Penn Medicine lossens the reins to speed data to doctors

Penn Medicine increasingly wants its clinicians to use information in its electronic health records system to understand what care their patients need.

The idea of its new initiative is to redesign the EHR to give clinicians automated real-time patient updates rather than sifting through the EHR, such as a notification when actions are required for specific treatment.

This could include referring a patient who had a heart attack to cardiac rehabilitation, or the prescribing of statins for patients who need to improve their management of cholesterol. It’s all about outcomes, says Ralph Muller, CEO of the University of Pennslyvania Heath System.

“We’re approaching this endeavor as if we were building a new clinical facility, laboratory or training program with a focus on clinician and patient needs,” he explains. “Everything that shapes patient care should be designed to support the best outcomes.”

In a message across the organization, Penn Medicine leaders announced the initiative and an EHR transformation team, and asked associates for ideas.

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In a New England Journal of Medicine article, David A. Asch, MD, executive director of the Penn Medicine Center for Health Care Innovation, along with colleagues, explained current limitations of EHRs and gave the organization a blueprint for its transformation.

“As compared to other digital transformations that have redefined the ways we consumer information, the effect of EHRs on clinicians’ engagement seems limited and effortful,” the authors contended. “Physicians in the hospital can keep up with feeds on the Philadelphia Eagles, Taylor Swift and the price of Bitcoin without consulting a newspaper. Yet, they must still go to the chart to check on their patients. What would it be like to instead “subscribe” to Ms. Jones in Room 328?”

Asch explained how a process to getting automated information on Ms. Jones benefits her and every other patient. Receipt of information on patient conditions would depend less on physicians remembering to search the chart and medication management would be improved.

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“For stewardship of antibiotics and antiepileptics for inpatients, for example, Penn Medicine had established automatic medication expiration, but the system required that residents remember when renewals were due. Necessary medications were not reordered in 10 percent of cases because a physician did not check the chart in time or didn’t notice the need for renewal.

To fix the problem, the organization built a web app to pull real-time data from multiple information systems and reassemble the data into customizable dashboards, mobile displays and push notifications, resulting in a platform that can tailor streams of data for particular clinical scenarios and measure the impact.

In a pilot test, residents did not need to visit the chart to learn of an expiration and the percentage of antibiotics and the percentage of missed doses and antiepileptics that were missed was reduced by one-third.

Other improvements arising from the subscription service included text reminders for patients needing total parenteral nutrition ordered before 3 p.m., and the realization that such services can shorten the lag time between when information becomes available and when it is used.

“Our old approach evaluated mechanically ventilated patients to see whether they could breathe without assistance when ICU rounds were over and patients’ readiness was evaluated when it was convenient for providers, Asch and colleagues reported in the New England Journal of Medicine article, available here. “Digital information has both enabled patients to be automatically evaluated according to specified readiness criteria and allowed clinicians to receive prompts to act when the criteria are met. Freeing these evaluations from dependence on the whims and routines of the day reduced delays so that patients spent on average a half-day less on a ventilator.”

In total, after one year of automated alerts, benefits realized included 30-day readmissions down 67 percent and total hospital days decreased by 56 percent, according to the authors. “Subscription services help erode the distinction in follow-up care between in-patients and out-patients, focusing on what patients need rather than on where they are.”

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