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Using EHRs to Cut Unplanned Readmissions in Half

When staff at University of Missouri Health Care (MU Health Care) designed an intervention using health information technology (IT) to reduce unplanned heart failure readmissions, their goal was to cut readmissions by 5 percent. To their surprise, after only nine months, the health system cut heart failure readmissions by nearly half.

This remarkable reduction in readmissions showcases how essential hospitals can use health IT — specifically electronic health record (EHR) systems — to improve patient outcomes and reduce health care costs.

Collaborating to Build Health IT Tools

Bryan Bliven, chief information officer, and Thomas Selva, MD, chief medical information officer, along with a multidisciplinary team, designed and implemented the project at MU Health Care. Quality improvement has been part of MU Health Care’s DNA for 15 years, Selva said. In 2017, Bliven, Selva, and the project team were recognized by MU Health Care with the CEO award for their role in reducing readmissions.

The readmissions project was realized as part of the MU Health Care Center for Health Care Quality’s Performance Improvement-Leadership Development Program. The center is committed to providing exemplary patient-centered care and improving the quality, safety, and value of patient care through research and educational programs. The leadership program focuses on six to eight core issues and recruits staff with related skills to lead a project.

For this project, the program targeted unplanned readmissions for patients with a primary diagnosis of heart failure. The selected team built the necessary tools to reduce readmissions, collaborating with health IT staff and cardiologists to develop and incorporate an algorithm for the EHR system. The algorithm mines EHRs, examining both data from the current admission and the patient’s medical history, to determine if a patient has heart failure and alert the clinical care team. The EHR then guides the care team through the appropriate steps to ensure they are treating the heart failure symptoms. The alert is particularly useful when a patient is treated for an unrelated condition and providers might not be aware the patient also has heart failure.

Involvement of clinical staff at all stages was one of the most important elements of the project’s success. Selva noted that the most successful IT-related interventions are “clinician-led and IT-enabled.” In addition to the cardiologists and IT staff who developed the algorithm, highly engaged nurses and a resident physician worked with the providers to perfect the algorithm. And at the highest level, success of the project required the involvement of executive sponsors — Bliven and Selva themselves.

While the project surpassed its goal, it wasn’t without challenges. For instance, project leaders faced resistance from providers; that’s where the associate chief medical officer stepped in. He educated resident groups and other divisions about the intervention and sold them on its importance. The project team also had to anticipate the effects of the intervention on staff workflow, accounting for extra work time and education for staff on the front lines of patient care who receive the alerts and have to adapt their care plan accordingly. Bliven said implementing appropriate data analytics also was crucial to measuring and maintaining progress.

The team at MU Health Care already is looking to expand the intervention to other readmissions beyond those related to heart failure — chronic obstructive pulmonary disease, for example.

The project at MU Health Care is just one example of how essential hospitals are leveraging health IT to streamline the provision of health care, improve health outcomes, reduce health care costs, and improve the patient experience. Federal laws and regulations require providers to adopt, implement, and use EHRs to avoid payment penalties under Medicare. While some of the requirements of Medicare EHR Incentive Program are difficult for some providers to meet, MU Health Care shows that using EHRs to solve complex problems can benefit the provider, the patient, and the health system at large.


About the Author

Shahid Zaman is a senior policy analyst at America's Essential Hospitals.

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