Putting Epic's EHR to work: Hawaii Pacific executives on the intersection of health IT & quality

Hawaii Pacific Health, based in Honolulu, is no stranger to the Epic EHR. The health system's contract with the EHR vendor is approximately 12 years old. The EHR is used in the system's inpatient and outpatient locations, as well as by 250 of its community providers. Well past the growing pains of implementing a new system, Hawaii Pacific is leveraging its EHR to better understand its patients' needs and improve overall care across the enterprise.

Steve Robertson, senior vice president and CIO of Hawaii Pacific Health, oversees the system's revenue cycle and IT operations. Melinda Ashton, MD, spearheads the healthcare system's quality initiatives as senior vice president and chief quality officer. Mr. Robertson and Dr. Ashton describe how their health system is using the Epic EHR to improve diabetes care and the need to align health IT and quality strategy.

Editor's note: Interview has been lightly edited for clarity and concision.

Q: Why did Hawaii Pacific choose to use its EHR to improve care for diabetes patients?

Dr. Melinda Ashton: We started on this journey because we identified patients with diabetes and their comorbidities as top reasons for readmissions and longer length of stay. These patients are also at higher risk for postoperative complications. We looked at how our system was managing hyperglycemia. We looked at glucose values for all of our patients. The EHR makes that possible. Looking at the data, I was quite concerned. We had a lot of patients with hyperglycemia.

There have been a lot of conversations at the American College of Surgeons National Surgical Quality Improvement Program meetings about hyperglycemia. Starting from there, we found a program [Glytec] to integrate into our EHR — something that could help with hyperglycemia management.

Steve Robertson: We wanted to establish a commercial ACO, and we realized we really needed to focus on length of stay improvement. This [diabetes care] became a high priority focus. We felt we could get to a different level.

Q: What did you discover during the process of this improvement initiative?

MA: It turns out we had previously not looked at the entire process of glucose management. For example, we have clinical assistants who do the testing. The problem was, they might do the test, but do they actually report the results immediately? Are the results on a piece of paper in their pockets? During this process, we integrated our glucometers with the EHR. There was no longer any delay factor.

We also found physicians hadn't necessarily adopted new ways of hyperglycemia measurement. They were using sliding scales. We began to talk about the way the new computerized protocols would help physicians through recommended dosage and timing. We found nursing education and physician champions to be important throughout this entire process.

Q: Do you have plans to use the EHR to explore and improve other disease-specific areas?

MA: We are already using our EHR to look at sepsis and surgical quality. Sepsis was actually our first project.

Q: What advice do you have for CIOs planning to use their EHRs in a similar way?

SR: CIOs must absolutely partner with chief quality officers. If you can move your office to the chief quality officer, it would be the best thing you can do for your patients and community. You can't have IT and clinical quality separating. There are no ways to get the improvements you are looking for without IT and quality working together.

Once you have the infrastructure in place, it becomes about the incremental changes that can transform everything you do. Do not underestimate clinical workflow and buy in.

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