Connected Health Case Study | Connected Health, No Longer Disruptive – UC Davis Health System

University of California, Davis Health System is an integrated academic health system with a mission to improve lives and transform health care through bold innovation to achieve a healthier world.  The organization has more than 13,750 faculty and staff, with approximately 1,600 physicians and 2,700 registered nurses. The Health System delivers primary, secondary and tertiary care in Northern California through a 619-bed fully accredited hospital and level 1 trauma center. In addition to over 30,000 annual hospital admissions, the health system’s 100-plus specialty and primary care clinics support more than 945,000 outpatient visits per year.

UC Davis is both a HIMSS Davies Award of Excellence winner, recognized for outstanding achievement in the use of electronic health records to successfully improve the health-care delivery processes and patient safety while achieving a demonstrated return on investment, and a HIMSS Stage 7 recipient for attaining the highest level on the HIMSS Electronic Medical Records Adoption Model.  Its Center for Health and Technology serves as a hub for advancing technology-enabled care, education, training and research.

UC Davis leadership made the modern EHR, telehealth and other associated health information exchange connections a top organizational priority years ago. We always are striving to improve our IT infrastructure and we continue to make investments and improvements. This strong support and institutional commitment, including clinician champions, strong funding support from leadership, and updated procedures and policies, have been successful in supporting our technology goals.”  — Michael Minear, former Chief Information Officer

The Center for Health and Technology is recognized for advancing innovation in technology-enabled clinical care, informatics research and health education. Leveraging its leadership in telehealth, and using an integrated approach for simulation-based education and distance learning, the center serves as a model for organizations worldwide and plays an integral role in the goals of UC Davis Health System.  The use of advanced technologies for health, education and research is embedded throughout the health system.  What follows are some of the center’s programmatic highlights.

UC Davis serves as a tertiary health-care provider for a large number of underserved rural communities throughout California. These communities frequently need specialty care services, care that can be challenging for patients to access because of geographical and economic barriers.

For 20 years, UC Davis’ Clinical Telehealth Program has been providing services to the underserved rural communities. Aligned with the health system’s mission to provide outstanding clinical care and public service, the program initially was established to improve access to specialty neonatal care for expectant mothers living in a small community 60 miles from UC Davis Medical Center in Sacramento. Today, the program is one of the largest telehealth programs in the country. It has expanded its reach through an internationally recognized and accredited education program, by providing leadership during the creation of the California Telehealth Network, effecting change through collaboration on telehealth policy and legislation, and by advancing eHealth adoption throughout the state.

For additional details about the impact of telehealth at UC Davis Medical Center, see the HIMSS Davies Awards of Excellence case study as well as the Telemedicine and e-Health Special Issue journal article, “Telehealth at UC Davis—A 20-Year Experience.”

The Pediatric Critical Care Telemedicine Program at UC Davis tracked its interactions with eight rural emergency departments between 2003 and 2009. Researchers collected detailed information on the costs of implementing and maintaining the telemedicine program and weighed those expenses against the transfer logs at the hospitals, as well as the costs of emergency department visits. The team focused on five conditions—asthma, bronchiolitis, dehydration, fever and pneumonia—because, with appropriate guidance, patients with those illnesses can be treated at rural hospitals without the need for having subspecialty physicians on-site.

There is a cost for urban hospitals to have subspecialists on-call to assist their rural colleagues. UC Davis researchers found that these and other expenditures averaged $3,641 per consultation.  However, having the capability to provide telemedicine consults reduced the number of patients being transferred from a rural community to the urban hospital by 31 percent when compared to telephone consultations, thus avoiding costly patient transport and distant hospitalizations. According to the UC Davis study published in the journal Medical Decision Making, the pediatric telemedicine consultations with rural emergency departments saved an average of $4,662 per use when compared to traditional telephone consults.
 
The pediatric telemedicine program is proving to be highly effective in helping to decrease health-care costs and increase efficiencies for smaller communities.  Today, the pediatric critical care telemedicine program connects with over 30 emergency departments throughout California.

In 2013, UC Davis Children’s Hospital was awarded a three-year, approximately $750,000 grant from the U.S. Health Resources and Services Administration to expand services for infants through its Pediatric Emergency Assistance to Newborns Using Telehealth (PEANUT) program.
 
Rural doctors and hospitals deliver great care. But they have limited access to pediatric subspecialists. By providing immediate access to neonatologists and other pediatric experts, PEANUT provides a safety net for rural clinicians and their patients.” --- Madan Dharmar, M.B.B.S., Ph.D., Assistant Research Professor, Department of Pediatrics and Betty Irene Moore School of Nursing.

Through telehealth, the PEANUT program provides eight rural hospitals that serve health-professional shortage areas and the medically underserved with 24/7 access to neonatologists and other subspecialists from UC Davis Children’s Hospital. This allows for important early intervention by pediatric cardiologists, decreasing the need for costly transfers that can be high risk for patients.  Since its launch two years ago, the program has helped provide care to approximately 50 newborn infants throughout Northern California.

The Improving Health in Diabetes Program, led by the Betty Irene Moore School of Nursing at UC Davis, is a health intervention that combines nurse coaching and mobile health integration with the electronic health record (EHR) to improve the well-being of persons living with Type-2 diabetes. The goal of the program is to engage and empower individuals so they are better able to understand and self-manage their disease.

The goal is to have a wellness conversation, and not just to manage the disease.”  — Madan Dharmar, M.B.B.S., Ph.D., Assistant Research Professor, Department of Pediatrics and Betty Irene Moore School of Nursing.

Several factors provide an important foundation for the program’s engagement and sustainability success. For example, individuals are directed to set their own goals for patient-generated health data (PGHD). Nurses, who serve as motivational health coaches, help patients understand the context for their health data and how it can correlate with their diabetes-management goals. The integration of PGHD into the health record, and use of the mHealth dashboard, enhances provider/patient discussions and help link patient goals and individual treatment regimens (including medication changes) to an enhanced management of this chronic condition.

The use of managed authentication is critical to the flow of PGHD, for both providers and patients.  Key components for success include enabling patients to have control over what they share and having consolidated data in a unified dashboard, which adds value to patient visits and more efficiency to provider workflow. One of the benefits of the mHealth dashboard is that it encourages the adoption of PGHD, which is a pathway to long-term use and sustainability.  

Additionally, the mHealth dashboard in a patient’s health record provides meaningful integration into a provider’s workflow by presenting at a glance the clinical data alongside the PGHD. In a conventional clinic setting, this type of information would require a multi-step, time-consuming process for the provider.  Integrating patient-generated health data into the EHR also offers the capability for the patient and provider to drill down to a specific time period and have a meaningful interaction around not just their disease but also their overall wellness.

UC Davis’ Center for Virtual Care is a state-of-the-art educational facility featuring a trauma bay, operating room, inpatient unit, six-bay simulation area, standardized patient exam rooms, debrief rooms, conference rooms, student carrels and an equipment and device repair area. The center offers educational simulators and task trainers, and is accredited as a Level I Comprehensive Education Institute through the American College of Surgeons.

With almost 11,000 square feet of space dedicated to simulation-based learning, the center provides UC Davis students, faculty, clinicians and surrounding community organizations with an amazing array of new technologies and resources. In 2015 for example, the center provided 32,500 learner hours that helped enhance interprofessional education opportunities, improve the scope, quality and impact of research and, ultimately, advance healthy outcomes for all.

Inspired by Tradition, Connecting the Future

As UC Davis Health System looks forward, the continuing advancement of technology-enabled health, learning and research for new models of care remains very promising and exciting. UC Davis researchers, working in collaboration with clinicians, are accelerating the use of advanced data analytics to enhance real-time clinical decision making. Information technology experts are engaged with clinical teams to optimize broadband communications technologies to offer a more effective way to monitor patients along the entire continuum of care. These new capabilities enable measures such as remote triaging, physician order entry and more efficient patient admissions processes prior to an emergency department arrival, all of which can improve care and save lives. Other effective approaches to improving health-care quality can be seen with interprofessional care teams that use high-fidelity simulation and distance-education tools to deliver innovative curriculums and improve learning and training. 

One of UC Davis’ other strengths has been to recognize the value of new health-related technologies while remaining committed to the patient- and family-centered care that resides in a non-electronic medical home. Linking people to the best care possible, at the right time and in the right location, helps defines quality of care and ensure successful outcomes. Connected health, after all, provides the optimal pathways to benefit everyone.

Acknowledgements:
Shelley Palumbo, MS, CCC-SLP, Chief Administrative Officer, Center for Health and Technology, Center for Virtual Care, Office of Continuing Medical Education; Michael Minear, CIO; Aaron Bair, MD, MS, Professor, Emergency Medicine, Medical Director, Center for Health and Technology, Medical Director, Center for Virtual Care, Associate Dean, Continuing Medical Education; Madan Dharmar, MBBS, PhD, Assistant Research Professor, Department of Pediatrics and Betty Irene Moore School of Nursing; Scott Foster, MS, Manager, Community IT Partnerships.

 


The inclusion of an organization name, product, or service in this document should not be construed as a HIMSS endorsement of such organization, product, or service, nor is the failure to include an organization name, product, or service to be construed as disapproval.

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Keywords: 
telehealth, telemedicine, Connected Health, Davies