A dou­ble win for Metrohealth

Modern Healthcare - - Information Edge -

Cleve­land came away with two AMDIS award win­ners this year— the MetroHealth Sys­tem and its chief med­i­cal in­for­mat­ics of­fi­cer, Dr. David Kael­ber. County-run MetroHealth, which op­er­ates a 566-bed safety net hos­pi­tal, MetroHealth Med­i­cal Cen­ter, has been climb­ing me­thod­i­cally up the health IT adop­tion wall since it be­gan in­stal­la­tion of its elec­tronic health record sys­tem in 1999. The hos­pi­tal is op­er­at­ing at high lev­els of clin­i­cian us­age. Physi­cians con­sis­tently plug or­ders into the hos­pi­tal’s com­put­er­ized physi­cian or­der en­try sys­tem at near-uni­ver­sal us­age rates “well above” 90% of all or­ders in the emer­gency depart­ment and in­pa­tient ar­eas, Kael­ber says.

But, over the past decade, more pro­found changes have oc­curred at MetroHealth than sim­ply swap­ping pa­per for hard­ware and soft­ware. “Go­ing back to 1999, we’ve been go­ing through the cul­tural shift of un­der­stand­ing that an elec­tronic health record is a pow­er­ful tool,” Kael­ber says. Even be­yond that, the IT sys­tem is re­garded as “the nerve sys­tem” of the or­ga­ni­za­tion’s clin­i­cal ac­tiv­i­ties. “So now, if there is out­come that peo­ple want to change, the peo­ple come to me.” That’s be­come some­thing of mixed bless­ing, since an IT sys­tem can’t re­me­di­ate a col­league’s lack of so­cial skills or ref­eree in­ter­de­part­men­tal dis­putes. “So, some of my job now is say­ing I to­tally un­der­stand how that’s a prob­lem, but I don’t know how this tool can help.” Clin­i­cal prob­lems are its forte.

For ex­am­ple, last sum­mer, when the hos­pi­tal saw a spike in in­ci­dences of pa­tient mor­bid­ity and mor­tal­ity associated with a mul­tidru­gre­sis­tant or­gan­ism, acine­to­bac­ter, MetroHealth formed a sys­temwide coali­tion to ad­dress the prob­lem that, of course, in­cluded IT sys­tems peo­ple from the start. Over the next six months, the IT group de­vel­oped a suite of tools to help ev­ery­one get a grip on the prob­lem.

Some func­tions were geared to­ward clin­i­cians and some de­vel­oped for in­fec­tion-con­trol staff. They in­clude, for clin­i­cians, MDRO best prac­tice alerts and the abil­ity to elec­tron­i­cally or­der MDRO screen­ing cul­tures; and for in­fec­tion-con­trol staff, au­to­matic pag­ing for ad­mit­ted pa­tients with new, MDRO acine­to­bac­ter cul­tures and daily e-mails of ros­ters of pa­tients with pos­i­tive cul­tures.

The IT-en­hanced ap­proach en­abled the hos­pi­tal to drive the MDRO acine­to­bac­ter case rate from 27 a month at the top of the spike, back down to the hos­pi­tal’s pre-out­break stan­dard of five to seven cases per month, a shift that doubt­less was noted by the AMDIS awards jury in nam­ing MetroHealth as one of two in­sti­tu­tional award win­ners this year.

“If you think about the stages of change man­age­ment and adop­tion, the early adopters, the mid­dle of the road, the lag­gers, the ones who don’t want change, I think we’re re­ally be­yond that at our hos­pi­tal,” Kael­ber says. “Peo­ple have turned around and are em­brac­ing the tech­nol­ogy.” At MetroHealth, “It’s not just a tool we need to use,” he says. Peo­ple are con­vinced, “If we think it through, we can to­tally transform health­care.”

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