Three Pillars of Clinical Process Improvement and Control

The following is a guest blog post by Brita Hansen, MD, Chief Medical Officer at LogicStream Health.

In a value-based care environment, achieving quality and safety measures is a priority. Health systems must have the capabilities to measure a process following its initial implementation. The reality, however, is that traditional improvement methods are often plagued with lagging indicators that provide little (if any) insight into areas requiring corrective actions. Health systems have an opportunity to make a significant impact on patient care by focusing on three pillars of clinical process improvement and control: quality and safety, appropriate utilization and clinician engagement.

Quality and Safety

Data in a health system’s electronic health record (EHR) typically is not easily accessible. Providers struggle to aggregate the data they need in a timely manner, often with limited resources, thereby hindering efforts to measure process efficacy and consistency. To achieve sustainable quality improvements, clinical leaders must equip their teams with advanced software solutions capable of delivering highly-actionable insights in near-real-time, thereby allowing them to gain a true understanding of clinical processes and how to avoid clinical errors and care variations.

Clinicians need instant insights into what clinical content in their EHR is being used; by whom; and how it affects patient care. This data empowers providers with the ability to continuously analyze and address care gaps and inefficient workflows.

For example, identifying inappropriate uses of Foley catheters that lead to catheter associated urinary tract infections (CAUTI) allows clinical leaders make targeted improvements to the care process or to counsel individual clinician outliers on appropriate best practices. This will, in turn, reduce CAUTI rates. To most effectively improve clinical processes, clinicians need software tools that enable them to examine those processes in their entirety, including process steps within the EHR, patient data and the actions of individual clinicians or groups as they interact with the care process every day.

Only with instant insight into how the care process is being followed can clinicians see in real-time what is happening and where to intervene, make the necessary changes in the EHR workflow, then measure and monitor the effects over time to improve care delivery in a sustainable way.

Appropriate Utilization

Verifying appropriate utilization of best practices also plays a critical role in optimizing clinical processes. Yet healthcare organizations often lack the ability to identify and correct the use of obsolete tests, procedures and medications. When armed with dynamic tools that quickly and easily allow any individual to understand the exact location of ordering opportunities for these components, an organization can evaluate its departments, clinicians, and patient populations for ineffective ordering patterns and areas that require greater compliance. By assessing areas in need of intervention, organizations can notify clinicians of the most up-to-date best practices that, when integrated into clinical workflows, will improve care and yield significant cost savings. Through targeted efforts to ensure proper usage of high-cost and high-volume medications, lab tests and other orderables, for example, health systems can achieve significant savings while improving the quality of care delivery.

The benefits of such an approach are reflected in one health system’s implementation of clinical process improvement and control software, which allowed them to more effectively manage the content in their EHR, including oversight of order sets. Specifically, the organization focused on reviewing the rate of tests used diagnose acute myocardial infarctions (heart attacks). It discovered that physicians were regularly ordering an outdated Creatine kinase-MB (CKMB) lab test along with a new, more efficient test for no other reason than it was pre-checked on numerous order sets.

Although the test itself was inexpensive, the high order rate led to massive waste and increased the cost of care. Leveraging the software enabled the organization to quickly identify the problem, then significantly reduce costs and save resources by eliminating an unnecessary test that otherwise would have remained hidden within the EHR.

Clinician Engagement

Enhancing clinician engagement is key to addressing dissatisfaction and burnout, often traced to alert fatigue and a lack of order set optimization within an EHR. The typical health system averages 24 million alert firings per year. Confronted with a high volume of unnecessary warnings, clinicians ignore alerts 49 percent to 96 percent of the time, resulting in poor compliance with care protocols. EHRs often contain an overwhelming number of order sets that can lead to confusion about best practices for patient care and a frustrating amount of choice to navigate. To increase engagement, alerts must be designed to send the right information, to the right person, in the right format, through the right channel, at the right time in the workflow; and order sets should be streamlined and make it easy for clinicians to follow the up-to-date best clinical practices.

For example, one hospital utilized EHR-generated alerts targeting potential cases of sepsis. These alerts, however, were rarely acted upon as they were not specific enough and fired inappropriately at such exhaustive rates clinicians grew to simply ignore them, creating a clear case of alert fatigue. By fine-tuning alerts and adjusting the workflow to ensure alerts were sent to the right clinician at the optimal time, the hospital was able to achieve and maintain nearly full compliance with its initiative. As early detection and treatment of sepsis increased, the hospital also reduced length of stay in its intensive care unit. Data-driven targeted interventions were developed to address outliers whose actions were driving unnecessary variation in the process.

Ultimately, when the three pillars—quality and safety, appropriate utilization and clinician engagement—are used as the building blocks for standardizing and controlling vital clinical processes, multiple objectives can be realized. Empowered with technology that supports these factors, healthcare organizations can truly achieve sustainable, proactive clinical process improvement and control.

Dr. Brita Hansen is a hospitalist at Hennepin County Medical Center in Minneapolis and Assistant Professor of Medicine at the University of Minnesota School of Medicine. Dr. Hansen also serves as Chief Medical Officer of LogicStream Health.