Hilo Medical Center | Davies Enterprise Award

2015 HIMSS Davies Enterprise Award of Excellence winner Hilo Medical Center (HMC) is a part of the East Hawai’i Region of the Hawai’i Health Systems Corporation (HHSC), serving as a safety-net hospital for two critical access hospitals, Hale Ho’ola Hamakua and Ka’u Hospital. The East Hawai’i Region also includes nine outpatient clinics with specialties. HMC is a 276-bed facility with137 acute beds, 20-bed behavioral health facility, and 119-bed, long-term care facility. Overall, 72 percent of HMC's patients have Medicare or Medicaid insurance.

As hospitals struggle with reduced reimbursement, hospital leaders are utilizing technology and data to maximize care delivery efficiency. Hilo Medical Center staff members could not make a cell phone call from inside their facility in 2009, yet by leveraging the data generated by health information technology Hilo has saved millions of dollars through more efficient care delivery and revenue cycle management. Health information technology has enabled standardized protocols to reduce hospital acquired infections and reduce the mortality rates of patients admitted with pneumonia. The story of Hilo Medical Center represents a model of health IT-enabled care delivery that can assist struggling small community and safety net hospitals leverage data to survive.

Clinical Value

 

Addressing continuity of care was of paramount importance as the capabilities of the EHR were evaluated for the provision of Computerized Provider Order Entry (CPOE), Clinical Decision Support (CDS), improved medication processing, and Barcode Medication Verification (BMV).  The results demonstrated in this Case Study represent a remarkable reduction in Adverse Drug Events (ADEs) along with associated cost savings to the organization.

 

 The overall impact of the EHR on clinical value is illustrated by the improvements in the medication administration process, appropriate antibiotic usage, and the CMS core measure addressing pneumonia.

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Return on Investment

HMC designed the EHR implementation timeline to begin addressing the core modules, to include revenue cycle management. Accounts Receivable (AR) open days were consistently above 100 days for the clinics prior to implementation of the system. The hospital goal was to decrease AR days to less than 50. Post-implementation HMC’s hospital monthly data reflects a steady fall of AR days to 58 by Q4 2013 where it has consistently remained (see Figure 1), resulting in a hard ROI of $10M. HMC’s clinic monthly AR days fell from 107.1 days (Q1 2014) to 33.3 days (Q4 2014) resulting in a hard ROI of $4M.

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Health Information Exchange

Hawai’i HIE was directed by the state to develop a seamless, effective, and secure statewide health information exchange that ultimately links to the nationwide health information network.[i] Currently, Hilo Medical Center, Queens Medical Center, Hawai’i Pacific Health, Castle Medical Center and 458 providers are exchanging information via the HHIE. Health eNet is electronic system implemented to accomplish the exchange and access of clinical information.  The Hawai’i Pacific Regional Extension Center (HPREC) is also under the umbrella of the HIE to assist providers in making the EHR implementation and upgrades easier for meeting Meaningful Use. 

Utilizing queries constructed within the HMC EHR, the identification of at risk patients and improved patient tracking for chronic disease conditions was obtained.  In the case of Diabetes, some of the specific data points include: type of Diabetes, BMI, Blood Pressure, HbA1c levels, and Patient Education.  In conjunction with an enhanced level of patient tracking, this data allows care providers to develop trend data to determine if their treatments are being followed as well as the impacts they are having.  As seen in Figure 4 below, trend data shows a marked increase in self-management support being provided to Diabetic patients. Trend data also indicates patients are following the care plans and utilizing the self-management education being offered as overall improvements in both Diabetic patient Blood Pressure measurements and BMI are observed.

 

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End User Efficiency

Using PACS technology and other information systems, applications, and enhancements, the Hilo Medical Center (HMC) Emergency Department (ED) has decreased the length of stay by 39% and increased patient volumes by 13 %.  An increase in all Imaging modalities patient volumes by 11% also occurred.  

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Leadership and Governance

Using the governance system, HMC has been able to implement progressive changes and further refine internal policies and procedures directly affecting physicians.  In 2013 Hilo Medical Center’s physician report deficiency rate was at 84%.  Without final reports and signatures, charts could not be closed and accounts could not be billed, increasing Hilo Medical Center’s accounts receivable (AR) days.  Using the governance structure now in place a suggestion from the Director of Heath Information Management (HIM) department was brought to iORF for discussion. The suggestion was to create a policy in which physicians are suspended after 24 days of unsigned deficiencies.  iORF ensured the physicians had all the tools possible to sign reports timely then passed the policy to PiORF for discussion.  PiORF agreed to the new policy and passed it to the MIS for vote, MIS voted with majority rule, where it was also voted and ultimately passed at MEC. 

Upon the implementation of PDOC, dramatic improvements were seen in electronically signed documentation by physicians, rising from 1,690 documents in August 2013 to 11,994 documents in the October – December period of 2014; see Figure 7.  HMC has over 120 document templates built for all 3 facilities

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