Cleveland Clinic slashes unplanned ICU transfers, patient length of stay with population health and remote monitoring tools
BOSTON — While electronic health records have had many positive effects on medicine, like many technologies EHRs also come with certain tradeoffs.
The demise of a single chart for each patient – and the need for multiple members of a care team to share it – removed a point of community and collaboration from care teams.
Now Cleveland Clinic is looking for ways to use technology to bring that collaboration back, according to Associate CIO William Morris.
"You would all fight for the one chart. And you’d fight for it, but it would force these conversations. Five, 6, 7 years ago any nurse’s station was Grand Central Station. It was a packed resource, everyone jockeying for that one chart,” Morris said at the mHealth and Telehealth World Congress here. “But now it’s become a ghost town. You miss this natural collaboration. This is why we feel like there’s opportunities to bring that back to the nurse’s unit and actually use visualizations in population health, to bring these collaborations."
One of several population and remote patient monitoring tools Morris and Administrative Director for Technology and Innovations Beth Meese discussed at the event is a color coded system that displays which patients are the sickest, based on EHR data, at the nurse's station. The system helps doctors and nurses prioritize their rounds, so rather than simply navigating the same route every day they prioritize the patients who need them most.
"You might think, how does that change anything?" Meese said. "Obviously there are lots of reports and different ways you could communicate around the data. The difference is that nurses changed their operational workflow, so the data is presented to the nurse, but now when they see it, if there’s a patient in a particular color, you need to escalate. So when you do escalate there’s no more of the conversation of ‘Why are you calling me? This looks fine.’ There’s a protocol so there’s no more of the new nurse not being sure what to do. The conversation changed from ‘Why are you calling me?’ to ‘We need to look at this patient, they’re in yellow. Let’s dig further and let’s have a conversation about this.’"
The system is part of a site-to-site telehealth and population health management called eHospital. With eHospital, nurses, nurse practitioners, and physicians staff a command center where they can keep an eye on the sickest patients in their hospital, as well as in smaller regional hospitals with fewer resources. They can initiate two-way video communication with the patients or family members at remote hospitals if need be.
"We’ve tried to make this noninvasive," Meese said. "There’s a small light that goes on and it actually hijacks the patient’s TV, so there’s not another piece of equipment in the room. It doesn’t feel like there’s more scary things. It’s all context-synchronized so the EMR and the application drives to all these different screens but they’re all simultaneous and real-time connected."
The eHospital and eCMU, which is a remote telemetry monitoring program, enable Cleveland Clinic doctors to have a much more holistic idea of how a number of high-risk patients in the hospital are doing.
Morris said this has led to improved outcomes.
"We’re seeing a decrease in length of stay, I think that makes sense," he said. "We saw a dramatic decrease in unplanned ICU transfers. Paradoxically, though perhaps not so paradoxically if you think about it, we're seeing a massive increase in rapid response calls. It’s a great thing. If things are looking south and you need to proactively call in the troops, that’s a good thing."