How one hospital landed a Davies Award
The University of Iowa Hospitals and Clinics which has already achieved Stage 7 on the HIMSS Analytics scale, will pick up its 2014 enterprise Davies Award at HIMSS15 this April. The award recognizes outstanding achievement of organizations that have used health information technology to improve patient outcomes.
With the use of its electronic medical record, UIHC improved workflow and documentation as well as significantly reduced adverse drug events and hospital acquired infections.
[See also: Iowa health system attains Stage 7 for EMR adoption.]
UIHC had developed its EMR internally back in the '70s, with improvements each decade. In 2004, leaders decided it was time to consider a commercial system.
"At the time we recognized how important these sets of tools are to facilitating high quality care," said UIHC's CIO Lee Carmen. "At that time, there was no Office of the National Coordinator; there was no Meaningful Use Program to adopt EMRs," he said. "We had just gotten to the point where the off-the-shelf tool had evolved beyond where we could get to," Carmen explained.
It was not until 2009 that UIHC rolled out its Epic EMR. Five years later, it is able to substantiate what hospital leaders view as an impressive list of clinical and business improvements.
- Substantial improvement in medication safety of adverse drug event causing harm count prior to implementation ≥ nine annually to two in the two previous fiscal years.
- Adherence to pediatric immunization guidelines improved by 50 percent.
- Anticoagulation venous thromboembolism adherence to guidelines increased 33 percent.
- Regulatory compliance with SCIP measures rose from 32 percent in CY 2007 to 96 percent inpatient in CY 2012.
- Preoperative antibiotics order errors reduced by 71 percent.
- Surgical H&P compliance rose from less than 50 percent pre-implementation to more than 98 percent.
- Early adoption of smart pump-EMR integration served to improve guardrail usage, which helps to avert severe harm.
How did the health system do it?
Incrementally, said Douglas J. Van Daele, MD, associate dean for clinical affairs and executive director of University of Iowa Physicians.
With the implementation of the EMR, there was some "siloing of activities," he said, "meaning this is the way a screen looks for the nurses; this is the way it looks for the doctors."
Over time, Van Daele said, UIHC was able to level the playing field. Today, everybody is working on the same data at the same time, the same reports and the same kind of triggers.
"It really helps to bring everybody onto the same page as it relates to how to care for individual patients, but also how to improve in certain areas," he said.
There was frustration at first, Van Daele recalled.
"It probably took the first year just for our workforce to get used to using the correct tool," he said. And the IT team, too, had to understand what changes needed to be made for optimum use.
"It's really then an iterative process rather than a specific date that we made changes," he explained. "With each upgrade, we tried to critically look at how we were using it among the different roles and make it look more similar."
[See also: Iowa to move to health information exchange.]
One thing the UIHC leaders knew for sure from the start is that everyone would be accessing the same technology.
"We have been an organization that prioritizes giving our providers a single set of tools," said Carmen. "We have not been a best-in-breed customer. On any given day our physicians may be in the operating room; they may be in the emergency room; they may be in clinic; they may be rounding on inpatient floors. It was absolutely paramount to them that they not have to log in and learn how to use different systems depending on the care setting. They wanted a single experience wherever they were."
According to the HIMSS assessment of improvements that led to the Davies Award, UIHC also employed almost 500 best practice alerts and analytics to "significantly" reduce instances of venous thrombosis, sepsis, pneumonia and other clinical conditions.
Moreover, as a result of improved documentation and secondary diagnosis capture, cost avoidance associated with improved clinical outcomes, and reduced mortality and length of stay, and incentives paid for quality improvements, UIHC has net cash flow of more than $50 million from July of 2013 to June of 2014 attributable the use of information technology.
As UIHC migrated from an in-house EMR to an industry standard in 2009, HIMSS notes, it improved patient and medication safety as well as showed improvement in CMS Surgical Care Improvement Project measures, keeping the project in the forefront of the organization's quality improvement goals.
"University of Iowa Hospitals and Clinics have done a tremendous job of leveraging information technology to integrate efforts to improve quality and the financial bottom line at the same time," said Jonathan French, HIMSS director of quality and patient safety, in a news release, announcing the Davies Award. "UIHC's use of information technology to improve care delivery and documentation has resulted in significantly improved clinical outcomes leading to cost avoidance, efficiencies, reduction in claims rejections and increased revenue. Thus, UIHC has achieved a positive return on investment without even factoring in meaningful use dollars."