Handling more than 1 million patient visits each year, including more than 100,000 in its emergency department—rated as one of the busiest in the nation— Cleveland’s MetroHealth System prides itself on providing high-quality care, enabled by health information technology.

The integrated health system has been a pioneer in the implementation and use of healthcare IT. In fact, it was the first public health system in the country to install an Epic electronic health record; it went live with the system in 1999 and was fully deployed enterprise-wide in 2009 throughout all ambulatory clinics, inpatient areas, and the ED.

It is an EHR system for which MetroHealth has won multiple industry awards, attaining HIMSS Analytics Stage 7 Ambulatory Status in 2014 and Stage 7 Hospital Status that same year. Most recently, it was named a 2015 HIMSS Enterprise Davies Award recipient.

The Davies Award recognizes the outstanding achievement of healthcare organizations that have used health IT to substantially improve patient outcomes while realizing a return on investment. By leveraging its EHR, MetroHealth has been able to significantly improve the organization’s clinical and business operations and, as a result, provide better care and achieve better outcomes.

David Kaelber, MD, chief medical informatics officer of MetroHealth
David Kaelber, MD, chief medical informatics officer of MetroHealth

“One of the keys to our success is that there is not a single magic bullet,” says David Kaelber, MD, chief medical informatics officer of MetroHealth. “It’s more of a secret sauce that requires stirring together lots of ingredients and then the magic happens.”

Through the implementation of seven different EHR-enabled interventions tweaked over the course of a decade, MetroHealth—a primary care provider for more than 10,000 adults with diabetes—has been able to significantly improve outcomes for them.

The EHR-based tools implemented fell into three categories: decision support tools for evidence-based best practice diabetes care; documentation tools to document appropriate care and care plans; and reports (at the patient, provider and system level) to summarize diabetic care provided and eventually tied to financial incentives for providers.

“For example, we put in clinical decision support alerts to make sure that people get the recommended testing they need as diabetic patients, such as the hemoglobin A1c test,” Kaelber says. “Now, is getting just the A1c test going to improve the outcomes? No, it’s just a blood test. But, that—in combination with better blood pressure, blood sugar, cholesterol, and weight control—all adds up.”

Over a 10-year period, process and outcome composite measures improved more than 30 percent. Providing better diabetes care to these patients enabled MetroHealth to avert 17 amputations and 2,200 hospitalizations. And, through better management of this chronic disease that consumes significant resources, the health system was able to realize an estimated 10 percent decrease in the costs of care for diabetic patients, resulting in cost savings of about $1 million annually.

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"You’ve got to implement [the EHR] and then you have to have a whole team constantly working to make sure you get the value-add that the EHR should be providing."

Kaelber hastens to add that functionality for these tools already exists n the EHR system, and that over the past decade of MetroHealth’s ongoing efforts, many hundreds of hours of staff time was spent on designing, building, testing and implementing the tools, which have been continually refined.

“In the ‘secret sauce’ responsible for our success are not just the technology tools that we implemented, but equally important is the cultural change, education, training and reporting that all has to come together,” he concludes. “If you have a good EHR system like Epic and the tools, people, and process to use it thoughtfully, you really can make significant improvements in patient care.”

Ultimately, for Kaelber, deriving value from an EHR is not a destination but a journey.

“All too often, for a lot of healthcare organizations, as soon as they go live they think the hard work is over and can walk away, leaving the EHR on auto-pilot,” he observes. “EHRs are not like that. You’ve got to implement them and then you have to have a whole team constantly working to make sure you get the value-add that the EHR should be providing for your system. The implementation is not the end, but the beginning.”

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