Hospitals and health systems on the 2015 Most Wired list are pushing beyond meaningful use and optimizing their systems to improve performance and patient care.
The Most Wired List: http://m.healthcareitnews.com/news/see-which-hospitals-made-2015-most-wired-list |
After more than a decade of building the foundational elements of a digitized health care environment, and billions of dollars in federal and private sector spending, hospitals and health systems are tapping into the power of the bits and bytes they’ve been collecting. This coincides not only with the requirement to meet federal standards for meaningful use of health information technology, but also the push toward value-based payments, population health management and cost-efficiency.
Optimize. It’s not a super sexy word. It sounds more like a command Tony Stark would bark at his computerized helper Jarvis to get the Mark 45 Iron Man suit ready for battle. With apologies to the genius/billionaire/playboy/philanthropist, optimization is actually the mantra for today’s real-life health information virtuoso.
As evidenced by data collected over the 17-year history of Health Care’s Most Wired Survey, hospitals and health systems have continually ratcheted up their use of cornerstone IT applications. For instance, 95 percent of the 2015 Most Wired hospitals have standing, evidence-based electronic order sets built into their CPOE systems. That’s up from 79 percent in 2010. Since 2008, the percentage of Most Wired organizations that have a compliance-driven alert system for Centers for Medicare & Medicaid Services key indicators leapt from 50 percent to 79 percent in 2015.
While work still needs to be done to bring implementation of these types of applications to 100 percent — and sustain their use over time — leaders at Most Wired hospitals are not merely resting on their laurels waiting to install the next gadget; they are using data to drive clinical improvement and shape strategy.
“Through implementation of our Epic system, we’ve been able to elevate the use of real-time information at the bedside,” says Paula Smith, senior vice president and chief information officer, Oakwood Healthcare, Dearborn, Mich. “We consolidated multiple, disparate systems into a single database that has provided more streamlined documentation of care delivery at every transition-of-care event.”
Records from emergency department visits, for instance, are instantly available to caregivers at the receiving inpatient unit. This, Smith says, accelerates quality care because the clinicians are prepared in advance of the patient’s arrival.
Organizations on the 2015 Most Wired list are extending the use of IT systems outside the hospital’s four walls, including connecting directly with patients. In fact, improvement in patient engagement — in its many forms — stands out in this year’s survey. More than two-thirds of the Most Wired extend the care environment to the patient and family via the Internet, providing education about his or her condition and allowing for e-visits with the care team, among other things. This dovetails nicely with efforts to improve population health.
At MetroHealth System, an automated screening and alert system led to a 15-fold increase in screening and 23 percent increase in diagnosis for depression between 2011 and 2014. There was a 25 percent increase in adolescent immunizations during the same period, largely a result of automated messaging to parents. And, importantly, between 2011 and 2012, a 15 percent increase in patients scheduling and completing referrals 30 days after discharge, reports David Kaelber, M.D., chief medical informatics officer for the Cleveland-based health system. All of these efforts are ongoing.
The engaged patient:
Part of the emphasis on patient engagement can certainly be traced to meaningful use regulations. In Stage 2 and the proposed rule for Stage 3, the Centers for Medicare & Medicaid Services places an emphasis on ensuring that patients can access their health records and become more connected with their providers. Stage 2 requires hospitals to show that 5 percent of all discharged patients have viewed, downloaded or transmitted their health information to a third party.
Of course, making records available is one thing, getting patients to participate online is something else entirely. At Citizens Memorial Hospital, Bolivar, Mo., staff called patients during the 90-day attestation period to get them to sign up for the patient portal and use secure messaging, says Chief Information Officer Denni McColm.
“We had to do some crazy things,” she explains. “If you signed up for the portal and sent a secure message, you were entered into a contest to win an iPad or a TV. We had one staff person in particular who would call up patients and say, ‘I saw you were at the doctor’s. I wanted to see how you were doing. Why don’t you get on the portal and let me walk you through it.’ And she would get them signed up.”
Most of those patients remain active users of the portal, McColm says.
To a certain degree, engaging patients online is a question of value, says Michael McCoy, M.D., chief health information officer, Office of the National Coordinator for Health IT. Is there enough information and meaningful interaction with providers to entice a patient to regularly visit a portal and become engaged?
“From my perspective, hospitals are missing the mark,” he says. “They complain about the number of [meaningful use] measures, rather than finding ways for doctors to be more proactive and responsive.”
While she contends that the regulations are too burdensome, Chantal Worzala, director of policy at the American Hospital Association, agrees that portal usage ultimately will increase as the sites become more user-friendly and useful. She says it’s encouraging to see in the Most Wired data that hospitals are going beyond meaningful use requirements to find ways of promoting patient engagement. For instance, 63 percent of Most Wired hospitals offer self-management for chronic conditions through the patient portal. And, 67 percent can incorporate patient-generated data through the portal, an important point since proposed Stage 3 regulations would require that hospital EHRs ingest patient-generated data from nonclinical settings for more than 15 percent of unique patients.
Worzala says there are still significant hurdles to marrying patient-generated data with an EHR, not the least of which is standards. McCoy adds that physicians are rightfully concerned about “being overloaded with noise.” It will be important going forward to figure out what information is truly useful to clinicians.
To that end, Worzala says the federal government needs to slow down on the regulator front.
“This is an opportune time to build on the tremendous investment in EHRs over the past few years,” she says. “We have so much interesting technology, let’s allow providers to figure out what the best uses are for providing care.”
Most wireless:
As with nearly everything in society, mobile technology is another part of the puzzle. The key is finding ways to connect with patients on their terms.
“I was surprised to see the high level of usage on mobile devices,” says Russ Branzell, president and CEO of the College of Healthcare Information Management Executives, H&HN’s partner in the Most Wired project. “We are seeing that mobility is an expectation in all parts of a consumer’s life. They’ll demand that from a patient engagement standpoint.”
Among Most Wired hospitals, 89 percent allow patients to access the portal via a mobile app, up from just 58 percent last year. Even among all respondents, there was a huge jump — 47 to 79 percent. Additionally, 63 percent of Most Wired organizations enable secure messaging, up from 40 percent in 2014. And 50 percent provide a mobile app for a personal health record, compared with 32 percent a year ago.
Looking more broadly, the field is challenged by the interoperability dilemma and the ability to exchange data across the continuum. As long as that challenge remains, it will be difficult for hospitals to fully move toward accountable care and value-based delivery.
“When you are at [financial] risk as a hospital, you want other providers who are caring for your patients to have the data,” says McCoy. “You want to ensure that patients are getting the right care at the right time.”
Part of the problem is that the payment system hasn’t caught up with the practice of more integrated care, says Branzell, who is quick to add that once incentives are aligned, hospitals need to be prepared to change lanes.
“Hospital leaders have to be ready because there’s a growing appetite to move away from fee for service,” he says.
2015 Most Wired Hospitals: Building a Foundation to Grow
More than a decade ago, leaders at Citizens Memorial Hospital took the bold step to invest mightily in information technology. Recall that those were the nascent days of health IT. The Office of the National Coordinator for Health IT didn't come into existence until 2004.
Still, across the industry, people were beginning to visualize how automated and digitized systems could streamline workflow and improve patient care. The board and executive team at the 89-bed rural hospital in Bolivar, Mo., were no different. In 2002–2003, they invested $6 million — roughly 12 percent of the organization's $50 million operating budget — on a health IT system.
“It was as much as we had spent on any building at that time,” says Denni McColm, CMH's chief information officer. “We had long discussions about the false sense of security that people had that their doctors knew everything about them. At that time, a patient's paper medical records could have been spread across 33 different locations so, of course, doctors had to redo tests.”
The significant capital investment coincided with a strategic plan to focus on the CMH brand. The hospital had been acquiring and affiliating with clinics and other providers. It was time to start acting like one organization, McColm says.
Flash forward to 2015: CMH is doing more than acting like one organization, it is using health IT as the underpinning to grow and drive care coordination across its market.
For instance, when CMH added a sixth long-term care facility to its portfolio in 2011, there was no hesitation in expanding the necessary infrastructure to ensure the flow of patient records.
“We administer a lot of medications to those 500 residents,” McColm says of the six long-term care facilities. “When we discharge a patient, we don't have to send the paper record. We just send the patient, because the record is all together” and available electronically.
CMH is also showing positive results in utilizing IT to improve population health. Through two years of a medical home program, IT is being used in 12 rural health clinics to help case managers improve care. They've seen significant improvement in care for people with diabetes, including a 7 percent climb in patients whose A1C is less than 8 percent; an 11 percent increase in females getting a mammogram; and a 10 percent increase in patients getting a colorectal cancer screening.
“IT is part of the foundation to grow and meet the needs of the community,” McColm says.
How Can YOU Become One of Health Care's Most Wired?
For the 17th year, H&HN has named the Most Wired Hospitals and Health Systems based on the Most Wired Survey. The 2015 survey results build on the analytic structure that was implemented in 2010 after two years of redesign. The methodology sets specific requirements in each of four focus areas. If any of these requirements are not met, the organization does not achieve the Most Wired designation. Thus, an organization may have many advanced capabilities, yet not achieve Most Wired status. The four focus areas are: (1) infrastructure; (2) business and administrative management; (3) clinical quality and safety (inpatient/outpatient hospital); and (4) clinical integration (ambulatory/physician/patient/community).
This year, there were additional requirements, many related to meaningful use Stage 2:
- identity management and access controls
- CPOE for medication, lab and radiology orders
- use of assistive technology for five “rights” with point-of-care medication administration systems
- clinical decision support-enabled drug formulary check and high-priority hospital condition
- medication reconciliation
- electronic identification of patient-specific educational resources
- EHR-generated listing of patients for quality improvement
- patient portal functionality for access to health information
- summary care record for transitions of care
This year, 741 hospitals and health systems completed the survey, representing more than 2,213 hospitals — more than 39 percent of all U.S. hospitals. The number of hospitals and health systems designated as Most Wired is 338 organizations, down
10 percent from last year due to additional requirements. H&HN uses the same criteria to name the Most Improved and the Most Wired–Small and Rural.
From a set of separately submitted essays, a panel of hospital and information technology leaders identifies noteworthy IT projects and names the Innovator Award winners and finalists. IT projects are evaluated on achievement of business objective, creativity and uniqueness of concept, scope of solution and impact on the organization.
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