advantage of every interaction with patients to address gaps in their care and address patients who are not being seen. Advanced analytics make it possible to slice and dice data, arming care teams with a variety of perspectives on their patient populations. But these tools must be available within the clinician's workflow and from the EHR, aggregated and normalized into information that clinicians are motivated to act upon. \ "How do we take data, turn it into information, and then get insights from it to create actions?" Dr. Blackman voiced this question, one he targets daily with his team at Allscripts as the company builds EHRs and software that ensure hospitals' population health strategies become population health accomplishments. Driving out variability in care to drive organizational change and patient outcomes Statistical methods are central to healthcare, allowing the study of diseases, patients and epidemiological events. But when it comes to their experience and outcomes, medians and means are less palpable to patients. "People don't perceive averages — they perceive variability or extremes," said Christopher Caggiano, MD, solutions director for Allscripts. "If you give a patient an average experience, they won't remember it. And if you give them a bad experience, they are often more vocal than someone with a positive experience." Consider the familiar process of transitioning a patient out of the hospital. If a patient note is written at 6 a.m., it can take 7 hours to get him or her out the door. "Why does it take so long?" asked Dr. Caggiano. Patient transitions need not be such a time-consuming task. To move patients out of the hospital and back into their homes more quickly, care teams need data to identify existing inefficiencies and eliminate them. "All that matters to the patient is that they leave the hospital," said Dr. Caggiano. "If you have quicker discharge times, patients will be more satisfied." Patient transitions are but one place where unwarranted variabilities occur and persist over time until the resulting inefficiencies are accepted as normal. Same goes for variations among physician practices. Perhaps Physician Practice A schedules appointments differently from Physician Practice B. Perhaps Clinic C moves from another product than Clinic D. Perhaps when two patients visit Physician E at different times of the week, they receive prescriptions for different medications for the same condition. Unwanted variation in care is a substantial, multifarious category of waste in the American healthcare system. In a study published in JAMA in October 2019, researchers estimate that failure of care delivery, failure of care coordination and overtreatment or low-value care — all of which involve variation in clinical operations or practice — cost the system $205 billion to $346 billion annually. Health systems, and community hospitals in particular, won't drive out wasteful variation overnight. But health IT can serve as a targeted intervention to help time-strapped, well-meaning care teams make more clinically sound and cost-effective decisions. Consider the ordinary order set, which has long been a workhorse within the EHR yet was often underutilized as a tool to better control for variation. Now, machine learning combined with human oversight has the potential to transform order sets to reduce variation and clinician burden while improving care processes and outcomes. Sepsis order sets, for instance, use evidence- based content to standardize care and reduce variation for a condition that can have subtle, non-specific signs and can mimic other conditions. Dr. Caggiano says the EHR, when equipped with the right tools and streamlined workflows, is an effective way to nudge physicians toward clinically effective decisions that reduce unwarranted variation among providers and sites of care. "You can't dictate a physician to do it one way, but you can constantly show them," he said. "If you input in the EHR why they should use a specific antibiotic, they will then use that. It makes it difficult for them to order something outside the norm." Conclusion Despite their thin margins and distinctive economic, social and geographic disparities, there is no way around it. Hospitals in small-town America have the same mission as hospitals in New York, Chicago, Los Angeles and any other town. They care for the sick and prevent disease in their communities. The size of their footprint may be small, but their missions and reasons for being remain enormous. Tight resources and thin margins mean rural and community hospitals cannot make investments lightly, even as they strive to solve for the same challenges that affect larger academic medical centers — population health, clinician wellbeing and reducing unwanted variation in care. "There is a reality to what you do, and I want you to understand that's something I get," said Mr. Black. "That's why we are building the solutions we've built and the infrastructure we have, in order to make that affordable for you. Our view is to give you all the functionality of Allscripts products and give you a single place to go for all of them." n

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