How embedding care pathways in an EHR improves care

The Cleveland Clinic has improved patient experience and care quality, while reducing expensive variations in care for physicians.

Regardless of which term you use, the concept of managing patients via care pathways is familiar to many healthcare providers. But the execution of care pathways looks different from one organization to another.

The general concept of a care pathway is a multidisciplinary-managed, tool-based health care plan for a specific group of patients with a predictable clinical course in which the different tasks by the professionals involved in the patients’ care are defined, optimized and sequenced. Using clinical care paths benefits both patients—by improving patient experience and care quality—and health systems—by containing costs, helping to reallocate resources appropriately, uncovering areas of needed improvement and benchmarking performance.

Our organization has partnering with Cleveland Clinic’s Heart and Vascular Institute to embed and enable care pathways within the EHR—a task for which there is no clear industry standard. By successfully embedding the Coronary Artery Bypass Graft (CABG) care pathway into the EHR, Cleveland Clinic has not only helped redefine what a care path looks like, but the Clinic has also been able to test whether electronic care pathways can reduce care variation—with promising results.

Something that is unique to Cleveland Clinic is the fact that physicians and administrators have viewed EHR-embedded care pathways as a way to optimize the EHR and to provide care for patients at the highest quality and lowest cost, even before work began with their teams. Laying the groundwork for EHR-embedded care pathways was just one part of their goal to reduce overall care variation.

By taking the Clinic’s agreed-upon, evidence-based guidelines (or consensus-based where evidence was lacking) and hardwiring them into the EHR, the CABG care pathway becomes automated where possible. This enables the EHR to prompt care team members to take the appropriate care steps for the patient at the right time in his or her course of care.

At the beginning of the partnership with Cleveland Clinic’s physicians and broader administrative care path team, one of their areas of focus was on physicians ordering unnecessary tests. The team hypothesized that there were two to three tests with runaway costs that physicians were ordering as a force of habit, with little attention given to the results.

By embedding care pathways into the EHR, they found that physicians were indeed blanket-ordering tests superfluously, increasing costs for both the patient and the health system. But with the electronic care paths, the appropriate tests were flagged for physicians in the EHR and ordered only when the physician was notified of a specific condition and prompted.

To bring this concept to life, let’s say a 75-year-old woman is admitted for bypass surgery and enrolled in the CABG care pathway by her physician. Because of her history of strokes, the electronic care path would automatically prompt the physician to conduct a stroke screening test, a warranted and evidence-based variation from the normal course of care. Because of the electronic care pathway for CABG patients, the physician orders the related screening tests only when necessary. Subsequently, Cleveland Clinic is expecting to contain costs while providing the appropriate level of care to the patient.

The Cleveland Clinic identified significant advantages to embedding care pathways within the EHR.
  • Improve quality outcomes: Pathways ensure that a patient’s care follows evidence-based care guidelines, which maximize care standards and quality outcomes.
  • Reduce care variation and control costs: The reduction of unwarranted care variation reins in costs by both reducing unnecessary diagnostic testing and focusing care dollars on proven care strategy.
  • Engage multidisciplinary teams: It is important to engage the whole care team and show those who are caring for the patient the value of their work.

Our organization and the Cleveland Clinic are very excited and encouraged by their results. No matter how sophisticated the technology is, organizations still have to work with people within processes.

No one organization is going to revolutionize the way we care for patients overnight. Change is hard work, and the challenge remains in convincing people on the frontlines of care delivery to adopt new processes and workflows. Yes, we still have to focus on the foundation of having a solid technology; however, the more important piece is investing in and engaging the people willing to use it.

The author and executives from the Cleveland Clinic will present a session at HIMSS about electronic care pathways during the Lunch and Learn session from 1 to 2 p.m. Thursday, March 8.

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