As hospitals and clinicians have settled in to the relatively new world of electronic medical records, many are beginning to look for ways to get the most out of their investment and benefit from the data these systems collect.
On their own, EMRs don’t offer a focus on logistics and optimization; their primary function is data collection and documentation. While several EMRs have added a basic bed management option to facilitate patient placement, it is only a small step toward driving efficiency in the hospital.
David Jenkins, Vice President and COO of the Virginia Hospital and Healthcare Association, said part of the challenge is that EMRs were not built with the purpose of solving operational efficiency challenges.
At Blessing Health System, an integrated health system based in Quincy, Illinois, CEO Maureen Kahn saw their system’s EMR’s limitations when it came to driving efficiency. “We saw growth in the inpatient setting while most other hospitals saw a decline,” Kahn said. “We knew we needed to be able to take on more volume while having consistent and sustainable performance, which meant we needed something bigger and bolder than the throughput projects we had done in the past.”
Four Best Practices to Optimize Efficiency
According to Samantha Platzke, Senior Vice President of System Performance and Chief Financial Officer at Care Logistics, there are four best practices hospitals can implement to build upon their EMR platforms and improve efficiency. Care Logistics is a company that helps hospitals optimize their patient flow, throughput, and patient progression.
First, Platzke recommends identifying patient status as soon as the patient enters the hospital. “Getting patient status right and removing variability in how you establish it is really the key first step because the whole care team is aligned for the type of patient they're caring for,” Platzke said.
Second, Platzke noted the importance of setting a target length of stay and having the care team driving toward that goal. “It’s vital to establish a target length of stay and a progression plan with specific times and milestones for every patient,” said Platzke. “This must occur at time of admission.”
The third key for optimizing efficiency is ensuring adequate resources based on demand. “The best practice is to be able to forecast for demand on the staffing in the hospital at least four to six hours in advance while understanding that demand needs must go beyond simply measuring patient census,” Platzke said. “It should be measured based on the actual care that a nurse must provide during those hours.”
Platzke said a final key factor is to create a system where every department and all leadership are working collaboratively. “To really optimize, you’ve got to create a system in which all the departments are together working simultaneously to implement and sustain all of those best practices,” Platzke said.
Achieving this sustainability has been important at Blessing Health as well. “In the past,” Kahn said, “We did smaller, focused efforts such as an ED throughput project, but we found that the improvements were not sustainable. Sustainability must be built in, and you must have the right tools to automate it. With our Care Logistics project, we started by putting the process improvements in place first and followed it with the technology to sustain our improvements.”
Kahn’s observations about sustainability are key. Once these best practices are implemented, they can be challenging to sustain without the right tools in place, and the EMR is often not up to the task.
For example, despite recent advances and integrations that have improved workflow, EMRs still struggle to handle simultaneous demand on resources. Matching the availability of equipment and clinical and diagnostic staff with the availability of the patient is not supported in the typical EMR. This can result in uncoordinated or delayed diagnostic testing for patients.
“A key factor for both inpatient and outpatient care is how you utilize your resources within the hospital to maximize patient flow and throughput and give patients a high-quality care experience,” Jenkins said. “With just an EMR, providers and other clinical staff spend a lot of time drilling down into EMR data patient-by-patient to find information they need, but Care Logistics pulls it all up to the surface.”
Sizable Returns Achieved
Hospitals that partner with Care Logistics also say that physicians, staff, and patients are much happier because there is a very clear understanding of what must be done to successfully progress the care of patients and what the real-time status of each patient is in his or her own progression of care. In addition, the financial opportunities are significant. On average, hospitals working with Care Logistics see an average annual financial improvement of $19.2 million. “Depending on the size of the hospital, the improvement could range from $6 million to as high as $55 million per year,” Platzke said.
By implementing best practices such as those outlined by Platzke, hospitals can build upon their own EMR platforms to optimize efficiency and achieve similar results. At Blessing Health System, adoption of best practices has resulted in the capacity to accommodate a 9.5 percent growth in admissions while simultaneously reducing the utilization of nursing overtime and agency labor. Total improvements have had an annual financial impact of $11.6 million.