Sometimes it seems as if the only news you read about computerizing healthcare is bad news. Errors, alert fatigue, unintended consequences . . . it’s almost as if people enjoy hearing what’s not working and can’t wait for the next installment.
Meanwhile, healthcare organizations that have invested in high-performance Electronic Health Records (EHR) and other advanced IT systems continue, often without fanfare, to make major advances in patient safety, quality of care, cost-effectiveness and efficiency. One such organization is Sarasota Memorial Health Care System, an 806-bed regional medical center on Florida’s Gulf Coast.
Literature and industry experts such as the Institute of Medicine (IOM) have described the risks associated with patients who, as their condition worsens, remain unnoticed, and therefore un-rescued. Patients who “crash” are among the most costly to care for. Sepsis alone costs the U.S. healthcare system an estimated $17 billion a year, and results in an estimated 20-50% mortality rate.
The trick is to notice “crashes” before they happen and avoid them – a perfect role for computerization in healthcare. Traditionally we’ve had to depend on hyper-vigilant and watchful bed-side clinicians to always be in the right place at the right time – impossible expectations.
Sarasota Memorial had first-hand experience with declining patients who went unnoticed and declined toward sub-optimal outcomes. They leveraged their high-performance EHR with advanced clinical decision support (CDS) to track and identify declining patients in time to intervene. They “taught” their EHR to compute and quantify the risk of deterioration based on statistically derived clinical criteria. These real-time and continuous computations reflect the information documented by all caregivers, along with all ongoing lab values, all medications, and data streams from electronic monitoring devices.
The result is a single, dynamic, composite number – the “index” – that quantifies each patient’s status. The index is continuously computed, reflecting the most recent data, and reporting back in both analyzable and graphable formats. The index rises and falls to reflect declines and improvements that are watched and acted on, even preemptively.
So patients don’t suddenly reach the threshold of sickness unnoticed; clinicians are alerted with time to act before “the crash.” The EHR sends clinicians alerts of dangerous declines even when “no one is watching” and can drill down to find the problematic clinical values and take focused remedial steps. And it all occurs before the failing patient falls into the catastrophic, riskier categories requiring rescue and higher cost care.
Sarasota physicians and nurses describe the results with superlatives and express thanks for this innovation they attest has helped them keep their patients safe from avertable and previously unnoticeable decline. And, bottom line, as a direct result of this innovation Sarasota’s avoidable sepsis cases are zero – an arguably impossible feat.
So what does this mean for the industry? The index and its benefits are clearly generalizable. That is, of course, if you have a high-performance EHR that is programmable and capable of real-time computations, data dynamic display, and can drill-down to underlying clinical detail.
Another important lesson: Good news about computerizing healthcare is abundant . . . it’s just that it rarely makes the headlines.