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How data is presented to clinicians can make work more efficient, bend the cost curve

Integrating cost and clinical-decision-support information reduced medication errors and burnout prevalence at Houston Methodist.

Jeff Lagasse, Associate Editor

If a hospital or health system's goal is to help providers make higher-value care decisions that improve outcomes and reduce costs, the key to doing so is data -- and presenting it to care teams in a fast, actionable manner.

Houston Methodist recently tested this hypothesis in a 90-day pilot study that explored how presenting clinical and financial data at the point of care could impact ordering behavior and facilitate cost-effective, quality clinical decision-making.

Led by Chief Medical Information Officer Dr. Nicholas Desai, the pilot consisted of 145 providers and 38 pharmacists. Providers were presented with a tool that offers real-time, patient-specific cost and select risk data for medications, labs and radiology studies, along with seamless access to patients' Texas Prescription Monitoring Program reports.

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Providers also received context-specific alerts directly within their clinical workflow based on electronic health record, PMP and clinical surveillance data. Utilizing these proprietary tools, the organization was able to shift the cost curve within the 90-day mark.

In a HIMSS20 digital presentation, Michael Liebl, director of system pharmacy services at Houston Methodist, said the health system already had access to scores of data ranging from lab data to drug and coding information.

But it could be overwhelming for clinicians to access this information through disparate channels, which contributed to an element of confusion, and exacerbated a sense of burnout among care teams. According to Liebl's data, about 50% of physicians say they experience symptoms of burnout, and 87% of those who do say it's due largely to administrative and clerical work. Emergency department physicians reported they spend an average of 44% of their time doing data entry.

"The notion of physician burnout has certainly reached the medical literature," said Liebl. "The number of published papers on this has risen sharply."

Delivering the right information to the right provider at the right time was part of the organization's goal to restore clinical efficiency, which could stem not only burnout issues but also the cost of delivering care.

"With all of the moving parts related to the cost of care, there's a lack of awareness of the costs of a particular treatment or test," said Liebl. "It's more difficult to find that information, and (providers) would certainly like to incorporate that into their decision-making process.

"We are asking providers to be cost conscious," he said. "We are asking patients to be cost conscious as well. What we're asking is for opportunities to share that information so providers can be cost conscious during the course of their day."

Alerts delivered to the relevant care teams resulted in faster clinical-decision support, faster medication-verification and a faster response to the medication formulary and pricing. Key in this effort was a pharmacotherapy alerting-system that made staff aware of medication errors they might have been making.

"What we did when we intervened, and we presented these outcomes in direct time sequences, within a minute or two of the pharmacist making the verification, they knew they had overstepped the conditions and were made aware of that," said Liebl. "It changed the behavior of those pharmacists over time, and there was a reduction in the number of alerts once we had done our intervention and made staff aware of the verification missteps they were making. It taught the pharmacists in the moment so they didn't perpetuate that behavior in the future. It was a powerful instrument to ensure we had safe, effective verification."

By providing this information outside of the EHR, there was a statistically relevant reduction in adverse events. Faster diagnostics also translated into a reduced average length of stay for patients.

Importantly, having access to cost information, which was integrated into the data, allowed providers to consider cost savings opportunities when administering care. During the trial period, laboratory costs went down and radiology costs dipped slightly. Medication costs saw a comparatively dramatic reduction. The link was clear: The more aware clinicians were of the costs, the more they took steps to reduce those costs when appropriate.

"Those data elements taken together have resulted in a cost per admission reduction of about 5%," said Liebl. "We think that's a relevant and important opportunity to justify the investment in time and energy for the platform."

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Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com