OSU Wexner Medical Center masters change during award-winning IT effort

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Ohio State University Wexner Medical Center (OSUWMC) has plenty of experience implementing technology. After all, it’s the first two-time winner of the HIMSS Davies Award.

Managing the changes that technology brings about also requires significant commitment and effort, the organization has found. It’s also worked hard to manage the change that information technology brings to a staff.

Enabling change management is no small taks at OSUWMC, which serves all patients and populations, with the uninsured and Medicaid population comprising approximately 25 percent of the organization’s patient mix. It has six hospitals with 1,300 beds, a staff of 20,000, and more than 58,000 admissions per year, with 1.66 million outpatient visits.

After a 2001 win for advances in computerized physician order entry (CPOE), the organization won an Enterprise Davies award in 2015 for achievements derived from its rollout, between 2008 and 2011, of a comprehensive electronic medical record system.

OSUWMC worked hard to adopt change management, and Milisa Rizer, MD, led by example. Rizer, the chief medical information officer for the organization, put herself on the line for the first rollout.

“The first ambulatory site to go live was mine, and I continued to practice and see patients,” she says. “Anything we asked our doctors to do, we tested out to make sure they were reasonable, and people got on board because of that. We've used a lot of physician leadership to get people on board.”

“We trained 13,500 staff, with over 1,000 per day attending, spanning 35 classrooms leading up to that go-live,” says Tom Bentley, deputy CIO for applications at the medical center.

Rizer agrees with the common assertion that change management is much more complex and challenging than the implementation of a technology solution, and says that for OSUMC, hard data has eased the adoption curve.

“I think the hardest thing is changing prescribing habits, changing behavior on the part of our care providers,” Rizer says. “But they all respond really well to data. We can show that [new processes or practices] make a difference and are really beneficial.”

Its “adventure with Epic,” as Rizer describes it, started in 2006. The first implementation, in ambulatory care, launched in 2008. From there, more ambulatory facilities were brought online.

“Then, in October 2011, we went big bang with Epic in revenue, inpatient, scheduling, ICU, all our hospitals, all at once,” Rizer says.

OSUWMC invested about $47 million in the EMR platform, and realized an estimated initial savings of $55.5 million. The specific achievements highlighted in its Davies award bid included:

  • Antimicrobial medication monitoring: Concerned about a rise in the use of antimicrobial medication, and the resulting costs and potential for developing drug-resistant organisms, OSUWMC built a data mart in 2013 that drew data from its EMR. The resulting insights led to decreased use of certain antimicrobial agents, $7.7 million in savings, and reduction of C. difficile infection rates.
  • ER improvement: OSUWMC focused efforts on raising the standard of care in two emergency rooms, and improving accuracy in billing that was costing $50 million per year in lost charges. A scoring system in the EMR helped determine correct charges, resulting in better care and more appropriate reimbursement.
  • Device integration. To decrease nurses' workload while improving the accuracy of information, the organization implemented NantHealth's device integration solution. Results included capturing 93 percent of vitals automatically and validating 81 percent of vitals within an hour. The solution saved 96 hours of nursing time per week.

The organization already had a longstanding data warehouse that it still maintains separately, although it’s fully integrated with Epic. “Our information warehouse is in-house developed based on the Oracle platform,” Bentley says. “It contains Epic data but also data from other systems and sources.”

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