Becker's Hospital Review

14 Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 because you've redesigned the system with the power nail gun in mind. If you try to deliver the same system of healthcare with EHRs, you're really undervaluing the power of the tool. You still want high-quality, safe, cost-effective healthcare, but you have to redesign the healthcare system with this tool at your disposal. David Kaelber Donna Staton: [Another one of Fauquier Health's] drivers is patient engagement as we look at how we create more engaged patients. There are multiple ways with which to do that. In the near term, we're going to be rolling out a hospital-based patient portal. There will be standard capabilities such as paying bills online, looking at hospital records and so on. There will also be an "e-chart," and we launched it internally to employees. The last thing is certainly meaningful use. We were a meaningful use early adopter, and we are prepared and are positioned for stage 2 in October 2013. ICD-10 readiness and other back-office capabilities are also important. Peter Banko Q: As healthcare becomes more digital, how is your organization attempting to make sense of "big data"? How are you coordinating strategies to streamline patient data and have it make sense for everyone? PB: St. Vincent, in particular, is doing work with our national colleagues at CHI. The platform we're going for is consistent across CHI. The data we collect, and even for clinical pathways or order sets for physicians, are trying to be standardized across the country to set a standard around the quality of care that we provide. Rodger Baker CB: We are officially in "big data." Our data warehouse just eclipsed 1 billion rows of data. There's a lot of volume, velocity and complexity. We're trying to reduce variability there. In order to control costs, you have to reduce variability in the way you practice. We have been engaged in this for three-plus years. DK: This is a very important question. My view is that healthcare is still far behind a lot of industries in ways we have to think about data. The reason you want data is you want to improve some sort of outcome. You have to start with outcomes you want to improve, and then go back and see how you need to visualize data to improve those outcomes. For example, we were talking with a pediatric gastroenterologist. She was new here and said, "I think I can be helping a lot more patients than I'm currently referred." You want to see more patients, so tell me what patients you want to see. She wants to see patients who are overweight and who need to have some recommended tests to see if [there are] liver problems. I said, "Wow, that's something the EHR can help out with." I can tell you who is overweight and who hasn't had the necessary test, and maybe those are the people we want to alert. Don't start with data. Start with a clinical issue you want to solve, and work backwards. DS: As an organization, we are probably not as far along in that journey as I'd like us to be. To help us move forward, we do have some products [to organize data] that we use today that sit on top of our health information systems, and we have some big goals and objectives going into next year. It's the analogy: We are data-rich but information-poor. Q: What role are evidence-based protocols playing in your health IT initiatives? PB: A large role — everything that we do clinically is evidence-based. We've taken this as an opportunity to consolidate practices. For example, our urologists in conjunction with CHI's urologists worked together to standardize 15 different order sets, which was one for each doctor, and now we just have one for prostatectomy. We used this as an opportunity to change the process and standardize clinical order sets that are used by physicians and nurses as well. CB: Epic has ability for best practice alerts, or BPAs. Evidence-based medicine is about if you do certain things at certain times on a certain patient, [treatment] can be predictable. For example, a patient comes in with a cardiac event. They come in during normal business hours, and their length of stay may be 1.5 days. But if they come in at Friday at 4 p.m., they don't get an ultrasound until Monday, and the patient might be here for four days. It's a length of stay issue that is inconveniencing the patient and costing us, the patient and the insurance company more. How do we apply the evidence we have to change behaviors? It may be having a tech on call at all hours to get the ultrasound, for example. DK: We have a number [of protocols] on both inpatient and outpatient. One of the challenges is there are a ton of protocols. Some are evidencebased, some aren't. In a given period of time, the evidence and protocols change. One of the strategic decisions I'm thinking about is how do we wrestle with that as a single health system? We are not experts in mining all guidelines out there. We need somebody to sort what important guidelines should be followed but also notify us when those guidelines change. I'm trying to get to the point where I'm not reactive. We're trying to get a message from [another entity] to tell us the evidence has changed and the protocol is outdated. DS: We are, up to this point, very manual in [evidence-based medicine], but we have had more clinical decision support this year. Standardizing care to produce consistent outcomes is important, especially as we look at value-based purchasing and other quality indicators we're going to be measuring. We've had a very loose process around that, but we're trying to bring more governance and structure to that this next year.

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