Ready to drive transformational change? Check your EHR

Col. Joseph Arthur Pocreva, M.D., Keesler Medical Center and Robert Hitchcock, M.D., FACEP, CMIO, VP and GM of Physician Solutions at T-System - Print  | 

Actionable data is a necessity in today's healthcare environment, yet the wealth of information that is collected through electronic health records is often underutilized and overlooked.

EHRs can drive improved efficiencies as well as improved outcomes, but only if you leverage the powerful data they provide. Understanding the power of your EHR and the data it offers can have a drastic impact on driving efficiency, better care delivery, satisfaction and the bottom line.

Consider the fast-paced nature of the ED – the critical front door to every hospital across the country. EDs face unique challenges in caring for patients, including varying acuity levels for a wide range of conditions and high patient volumes, paired with a higher risk for staff burnout and stress.

At the U.S. Air Force's Keesler Medical Center emergency department, challenges were in abundance. In 2010, the average door-to-doctor time was 77 minutes. You could watch a full length feature film before seeing your doctor. Without the appropriate processes in place, bottlenecks, long waits, angry patients and a disappointed staff led to inefficiencies and dissatisfaction for both patients and providers. The ED was broken and ready for much-needed change.

By pulling actionable data from their EHR, Keesler was able to obtain an accurate picture of deficient areas within the department and actively test, manage and make decisions related to clinical flow, throughput, staffing resources, bottlenecks and more.

In 2009, Keesler had 500 patients left without being seen encounters, an average 2.2 percent of visits. While this was within the national average, it was still 500 patients who had given up on the organization. In 2014, that number was down to just four LWOBS, combined with decreases in length of stay by 29 percent, door-to-doc time by 78 percent, and LWOBS by 99 percent. At the same time, staff satisfaction increased.

Continually learning from and leveraging real-time EHR data on an ongoing basis and capitalizing on areas for improvement, Keesler was able to accomplish transformational change. The ED, which had previously ranked last in the Air Force Medical Service's emergency services metrics, soared to first in six of the seven metrics.

Keesler learned you can't underestimate the value of good information. When driving change, consider these three steps to turning your EHR data into actionable intelligence:

Step 1: Use data to identify inefficiencies and bottlenecks

The cost of inefficient processes can quickly build and cause a snowball effect, especially in an episodic care setting. When issues and inefficiencies surface, making fundamental changes can be painful. Providers run the risk of making uninformed decisions and changes without valuable information. A good EHR provides data that helps you quantify and identify your inefficiencies.

As with most EDs, Keesler was drowning in low to mid acuity patients. EHR data allowed the organization to identify the true bottleneck – bed space was at a premium and was often taken up by patients that did not require a monitored bed. Keesler reengineered processes for triage, bedding and information capture for low-acuity patients, saving bed space and resources for higher-acuity patients. One specific change included placing a provider in triage, which allowed low- to mid-acuity patients to be treated and discharged from the triage room, freeing up valuable bed space for patients that needed the beds. These changes reduced D2D time from 75 to 67 minutes in the first month, and from 67 to 36 minutes in the second month.

Leveraging the power of their EHR data, Keesler was able to uncover and quantify bottlenecks. The EHR's ease of use, data mining capability and reporting helped them make intelligent decisions based on data rather than instinct or myths. When wait times were excessive, the cause could be discerned and acted upon quickly. In contrast, when Keesler saw success, their EHR data was the driving force for reproducing it.

Step 2: Use data to drive change and gain buy-in

Understanding inefficiencies and bottlenecks does not always equate to successful change. Buy-in from key stakeholders is essential for driving positive and lasting change.

Instead of limiting access to data, Keesler made a point to share data with physicians and nurses to gain their support and to demonstrate on an ongoing basis how changes put in place were making a real difference. At the beginning of the process, Keesler published data on a daily basis. The staff was able to buy into long-standing practice changes because improvements were noticeable.

Information and data are foundational to successfully driving change and shifting the culture of a department or organization. Arming yourself with data helps address naysayers and motivate staff on a daily basis. We continually used data to test, facilitate, implement, measure and showcase successful process changes, the efficiencies created and how resources were utilized.

Step 3: Embrace a philosophy of total transformation

It's easy to get caught up in the "measure du jour." To see impactful, long-term transformation and results, organizations have to go beyond managing to a specific metric, like D2D time. The truth is, single measures can be manipulated without any real transformation or process change.

It's time to consider the overall placement of resources, department processes, throughput and the physical environment. The EHR can become the common thread to reorganization, proper use of resources and cultural change. Discover and understand the data that can be generated from your EHR; and if you don't know what to access or how, look to your technology partner for support.

Finally, don't underestimate the power of communication and data in your transformation. Keesler found that staff believed in and supported new practices and processes because the data supported and proved improvements would make an impactful difference. The numbers don't lie.

Making a few key changes to a process and instilling a new culture of efficiency and pride can make a huge difference. People want to do good work and be proud of what they accomplish. The system they work in can be designed to facilitate this.

Now, answer this question. Is your organization promoting a culture of data-driven change? The time is now for hospital leadership, physicians and nurses to fully explore the capabilities of their EHR and the data available. Too much is at risk – patient experience, staff satisfaction and improved care delivery – to not let this technology work for you and miss capitalizing on areas for improvement.

Col. Joseph Arthur Pocreva, M.D., is a board certified emergency medicine physician who currently serves as the emergency department medical director at Keesler Medical Center in Biloxi, Mississippi. Keesler is one of the largest U.S. Air Force medical facilities in the country. Commissioned in the Air Force since 1992, Col. Pocreva, MD has held prior U.S Air Force medical positions, including assistant director of operations for 1 Special Operations Support Squadron and commander of Special Operations Critical Care Element at Hurlburt Field, staff emergency medicine physician at Eglin Air Force Base and chief of acute care services at Davis-Monthan Air Force Base.

Robert Hitchcock, M.D., FACEP, is CMIO, VP and GM of Physician Solutions at T-System. He is a nationally recognized Meaningful Use expert and active member of the HIMSS Physician Committee and other HIMSS subcommittees advocating usability and responding to regulatory issues. Dr. Hitchcock is a practicing ED physician and an Emergency Department Practice Management Association (EDPMA) board member. In 2001, he earned recognition for excellence in teaching from internal medicine residents and was the readers' choice #3 pick for ONC National Coordinator in a poll conducted by Modern Healthcare magazine. His goal is to advance system adoption and usability to improve the quality and efficiency of ED delivery.

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