Lessons in clinical performance
Informaticists discuss financial pressures, CPOE compliance challenges
Editor’s note: The following is an edited excerpt of the transcript of an editorial webcast, “Improving patient care, by the numbers,” conducted by Modern Healthcare on Nov. 17. The three panelists were named to Modern Healthcare’s inaugural list of the Top 25 Clinical Informaticists in Healthcare. They discussed the role of clinical informaticists in improving their organization’s clinical performance and the connection between clinical performance and financial results. The panelists were Elizabeth Johnson, vice president of applied clinical informatics at Tenet Healthcare Corp.; George Reynolds, vice president and chief medical informatics officer at Children’s Hospital & Medical Center in Omaha, Neb.; and Christopher Snyder, chief medical information officer and medical director of performance improvement at Peninsula Regional Medical Center in Salisbury, Md. Modern Healthcare reporter Maureen McKinney moderated the webcast.
Maureen McKinney: Dr. Snyder, have any physicians declined to use the mandatory CPOE tools and how did you address it? What were some of the ways that you’ve encouraged compliance?
Christopher Snyder: The ways we’ve encouraged compliance is it’s been pretty much one-on-one training with myself and all the medical staff. And I have a daily utilization report I look at with the docs, and I actually show that report at all department meetings, so we use a fair amount of peer pressure.
When we were first starting to roll out five, six years ago, it was much more difficult. Obviously in 2011 we have a much greater incentive with meaningful use and just the financial benefits of those things, plus also the fact that everybody’s looking at it. And I think that really you have to preach safety. We’ve always preached safety from the board down. And wherever I’ve gone to these guys, we may throw in movie tickets here or there just as kind of a fun thing, but the majority of the time it was one-on-one, saying, ‘Hey, you know this is safer.’
And in ’08, when (a doctor) said to me, ‘Prove it.’ That was a very challenging task, but I honestly thanked him for doing that because he really pushed me to want to show that we could make a difference. But I think the safety thing—most physicians, most nurses, most clinical folks really do want to make things better. And if you can, again, show them the money with the data as far as showing safety improvements, it just has a huge impact on the medical staff.
And what do I do with the refusers? I confront them with their data, and then I bring them up in front of MAC and let them explain to us why they’re not using a safer tool.
McKinney: Dr. Reynolds, for smaller hospitals that are thinking about starting to develop a clinical analytics program, do you have any advice or feedback for them?
George Reynolds: Great question. I think the first thing is to develop a philosophy. Our philosophy at the very beginning was: If the data is available—if the data is recorded electronically, it should be available. There’s no way that we’re going to invest in these systems and then have them kind of be an ATM you can put money into but never get money out of. We wanted the data back out.
It requires a fair amount of work at the front end to understand what the data structure of your EMR is. In our case, we actually have a different EMR on the ambulatory side than on the inpatient side, so much of this was driven out of our data warehouse strategy. But I think my advice would be: Start with questions that people care about. The tools we use are com- mercially available off-the-shelf tools. It’s not anything that we’ve custom-designed or anything like that. It’s not that hard to get started.
McKinney: I have an audience question for Liz Johnson. How do you guard against letting financial considerations seep into clinical decisionmaking given that the data are used to watch costs as well as monitor quality of care?
Elizabeth Johnson: I’m not sure I have a terrific answer for that, because it’s not been a problem yet. And I certainly understand and respect the question.
What we have been so driven by the ability to improve the quality of patient care, that although we certainly are getting asked to produce the financial output. … we know that it’s very difficult to say that because we avoided an event, this is the cost we avoided, because it is a academic exercise. But yet we can make some sort of cognitive leap to the fact that if we avoid 4,000 errors over a million patient lives, then we do a scientific formula to say this is how much we avoided.
But the truth is, it’s because our board and medical staff are so driven to improve the quality of the patient care, and frankly the other part of it is our clinicians are saying, ‘It is critical that we have these tools to be better clinicians, that we think we can do a better job.’
So, frankly, I haven’t had to face it. Again, we’re going to measure it, but I think our financial people are more comfortable around things like reduction of paper, if there are some clinical hours that can be saved because we’re using the ability to download clinical data. And therefore it takes fewer people to render care.
Again, we’re not being held accountable to a target at this point because I think they are more interested in getting the value that they believe in delivering the quality of care.