An exhausted mother pours a cup of coffee. A visitor approaches the front desk and asks directions to a room. Nurses rush about. It’s early in the day, and Mary Anne Leach is doing her rounds on a busy floor at Children’s Hospital Colorado. As Leach walks, she notices small but critical elements that create the heartbeat of the entire facility. She sees an important alert pop up on a computer screen, reminding a nurse of a patient’s allergy. She watches as a father checks his sick child’s progress using the MyChart app on his smartphone. She hears researchers chatting about data they’ve pulled from online systems that Leach helped create.
To the casual observer, these small details may seem insignificant, but Leach knows the difference they make. She is Children’s Hospital Colorado’s senior vice president and CIO. In the role that she’s held since 2007, Leach coordinates IT efforts for the regional pediatric health delivery system, which encompasses 16 locations, 553 licensed beds, more than 600,000 annual outpatient visits, and nearly $2 billion in gross annual revenue. Her teams work to help clinicians use tools to make more informed decisions that directly impact patient care. They design systems that are easy to navigate and alert users in the right places so they think differently and change their behavior. And since Children’s Hospital Colorado is also a research facility, physicians are using the data and tools Leach creates to develop new, groundbreaking treatments.
While many CIOs working in health care are busy implementing electronic health records (EHRs), Leach and Children’s Hospital Colorado are well beyond that first step. The health system finished EHR implementation in 2007 and has shifted to focus on two major areas that will help the hospital provide better care: optimization and analytics.
Optimization is key for IT professionals working at the intersection of software and medicine, as each field is evolving at a dizzying pace. IT departments must constantly reconfigure and redesign technology to optimize workflow and ensure providers are as efficient and informed as possible. For Leach, that means efficiency is always on her mind, whether she’s discussing new capabilities with vendors or brainstorming a new technology solution with her users and teams. “We’re constantly working to find new, better, and faster ways to allow everyone who interacts with our solutions to do what they do in a more efficient way with higher quality outcomes,” she explains.
Analytics and informatics are leading to many exciting advancements at Children’s Hospital Colorado. The health system does analytics within its EHR systems, using Epic’s integrated software. At the level of the care team, engineers have built dashboards and embedded available technology into clinical workflow. A new enterprise data warehouse with an Oracle database holds patient records and data about costs, patient experience, and industry benchmark data. Leach and her team have also built database registries using HIPAA-compliant tools like REDCap for data capture and complemented that with more sophisticated reporting tools like SAS, a business analytics reporting tool. Together, these tools and data improve quality and safety while reducing costs and advancing research.
INSIDE HEALTH DATA COMPASS
Although Children’s Hospital Colorado has its own data warehouse, the facility is partnering with three other entities—the University of Colorado, UCHealth, and University Physicians Inc.—to build a data warehouse campus over the next five years. Known as Health Data Compass, planning began in 2012 and a contract was recently signed with ProFicient Technologies for an Oracle-based tech solution. The facility will securely store and connect many pieces of clinical, research, scientific, and financial information culled from numerous sources, including Epic’s EHR technology.
Some new analytics tools are allowing Leach to realize the full potential of the long-discussed but previously unattainable promise of self-service business intelligence. Tools like Tableau Software, a federated, in-memory data visualization tool that can connect to almost any data source, gives health IT personnel, clinicians, and staff the ability to deliver real value. Users have the ability to create interactive dashboards that allow them to access data in real time, visualize trends, and drill down to details. The goal is real-time, actionable data that is eventually predictive and preventive.
The data aids critical decision making and gives nurses and physicians accurate information more quickly than ever before. “We have to deliver platforms that our users can leverage integrated into their clinical workflow, and our job is to build that data infrastructure,” Leach says. “Then our customers can really use the data. Our goal in health care right now is to increase quality and improve patient experience while reducing cost. We can’t do that without powerful analytics tools.”
In the age of big data, plain information is not enough—information must be accurate. “Data quality and data governance are so important,” says Leach. “If it’s inaccurate or mistrusted data, it won’t be used. We have to make sure the data we use and provide is both trusted and actionable.”
As massive amounts of information stream in, organizations like Children’s Hospital Colorado must be vigilant to make sure data is current, complete, accurate, and secure. Leach accomplishes that through a data governance unit comprised of IT workers, business leaders, frontline staff, vendors, nurses, and physicians. Next, she focuses on communicating to doctors, nurses, and other key staff members to get buy-in. “We aren’t doing our job in health IT if we don’t provide tools that are effective and efficient for those working in our facilities,” she says. “We don’t want physicians and nurses spending their whole day at a computer—we want them working with patients.” By engaging end users at the start of a project’s development and by asking probing questions, she and her peers can build the most effective solutions. The conversations, coupled with close workflow observation, help IT professionals uncover new ways to harness the power of technology to solve problems. During the process, Leach says CIOs should be careful to explain data and its full implications. If other hospitals have better discharge rates and outcomes, for example, IT executives and physicians can examine available information and figure out the underlying factors. “Engage physicians, show them actionable data, partner on an outcome, and let them pilot the solution,” Leach says, adding that engineers should return to physicians with beta models to test and then solicit feedback before rolling out the final product.
“Our goal in health care right now is to increase quality and improve patient experience while reducing cost. We can’t do that without powerful analytics tools.”
Naturally, doctors and nurses embrace solutions that make their professional lives easier. Today, mobile applications are increasingly in demand. “People who work in medicine are always moving around during the day,” Leach says. “We’ve been waiting as an industry for rich mobile applications for a long time, and we’re almost there.” Children’s Hospital Colorado’s facilities have strong wireless infrastructures, and vendors are starting to produce mobile applications in greater numbers. Epic’s Haiku smartphone apps and Canto’s iPad apps have put the EHR on mobile devices, along with MyChart mobile, which lets patients view their clinical records and gives them access to test results. With MyChart, patients or their proxies can request appointments, ask questions, refill subscriptions, and read clinical results triggered by EHR data. Another Epic app, Bedside, will give patients a visual summary of their care team, let them record notes as they prepare for discharge, and provides messaging and education hubs.
Additionally, the IT team creates and develops proprietary mobile applications where there are gaps or when unique needs arise. ChildrensMD was initially created for iPad and iPhone, for instance, and is now Android compatible. For the most part, however, Leach is relying on mobile apps from vendor partners, and those that are inexpensively available in the mainstream marketplace. “When patients can download great apps for ninety-nine cents, there’s no need for us to recreate the wheel when our time is better served on other projects,” she remarks. In the last few years, widely available apps have helped increase patient and family engagement, have improved health, and have connected communities to their providers in new ways.
When it comes to progress, the IT department at Children’s Hospital Colorado may be ahead of its counterparts, but Leach says the Epic EHR is still one of their most important tools. “An industry-leading EHR has given us a great foundation and tool set for all we do,” she says. “As we forge ahead with optimization and analytics, we’re building the strongest system possible to match the vision and mission of our organization.”
Now, an important industry theme is the need to remove variation in cost and quality. “We need to reduce the cost of health care, and we can do that with analytics,” says Leach, adding that experts have predicted analytics can help cut costs by hundreds of millions of dollars each year. As an industry, the rate of year-over-year cost increases is slowing, leveling, or declining. However, the cost of health care is still nearly eighteen percent of the national gross domestic product. If technology enhances quality of care, major costs like treating Type 2 diabetes and obesity will shrink along with the number of patients who are readmitted for repeat care. “Quality and cost are linked,” Leach says. “We have to help the payer community understand the value proposition.” Leveraging technology and data can have a huge impact on the health of the patient population and the US economy as a whole.
“We’ve been waiting as an industry for rich mobile applications for a long time, and we’re almost there.”
Another way to improve quality is to work upstream into EHRs and build risk profiles. For example, when a patient comes in, physicians and nurses armed with the right data may know if that patient is at risk for a specific disease or medical incident. With that data, the system can alert the caregiver and provide instructions for preventive measures. “We have opportunities to embed more evidence-based, best-practice protocols into the clinical workflow,” Leach explains. “We need to bring more science and translational medicine to the bedside.” To do this, Leach has worked with her IT engineers and developers to automate “best-practice alerts” that fire under specific conditions. Approximately 300 best-practice alerts on Children’s Hospital Colorado’s clinical system alert caregivers to medications, risks, and opportunities for prevention.
In the middle of all of these advancements and innovations, Leach says she and her colleagues must stop to remember that there’s a patient and a family at the other end of the wire. “No matter what we do in health-care technology, we don’t want to lose that personal touch,” she remarks. The governance committees are careful to limit automated alerts to prevent user fatigue. The goal is to liberate caregivers to “do what they do best,” which is to devote more time to face-to-face interactions with patients, families, and other providers on the team. Technology should enhance the patient-doctor relationship and care team collaboration, not remove or replace them.
Although the coming years are sure to be exciting, they may also be difficult. Leach says she expects continued pressure on IT budgets. Despite limited resources, teams will still need to deliver more analytics, capabilities, applications, and solutions. “It’s a challenging road ahead, but it’s a very rewarding one, too,” she says. The health IT community is transforming care through the tools it develops. Those solutions are bringing higher quality health care at a lower cost in a combination that is literally saving lives.