We began with the goal of leveraging our current Information Technology (IT) infrastructure to enable our clinicians to provide more efficient, higher-quality, and more cost-effective care to the citizens of Arkansas.  To accomplish this, we needed to improve our clinicians' daily workflow by providing them with easily accessible clinical data that helped them quickly identify and respond to critical patient needs.  

Before this project began, our clinicians had to manually identify clinical intervention opportunities.  This included printing reams of paper containing active medication orders for each patient and then combing through these documents, while accessing other clinical systems, to view lab results or other clinical findings.  This manual process was usually performed just once daily and increased the risk of missed clinical changes and opportunities for interventions.  These missed opportunities could prove costly for the patient and our health system.  

To achieve our project goal, we had the following objectives:  (1) Provide our clinicians with the ability to view information from the various hospital information systems (HIS) in a single, easy-to-use location, (2) Use the latest advancements in mobile technology to give clinicians anytime, anywhere access to comprehensive patient information and clinical evidence, and (3) Help care providers identify opportunities for interventions early before an undesirable event or outcome could result.

To start, we selected and deployed Clinical Xpert Navigator (Navigator), formerly MercuryMD MData, as our technology solution to provide our clinicians with access to real-time patient information in a single view via their desktop or mobile devices.  The initial pilot saved our physicians and clinical pharmacists up to thirty minutes or more per day while rounding, due to the improved access to patient information via a single view.  Having this information readily accessible assisted our clinicians in prioritizing their rounding schedule as it was easy to identify patients with critical results, vitals, or other important needs for improved quality of care.  

We expanded use of the solution beyond the pilot phase in 2002 and increased the number of infrared synchronization stations we had supplied for those using mobile devices.  Installation of our wireless network was completed for all of our facilities in 2006.  As our wireless network expanded, more and more clinicians began accessing clinical information and referential content both within and outside of the hospital setting.  This proved to be an added value to our physicians who were on-call, following their patients throughout the day, and caring for patients in several of our facilities.

After the successful deployment of Navigator, we approached our clinical pharmacists regarding use of the real-time clinical surveillance module of Clinical Xpert, known as CareFocus.  Clinical surveillance is the process of using real-time patient information and evidence-based clinical logic to identify high-risk patient populations based on specific, hospital-defined clinical conditions.  This idea was well-received by our pharmacists who were eager to improve efficiency, improve clinical outcomes, and expand the use of the Clinical Xpert platform that helped them transition away from the existing manual, time-consuming and resource-intensive efforts related to rounding and clinical surveillance.  

Since 2006, thirty-nine (39) pharmacy clinical surveillance profiles have been created to assist the clinical pharmacists in their medication management efforts.  These profiles are set to run as often as every 15 minutes for critical surveillance criteria.  This means that our pharmacists can now access a list of their high-risk patients anytime and take prompt interventions when necessary. No more manually creating patient lists.  The result has been improved efficiency, increased interventions, and financial savings for the organization.

The technology used for this project was critical to accomplishing our objectives.  Since we had already made large investments in our current HIS and were planning for wireless mobility, we wanted to avoid other costly IT purchases.  We needed to overcome the challenges, yet optimize the value, of not being partnered with a single-vendor for all our information technology needs.  Since the Clinical Xpert technology can be integrated with any existing or future IT systems that allows for HL7 messaging, we knew it was the optimal choice for our needs. The technology was not only important because of the inherent value it provided (i.e., mobility and clinical surveillance), but because it also helped us maximize ROI of our existing technology by tying multiple information systems together to present a single comprehensive view of patient information.  

The Clinical Xpert core architecture takes real-time HL7 data feeds from the various components of our HIS - such as demographics, radiology, labs, medications, microbiology, vitals, and other transcribed reports - and populates a staging database, therefore, creating a complete patient record in a single location.  Because it maintains a direct link to our systems via HL7 messaging, the staging database always has the most current data available from our HIS (this allows the technology to serve as a downtime solution if our core HIS is down for any reason).  

The staging database resides within the hospital firewall and uses clinical patient data to populate the Clinical Xpert applications such as Navigator and CareFocus.  The data compiled in the staging database is pushed out internally to desktop computers and mobile devices within our firewall using the hospital network and internal wireless and infrared synchronization stations.  

We provide our clinicians with access to this data outside the healthcare system through a proxy server and 128-bit encryption to deliver the same clinical patient data anywhere there is Internet or cellular connectivity.  This flexible technology allows our clinicians to access their patient information through a variety of channels:  internet, wireless/WiFi, cellular, and/or infrared synchronization - all while ensuring full HIPAA compliance.   

Furthermore, it is within the staging database that the evidence-based clinical profiles run to identify patients who are at greatest risk.  Examples include, risk for an adverse drug event, worsening conditions, costly medications that could be converted to those that are just as effective but less costly, or those in need of other clinical interventions or pathways of care.  This technology has allowed our clinicians to replace manual, time-consuming, and resource-intensive processes with those that are fully automated, more efficient, and cost-effective.  

Finally, this technology was easy to use.  Our clinical pharmacists collaborated with the IS staff to quickly learn more about the solution and build several clinical surveillance profiles (also known as queries or alerts) into the system.  Patients who met the hospital-defined criteria would automatically populate a clinician's rounding list.  Since all the clinical information now resides on a single platform, our clinicians can immediately access all relevant clinical information for that patient in order to determine the need for an intervention.  

Yes

Yes

This project saves lives, time, and money while improving the overall healthcare for citizens throughout the state of Arkansas. It has also provided our clinicians with a more efficient and effective workflow that impacts the quality of care they provide and the number of lives saved within our patient population.  Clinicians can now spend more time providing patient care and improving clinical outcomes versus manually combing through charts or multiple systems to piece information together in the hope of not missing critical information and intervention needs.  Using real-time clinical surveillance, our clinicians can now take a proactive approach to patient care - identifying and intervening with high-risk patients earlier, rather than responding to them after their conditions have become more severe or potentially life threatening.  The project has inspired a newfound enthusiasm among our clinical staff as they now have the technology that not only makes their jobs easier and more efficient, but also enables them to provide better healthcare to all of our patients.

The use of a real-time clinical surveillance system has already made a huge impact at one of our facilities.  The pharmacy department now uses 39 clinical surveillance profiles broken out into numerous facility and unit-based rounding lists for the clinical pharmacists to use daily in their medication management evaluation efforts.  Pharmacy interventions at the 220-bed North Little Rock facility have increased by 30% since deploying the new solution.  This means we can now more easily identify patients whose condition could potentially deteriorate into an adverse event or clinical outcome.

Identifying these patients is only half of the story.  With our system, we are now able to quickly respond to these patients and address their condition before it deteriorates and/or identify more cost-effective medication choices.  The increase in pharmacy interventions has translated into pharmacy cost savings of an average of $39,000 per month.  Over $1 million has been saved to date at our North Little Rock facility through increased and improved pharmacy interventions.  The faster response time and more cost-effective care choices has resulted in a higher level of quality healthcare for our citizens throughout the state of Arkansas.  

A 30% increase in pharmacy interventions helped us realize, on average, $39,000 per month in additional cost savings totaling more than $1million.  Our clinicians save 30 minutes or more per day accessing and reviewing clinical information.

David House, Vice President and CIO:  "The technology has been a tremendous asset to our organization and a great example of how information technology is improving our delivery of care.  This solution places the powerful clinical information we have in our system into a single, easy-to-use format and allows our clinicians to be more responsive to patient needs.  The idea was to identify at-risk patients faster, allowing our clinicians to intervene earlier, lower costs, and improve outcomes.  This project has enabled us to do just that."  Kevin Robertson, PharmD, BCPS, Pharmacy Clinical Coordinator at BAPTIST HEALTH Medical Center - North Little Rock:  "The technology allows pharmacists to expand daily clinical involvement in direct patient care by proactively identifying patients in need of our services.  It allows us to focus our energies on patients that need us most without having to manually sift through over-whelming amounts of data manually."  (APPENDIX 1:  Dr. Robertson and Jason Eakin, PharmD collaborate).  Marina Young, RN, ACM, Case Coordinator at BAPTIST HEALTH Medical Center - North Little Rock:  "This project has been very beneficial in daily workload prioritization efforts by providing me electronic access to information in a single location.  As a result, time management and continuity of care has improved.  For example, patients requiring interventions for Core Measures can easily be identified." (APPENDIX 2:  Marina prioritizes her patient schedule).  Dr. Jack Griebel:  "The simple design of this technology minimizes the learning curve and provides accurate and timely patient data for improved clinical decisions.  I can't imagine Clinical Xpert Navigator not being a part of my daily routine." (APPENDIX 3:  Dr. Griebel evaluates patient information).  John May, Epidemiologist:  "The solution arms infection control professionals with real-time data needed to fight the battle of hospital acquired infections.  Immediate notification allows infection prevention teams to facilitate rapid investigation and prevention through an automated solution."  Dr. Michael Church:  "This allows me mobility and freedom.  I no longer have to search for a nurse or a computer station.  I had no experience with a hand-held device, but it's so easy I learned very quickly.  You just push a button to sync and it does everything for you automatically with up-to-date information on my patients and my partner's patients."  Becky Layes, PharmD, Pharmacist Coordinator at BAPTIST HEALTH  Rehabilitation Institute:  "The solution adds an extra safety net to guard our patients against adverse events from medications.  It places the information of our patients - who might be at increased risk of having a drug reaction - in front of us immediately.  We then perform a closer review of their lab data and medication profile to look for potential problems or needed adjustments and communicate that to their doctor."  Tonya Robertson, PharmD, BCPS, Pharmacy Clinical Coordinator at BAPTIST HEALTH Medical Center - Little Rock:  "With CareFocus, our pharmacists are more efficient and have a more significant impact on patient care.  For example, we are using it to improve hospital vaccination rates, identify patients needing renal dose adjustments, and find opportunities to provide more cost-effective medications."  Terrah Alexander, MS, RD, LD, Nutrition and Food Services Coordinator:  "Our staff uses this technology to be notified of patients on coumadin, those at risk for nutritional complications, and to identify patients on TPN and PPN for further assessments and chart auditing.  It assists us in meeting Joint Commission National Patient Safety Goals related to nutrition therapy and services."  

It saves lives:  We have realized a 30% increase in pharmacy interventions.  
It replaces a manual high-risk identification system with one that is automated, real-time, and evidence-based.  This means our clinicians can respond earlier to patients who are at risk, preventing potentially life-threatening adverse drug events.

It saves money:  We have realized an average monthly pharmacy cost savings of $39,000 - totaling more than $1 million - by proactively identifying patients who could receive more cost-effective medication options with equal efficacy.  We have leveraged our existing IT infrastructure to optimize value from the dollars we have already invested in our core hospital information systems.  

It saves time:  Our clinicians now save a minimum of 30 minutes per day - time they used to spend manually collecting or waiting for patient information and constructing patient rounding lists.  This process is now automated and allows clinicians to spend more time providing quality patient care.

It is scalable:  This project has been scaled to support five of our seven hospitals (the remaining two are newly acquired and currently undergoing technology assessments). This single technology solution supports our physicians, nurses, pharmacists, infection control, case coordination, stroke center, respiratory care, and nutrition and food services staff.  We are continuing to expand use of this technology in all of these areas.  As our healthcare system and user needs grow, we've planned for this project to easily scale to size to support the increased needs of our organization.

It is flexible (existing technology):  This project seamlessly integrated with our existing IT architecture and leveraged our investments in the hospital information systems.  As we continue to add or replace systems within our IT environment, the flexible architecture of this project allows us to easily accommodate those changes with no impact to our existing clinical workflow. With this technology in place, we also have an effective HIS downtime solution that ensures we have access to relevant clinical data during planned and unplanned downtime situations.  

It is flexible (new/maturing technology):  We started this project using infrared synchronization stations to distribute the real-time patient information to wireless devices.  As wireless capabilities advanced for healthcare, we adapted our project to support those capabilities.  As mobile and wireless technologies continue to develop and mature, this project will grow with them and support those advanced distribution technologies.  

With any clinical IT project in healthcare, getting buy-in and cooperation from the end users is always one of the biggest challenges to ensuring a successful project.  With the myriad of systems, tools, and processes clinicians are expected to use and follow, often times the last thing they want is another piece of technology to learn, use, and incorporate into their daily activities.  We knew that without the clinical expertise and active participation of our clinicians, the technology would not have been successful.  

With this project, we had all the key elements to making it a success in terms of funding, IT resources, and organizational support.  The last outstanding item, yet most critical element, was garnering support from our clinicians.  Fortunately, this process was not nearly as difficult as we had anticipated.  

We held several meetings with key members of our clinical staff to outline for them the features and benefits of this project and how it would improve their daily workflow and help them provide more efficient and effective patient care.  We started small, with a pilot limited to just a few clinicians, which helped us to measure the effectiveness of the technology and strategize regarding our approach to deployment throughout the entire healthcare system.  

More importantly, this pilot gave the clinicians an opportunity to use the technology and experience first hand the positive impact it would have on their daily activities.  Once they saw the potential benefits of the project, they enthusiastically partnered with us to leverage the tool to our patients' benefit.  This approach also allowed these early adopter clinicians to speak with their colleagues and evangelize the benefits of the technology.  By the time we fully launched the project, we already had a tremendous amount of support and interest from our end users.  By using this approach, we were able to minimize any objections or concerns from our clinical staff.

BAPTIST HEALTH has always strived to be at the forefront of providing our clinicians with the latest advancements in effective healthcare technology that ultimately allows them to provide the highest level of care to the citizens of Arkansas.  With this in mind, we were able to quickly identify this technology as something that would have a significant impact on clinical quality and patient safety.  That, combined with the fact that it leveraged our existing IT infrastructure, helped us to identify this as a high priority project and gain approval for funding the effort.  Once the organization realized the full value the project would provide - and the impact it would have on departments across the system - it moved quickly to provide the necessary funding and resources to ensure a successful deployment.

Exceeded

For BAPTIST HEALTH, as we add to or enhance our core systems, we will have the ability to integrate more and more information into the Clinical Xpert platform.  Doing so means our clinicians can continue to review clinical information in a single location and it further enhances their ability to provide real-time clinical surveillance through this growing repository of information.  This will ensure that we will continue to adhere to and exceed Joint Commission National Safety Patient Goals, Core Measures requirements, and additional ongoing performance improvement initiatives.  Finally, it will assist our clinicians in providing improved quality of care, efficiently and effectively, resulting in improved clinical outcomes and lowered healthcare costs.

This project also has the potential to benefit the lives of millions of people throughout the United States and contribute greatly to our national healthcare agenda from the perspective of utilizing information technology to improve care quality and reduce costs. BAPTIST HEALTH has made a concentrated effort to improve our clinical workflow, improve clinical outcomes, and lower costs using the internal and external resources available to us.  With this project, we were able to achieve quantifiable improvements in patient care and cost savings.  We improved our identification of and responsiveness to our high-risk patients and proactively worked to provide them with the critical care they needed before conditions could deteriorate.  We also identified and acted upon opportunities to decrease the overall costs of medications being administered while maintaining the efficacy of medication therapies and resulting quality of care for the patient.

As we continue to improve our processes, further leverage the use of this solution, and tell our success story - through important venues such as Computerworld - we are hopeful that other hospitals and integrated healthcare delivery networks across the country will work to emulate such quality improvement efforts and achieve equal successes.  If only ten percent of U.S. hospitals were to increase pharmacy interventions by 30% and reduce costs by over $1 million, that would have a tremendously significant impact on both the quality of healthcare delivered and costs of care incurred by patients, providers, and payers across the country. 

Our clinicians have rapidly adopted the solution into their daily workflows to improve collaboration and continuity of care.  Minimal time is necessary for our clinicians to become proficient users of the solution.  Our IS staff continues to collaborate with clinicians to build and strengthen profiles within the clinical surveillance solution.  This effort continues to be a part of our ongoing list of healthcare IT initiatives.