Data technology holds the key to unlocking “gold nuggets” of information from electronic health records and other data systems that are paving the way to earlier patient discharges, fewer readmissions, and improved outcomes. Nowhere is this more evident than at the Penn Medicine Center for Health Care Innovation. The most recent issue of System News
explores this high-tech world, where the Center’s multidisciplinary – and interprofessional – teams are developing health care strategies that are having a tremendous impact on patient care.
Agent is one of the Center’s key initiatives. This technology platform pulls real-time data from multiple electronic data sources focusing on specific patient populations and then delivers this critical information to clinicians through alerts to their phones or through a dashboard which is easily accessible to a patient’s care team. Collaborations with Agent have led to several successful interventions throughout Penn Medicine.
For example, at the Hospital of the University of Pennsylvania, it helped tackle the challenge of “high utilizers.” While these patients – who are admitted many times per year – represent a very small percent of admissions, “they use a disproportionate amount of resources,” said Kirstin Knox, MD, PhD, a hospitalist in Internal Medicine.
Knox explained that putting together a complete history on these patients, whose care is often fragmented – they are seen in many systems and by many providers – is a challenge, especially in the ED where time is of the essence. And, while these patients receive the acute care they need during each hospitalization, often “we’re not able to identify or address the underlying problems,” which commonly involve a combination of social, psychological, and medical issues.
Starting in 2015, a multidisciplinary group – which included doctors, nurses, social workers, community health workers, and other care providers – began putting together customized continuity care plans for high utilizers that are available to all providers as part of the patient’s electronic medical record. Working with the Agent team, the group developed a dashboard that allows team members to track patients and organize and assign care coordination tasks.
In addition, “Agent now sends us an alert via Cureatr [Penn Medicine’s secure and HIPAA-compliant texting system] every time one of our patients comes to the ED,” Knox said. “We can go down to see the patient or call the ED provider, depending on what’s appropriate, and make a decision on what needs to be done.”
Having patient information available on a dashboard – and not in multiple places – and receiving real time alerts have helped to decrease these admissions to HUP by 40 percent. “We’re able to intervene earlier and that makes a difference,” she said.
Another recent Agent project – in partnership with Information Services and Data Science – focused on weaning patients in the medical intensive care unit from mechanical ventilators. Studies show that the less time spent on a ventilator, the less chance of complications, but the weaning process is complicated and requires multiple interdisciplinary steps, including adjusting medications and reducing sedation. Thanks to Agent’s single dashboard displaying real-time results and alerts sent to providers, both the time spent on a ventilator – and in the ICU – were reduced.
The Agent team is unique in that physicians play key roles in the process. “We not only create the application but also make it fit into the clinician’s workflow and have the features they need,” said Eugene Gitelman, MD, clinical informatics manager. “We’re coming at problems as clinicians first.”
Sometimes just changing a default in a data system setting, such as on an electronic health record, can make all the difference. Penn Medicine’s Nudge Unit, which “guides” people to make better decisions, has used this strategy to tackle several challenges in the health care arena.
One collaboration effort focused on prescribing cardiac rehabilitation for heart attack patients. Studies show that this type of rehab – which includes exercise, education, and life-style changes – reduces mortality by 30 percent, but last year, Penn providers referred only 15 percent of these patients to structured exercise programs. Although there are several reasons for this low rate, one contributing factor was the manual referral process.
“Doctors had to handwrite the prescription,” said Mitesh Patel, MD, MBA, director of the Nudge Unit.
Working together, the Nudge team and cardiology group redesigned the referral process by changing the default for referral from “opt-in” to “opt-out” and delivering real-time alerts to frontline providers via Cureatr. Since the changes were instituted in February, the referral rate has skyrocketed to 80 percent.
Another project changed the default for ordering CT scans for patients on palliative care who receive radiation therapy to alleviate certain side effects. When used as treatment, a CT scan is always performed to perfectly target the rays, but for this palliative population, national guidelines recommended no scans. Since the default change was initiated, CT orders for this population have seen a significant decrease.
Patel said that changing defaults “works well for clinicians because it doesn’t change their workflow and they can override the default when it makes sense to. It works and it’s sustainable.”
Read more about Penn Medicine’s successful partnerships between technology and medicine in the most recent issue of System News, the monthly newsletter for employees, faculty and staff of the University of Pennsylvania Health System.