HIMSS14: Rapid adoption saves Lakeland Healthcare millions
ORLANDO—Lakeland Healthcare saved millions of dollars by pursuing “fast and furious” EHR implementation, said Norma Tirado, MBA, vice president and CIO, at the Health Information and Management Systems Society's annual conference.
To date the Michigan-based system has spent only $37 million of the $60 million projected on adoption, but once all the expenditures come through Tirado estimates a total of $10 million in savings by speeding implementation.
While for the most part Lakeland did not use many consultants during adoption, it did partner with a consultant to target key EHR benefit focus areas, quantify a set of expected EHR benefits and develop a governance structure to support accountability and benefit realized, explained Karen Kinyon, PhD, MS, RN, director of clinical transformation and analytics.
In house, they reviewed and normalized data to create a benefit assessment and identified key performance indicators, as approved by leadership. “It was not just about implementation, but about getting value out of it,” said Kinyon.
A RaDAR Team of ConnectCare team members, operational partners and executive sponsors was assembled to develop key performance indicators that would drive better outcomes. With a low budget, Lakeville relied on clinician volunteers and found that many were willing to participate in the process. She attributed interest to the desire of clinicians to fulfill a greater mission of improving care and saving lives.
The purpose of RaDAR was: identifying clinical/financial ROI, ensuring team accountability, identification opportunities and pushing forward the capture, reporting and response parts of the rapid implementation cycle.
As the cycled circled through, Lakeville saw a number of benefits.
The system saw immediate savings as CPOE adoption reduced hospital transcription. “We saw that oversight,” said Kinyon.
The post-EHR health information management system had a positive impact on revenue cycle. The paperless coding handles all Correct Coding Initiative and medical necessity edits pre-bill, and pre-bill audits are completed in one day. “We were able to reduce uncoded days.”
The team also looked to reduce readmissions, utilizing a strategy that involved multidisciplinary rounding, bedside shift reports, medication reconciliation improvement, established chronic heart failure (CHF) navigator, navigator work list, ED white board 30-day readmission flags, predicative risk scoring and vital sign alert scoring.
The effort paid off, with CHF readmission rates falling from 24.7 percent in 2011 to 20.8 percent in 2013, Kinyon said.
Also, the system was able to reduce adverse drug events utilizing CPOE and barcode scanning, saving more than $500,000 in 2013. “As scanning rates went up, errors decreased,” Kinyon said.
The team also developed new practices for core measure compliance, which involved order sets with pre-checked boxes, reminders on papers and forms used in care delivery and memory-based reminders, reinforced with education and training. “We saw slow but steady improvement," Kinyon said.
Other successful initiatives included a patient-based radiation safety program that flagged patients who had received more than five CT exams. As alerts began firing at physicians, they started choosing alterative procedures that involved no radiation exposure. “As alerts increases, less CT exams were ordered,” she said.
Transitions of care also improved, with new protocol implemented that required care managers and primary care providers to schedule appointments for high risk and moderate risk patients, and others as needed. Kinyon cited a patient discharged that had failed to receive oxygen and was short of breath. A follow-up call alerted the provider to the problem, who was able to get oxygen to the patient.
Other cited improvements included the integration of immunization records with the EHR, improved patient engagement and appointment setting through the portal, and a new quality program targeting sepsis.
Most importantly, the health IT program translated to 32 saved lives, said Tirado. “We believe ROI really is defined in terms of lives saved.”