Simple EHR Tool Creates 3 Benefits for Queen's Health Systems

An electronic EHR 'ribbon' provides one-click access to data and reduces certain costs by 14%.

What if it a simple one-click solution existed that enabled hospitals to reduce certain costs by 14%, ensured compliance with narcotics prescription mandates, informed physicians of coding gaps, and notified the doctor if a patient was due for a test?

In an era of complex electronic health records (EHR) that are sometimes difficult to navigate, this goal may seem impossible, yet The Queen's Health Systems in Honolulu has achieved all of those objectives and more. The solution? A simple "Smart Ribbon" from IllumiCare that appears on the EHR screen. The graphic floats across the screen, like a toolbar, issues no alerts or warnings, and can be ignored, if desired.

The solution is so simple to use, the health system experienced the cost savings without conducting physician training or even promoting the tool. About a year ago the ribbon began appearing on EHR screens, and doctors began using it on their own.

"The IllumiCare ribbon provides decision support and information at the point of care that is patient-specific," says Becket Mahnke, MD, chief medical information officer for The Queen's Health Systems, which includes four hospitals and 70 healthcare centers and labs throughout Hawaii and the Pacific. "The ribbon itself has a variety of different applications that can be placed upon the device, depending on the hospital system's intent."

Queen’s is experiencing three benefits by using the tool: reduced costs, the opportunity to enhance compliance with opioid prescription mandates, and the ability to bring other data to the forefront for physicians, including reminders for routine tests and screenings, plus notification of coding gaps to maximize reimbursement. (See Editor’s Note below.)

1.  Reducing Costs
 

A look at how Queen's is using this tool may provide a model for others who are seeking to reduce costs and find easier ways to access and utilize crucial data. The system is involved in other innovative cost-cutting measures. In July 2018, HealthLeaders reported on an initiative that reduced write-offs at its flagship hospital from $2.7 million to $92,000 and improved its cash flow by $5 million.

Interestingly, Queen's didn't deploy the IllumiCare solution for any of the issues the tool now addresses. The original intent was to make predictive analytics from a third-party vendor immediately visible on the EHR screen so that physicians wouldn't have to perform complex navigations to access the data.

There was a targeted rollout to select physicians who would benefit from the analytics, but no formal announcement to other physicians on staff. "We just kind of turned the functionality on," recalls Mahnke.

While the arrangement with the other predictive analytics vendor didn't work out, to the surprise of administrators, physicians using the EHR noticed the ribbon provided access to costs for radiology and laboratory tests. They spontaneously began using those functions and the money saved more than paid for the engagement with IllumiCare, which is based in Birmingham, Alabama. 

Based on that accidental success, the system expanded its relationship with the tech company and has launched the Stewardship app, which also includes medication costs, systemwide. About 300 high-volume physicians have been using the tool; the rollout includes an additional 900. Most valuable, perhaps, is immediate access to cost information, which displays wholesale prices (not charges to the patient).

"Before, we had no way to convey this information, and most healthcare organizations and physicians have no idea what the costs of medications, labs, and radiology tests are," says Mahnke.

So far, Queen's is saving about $110 per admission, reducing medication, laboratory, and radiology costs by about 14%.

There are 120 hospitals using the technology, and Queen's is not the only health system to experience a cost reduction. In partnership with the technology company, the Texas Hospital Association tested the ribbon at a number of facilities in the state. The pilot demonstrated, on a DRG-adjusted basis, a $170.16 per admission decrease in the cost of inpatient medications, labs, and radiology tests. This includes a 14.2% average reduction of inpatient medication costs, a 14.3% reduction in inpatient lab costs, and a 5.6% reduction of inpatient radiology costs per hospital, encompassing more than 143,000 admissions.

Besides cost information, the Stewardship app provides additional value:

• The system displays lower-cost and dose-equivalent alternatives (if applicable and on the formulary), as well as the increased risk of C. difficile from antibiotics and proton pump inhibitors, risk of adverse drug reactions from polypharmacy, and excess fall risk from sedatives and opioids.
   
• Besides the cost of imaging, it also reveals cumulative medical radiation exposure across patient encounters and estimates the associated cancer risk based on patient-specific factors in lay language for patients.
   
• Costs for lab tests are supplemented by information, such as timing intervals to discourage repeated labs within a non-clinically useful time frame, as well as phlebotomy-associated blood loss and associated anemia risk.
   
• Another option: Physicians can see how their costs compare to their peers.

Simplicity is one of the primary advantages of the tool, says Mahnke.

"The technology is intuitive to use," the CMIO says. "You don't need special training and that's how good technology or good applications work. The information is readily available and there when you need it, but not too intrusive."

2.  Enhancing Opioid Compliance
 

Also critical to Queen's is a function that enables physicians to quickly check for a patient's previous opioid use. As of July 2018, doctors in Hawaii are required to check a state database to review whether a patient has any current or previous prescriptions for controlled substances, a process that adds several minutes to each patient encounter.

"There's great intent to that law," says Mahnke. "The problem is, it's yet another thing that the provider has to do, and that takes away time from the doctor-patient interaction."

The ribbon provides a one-click shortcut. In a pilot, the tool cut about two minutes out of the process.

"It will be a phenomenal time-saver," says Mahnke, "returning that time back to the doctor-patient relationship."

Nicholas Desai, MD, enterprise chief medical officer with Houston Methodist, is also using the ribbon for a similar purpose and in a January 8 article in the Houston Chronicle said, "This will help in alleviating the overprescribing of opioids that is surpassing norms."

3.  Bringing Other Data to the Forefront
 

Queen's also has customized the ribbon to put additional information front and center for physicians. The health system works with Health Catalyst, which, among other things, provides useful information about health maintenance and coding gaps.

"We've got this fabulous information, but it's locked away in another system," explains Mahnke.  The health system decided the ribbon would be the perfect place to provide access to the information. The two vendors worked together to devise a solution.

Physicians can now easily see if patients are due for routine diagnostic tests, such as colonoscopies, mammograms, prostate, or high blood pressure screenings, and other tests.

"It's readily available to me at the point of care," says Mahnke. "It takes one click to get to it and, therefore, I'm likely to attend to that critical information and the provider can spend time providing care, not trying to find information."

In addition, the ribbon identifies coding gaps for newer payment models "where you're not paid by how much care you deliver, but you're paid by how sick your patient is," says Mahnke. To ensure proper reimbursement, once a year certain codes need to be logged into the system. The ribbon reminds them to do it.

Editor's note: This story has been updated to clarify the benefits that Queen’s is experiencing.