EMR in the Clouds

 
 
By Wylie Wong  |  Posted 2012-01-19
 
 
 

Seton Healthcare Family, in central Texas, is using business analytics (BA) and business intelligence (BI) to diagnose and solve a problem every hospital faces: costly readmissions.

The Austin-based health care provider—which has 38 clinical locations, including 11 hospitals—is mining patient data in electronic medical records (EMRs) to discover the root causes of why patients are returning to the hospital for the same health problems. Seton’s administrators hope to spot patterns that will allow them to identify patients who might be at risk of readmission, and, in turn, develop programs for early intervention.

“The worst thing is to have a preventable readmission,” says Ryan Leslie, Seton’s vice president of analytics and health economics. “It’s getting actionable information in aggregate that will allow us to design programs to be more proactive.”

The use of BA and BI is a growing trend in the  health care industry, as more providers move away from paper-based records and adopt EMRs, analysts say. By analyzing vast amounts of medical, billing and administrative data, hospitals can detect trends and patterns, measure performance and make forecasts that will allow organizations to improve patient care and boost operational efficiencies.

“It’s a huge trend—essentially data warehousing that we couldn’t do 20 years ago,” says Gartner Research Vice President Barry Runyon. “It’s about improving patient outcomes and saving money.”

The health care industry continues to invest heavily in IT in an effort to improve patient care and get a handle on rising medical costs. It is taking advantage of everything from server virtualization, cloud computing and analytics on the back-end to EMRs, wireless telemetry equipment and automated pharmacy equipment on the front end. The goal? To improve medical care, bolster performance and reduce inefficiencies.

“You are automating workflow,” points out Tim Gee, principal of Medical Connectivity Consulting. “It’s about higher patient safety, improved outcomes and shorter length of stay, and all those things translate into lower health care costs.”

EMRs and Beyond

Health care organizations are increasingly deploying EMRs as the federal government pushes for adoption, even offering monetary incentives to increase usage. In fact, EMR adoption is expected to grow from less than 25 percent in 2009 to more than 80 percent by 2016, according to an IDC Health Insights study released last November.

To receive the incentive funds from the federal government, however, health care groups must show “meaningful use”: In other words, they must demonstrate that they are improving the quality, safety and effectiveness of care. As a result, many hospitals and clinics are busy implementing EMR-related technologies, such as e-prescription software, electronic physician order-entry software and patient portals, all of which can help make the case for meaningful use.

Good Samaritan Hospital, in Vincennes, Ind., for example, is working to implement a new Computerized Physician Order Entry (CPOE) system, which will allow the doctors to prescribe medicine and order blood and imaging tests electronically. It will both speed health care delivery and reduce the potential for errors.

The 232-bed hospital installed EMRs using McKesson’s Horizon software three years ago, providing physicians with real-time access to patient information at the hospital, at remote offices and even at home. In fact, with CPOE, physicians can do “virtual rounds” from home in the morning before they head to the hospital, says Good Samaritan CIO Charles Christian.

“They can have breakfast at 5:30 a.m., look online and see the latest labs,” Christian says. “They won’t have to worry about hunting down a nurse and ordering lab work over the phone—they can do it themselves remotely.”

Christian has spent the past year perfecting CPOE, removing items on the order list to avoid duplication and making sure the entire process is seamless for hospital staff. He is also incorporating clinical decision-support tools, which provide best practices for care. The system can alert doctors if a patient is allergic to a medication they are prescribing, he says. Evidence-based research can also provide physicians with information on the appropriate treatment for certain medical conditions.

“These are multimillion dollar investments that we are making, and they take a long time to implement,” says Christian. “We take a strategic view. It’s not just the technology itself, but the processes surrounding how it works and how to integrate the best possible experience.”

Beyond EMRs, Christian has aggressively invested in IT infrastructure and health care technology. He virtualized his servers three years ago and upgraded the hospital’s data center about two years ago. A wireless network has increased mobility and helped speed the flow of information and communications.

Today, physicians making their rounds can pull up patient EMRs on wireless laptops on carts. Wireless telemetry equipment, such as glucose monitoring devices, wirelessly input data into patient EMRs, so nurses don’t have to manually input data. Clinical nurse specialists and nurses in intermediate care carry wireless voice-over-IP phones, speeding up response times and improving patient safety.

“We’ve been pretty aggressive with technology—you might call us early adopters,” Christian says. “It’s all about servicing our customers and using technology to positively impact and provide high-quality care for our patients.”

EMR in the Clouds

Not every health care provider implements EMRs in-house, however. Small clinics and doctors’ offices can subscribe to EMR applications, rather than purchasing and installing the technology themselves.

Consider Cincinnati Children’s Hospital Medical Center, which offers EMR and revenue-cycle management applications to its medical staff who own their private practices, as well as to independent practices in the region. 

Not only is it more cost-effective for the community-based practices, but they don’t have to fret about troubleshooting and maintenance. “They don’t have to worry when a server goes down,” says Michele Fronckiewicz, the medical center’s executive director and business manager.

The medical center’s Community Practice Services department, which provides the service to the local practices, turned to the Dell health care cloud to host the EMR and revenue-cycle management applications. “Having a hosting partner take care of our servers and refreshes and redundancy has enabled us to invest in supporting the applications—and, at the end of the day, that is all the doctors care about,” she says.

Today, the medical center’s Community Practice Services department has 14 clients across Ohio, Kentucky and Indiana. Staffers from the community-based practices connect to the health care software using remote desktop connections. The patient and office data are housed in SQL Servers in the Dell cloud, Fronckiewicz says.

The medical center is currently rolling out patient portals to help practices meet meaningful-use requirements. Through the portals, patients can email their doctors questions, request prescription refills and access health records.

 

Analyze Unstructured Data

To reduce its readmission rates, Seton Healthcare Family recently installed IBM’s new Content and Predictive Analytics for Healthcare software, which integrates structured and unstructured data and uses natural-language processing and content analytics. Seton, a member of Ascension Health, installed the software using virtual servers in Ascension’s private cloud.

The software—combined with IBM’s Cognos business intelligence tool—will allow Seton to analyze its unstructured EMR patient data, such as physician notes, nurse assessments, discharge summaries and other medical documents, says Seton’s Leslie.

“We want to understand what it is about patients that is causing them to be hospitalized—and then prevent it,” he says. “This will help us identify high-risk patients, give us context as to why they are high risk and allow us
to intervene.”

Seton is initially running a pilot, focusing on patients with congenital heart failure. In the future, they will use the analytics software on other patients with high readmission rates, as well as look for quality improvement initiatives, such as gaining insight into how to make surgical care safer and less costly.

“Seton is addressing these challenges earlier than many, but everyone will need better data on patients,” Leslie says. “As more health systems use EMRs, they all will have the same unstructured data. And as the government wants more reporting on quality measures, everyone will need to figure out how to manage their unstructured data.”