Healthcare has a waste problem. Here's what hospitals can do about it.

Excessive variation in care delivery fuels the overuse of services. Healthcare spending is projected to account for 20 percent of U.S. gross domestic product by 2020 — 2.5 percent of that will be pure waste, according to a study published in JAMA.

This article is sponsored by LogicStream Health

Waste is straining hospital operating margins as costs continue to balloon and reimbursements from government and commercial payers shrink. Simultaneously, patients and payers are demanding higher value for their healthcare services.

"Hospitals are approaching a crisis point," Brita Hansen, MD, CMO of LogicStream Health, told attendees during a May 11 executive roundtable at Becker's Hospital Review's Health IT + Clinical Leadership 2018 conference in Chicago. Dr. Hansen oversees product development at LogicStream Health, a provider of clinical process improvement and control software for EHRs, and is also an internal medicine hospitalist at Hennepin Health in Minneapolis.

"We are operating in an environment where we cannot tolerate this level of variation and waste any longer," she added.

The solution? Unlock information trapped in the EHR to inform clinical workflows and streamline clinical process improvement to limit healthcare waste.

Healthcare's biggest waste driver: Poor process standardization

Physician engagement, patient safety and cost-containment — all essential for controlling waste — can only be improved once clinical processes are stabilized and standardized, according to a recent article published in Harvard Business Review.

However, gaps between what providers consider best practices and the care actually delivered close at a snail's pace. Oftentimes a 10- to 20-year lapse exists between when medical literature is published and when hospitals update EHR order sets and protocols accordingly.

The director of informatics at a 169-bed pediatric hospital in the Northeast thinks this is the crux of the problem. "It's a very slow, painful change," she said. "We don't have the resources. [Clinical process standardization isn't] No. 1 on our goal list where it should be."

A slow-moving standardization process also begets inappropriate ordering of healthcare services and tests, which leads to excessive use of low- or no-value services. A recent Health Affairs study of Virginia's all-payer claims database found $586 million of the state's healthcare spending funded low-value services in 2014 and accounted for approximately 2.1 percent of Virginia's healthcare costs.

The CMO of a 461-bed hospital on the West Coast said low-value services slip past well-intended EHR protocols, such as alerts, because frontline staff often treat patients based on individually held beliefs, rather than a standard process.

"That's where you're going to get your waste. We're not notifying each other; our computers aren't notifying each other. It's individualized. I don't think we're in a world where we can be individualized anymore," he said.

The CMO's words echoed a consensus at the roundtable: A lack of clinical process standardization is pushing hospitals closer to the "crisis point." Hospitals must begin examining closely held assumptions about their clinical processes, abandon what's not working in their EHRs — and, more importantly, implement practical solutions.

How instant and consistent EHR insights help standardize care

As noted in the Harvard Business Review article, "Because few standardized processes exist in care delivery there are many possibilities for error. That's why simply making a poor process electronic by implementing an [EHR] doesn't lead to better quality or cost."

Consider the earlier argument that frequently changing clinical literature means EHRs rarely house the most up-to-date guidelines. The director of clinical optimization at a 126-hospital system in the South said, "Our EHRs continue to have the 'check the box' mentality. We have been working desperately on standardization, where I think we have made huge strides, but we're far from [getting] where we need to be."

Alone, EHRs will not solve the problem of standardization, but that doesn't mean they can't be leveraged. A new EHR-enabled workflow can give clinicians what they want: standard and instant insight that speeds up the process of eliminating outdated order sets and unnecessary care variations. The LogicStream Health software platform improves EHR workflows by optimizing content and managing order sets to ensure information is up-to-date and consistent. Customers who deployed LogicStream Health's clinical process management solution have witnessed an 18 percent decrease in order set libraries and pocketed $100,000 to $300,000 in annual cost savings, according to the company.

The solution also determines which clinicians may be more apt to use outdated clinical content, allowing hospitals to target corrective communication and avoid clinician confusion when new clinical data replaces retired information.

"I can sum this up in six words: It's all about the workflow," the director of clinical optimization said. "If you can get the workflow down straight, then you're golden. It doesn't mean you're not going to have problems, but a lot less."

Effective leadership is essential when rolling out these advancements. According to the Harvard Business Review article, "When it comes to change, the technology is the easiest part. ... The hard part is to get the doctors, nurses and administrators to agree on what is the best way to deliver the care."

During the transition, it is necessary to tap a clinician champion, according to the CMO of a 110-bed hospital in the Southeast.

"A lot of these initiatives … when the provider understands the why behind it, sometimes it's a no brainer," said the CMO. "Find a physician champion, someone who believes in this cause and can speak the clinical language to [other] provider[s]."

Reduce waste, improve patient care

Standardization is key to ensuring clinicians are engaged and providing evidence-based care. Standard clinical processes also direct clinicians away from low-value services that may have questionable success but place an unquestionable cost burden on the healthcare system.

A sustainable path forward requires instant and insightful data conveyed consistently within a hospital or health system's EHR. Best-practice protocols and smarter resource use will not only reduce costs — they will also improve patient care.

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