What my brother's fatal hospital stay taught me about EHR optimization

Advisory Board Senior Vice President Rob Barras shares a personal and tragic account that highlights the immediate need for technology that reduces dangerous variations in care.
By Rob Barras
04:04 PM
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EHR optimization Rob Barras

I’ve been in healthcare IT for more than 25 years, but no amount of experience can prepare you for a personal health crisis. Yet, there are lessons in these moments that can teach about healthcare and the role of technology.

In September 2015, I lost my 40-year old brother, Paul, to a hospital-acquired condition. He’d collapsed on a soccer field from a heart attack. A teammate, an Army Reserve medical technician, administered CPR. Emergency responders arrived and continued CPR, while transporting him to the nearest community hospital. From there, he was medically evacuated to the closest trauma center.

Paul had a massive heart attack and two stents were needed to open the blocked arteries. He’d aspirated during CPR, resulting in lung damage. Two days later, he was stable enough to be moved to the city academic medical center’s ICU, where they had more experience with Paul’s conditions.

Paul began to stabilize, but we were notified that at some point he’d contracted a C-Diff infection. It caused circulation issues in his extremities, which led to gangrene and sepsis. Antibiotics and multiple amputations of his right leg weren’t enough to save him, and he died 10 days after the soccer match.

The nurses, doctors and staff were incredible, and our family doesn’t feel anything but gratitude toward them for their tireless efforts and compassionate care. But for better or worse, healthcare is a people business, and people make mistakes — though mistakes are precisely what healthcare technology is designed to minimize.

While I don’t believe any single mistake cost my brother his life, the experience added depth to my convictions on the importance of tailoring point-of-care technology to help care teams perform their best. Patient care is complicated. We must take advantage of existing technology to simplify clinicians’ work wherever possible.

Industry trends exacerbate the need for point-of-care IT optimization

Looking beyond the lens of personal history, there are two big industry trends that shed light on how clinicians use technology.

The first — provider consolidation is at an all-time high, with 19 percent growth in consolidation activities for the past 10 years. This contributes (informally) to the second trend — unwarranted variation in how care is delivered. I say informally as the industry lacks standard quality metrics and data that show whether mergers and acquisitions yield quality gains. However, variation is bound to increase any time two unique organizations, each with different practice standards, come together.

Repercussions of unwarranted care variation are widespread. For example, typical health systems have an increased length of stay by 1,200 extra inpatient days due to unjustified variation in total hip and knee replacements.

Unsurprisingly, the electronic health record, due to its prevalence and point-of-care influence, is the technology with the most opportunity to support reductions in care variation. So why isn’t it happening yet?

Strategic plan? Check. Follow-through? Not when it comes to the EHR.

Leadership has a list of what they plan to optimize within the EHR. However, what actually gets done is based on who is making the loudest noise and taking a “fly by the seat of your pants” approach to optimization.

Associated EHR-related activities need to top the list when organizational strategies include reducing care variation or consolidating with other entities — regardless of other needs. But most organizations struggle to appropriately prioritize EHR optimization projects. A programmatic approach to EHR optimization by assessing associated benefits or value of a particular project and overlaying that with the strategic plan creates a roadmap for where to apply resources.

Of course, this isn’t just true for care variation reduction or consolidation, but for any strategic objective. The health systems making the most of EHR investments are optimizing to further strategic priorities and making it easy for clinicians to do what is right for their patients. Taking a programmatic approach can point the way to simplifying workflow at the point of care and reducing unwarranted care variation.

I shared the excruciating detail of my brother’s hospital stay to show the impact on a life caused by the complexity of patient care. And simplicity in a world that seems to have endless change can have profound impacts on the lives of patients and their families.

Rob Barras is Senior Vice President of Consulting at Advisory Board.