Data, Data, Everywhere . . .
There’s no shortage of data that care providers can access to facilitate patient care. What providers often lack, however, are tools to help them make optimal use of that data.
Traditional electronic health records (EHRs) are built as information stores, not information delivery systems. Thus, care providers must actively seek out the data they need. As a result, their situational awareness is only as good as the timing and quality of their last search.
The team at Penn Medicine’s Center for Health Care Innovation (Philadelphia, Pennsylvania) developed a way to bridge the gap between what is stored in an information system and what is known by care providers at the time they are caring for the patient. Their solution earned the team ECRI Institute’s 11th Health Devices Achievement Award. The award was presented to team leaders in June during an Innovation Speaker event at the University of Pennsylvania’s Perelman Center for Advanced Medicine.
Care providers need to be aware of events that can affect a patient’s care, such as an expiring order for a critical medication; and they should be informed when actions are required to keep the patient safe, such as conducting an extubation risk screen for intubated patients. To improve providers’ situational awareness, the Center for Health Care Innovation team developed a technology platform for creating apps that prompt care providers when actions are required for targeted clinical populations – that is, for groups of patients that meet clinician-defined criteria.
The custom apps built on Penn Medicine’s “Agent” platform, as it is called, and can pull real-time data from multiple EHR and clinical data sources to address a clinical need. Apps can be designed to proactively identify patients who require a particular intervention – say, ventilator patients who are due for an extubation risk screen – and then deliver that information to appropriate care providers via push notifications or on a shared dashboard.
By bringing to clinical teams relevant, timely data that previously was not easily accessible, the Agent platform helps Penn Medicine’s providers make better use of this data to improve patient care.
Features of the Agent platform include:
Data extraction – Custom-built APIs (application program interfaces) enabled by the Penn Medicine Information Services department allow data to be pulled from the University of Pennsylvania Health System’s EHRs and other data warehouses.
Data delivery – The platform can deliver information through a secure push notification channel (e.g., text, email) or through a “pull” view using a dashboard with a live-updating patient list.
Application customization – The team works closely with clinicians to identify potential use cases (i.e., problems that can be solved) and then uses the Agent platform to build an application to address the problem. The iterative and agile approach that the team takes to designing, testing and implementing solutions allows it to experiment quickly at low cost, scaling only when high-impact solutions are identified.
Penn Medicine reports that the Agent dashboard and alert platform has enabled teams across multiple entities within the University of Pennsylvania Health System to improve patient safety and reduce harm. The power of this approach is illustrated by one of the group’s first use cases: preventing missed doses of critical medications due to an expiring order.
In an effort to limit unnecessary antibiotic usage, Penn Medicine implemented automatic stop dates for antibiotics at seven days. One unintended consequence of this effort, however, is that it led to orders for medications expiring without the awareness of the primary team. If the patient needed to remain on the medication beyond seven days, missed doses would sometimes result.
With the Agent solution: An automatic reminder was sent to front-line clinicians about expiring medication orders – this was limited to only critical medications not reordered at the time of expiration. Additionally, a list of expired medication orders was provided to the inpatient pharmacist so the pharmacist could verify, reorder or engage the front-line clinician to address impending expirations before doses were missed.
In the two months after the start of the intervention, the number of missed doses was decreased by 45 percent compared with before the intervention. On average, pharmacists were catching one case every other day in which an antibiotic expired inadvertently at two hospital sites. Additionally, during the first year, more than 350 interventions were made by pharmacists at five hospital sites using Agent.
Additional use cases that have been implemented to date include the following:
Coordinating cross-disciplinary and continuous ventilator weaning protocols for intubated patients.
Managing, in real time, patients with a history of high emergency department utilization.
Coordinating transitions of care for patients on hemodialysis from inpatient care to an outpatient hemodialysis unit at the time of their discharge.
Pushing evidence-based pathways to providers treating patients suspected of having a gastrointestinal bleed, delivering this information at a time when it can inform the care provider’s decision making.
Enrolling patients who are discharged with IV antibiotics in a monitoring and management program that has helped decrease readmission rates.
Keys to Success
The Center for Health Care Innovation team notes that forming partnerships with passionate clinical champions was absolutely critical to Agent’s success. The team solicits ideas for potential use cases from front-line clinicians and staff and works closely with those individuals throughout the design and testing phases. This helps assure that each app will successfully meet a clinical need.
Such collaboration facilitates another key to the team’s success: rapid iteration. App designs are adjusted based on feedback from the end users, leading to designs that effectively meet the users’ evolving workflow and complex needs.
Finally, the Information Services department provided a key technological component: custom-built APIs that provide access to real-time data from multiple EHR and clinical data sources.
Also Deserving Recognition . . .
In addition to honoring the team from Penn Medicine’s Center for Health Care Innovation, ECRI Institute recognized three organizations as finalists for the 2017 Award. We’ll highlight those organizations in next month’s issue.
Next year, it could be you. If your organization has engaged in a health technology management project that deserves recognition, ECRI Institute wants to hear about it. The nonprofit research institute presents its annual Health Devices Achievement Award to the member health care facility that has carried out the most exceptional initiative to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology.
ECRI Institute will begin accepting submissions for next year’s Award starting in October 2017. For additional information, visit www.ecri.org/HDAward.
This article is adapted from ECRI Institute’s membership website. The full article features additional details about the Penn Medicine project and about other honorees. To learn more, visit www.ecri.org/HDAwardwinner; call (610) 825-6000; or email firstname.lastname@example.org.
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