Robert Altemose, Director Clinical Operations Analytics, AdventHealth
EMR’s have, and continue to, change healthcare. They have streamlined many processes, eliminated duplicate work, and generally improved the timeliness and quality of care that is delivered to our patients. However, one of the most powerful opportunities that has been created by EMRs has been frequently relegated to playing a minor support role. Huge volumes of exhaust data are being generated every minute of every day simply as a result of clinicians documenting the work they have done within their EMR, but often this data is used to create dashboards, scorecards, etc. that report on what occurred yesterday. Metrics such as Central Line Associated Blood Stream Infections (CLABSI), Catheter Associated Urinary Tract Infections (CAUTI), and Sepsis are created to track the quality of the clinical care being delivered each day. Unfortunately, this means that the data is being used to identify success or failure, and infrequently does it have a any real impact on the care being delivered.
What if we were to rethink how we leverage the data available right now, rather than waiting
until tomorrow to find out there was a problem? While data is often thought of as a measuring stick, couldn’t that same data be leveraged in a timelier manner to tell what is happening right now?
Let’s look at CLABSI as an example. Once a patient is identified as having a central line associated blood stream infection it is too late to turn back or to make a change. In this case we must move forward and do what we can to ensure that the patient does get any sicker. So, knowing which patients already have a CLABSI while they are still in the hospital doesn’t do us any good. But what is driving CLABSIs? The evidence tells us that properly caring for the dressing on the central line significantly reduces the risk associated with a patient getting a CLABSI. More specifically for central lines with a clear dressing, a new dressing should be applied if the current dressing is lifting or damaged in any way or at least every seven days. Knowing that something this simple can have such a substantial impact it only makes sense to monitor the cycle times between dressing changes in order to keep the risk of CLABSI as low as possible.
This is where the EMR leaves much to be desired. The data is there and available for review through the UI but, even in a smaller hospital, manually reviewing charts is time consuming and creates opportunities for mistakenly missing a patient with a central line or missing documentation and driving the changing of a dressing sooner than is necessary. In a large facility, or group of facilities, doing manual chart reviews is entirely cost prohibitive.
This is not to suggest that there couldn’t be a once a day report that can be run and used to identify patients at risk. In fact, this practice is being used at many facilities and can be very effective for a handful of metrics driving clinical quality. However, there are many metrics that can positively impact the care being delivered and, as such, would require this kind of visibility in order to drive clinical care quality across the board. Receiving and reviewing 40+ reports a day is also not a scalable option for any clinical care quality specialists/patient safety officers.
What is truly needed is a clinical care quality indicator dashboard that monitors all these metrics in real time. An application that will allow a central office to quickly look at all these driving metrics, identify opportunities to improve the delivery of care, and take action to assist the clinicians, as needed, to ensure that the best possible experience is provided to every patient every time. The key intent of a tool like this would be to use the data to create action, not reaction. Fundamentally, this would remove the challenges associated with chart reviews, one off reports.This platform could also be setup to allow for increased communication between direct patient care and support personnel and a point for escalating patient safety issues, or general delays in care.
With the increased focus on new payment models, like pay for performance, avoiding CLABSIs, CAUTIs, and other indicators of poor-quality care that are part of each facility’s CMS 5 Star rating is going to become increasingly important in order to ensure that hospitals can maximize reimbursements and minimize risk.