Through the use of EHR-enabled clinical workflows and standardized documentation, University of Iowa Hospital and Clinics significantly reduced adverse drug events and hospital acquired infections. With the use of almost 500 best practice alerts and analytics, UIHC significantly reduced instances of venous thrombosis, sepsis, pneumonia, and other clinical conditions. As result of improved documentation and secondary diagnosis capture, cost avoidance associated with improved clinical outcomes, and reduced mortality and length of stay, and incentives paid for quality improvements, UIHC has net cash flow of over $50 million from July of 2013 to June of 2014 attributable towards the use of information technology.
University of Iowa Hospital and Clinics | Davies Enterprise Award
As the University of Iowa Hospitals and Clinics (UIHC) migrated from an internal developed Electronic Health Record (EHR) to an industry standard in 2009, improved patient and medication safety as well as improvement in CMS Surgical Care Improvement Project (SCIP) measures were in the forefront of the organization's quality improvement goals. Five years post go-live, UIHC has observed
- Substantial improvement in medication safety of Adverse Drug Event (ADE) causing harm count prior to implementation ≥ 9 annually to 2 in the two previous fiscal years.
- Adherence to pediatric immunization guidelines improved by 50%
- Anticoagulation venous thromboembolism adherence to guidelines increased 33%.
- Regulatory compliance with SCIP measures rose from 32% in CY 2007 to 96% (Inpatient) in CY 2012.
- Preoperative antibiotics order errors reduced by 71%.
- Surgical H&P compliance rose from less than 50% pre-implementation to over 98%.
- Early adoption of Smart Pump EHR integration served to improve guardrail usage which helps to avert severe harm.
Focusing on a limited number of metrics, University of Iowa Hospital and Clinics generated a 159% return on our investment in year five following implementation, far surpassing the conservative pre-implementation predictions of a break-even point in seven years. This translates to $103 million in total savings after the first five years.
The EHR and patient portal has been crucial to support health benefit gains and cost saving for University of Iowa Hospital and Clinic's ACO population management. The portal plays a key role in communication and exercise of shared decision making between the patient and care team. In particular, the transitions of care management and shared plans of care required by UIHC's ACO are greatly enhanced with the portal. In the first year of the UIHC ACO, UIHC observed lower costa compared to all other ACOs but significantly improved outcomes as measured by reductions in admissions (-2.27%), reduced number of ED visits(-12.53%) and reduced Length of Stay(-10.76%).
The University of Iowa Hospitals and Clinics (UIHC) used their EHR to address inpatient documentation inadequacies, which lead to low quality and safety ratings for physicians in the Otolaryngology department. This resulted in an increase in net revenue of approximately $2,700 per case and $1.8 million per year in the MS-DRG Tracheotomy. By expanding the EHR-driven solution to other departments is conservatively estimated to increase our revenue by $9.5 million without substantial increase in expense.
Following this model, UIHC has expanded the effort to other lines of service. Substantial improvement of goal metrics have been observed including higher Case Mix Indexes (CMI), drop in Case Weight Opportunity, higher Severity of Illness (SOI) and Rate of Mortality (ROM) at admission, and lower LOS and Mortality (expected/observed) indexes.
Improving patient care and outcomes, managing costs associated with blood management and administration, and conserving increasingly scarce blood products were the goals of an EHR-enabled Blood Management program implemented by the University of Iowa Hospitals and Clinics (UIHC). Using targeted blood management teams and clinical decision support in our electronic health record, this program reduced the number of blood products administered, the number of patients receiving two units of blood, the number of patient blood draws per day, and the number of incorrect medication administrations, all while saving $9,300,000.