When Sentara Healthcare CIO Bert Reese visits an outside hospital that has implemented electronic medical records, he always hears the same boast: “We are a data-rich organization.” And he always has the same question: Yes, but what are you doing with the data?”
When H1N1 was spreading, Norfolk, Va.-based Sentara’s medical leadership agreed on a standard set of protocols for diagnosing the flu strain to help physicians understand the differences between H1N1 and other types of flu. The protocols were immediately shipped out to all acute care and ambulatory physicians in the eight-hospital delivery system through the enterprise EHR from Epic Systems Corp.
With more accurate H1N1 diagnostic data getting into the EHR, Reese then was able to use dashboard-based data analytics software to drill down on the epidemic. “Now, I can see H1N1 coming into the community, I can see it over 200 miles,” he said at the Physician IT Symposium during HIMSS11 in Orlando. “I know where I need more vaccines and supplies.”
Reese spoke of the benefits of not just having an EHR, but the analytics capabilities to use data from the system to gain optimum value from the EHR. He bought 30 physicians to the HIMSS Conference in 2004 to kick the tires on EHR products and the first go-lives started in 2006.
The total cost of ownership over the first 10 years is projected at $237 million. But after expenses far outweighed benefits during the first three years--burning $4 million a month at the peak--the expense/benefit rate was almost even in 2009. In the fifth year, 2010, the EHR generated $41 million in new money through improved charge capture, increased efficiencies, reduced duplication of services and higher quality of care such as better medication management. And the additional $41 million doesn’t include $64 million in expected meaningful use incentive payments.
Reese attributed much of the new money to widespread use of data analytics software with dashboards to visually explain results. Eighteen processes drive the return on the EHR investment, they are 18 processes common to almost all hospitals, and improving the processes all involve looking at the same three things: Where communication takes place, where hunting and gathering takes place and where patient handoffs occur.
“There’s a bunch of metrics that you can measure on a daily, weekly or monthly basis to get a pulse on how the organization is doing,” he said.
Improvements achievable via dashboard-assisted analytics include faster emergency department throughput, avoiding medication errors and faster medication administration processes. For instance, Sentara’s average time between an order written and the order being available to act on has dropped from 59 minutes to 4.5 minutes, and from 132 minutes to 38 minutes for a NOW order being written to being administered.
Registration is an area ripe for analytics, Reese noted. It’s important to watch for overlays and duplicates in registration, because when in doubt, a clerk generally creates a new patient account. But it isn’t tolerable in a clinical environment to have two accounts for a Bert Reese when only one exists, he added.
Having an enterprise EHR has proven to be a market differentiator for Sentara Healthcare, Reese said. But now a competitor this year is implementing its own enterprise EHR from Epic and that differentiator will go away. “What happens then is the market differentiator is what you do with the data.”
To increase the value from analytics requires having only one version of the software operating throughout out the enterprise to get consistent and clean data, Reese contented. That means hospitals all get the same software without customizations, as do physicians and specialists.
To ensure the EHR met clinician needs, Sentara FTEs for the project included 195 physicians, nurses and other clinicians. The delivery system also paid more than 50 physicians to commit at least four hours per week to serve on an advisory board with one of their duties being the building of order sets. And to build goodwill for the EHR, Sentara compensated physicians for loss of productivity for a period after go-live.
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