Part II: Implementation of Optimization Strategies that Improve Quality Programs
In the first part of this blog series, we explored the concept of value-based care and what that means for healthcare organizations in 2019 and beyond – why it is important to take the necessary steps to ensure your organization is quality driven and how that will affect revenue, growth, and payer partnerships.
In part two, we demonstrate how easy it can be to implement optimization strategies that improve quality programs.
Let’s shift our focus to Valley Health System in Ridgewood, NJ. A quality-driven organization from the start, Valley holds the gold standard for care in the New York/New Jersey area serving over 440,000 people in Bergen county and the surrounding communities. They have been recognized nine consecutive times for service excellence by the JD Power and Associates Distinguished Hospital Program, and are committed to providing outstanding patient experiences. They have held MAGNET status for nursing excellence since 2003, which is one of the highest honors in healthcare, hold an A grade leapfrog patient safety status, and have received dozen awards and accolades from organizations like Healthgrades and the AHA.
Valley also takes technology seriously, as they have a 150+ person IT staff dedicated to supporting digital health innovation. They have been on the “Most Wired” list since 2014 and continue to adapt new technologies to improve the patient and user experiences.
A Meeting of the Minds
When I first met Valley at a MEDITECH user conference, I was showcasing a TPN toolkit we were working on for our Galen ENGINUITY solution. These toolkits (or as I call them Rulekits) use rule logic to drive protocols that otherwise would not be possible in MEDITECH. Throughout the demonstration I could tell they were skeptical, asking pointed questions like “How are you doing that?” and “We thought that wasn’t possible?”
After the presentation, I learned from the team that Valley was having trouble with their VTE Prophylaxis compliance rates, dropping sharply from 96% to 79% in just 6 months post-implementation of MEDITECH’s newest platform in 2015. Moving from MEDITECH MAGIC to 6.1 allowed Valley to access more modules and functionality, but the conversion left behind years of perfected custom attribute code that Valley used to drive compliance protocols facility wide.
“We don’t have as many hospitals or employed doctors, so it’s hard for us to use policy to direct workflow. We needed something that could be automatic and intuitive like the attributes that drove this protocol in our MAGIC system” -Chris Neumann, Senior Project Analyst, The Valley Hospital, Ridgewood NJ
Implementing Intuitive Clinical Decision Support
Valley saw the value in our ENGINUITY solution and we saw the value in partnering with them on this optimization journey. Since VTE/DVT/PE’s are such commonly acquired (not to mention costly) conditions, and compliance with prophylaxis ordering can affect so many quality initiatives and programs (eCQM’s, Patient Safety Indicators (2019), HAC’s, 30/90-day readmissions), we had already designed a ready to implement toolkit for blood clot prevention using the AHRQ’s best practice guidelines. After receiving feedback from their Physician Advisory Council, we made some necessary changes to fit the toolkit seamlessly into their inpatient provider workflow.
Implementation was a breeze as this simple two-step protocol is designed to present meaningful messages to only the users that need them. This is the key preventing clinician burnout and maximizing provider satisfaction. I like to look at multidisciplinary care delivery like I’m preparing a meal. When you gather the ingredients you need to ask the right people. Would you ask your butcher for a loaf of bread? Frustration and pop-up fatigue almost always stems from being inundated with alerts and reminders that someone else was supposed to do something that’s out of your hands. We further mitigated frustration by embedding a FAQ, which virtually eliminated calls and questions to the Valley IT support staff. To date they haven’t received any calls, questions or complaints.
How it works
- Passive reminders when providers select commonly placed orders (CBC, EKG, BMP) that a risk assessment or prophylaxis orders are needed
- Shows the provider a countdown of how long the patient has be admitted for
- Only presents alert reminders to the patient’s Admitting/Attending or Providers in their work group
- Only presents alert reminders if the patient is an inpatient who is over 18
- Tracks how many alerts each provider receives per patient
- Allows providers to quickly and easily assess the patient’s risk level
- Suggests CMS approved pharmacological and/or mechanical prophylaxis orders based on the patient’s unique risk (this reduces variants in care delivery that typically lead to lower quality and never events)
- Allows providers to select and queue up orders from within the protocol significantly reducing time spent/clicks
- Prompts the documentation of contraindication reasons should orders not be placed
“I like this protocol because it is plug and play. Sepsis, Falls Risk, Pressure Ulcers, really any measure that has a risk assessment and required follow-up can use this two-step protocol to increase compliance and patient safety. Galen is committed to, and passionate about providing technology to improve patient outcomes. In addition, we are giving providers important information just in time when they really need to see it! This protocol not only does that with proven results, as seen at Valley Health, it also improves the organization’s bottom line and meets regulatory driven requirements. I call that a WIN-WIN!” -Christy Erickson, MSN, PMP, PCMH CCE, Director, Clinical Transformation
Valley Health went LIVE with the ENGINUITY VTE Prophylaxis Compliance protocol in November of 2018 and in just three months post implementation, compliance is at 94% and on the rise. This is the highest compliance rate Valley has seen since 2015. Trends from the AHRQ indicate that VTE prophylaxis compliance over 90% results in a significantly lower blood clot rate (VTE-6).
You can see how your blood clot rate measures up on Hospital Compare – Timely & Effective Care – Blood Clot Prevention.
Happy Patients and Providers
We have seen 100% end user satisfaction with this protocol despite providers acknowledging over 3000 reminders since LIVE. Behind the scenes we track the Alert to Follow-up ratio and provide Valley executives with a monthly analysis report. In most instances, reminder alerts are followed up with completed assessments and prophylaxis orders within 5 minutes. To us, this means that the messaging is meaningful, helpful, and undisruptive to workflow.
“What the ENGINUITY Team is doing for us is filling a full-time job. A job that requires a very niche skill set that is really hard to find. Galen has been able to build for us in 6 months what our IT team has been asked to do since we went LIVE with 6.1 in 2015” -Chris Neumann, Senior Project Analyst, The Valley Hospital, Ridgewood NJ
Next Steps/Strategic Advisory
Being an organization that strives for excellence, Valley Health is looking to further close the compliance gap for optimal results. The Galen ENGINUITY Strategic Advisory Team has conducted data analysis and recommended the additional following steps:
Increase the likelihood of receiving an alert
Alert reminders are only attached to the 8 most common orders and are suppressed if the order is placed as part of a set. Because of this, there are some cases where a provider will not see a reminder. We are exploring adding more common orders to widen the chances of receiving a reminder.
Our analysis shows that adding the protocol to more orders increases the chance of completing a risk assessment, which ultimately leads to placing the patient on prophylaxis. The likelihood of placing the patient on prophylaxis if no risk assessment has been completed is only 18% so we will focus on getting assessments completed within 24 hours of admission.
Identify offenders and adjust protocols as needed
Since provider alerts can be tracked and trended, further analysis can be applied to identify specific providers, or locations that are less compliant than others. Protocol logic can then be adjusted to present messages more frequently or present different verbiage to repeat offenders.
We do advise that implementing these types of enforcing protocols could lead to a decline in provider satisfaction. When it comes to optimization, it’s about finding a sweet spot that keeps everyone happy; patients and providers.
Overall, we are thrilled to continue to work with Valley Health by rolling out our suite of ENGINUITY toolkits. We are committed to improving outcomes, decreasing provider burnout, and optimizing their MEDITECH EMR.
“We’ve seen excellent results with ENGINUITY. The VTE Protocol is instrumental in improving compliance and there is no doubt that ENGINUITY has prevented patients from getting blood clots” – Dr. Joseph Yallowitz, VP & CMO, Valley Health System