Hospital for Special Surgery (HSS) was named a 2018 HIMSS Davies Enterprise Award recipient for leveraging the value of health information and technology to improve outcomes. The three award-winning use cases cover the implementation of a newly revamped physician referral services legacy system and an express check-in system for patients to reduce wait times, plus census reporting & clinical pathway management that improved capacity and optimized patient care.
HSS believes improved patient outcomes begin with optimized access; this means getting patients to the right level of care, at the right time, in the right location. The Physician Referral Services (PRS) legacy system was inefficient and inadequate to scale in support of strategic expansion of HSS offerings and capacity specifically to HSS regional locations. The legacy system was also difficult to maintain because physician profiles, scope of practice, and insurance participation had to be maintained by the HSS IT department and with the vendor.
The new system provides PRS with advanced filtering capability, a tool for referral tracking, smart search functionality, integration with data interfaces, templates, and advanced analytics. This resulted in improved patient and physician engagement, greater referral accuracy, more efficient operations and higher value delivery.
The centralization of Patient Access Services (PAS) staff to the main lobby in 2016 proved to be a more reliable model for the hospital admissions process at HSS. Despite reductions in overall cycle time, patients arriving at peak hours experienced undesirable service levels. Operational leadership quickly linked the peaks with the pre-surgical screening (PSS) patients arriving for their mandatory pre-op education class. With budget and space limitations in place, the PAS team looked to find a solution to create additional server queues to improve the patient experience through the electronic health record.
Part 1: Reduction of Work Effort for Census Notification
Patient Access Services (PAS) at HSS is tasked with bed management for more than 18,500 orthopedic inpatient surgeries annually, requiring close monitoring of bed utilization to accommodate patient volume. Hospital bed census report is communicated to HSS leadership and operational owners four times per day; therefore, collecting data manually, presented significant operational challenges. After the implementation of the electronic health record, operational and IT leadership looked for a way to leverage new technology to transform the bed planning process at HSS. Leveraging the HSS Capacity Management Dashboard resulted in increased flexibility of PAS staff, increased capacity, and a 96 percent Reduction in OR cases put on hold due to PACU bed shortages.
Part 2: Clinical Pathway Management
At HSS, clinical pathways are procedure-specific post-op order sets that coordinate and standardize care. They are made up of time-based goals and milestones for interdisciplinary care of a defined patient group and were created to reduce variation in care and increase value for similar patient groups. Pathway performance is measured as pathway length of stay adherence. If all HSS patients adhered to pathways, capacity would improve significantly. To improve pathway adherence, an interdisciplinary project team was chartered to determine top contributors to adherence. Several electronic medical record changes were required to operationalize the new process.