Communication & EHR Integration Improves Patient Experience

March 2, 2016

Liz Michael, RN, BSN, MS, NEA-BC Vice President of Patient Care Services and Chief Nursing Officer

Stillwater Medical Center

Conflict of Interest

Liz Michael, RN, BSN, MS, NEA-BC

Vice President of Patient Care Services and Chief Nursing Officer

Stillwater Medical Center

Has no real or apparent conflicts of interest to report.

Agenda

• About Stillwater Medical Center

• Overview of Learning Objectives

• Communication and Workflow Challenges

• Communication and Clinical System Integrations

• Benefits Realized

• Next Steps for Continuous Improvement

• Q & A

Stillwater Medical Center

• 117-bed acute care general hospital

• Not-for-profit, public trust hospital facility serving patients throughout north central Oklahoma

Essential Values:

• Strive for performance improvement.

• Respect the dignity of every individual.

• Promote an environment that is receptive to new and creative ways to achieve excellence in the services we provide.

Compassion, mutual trust and cooperation are the foundation on which these values are built.

Learning Objectives

• Evaluate how seamless care team communication and collaboration reduces errors and improves patient satisfaction

• Demonstrate how integrating communication technology with the computerized physician order entry system improves workflow efficiency and patient care, allowing clinicians to make more informed decisions and spend more time at the patient bedside.

• Analyze the need to bring a new level of reliability and repeatability to care delivery by helping hospitals standardize processes and hardwire best practices, redefining how organizations connect and share information

Industry Communication Challenges

Hospital

communications

related failures

are the 3rd

highest cause of

death in the

U.S.(1)

SAFETY SATISFACTION

Communication

impacts patient

experience and

CMS revenue

reimbursement(3) $12 billion

is wasted

annually in

U.S. hospitals

as a result of

communication

inefficiencies.(2)

WASTE

(1) New Evidence-Based Estimate of Patient Harms, Journal of Patient Safety, Sept., 2013;

Centers for Disease Control, 2010 data; The Joint Commission (2) Agarwal et. al. Univ. of Maryland, 2010 (3) Centers for Medicare and Medicaid Services (CMS)

Audience Engagement: Question #1

What is your No. 1 Communication Concern or Challenge?

A. Alarm Fatigue

B. Bring Your Own Device-BYOD

C. Care Team Communication

D. EHR Integrations

E. Patient Engagement

F. All of the Above

G. None of the Above

Audience Engagement: Question #2

Which improvement effort is a top focus in your organization?

A. Length of Stay

B. Patient Experience & HCAHPS

C. Patient Safety

D. Physician Engagement

E. Staff Satisfaction & Retention

F. All of the Above

G. None of the Above

“Communication is a foundational pillar

that every hospital should have at the top

of their priority list.

As the speed of staff communication

increases, so does coordination of care.”

Chris Roark

Chief Information Officer

Stillwater Medical Center

Addressing Communication Challenges at Stillwater Medical Center

Mobile

Communication

and

Nurse Call

Systems

INTEGRATE INTEGRATE

CPOE

and

Mobile

Communication

System Implement

Computerized

Provider

Order Entry

(CPOE)

Communication Goal 1 Reduce Response Time, Increase Satisfaction

SOLUTION: Nurse Call Integration

• Automate Patient and Staff Requests

• Enable Direct Nurse and Patient

Communication

• Escalate Requests to the Right Care

Team Member(s)

CHALLENGES:

• Staff Highly-Mobile

• Staff Not Tethered to Nurse’s Station

Communication Goal 2 Improve Workflow Efficiency, Experience

CHALLENGES:

• Physicians wrote paper orders

• Secretaries entered orders into EHR

• Orders were sent to printers in specific

hospital department(s)

• Paper shortages, system failures, and

outages caused further delays

“In health care, changes in the way we

organize our work will most likely be the

key to improvement.”

“It means creating new ways to build

teamwork once doctors and nurses are

no longer yoked to the nurse’s station by

a single paper record.”

Robert M. Wachter, MD

The New York Times

March 21, 2015

Solution: Intelligent Integration CPOE and Existing Communication System

“Would you

like to mark

room cleaning

in progress?”

“Yes”

Real-time EHR Updates Hands-free, Two-way Communication

Clinical system integration delivers the right information to the right person at the right time and place.

Enhance Patient Safety

Increase Patient Satisfaction

Improve Nurse Responsiveness

Improve Workflow Efficiency

Nurse Call

RTLS / RFID

Impact of Integrated Systems

Mobile Communication

System CPOE

Impact on Patient Satisfaction Nurse Call, Mobile Communication Integration

Staff Responsiveness

HCAHPS Scores Increased

74% to

82.4%

Pain Management

HCAHPS Scores Increased

66% to

81.3%

STEPS: SATISFACTION

Improved

reliability of delivering orders,

and improved order-to-response

turnaround times

Reduced Medical Errors

by eliminating handwritten

orders

Impact on Treatment CPOE and Mobile Communication Integration

STEPS: TREATMENT / CLINICAL

Impact on Treatment Eliminating Hand-written Orders, Reducing Errors

Source: Journal of Health Care Finance, Vol. 39, No. 1, Fall 2012,

published by Wolters Kluwer Law & Business

Nearly $1 Trillion

economic impact

200,000 Americans die from preventable

medical errors.

Satisfied Provisions

of HITECH Act to Achieve

Meaningful Use Compliance

STEPS: ELECTRONIC SECURE DATA

Impact on Electronic Secure Data

Increased valuable time that care team members spent at the patient

bedside

Impact on Patient Engagement

STEPS: PATIENT ENGAGEMENT & POPULATION MANAGEMENT

Improved bed turnover rates

and ensured beds were

available for patients

Reduced time

resources, and materials

needed to print and retrieve paper orders

Impact on Savings

STEPS: SAVINGS

“We owe them journeys – not fragments.”

Don Berwick, MD

September 13, 2010

LOOKING AHEAD: Next Steps to Improve Care Team Communication and Collaboration

• Add physician order sets to the

communication cue

• Continue evaluating technologies to

keep caregivers at then bedside

• Improve wireless access points

• Evaluate human-centered

innovations that improve patient care

Goals:

Audience Engagement: Question #3

What unintended impact has occurred due to deploying an EHR?

A. Requires Constant Checking

B. Difficult to Find Time-sensitive Info

C. Distracts from Patients

D. Less Real-time Comm w/Staff

E. Poor or Fragmented Workflows

F. All of the Above

G. None – Don’t Have An EHR

Audience Engagement: Question #4

What tech will make the most impact in the next 2-3 years?

A. Alarm Management & Analysis

B. EHR Integrations

C. Secure Texting Among Docs

D. Texting b/w Patients & Docs

E. Telemedicine

F. All of the Above

G. None of the Above

Questions?

Liz Michael, RN, BSN, MS, NEA-BC

Vice President of Patient Care Services and

Chief Nursing Officer

Stillwater Medical Center

Lmichael@Stillwater-Medical.org