Some time ago (i.e., 2008), the Centers for Medicare & Medicaid Services (CMS) implemented policies aimed at eliminating reimbursements for several “never events.” CMS estimated that avoidable adverse events and errors cost $300 million annually – not to mention unnecessary patient suffering – and so needed to end. High among the focal never events were falls, including falls with injuries, and decubitus or pressure ulcers (PUs), especially those of higher severity, risk and cost, Stage III or Stage IV.

Yet no computer can turn a patient to avoid a pressure ulcer, nor catch a patient to avoid a fall. So how can a programmable electronic health record (EHR) make a difference?

Conquest of pressure ulcers and falls is not simple, but can an EHR help?

PUs are the second most common of the never events, estimated to occur for as many as 34 of every 1,000 patients, and cost $10,845 per case. So it is mission critical that healthcare organizations do all they can to avoid acquisition of PUs, and reduce the rate of patient harm and financial damage.

Many factors come into play by which the EHR can help beyond antiquated paper-based risk assessment, including encouraging key assessments through the EHR, alerting when needed assessments are missing, then advising clinicians of patients at risk as identified by the EHR. Also the EHR can remind bedside clinicians to turn patients at risk on a frequent cadence.

Falls are not any easier to avoid than PUs. The more severe falls are those in which a patient suffers an injury. CMS has long ago determined to provide no reimbursement for falls. And falls, particularly those with injury, are extremely costly – recent estimates of the cost of a fall with injury are as much as $14,000 per event. What’s more, a fall with injuries can result in extended length of stay by as much as an additional six days which has led to estimates as high as $35,000 per fall with injury.

The EHR-enabled solution

With a locally programmable EHR, clinicians can finally join with IT professionals in the long sought after collaborative partnership. Clinicians select the crucial indicators for never events, along with the EHR-accomplished computations needed, to enable notifications that will lead to favorable actions. The IT professionals then program the EHR to automatically and continuously assess each and every patient for risks, all through embedded medical logic modules (MLMs) within the EHR.

When clinicians and IT professionals collaborate, we see great examples of reductions in PUs at Allscripts client sites with a programmable EHR:

  • 70% reduced at an Alabama hospital
  • 69% down at a Florida hospital – and four consecutive quarters of zero acquired PUs
  • 74% fewer at a Connecticut hospital
  • 79% less at a United Kingdom hospital, and zero Stage IV cases for 14 months now

Examples of reductions in falls with injury post-implementation of the programmable EHR at the same four Allscripts implementations include:

  • 57% reduced at a Connecticut hospital
  • 70% lower rate at an Alabama hospital
  • 84% fewer at a Florida hospital
  • 46% less at a United Kingdom hospital

The collaborative partnership of clinicians with their local IT professionals works, even within the United Kingdom’s completely different healthcare model and role mixture. And the culture of these organizations changes from clinician compliance to shared collaborative solutions. All enabled by the nature and capabilities of the locally programmable and adaptable EHR.

What more could any organization want?

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About the author

Steven H. Shaha, Ph.D., DBA, is a Professor at the Center for Policy & Public Administration, and the Principal Outcomes Consultant for Allscripts. Dr. Shaha received his first doctorate in Research Methods and Applied Statistics from UCLA and has taught and lectured at universities including Harvard, University of Utah, UCLA, Princeton, Cambridge and others. An internationally recognized thought leader, lecturer, consultant and outcomes researcher, Dr. Shaha has provided advisory and consulting work to healthcare organizations including the National Institutes for Health (NIH), and to over 50 non-healthcare corporations including RAND Corp, AT&T, Coca-Cola, Disney, IBM, Johnson & Johnson, Kodak, and Time Warner. Dr. Shaha has presented over 200 professional papers, has over 100 peer-reviewed publications in print, over 35 technical notes and two books. He served on the 15-member team that authored and piloted the Malcolm Baldrige National Quality Award for Health Care, and he contributed to the Baldrige for Education.


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