Just 4 years after first EHR go-live, rural hospital aims for HIMSS Stage 7

At HIMSS18, Pagosa Springs Medical Center CMIO Michelle Flemmings will explain how the Colorado critical access hospital has made the most of its clinical data.
HIMSS Stage 7

Tiny, 11-bed Pagosa Springs Medical Center, based in Archuleta County, Colorado, doesn't have a lot in the way of technology resources and staff.

"I've got one IT guy and four informaticists," said Michelle Flemmings, MD, the hospital's chief medical information officer.

But the facility is extremely important to residents for miles around, and accomplishes quite a bit with those limited means.

"We are a critical access hospital," she said. "Our closest referral center is 50 miles away – an hour by ground. That's a Level III trauma center, we're a Level IV trauma center with expanded scope because we do orthopedics. We don't do OB, we don't do ICU, we don't have a cath lab.

"All of that has made us have to be very efficient in how we see patients and how we transfer patients – especially when we're talking trauma, sepsis and pediatric kids who need extra services," Flemmings said.

But until fairly recently, "every single thing was on paper, with the exception of the clinic and finances," she said.

In 2014, Pagosa Springs Medical Center went stem to stern with Cerner. That's changed everything.

"What we love about it is that everybody is working from the same record," said Flemmings. "So the one record can be the source of truth for everyone from billing to the clinic. That's very, very nice."

After hospital staff recovered from the initial shock of, 'Wow, everything we needed is right where we thought it should be and accessible,'" she said, "we decided to start playing a little bit with the data."

So much data. With everything discrete, digitized and at their disposal, the clinicians were excited to dig in.

"At first we wanted to look at every single thing, like a kid in a candy store," said Flemmings. "But then we decided to get down to brass tacks and focus on what's important."

That meant making the most of its data – homing  in on sepsis, CVA and other critical indicators from its EHR to assess relevant KPIs and use them to improve the efficiency and safety clinical workflows.

"The first thing we went for was the low-hanging fruit – like door-to-doc time," said Flemmings. "We knew that we were about 30 or 35 minutes, initially. And looking at the EHR what we've been able to do is change around everything – except the doc staffing, interestingly enough. We've added more registration clerks in order to have bedside registration become the rule rather than the exception."

Thanks to those insights, the hospital's door-to-doc time is averaging between six to eight minutes for the past several quarters, she said.

That's a marked improvement from even a year ago.

"We were actually just playing with the data again because we're going to have a HIMSS Stage 7 evaluation in February," said Flemmings. "A year ago, in January, we were somewhere about 18 minutes, which according to The Emergency Department Benchmarking Alliance is fantastic for our size. And now we've taken that and cut it in half again, to about eight minutes."

Another insight gleaned from the new EHR data? 

"We figured out that, based on the volume curve at registration, we needed to have a nurse that bridged the evening into the night shift: That way the night nurse could be better able to process through the patients," she said. "As the volume curves changed and showed that we started having peaks later and later into the evening and then into the night, we were able to justify the fact that we needed to have an FTE for a nurse overnight, every day of the week. That works beautifully. We don't have any log jams or prolonged lengths of stay for night patients versus day patients."

Making sure patients are being taken care of promptly and efficiently, and getting them to where they need to be, is paramount at a hospital such as Pagosa Springs. 

"We are our own backup," said Flemmings. "We needed to be certain about what we were doing to get patients from point A to point B, and then either admitted to our hospital onto a tertiary care hospital happened as quickly and safely as possible. The EHR has certainly gone a long way toward that."

Beyond the low-hanging fruit, clinical staff has also been able to make more advanced data-driven improvements.

"We started looking at things like our CVA turnaround time, based around the MINS criteria. We're doing well with that. There's only one month, I think, this past year it looked like our time for getting patients into the hospital, looked at, and back out, that creeped up a little bit and we're starting to look into what happened. My thought is that it's more patients. Since 2014, we've gone from seeing about 2500 patients a year to now seeing 8300. So I think it’s a numbers issue, really, as to why that's happening, as opposed to inefficiencies or our guidelines.

"Then we looked at sepsis and troponin turnaround times – docs were concerned that it was taking an inordinate amount of time for the labs to come back," she added, and the hospital has been able to make targeted improvements in those areas too.

“We are exquisitely rural,” she said. “Anyone who's ever worked in that kind of environment understands that rural, yes, has guidelines, but it's just so very different because of resources – or lack thereof."

In situations like those, where every budget allocation, FTE deployment or new workflow tweak can improve safety and efficiency, smart analytics performed on the right data can make a huge difference.

Flemmings will be speaking in the session, “By The Numbers - Leveraging Your Clinical Analytics Data,” at 10 a.m. March 8 in the Venetian, Palazzo D.

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An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

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