Information technology has changed the world, and now it’s changing health care in dramatic and fast-moving ways. Rush is a national leader in using IT to achieve better outcomes, lower costs and improve the patient experience.
Recognizing this leadership, the Health Information Management and Systems Society (HIMSS) named Rush University Medical Center a winner of the HIMSS Nicholas E. Davies Award of Excellence for its use of health information technology to substantially improve patient outcomes and value. Announced Jan. 10, the award recognizes organizations that meet HIMSS’s stringent evaluation criteria and use health information technology to achieve sustainable improvement in outcomes.
The three Rush projects submitted for the award make innovative use of the Epic electronic health record (EHR) to improve quality of care, increase efficiency and reduce providers’ workload to free up more time for patient care.
Reducing C. difficile infections: targeting the true cases
Many of us carry C. difficile bacteria in our intestines as part of the body’s normal bacterial flora. If that balance is disrupted (because of long-term antibiotic use, for example) C. diff. can cause an infection that leads to diarrhea and other symptoms — which in some cases can be fatal.
Patients with active infection are contagious; the bacterium is very difficult to kill, and spreads via health care workers’ hands and contaminated surfaces. At the same time, because so many people are C. diff. carriers, it’s easy to misidentify patients as being actively infected, which leads to unnecessary patient isolation, antibiotics, cleaning protocols and protective gear.
When Rush leaders realized in 2016 that the Medical Center’s reported incidence of hospital-onset C. diff. infections was higher than national benchmarks, it was time to go on the attack — and to zero in on true cases of C. diff. An interprofessional team was convened to reduce infection rates by identifying patients with active infections and focusing infection control efforts on them.
The Rush IT team brought technology to the fight in several ways. First, they added best practice advisories (BPAs) to the EHR to help nurses identify C. diff. symptoms earlier — and to empower them to order C. diff testing when indicated, to confirm active infection earlier. A newer BPA alerts providers to discuss the patient’s clinical status with an on-call infectious disease physician on call before ordering a test; this helps with decision-making and reduces the number of tests ordered for patients who don’t have clinical symptoms consistent with active C. diff infection.
Now, “pushed reports” are sent out daily, identifying all patients who have tested positive for C. diff. These reports alert nurses and environmental services staff to enact infection-control protocols, including twice-daily room cleanings as well as specific hand hygiene and disinfection instructions. Auditing and reporting tools eliminate the data errors inherent in processes that had previously been done on paper (e.g., environmental cleaning audits). And reports pushed to leaders keep them informed when BPAs are issued.
The results: As of August, these new EHR tools had helped Rush University Medical Center decrease its rate of hospital-acquired C. diff. infection by more than 57 percent, putting it below the national median. Patient outcomes and quality of life have improved; for example, proper screening for active infection has decreased the number of patients placed in isolation or prescribed antibiotics they don’t need. And while there are costs associated with early identification and treatment, the cost reduction achieved by avoiding unnecessary treatment and precautions means that the total cost of treating patients with C. diff is down an estimated $1.2 million over the last two years.
Substance Use Intervention Team: Universal screening means help for more people
According to the Chicago Department of Public Health, the rate of opioid overdose deaths in Chicago is 50 percent higher than the national rate. In response, an interdisciplinary task force at Rush came together last year to develop a comprehensive program to screen all inpatients for substance misuse, begin treatment for those who need it and help them transition into outpatient care.
To eliminate any possibility of bias in screening patients for substance misuse, two questions about substance use now are required entries in each patient’s EHR. If patients’ answers indicate that they need help, the EHR triggers a visit from a hospital social worker, who conducts a more in-depth screening. When needed, the EHR prompts the next step: a referral to the Substance Use Intervention Team (SUIT).
“Universal screening breaks down the stigma and prejudices that many people — including health care providers — have around substance use,” said Kristin Hill, MA, practice administrator of population behavioral health in Rush’s Department of Psychiatry. Noting that people of every race, socioeconomic status and diagnosis misuse opioids and alcohol, Hill added, “now, those two questions are front and center for everyone” as required EHR entries by inpatient nurses.
Because many insurance providers offer limited mental health coverage, SUIT consults and referrals are provided by toxicology-certified emergency medicine physicians rather than by a psychiatrist. A SUIT social worker helps the patient transition to Rush’s outpatient addiction medicine clinic and other resources, including psychotherapy and case management.
The results: SUIT has used these EHR improvements to help Rush identify and treat a population of substance users who had previously been missed. Since October 2017, nearly 35,000 patients have been screened for substance use, SUIT has responded to 218 inpatient consult orders, and more than 100 patients have begun medication for addiction treatment in the hospital or in the addiction medicine outpatient clinic, which continues to be a bridge clinic for more than 50 patients.
The Road Home Program: improving treatment in real time
Nearly one-fourth of veterans who’ve served in Iraq and Afghanistan suffer from post-traumatic stress disorder (PTSD), but research suggests that less than 20 percent of veterans who need it receive evidence-based treatment. The Road Home Program: The Center for Veterans and Their Families at Rush, established in 2014, aims to make sure that veterans receive and complete the treatment they need for a wide range of mental health problems, including those resulting from combat trauma and military sexual trauma. Evidence-based PTSD treatment is part of its three-week intensive outpatient program (IOP).
The Road Home Program was able to streamline data collection with specialty forms in the Epic EHR plus online client surveys. Continuous analysis of this data lets clinicians track each client’s progress in real time during the IOP and regular outpatient care, enabling them to adjust session content as needed to ensure the most effective care possible.
The team designed its tools with input from clinicians, researchers and system administrators, with an eye toward minimizing the time clinicians spend on documentation. All documentations can be completed in 90 seconds or less, and captured data can be easily extracted and analyzed to support continuous improvement — not only of each client’s treatment, but also of the overall program.
The results: In 2016, about three-fourths of IOP participants had a clinically meaningful reduction in PTSD symptoms, and just over 20 percent no longer met the diagnostic criteria for PTSD at the program’s end, Today, the same percentage experience a reduction in symptoms, but 58 percent no longer meet the criteria after completing treatment — demonstrating that the program has become more effective over time as a result of these data-driven changes. Rush has shared the Road Home Program data-capture system with other academic medical centers in the nationwide Warrior Care Network of PTSD treatment centers, so that more veterans can receive effective care.
Transforming care demands leading-edge tools
As one of the highest honors an IT organization can receive, the Davies Award recognizes Rush’s work toward its vision to transform health care. “We’re incredibly honored to have received this award, especially because this was our first time applying for it,” says Brian Patty, MD, vice president and chief medical information officer at Rush. “For our team, improving the quality of care means focusing on the clinical side of IT to give providers the best possible tools for hardwiring quality into the process.”