1/24/19 | Empowering Wellness
MU Health Care Surpasses Readmissions Goals for Congestive Heart Failure
To improve patient outcomes, MU Health Care staff set a goal to lower congestive heart failure (CHF) readmissions by 5%. The EHR intervention project proved so successful, MU Health Care cut CHF readmission numbers by nearly a third. The project received the MU Health Care CEO Award, which recognizes innovative solutions to complex problems.
The improvement team worked with cardiologists and other key stakeholders to build tools and develop an algorithm within the EHR to lower CHF readmissions. The algorithm digs through EHR data, comparing information from the current admission and the patient’s medical history to determine if the patient may have CHF. If the algorithm identifies the patient, it prompts several possible actions. For example, in some cases, a physician receives an alert informing him or her the patient potentially suffers from heart failure. In most instances, however, when a patient is identified with heart failure, the provider does not receive an alert.
To remove ordering burden and alert fatigue, the algorithm automatically fires certain tasks to appropriate care team members. For example, it prompts nurses to take daily weight and inputs and outputs, patients to view CHF-related videos and the pharmacy and nutrition teams to perform specific tasks. The cardiac rehabilitation team also receives tasks for education and outpatient cardiac rehabilitation.
Communication between teams is vital,” said S. Hasan Naqvi, MD, associate chief medical officer. “Using technology allows us to increase communication, better assess patients, and ultimately, make significant improvements in patient outcomes.
Projects like this, where IT staff join clinical performance improvement teams, bring success with the combination of the robust IT solutions and the diligent work of MU Health Care clinicians.
This algorithm is now available as a standard for all Cerner Millennium implementations.
The Big Bang Theory at MU Health Care and Capital Region Medical Center
MU Health Care is replacing its legacy revenue cycle system (GE/IDX), which has been in place for nearly 40 years, with Cerner’s Revenue Cycle.
Cerner was the clear choice to help us achieve clinical and financial integration throughout our health system and optimize the revenue cycle,” said Jonathan Curtright, CEO, MU Health Care. “MU Health Care and Cerner have a long-standing relationship. We share a similar vision of health care for the next five, 10, 20 years and beyond.
MU Health Care will integrate Cerner’s registration, scheduling, patient accounting and practice management solutions, and transaction services with the existing Cerner Millennium EHR.
Integrating this data will help MU Health Care streamline the financial experience for staff and patients while controlling the organization’s cost to collect.
Concurrently, Capital Region Medical Center is implementing Tiger Institute’s instance of our EHR and other Cerner applications at MU Health Care, replacing CRMC’s current EHRs (Meditech and eClinicalWorks).
Separately, these are both major projects. But to make things more interesting, we decided to combine them into one big bang go-live scheduled for March 2020. Hundreds of associates from Cerner, CRMC, MU Health Care, and the Tiger Institute will help us ensure we have a smooth transition to the new platforms.
MU Health Care’s and CRMC’s transitions to one integrated system will give doctors and nurses access to one complete digital record of their patients’ health history, including clinical and financial data, which will help them improve outcomes.
Precision Medicine Collaborative Forum
In 2018 Tiger Institute partnered with the newly formed MU School of Medicine Center for Bio-Medical Informatics (CBMI) to launch the Precision Medicine Collaborative Forum. Together, we plan to facilitate the formulation, launch, and support of multidisciplinary collaborative research projects. Our primary focus will be on research programs that improve human health care and outcomes.
For investigators who want to participate in the collaboration, we assess project requests in line with the forum’s charge to create, participate in and support collaborative multidisciplinary health care and patient outcome improvement research projects.
The forum meets bi-weekly with an open invitation to all clinical investigators with relevant research interests.
We plan to increase investigator productivity (e.g., more publications and external funding) by supporting them with:
- EHR data
- Data science/informatics
- Innovating within the clinical workflow
Solution Partner Testing
Tiger Institute is a valued tier one member of Cerner’s Solution Validation Partner Program. We have consistently ranked in the top one or two clients every quarter in volume for the last four quarters.
We partner for more pre-general availability projects than any other client, sharing what we learn and identifying defects to improve the software.
For the 2017 calendar year, we partnered on 91% of all pre-general availability projects when we had the corresponding workflow and solution already in use.
Some additional highlights over the last four quarters include:
- Identified 100% of defects prior to go live
- Averaged less than 100 days for project duration
- Improved cross-organization collaboration
Some examples of the projects we tested that are now live in the production environment include PowerChart Touch ONE Doc App Advancement, Know Me View, SMART Zone, Waveform, ED Real Time Dashboard with NEDOCS details, and Video Visits—Cloud App Development.
By The Numbers
Since November 2014, the patient/provider portal has had more than 18 million page views, with 7 million views this past year alone. In the last year, patients and providers messaged each other more than 650,000 times (a year-over-year increase of 225%) and patients self-scheduled appointments more than 22,000 times (a 120% increase over last year.)
Enrollment in the portal continues to climb with more than 103,000 portal accounts, a year-over-year increase of 22%, representing 41% of MU Health Care’s patient population.
The innovation teams at Tiger Institute continue to develop new ways to improve the patient experience and to improve communication between patients and their providers.
Our implementation of HealtheRegistries not only aligns with payor priorities and other quality initiatives, it also empowers patients to manage their own health with their provider.
The Health Scorecard, available through the patient app, shows how the patient is doing on various measures and when additional screenings are due to maintain or improve health status through one or more of the following registries:
- Three Wellness Registries (Adult, Senior, Pediatric)
- Six Chronic Disease Registries (Diabetes, Heart Failure, Chronic Obstructive Pulmonary Disease, Hypertension, Ischemic Vascular Disease/Coronary Artery Disease, and Asthma)
- One Acute Condition Registry (Ambulatory Urgent Care)
In total, we support 32 measures, including these additions from the past year:
- Screening for Osteoporosis for Women (Senior Wellness)
- HPV Vaccination (Pediatric Wellness, Adult Wellness)
- Shingles Vaccination (Senior Wellness)
Patients can now enter their blood pressure readings taken outside a clinical setting into their MU Health app. Not only can it help them track their own numbers, but it also feeds data into the EHR so that their providers can see how they are doing outside visits.
This gives patients and providers an easy way to determine the effect of medication and ensure the patient has the best options to control hypertension.
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