By Brita Hansen, MD, Chief Medical Officer, LogicStream Health
Twitter: @Logic_Stream
The era of modern medicine has produced groundbreaking discoveries that have helped save countless lives. But despite their value to patient care, these discoveries also place a heavy burden on providers and their organizations. A study published in 2011 estimated that as of 2010, medical knowledge began doubling every 3.5 years. By 2020, the doubling rate is expected to drop to approximately 73 days. This rapid rate of change has a significant influence on clinical processes. Today’s best practices may be outdated tomorrow. This, in turn, creates unnecessary variation in clinical processes and increases morbidity and mortality risks that can be avoided.
A 1999 report by the Institute of Medicine examining the underlying causes of medical errors notes that they primarily stem not from individual carelessness, but rather from faulty systems or obsolete processes. Today, intense federal scrutiny of quality measures has forced healthcare organizations to increase their focus on clinical process control and improvement, updating obsolete or ineffective clinical processes to mitigate risks to patient safety, reduce resource waste and prevent regulatory penalties.
Now more than ever, provider organizations must develop strategies that streamline best-practice adoption and reduce variation in clinical processes. Many healthcare facilities are turning their attention to clinical process and employ strategies, such as Plan-Do-Study-Act cycles, Lean or Six Sigma. Unfortunately, these efforts often fall short of generating meaningful and sustainable improvements to patient outcomes. The reason? These methods require substantial resources and significant time to aggregate and analyze the requisite data that highlights the workflows requiring intervention. We often end up relying on manual data collection to support this work or simply go without the needed information. Our current reporting cycles are simply too long to support robust process improvement and rapid cycle iterations. What is needed is instant insights put directly into the hands of those doing the improvement work.
Given the limited resources of most hospitals and health systems and the growth rate of medical knowledge, traditional methodologies for process improvement and control are neither sustainable nor scalable. Value-based care demands instant insight into quality data that facilitates real-time process control and improvement. Recognizing the need for continuous process measurement and change management, many provider organizations are turning to health IT software solutions to develop streamlined, continuous clinical process control and improvement initiatives.
Technology’s Role in Clinical Process Control and Improvement
In the years following HITECH, electronic health records (EHRs) became the central repository of clinical data and content, making these systems, in many ways, the primary driver of care. Leveraging clinical process control and improvement software systems capable of analyzing this information affords clinical leaders and improvement teams the ability to eliminate their dependence on outcomes data to direct process decisions. Technology-enabled process improvement involves the clinician-led review of clinical knowledge and decision measurement to identify outdated or redundant processes and best-practice adherence, versus relying on lagging indicators such as outcomes.
Knowledge Management and Process Standardization
The EHR workflow and the content within the system heavily influences the care that clinicians provide. As healthcare organizations undertake new improvement initiatives, they often build layers of non-standard content into their EHRs—content that rarely drives changes in clinician behavior. For example, health systems nationwide experience approximately 24 million alert firings a year and on average, clinician responses, whether delays in response time or alert overrides, vary by approximately 65 percent. One reason, an excess of non-standard content can decrease alert sensitivity and specificity, causing alert fatigue, which in turn, causes clinicians to lose trust in the alerts, representing a serious risk to patient safety. Removing all non-standard content so that only the latest best-practice knowledge remains is essential to reducing process variation.
Process design is equally important as it determines how clinicians interact with content. Clinical and EHR workflows often don’t align, creating even more variation in patient care. When weeding out non-standard content, CPI teams should remain cognizant of the “Five Rights of CDS” (clinical decision support) and make corrections to ensure that the 1) right information is delivered 2) to the right person 3) in the right format 4) through the right channel 5) at the right time in the workflow.
Process Adoption and Change Management
Building and managing standardized processes alone, while imperative, does not guarantee adoption among clinicians. Several factors can lead to process variation. In some cases, variation is warranted, which is why it’s important to only eliminate needless systemic disparities in the use of best practices. Using a clinical process control and improvement software solution, organizations can continuously measure clinician decision-making and process adherence at both the individual and group levels rather than waiting on final outcomes data. When a pattern of variation is identified during routine measurement, clinical leaders can target interventions to individual clinicians—a strategy that is more likely to lead to sustained changes in behavior. If, however, a problem lies in the process, these issues should be addressed before correcting clinicians’ actions.
Dynamic Solutions to Discrepancies
To create a sustainable, resource-efficient clinical process control and improvement strategy, hospitals and health systems must continuously monitor clinical outcomes in the context of process interventions and clinician actions. Traditional quality improvement methods rely too heavily on lagging indicators and offer little insight into where corrective actions are needed.
The modern healthcare environment requires dynamic solutions to address the discrepancies in the use of best practices to treat patients. One academic facility in the Northeast used a clinical process control and improvement software platform to assess the effectiveness of alerts and analyzed clinician responses when they fired. The facility discovered that approximately 20 million alerts were fired annually caused by a plethora of redundant and outdated content. In removing the non-standard content, the organization reduced alert firings by roughly 50 percent, thereby lightening the burden on the clinical workflow. The facility also used CPI technology to tackle variations in lab orders and eliminate inappropriate test ordering. As part of the response to the results of its analysis, it eliminated one redundant lab test, resulting in savings of more than $120,000 in the first year.
In leveraging clinical process control and improvement software to improve processes and adherence, provider organizations can correct the issues inhibiting quality improvement today and position themselves to streamline the implementation of new medical knowledge in the future—reducing the time from discovery to practice where it can influence care quality and outcomes.