The MetroHealth of Cleveland | Davies Enterprise Award

The MetroHealth System (MHS), a safety-net/essential healthcare system in Northeast Ohio affiliated with Case Western Reserve University’s School of Medicine, started to implement the Epic electronic health record (EHR) throughout MHS ambulatory clinics in 1999. By 2009, the MHS had fully deployed Epic enterprise-wide: throughout all ambulatory clinics, inpatient areas, and the emergency department.  Over the last five years the MHS has focused on enhancing  the use of the existing EHR foundation to do things not possible without a fully deployed, enterprise EHR and to meet ongoing MHS needs.

The MHS views the EHR as a critical component of administrative, clinical, operational and quality activities. As such, numerous areas of the healthcare system are continually asking if/how the EHR can help issues/opportunities their areas are interested in. Additionally, information services and informatics staff are always looking for opportunities to leverage existing and new EHR functionality in ways to improve the MHS.

 

The health information technology (HIT) value examples described in this section represent a broad sampling for the local problems the EHR has been used to address within the MHS.

The HIT value examples include:

  • Health information exchange
  • Heparin (high risk medication)
  • Code status reconciliation
  • Vaccine adverse event reporting
  • Outpatient depression screening
  • Automated patient clinical messaging
  • Internal referral completion
  • Common high risk/high cost hospital acquired infections
  • Core measures
  • Blood pressure diagnosis research and improvement

The MetroHealth System (MHS) is the primary care provider for over 10,000 adult patients with diabetes, which is one of the top ten adult diseases associated with morbidity and mortality in the US, and causes billions of dollars in annual healthcare costs. Over the last decade, MHS has deployed a number of electronic health record (EHR) features as part of its overall programs and strategies to improve the care of adult diabetic patients. EHR-based initiatives designed to improve the care of diabetic patients included:

  • EHR report generated and standing order for pneumonia vaccines (for diabetic and nondiabetic patients) (2003)
  • Standardized EHR reports of diabetic patients for each provider (beginning 2005; updated 2013)
  • Diabetic patient clinical decision support (best practice alerts and health maintenance reminders) (initial 2005; revised 2007)
  • Diabetic patient care plans (2010 by letter; 2012 by goals, barriers andinterventions)
  • Diabetic foot exam and eye exam discrete documentation tools(2011)
  • Regular comparative reports showing how each provider compares to others on key diabetes performance measures (2009) and then tied to financial quality incentives (2011)
  • Diabetes “Synopsis reports” (which summarizes diabetes care for a given patient)(2012)

Overall, over the ten year period, process and outcome composite measures improved over 30%, with outcomes composite measure improvement lagging several years behind process composite measure improvement. These changes in care caused an estimated 10% decrease in the costs of care for diabetic patients. As these EHR tools are very scalable across MHS and are applied across the population of over 10,000 diabetic patients, the cost savings is approximately $1 million per year.

Read The MetroHealth System's Diabetes Population Management Case Study

Guidelines for screening for high risk infectious diseases, specifically human immunodeficiency virus (HIV) and hepatitis C virus (HCV), are of particular importance in relatively high-risk patient populations like those seen within the MetroHealth System (MHS). The recommendations have evolved: In January 2005, the US Preventive Services Task Force (USPSTF) recommended oncelifetime screening for HIV among “high risk” adolescents and adults ages 15-64 (where the CDC defined a population as “high risk” based on its baseline prevalence for HIV within all patients of the healthcare system). As a whole, the MHS patient population met the definition. In June 2013, the USPSTF recommended once-lifetime screening for HCV among adults born 1945- 1965. 

The MHS implemented electronic health record (EHR) health maintenance reminders for HIV and HCV in July 2010 and July 2013 respectively. For HIV, these reminders caused an increase in screening of more than 225% and an increase in disease detection of 11%. For HCV, these reminders caused an increase in screening of over 2500% and an increase in disease detection of 560%.

 

Read The MetroHealth System Case Study on HIV and Hepatitis C Screening and Population Management

 

Acinetobacter is a rare, virulent and typically multi-drug resistant organism that can cause significant morbidity and mortality. In the summer/early fall of 2010, the MetroHealth System (MHS) experienced an outbreak of Acinetobacter in our hospital. As part of the multi- disciplinary rapid and ongoing response to this outbreak, four different EHR tools were developed and implemented for clinicians. A set of three additional EHR tools were developed and implemented for infection control staff. These seven EHR tools, in combination with other non-EHR interventions, stemmed the Acinetobacter outbreak and have led to a steady, now over 30% reduction in overall Acinetobacter cases throughout the MHS, eliminating over 200 infections that otherwise would have been expected to occur, saving several million dollars in healthcare costs and probably preventing several deaths. Since implementation five years ago, the MHS has never had a month with as high a number of new Acinetobacter cases as it did the month before these tools were implemented.

Read The MetroHealth System's Acinebactor and Infection Prevention Case Study

The MHS views the EHR as a critical component of administrative, clinical, operational and quality activities. As such, numerous areas of the healthcare system are continually asking if/how the EHR can help issues/opportunities their areas are interested in. Additionally, information services and informatics staff are always looking for opportunities to leverage existing and new EHR functionality in ways to improve the MHS.

The health information technology (HIT) value examples described in this section represent a broad sampling for the local problems the EHR has been used to address within the MHS.

The HIT value examples include:

  • Health information exchange
  • Heparin (high risk medication)
  • Code status reconciliation
  • Vaccine adverse event reporting
  • Outpatient depression screening
  • Automated patient clinical messaging
  • Internal referral completion
  • Common high risk/high cost hospital acquired infections
  • Core measures
  • Blood pressure diagnosis research and improvement

Read The MetroHealth System's examples of how utilizing health IT improved clinical care.

This analysis shows a positive ROI for the EHR in every year of 2010-2014, on average just   over

$20 million per year, with ongoing estimated positive ROI of just under $20 million per year.

Other highlights of this analysis include:

  • Federal incentive programs (Meaningful Use, PQRI/PQRS, e-prescribing) provided  over $36 million in hard financial benefits related to EHR ROI
  • Even without federal incentive programs, net ROI for the EHR would have been
  • Hard financial benefits begin being realized at the time of implementation
  • Soft financial benefits accrue slowly after implementation and are not fully realized at the time of implementation
  • Soft financial benefits increased by almost an order of magnitude
  • Soft financial benefits increased from ~10% of total benefits to ~30% of total benefits
  • Even without soft financial benefits (and federal incentive programs), net EHR ROI is positive

Read The MetroHealth System ROI Analysis

Keywords: 
Medical Device, Davies, electronic health record, diabetes, Medication Management