For Community Medical Centers, converting medical records to an EHR format was the first step on its digital journey. Now the challenge the Fresno, CA-based health system is embracing is how to leverage technology, information, and data in ways that improve efficiency and productivity while delivering optimal — and cost-effective — patient care.
To that end, Community Medical Centers has been moving toward an evidence-based approach, integrating CDS tools into their care plan and patient education activities. The approach blends new technology with process and behavior change management initiatives.
By Scott Westcott, Contributing Writer
Seeking to deliver the best and most cost-effective patient care, healthcare providers such as Community Medical Centers are tapping clinical decision support (CDS) technology to develop an evidence-based approach to care.
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For Community Medical Centers, converting medical records to an EHR format was the first step on its digital journey. Now the challenge the Fresno, CA-based health system is embracing is how to leverage technology, information, and data in ways that improve efficiency and productivity while delivering optimal — and cost-effective — patient care.
To that end, Community Medical Centers has been moving toward an evidence-based approach, integrating CDS tools into their care plan and patient education activities. The approach blends new technology with process and behavior change management initiatives.
“We wanted to do a better job sharing documentation and information, as well as add better tools for interdisciplinary teams to operate more efficiently and ultimately provide better patient care,” says David Boyd, DNP, RN-BC, CNIO. “Our leadership saw the need to look at the continuum of care in a way that recognizes a patient as an individual person and to find the best ways to help them progress to the next level of care while reducing length of stay and improving outcomes.”
Evidence-Based Medicine Next Logical Step After EHR
Community Medical Centers faces the same challenges most healthcare organizations around the country do. Consumer expectations regarding their medical care has increased significantly as patients take a more active role in managing their own healthcare. Meanwhile, healthcare reform has altered the landscape in terms of providers increasingly being reimbursed — and evaluated — based on the quality of care as opposed to the number of services. Hospitals face reductions in Medicare payments if they do not meaningfully use technology to deliver better, safer, and more coordinated care.
Community Medical Centers had migrated patient information into a digital Epic EHR system several years ago. The move to an evidence-based approach was the logical next step to unlock the potential of sharing information and leveraging data in a digital environment.
To that end, they began in late 2012 to integrate Zynx Health Order Sets and Plan of Care templates with the AuthorSpace collaboration tool. The solution helps prompt individual physicians and clinicians to recommend and provide relevant services by drawing more directly on their expertise as well as providing ready access to the latest research comprising hundreds of diagnoses and procedures. Physicians and clinical staff can view order sets and provide and view feedback from other associates. Ideally, patient care becomes more targeted and coordinated as treatments, preventative services, and recommendations are traced as the patient moves from provider to provider within the healthcare system.
Encouraging Critical Thinking
The first step for Community Medical Centers was to address the generalized care plan templates that had largely evolved into generic checklists as opposed to a more patient-specific plan of care. For instance, time was being consumed reviewing daily task-based interventions for obvious items such as starting ordered IV infusions or taking safety- and policy-driven precautions to prevent fires.
“We wanted to move staff away from documenting things that were already covered by hospital policy and instead be critically thinking about what would be relevant to that specific patient,” says Lauren Garrick, RN, Corporate Informatics Nurse for Community Medical Centers.
All told, Community Medical Centers had 30 to 40 general planof- care templates, with each department having their own content based on the care setting. A central piece of the conversion was the establishment of 122 disease- and condition-specific templates. Several of the initial templates were rolled out in a pilot program to assess effectiveness and garner staff feedback toward developing clear communications and training support.
“We have an environment where you can kick the tires and allow the end user to go into what we call the playground environment and experiment without concern,” says Boyd.
Following the pilot, the new solution was rolled out systemwide along with ongoing support and education efforts. Garrick concedes a key element of success is encouraging behavior change, particularly for those who have been using existing documentation protocol for many years.
Sharing Relevant Patient Data Improves Health & Wellness
“It takes time and definitely does require a culture change,” Garrick says. “Evidence-based medicine changes a very conventional workflow, and it can be a tough challenge for people who were used to a daily checklist style of care planning. It’s a different tool now, and that’s the biggest challenge.”
Garrick said this particular challenge is being addressed in a range of ways, and certain groups have been more progressive in adopting the new approach. Their increased use of the system has created growing peer expectations of other departments, which, in turn, has led to greater participation.
In addition, better communication and coordination between the care team members has been achieved with each discipline documenting and sharing the same patient problems and goals. This benefits both patients and providers, who become more engaged in using their clinical knowledge and critical thinking skills to develop a more customized treatment approach, improving the chances of better patient outcomes.
“We want everyone to work to the top of their license, sharing as much information with the team that is relevant,” Boyd says. “We are moving away from focusing on only electronic records and instead on some very specific goals to guide the patient to the next level of health and wellness.
“People start getting a greater understanding of how others are using their contribution,” Boyd continues. “They start to see that they might have been squirreling away their contribution and knowledge about patient care by documenting in silos. When they start sharing information in the plan of care, it helps create a beneficial outcome for the patient. They realize they really are making a difference.”
Including The Patient In The Evidence-Based Process
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Community Medical Centers has also seen early signs of success with the evidence-based approach. For instance, the development of new plans of care templates for various conditions are more in line with current standards. A specific example: A plan of care for orthopedic joint treatment no longer includes standard use of a continuous passive motion (CPM) machine, but rather allows for range-of-motion to be addressed per patient-specific needs. In addition to this, through interdisciplinary sharing of the patient’s problems in the plan of care, Physical Therapy staff has reported that nursing staff has easier access to PT/OT/SLP (physical therapy/occupational therapy/ speech-language pathology) documentation regarding patient activity, mobility, cognitive, swallowing, and self-care needs.
Moving forward, the team is working toward continuing to enhance the change management process to gain wider adoption throughout the organization. A second goal is developing better integration of the patient and the patient’s family in the process.
“We’re expected to share relevant information and provide education to the patient and the patient’s family,” Boyd says. “We are working now toward weaving that patient and family into the chart and the workflow. That is key to really moving patients to the next level of care.
“The patient, the person receiving care, is the most important part of this process, and all our work to directed toward how we are really making a difference for the patient and the families.”
The evolution toward evidence-based care is ongoing and will require continued education and engagement of physicians and clinicians to achieve the goal of better care delivered in more efficient and cost-effective ways.
“There is really no end to this work,” Boyd says. “It’s an evolving process in which we continue to ask how do we better use the actual evidence we have to deliver the best care in the most efficient way possible.”
For Community Medical Centers, converting medical records to an EHR format was the first step on its digital journey. Now the challenge the Fresno, CA-based health system is embracing is how to leverage technology, information, and data in ways that improve efficiency and productivity while delivering optimal — and cost-effective — patient care.
Community Medical Centers has also seen early signs of success with the evidence-based approach. For instance, the development of new plans of care templates for various conditions are more in line with current standards. A specific example: A plan of care for orthopedic joint treatment no longer includes standard use of a continuous passive motion (CPM) machine, but rather allows for range-of-motion to be addressed per patient-specific needs. In addition to this, through interdisciplinary sharing of the patient’s problems in the plan of care, Physical Therapy staff has reported that nursing staff has easier access to PT/OT/SLP (physical therapy/occupational therapy/ speech-language pathology) documentation regarding patient activity, mobility, cognitive, swallowing, and self-care needs.
