Integrating Clinical Alerts into Clinician Workflows: Houston Methodist’s Approach

Data can help physicians and pharmacists make smarter patient care decisions, but the way in which physicians receive that data plays a huge role in whether the information drives higher-value care.

Physicians benefit most from data that is:

  • Current;
  • Easily integrated into their workflows; and
  • Targeted to their specific needs at that moment in patient care.

Many health systems are struggling to meet these three objectives. In fact, turning data into actionable information is the most pressing health IT challenge healthcare organizations face, according to a recent survey of 100 healthcare executives by Managed Healthcare Executive.

At HIMSS 2019, Nicholas Desai, MD, system chief medical information officer at Houston Methodist, shared how his organization is addressing this challenge.

To view his full presentation, click here.

To download the PDF case study, click here.

Houston Methodist—which is made up of seven hospitals, eight emergency care centers, and a large network of more than 6,700 affiliated physicians and 675 employed primary care and specialty physicians—recently embarked on a 90-day pilot to test how integrating clinical alerts into its EMR workflow could help physicians and pharmacists make more cost-effective, higher quality care decisions.

About 130 clinicians and 38 pharmacists were involved in the pilot, said Desai, during his presentation at the VigiLanz booth on Wednesday, February 13.

The alerts were pulled from a variety of sources, including Houston Methodist’s own data and data from its partners, such as VigiLanz. The alerts were integrated into the EMR workflow via IllumiCare’s Smart Ribbon.

“The ribbon is an executable file that sits right on top of our [EMR]. It aggregates data and everything right from our [EMR], but the best part is it pulls it all together in one place,” said Desai. “I can call it up when I want it, I can force it to be passive or active.”

Two Tips for Effective Alert Integrations

  • When integrating alerts into the EMR, consider passive and active alerts that you want to make front and center. For example, if there are five drugs your organization is watching and monitoring closely, consider how you can use alerts to highlight those as top of mind for clinicians.
  • Bring various stakeholders to the table to help determine what type of alerts and data should be integrated. For example, if your organization’s PDMP task force is involved, it might reveal that integrating PDMP-related reports is key.

Pilot Results

The results of the pilot are impressive. The organization was able to shift the cost curve within the 90-day mark about $107,000, said Desai.

“Overall, we believe that in 2019, for this hospital, we have an opportunity of 4.5 percent reduction in our costs, which will lead to between $1.7 million and $2.8 million, just for one hospital,” he said. “As an organization, it’s upwards of what appears to be closer to in the ballpark of $18 [million], $19 [million], $20 million dollars.”  

Desai said the VigiLanz alerts in the Smart Ribbon are also extremely helpful to pharmacists, because they can see alerts directly in the EMR without needing to go into the VigiLanz app to view them.

“The reality here is we’re giving [clinicians] tools and working with partners like VigiLanz and Illumicare to really bring together the efficiency tools that our providers need,” said Desai. “That’s what matters.”

To learn how health systems are using clinical surveillance to support high-value care, read: “Clinical Surveillance: The Next Step in Value-Based Care.”

Perhaps most importantly, clinicians responded very favorably to the integrated alerts. “Seventy-two percent of doctors, at the end of our pilot said, ‘This is not just valuable, finally you’re giving me a tool that is meaningful,’” said Desai. “In every one of those conversations, cost was important, but not the only reason why they liked the tool. What they liked about it was that this allowed them to see things in a more holistic view in one place.”

This post has been updated from a post previously published on February 28, 2019.

Real Hospitals Share Clinical Surveillance Benefits

High Impact, High Reward: Hospitals Reap Cost, Quality Benefits from Clinical Surveillance

Real Hospitals Share Clinical Surveillance Benefits

As hospitals incorporate clinical surveillance into more patient care areas, the impact on quality, costs, and the bottom line is growing. More than 90 percent of hospital executive respondents to a recent survey said clinical surveillance improves care quality. Nearly 80 percent said it has an ROI.

Here’s your chance to learn more about the ROI three hospitals have experienced (including for one hospital, more than $100,000 in savings just in the emergency department alone).

NINJA Program, Supported by VigiLanz, Helps Prevent Pediatric AKI

The following is an excerpt from Pharmacy Practice News. For more information about the collaboration between VigiLanz and Cincinnati Children’s to reduce AKI, please read our press release and learn more about the solution that is functional and customizable for any hospital, regardless of EMR platform.

Dubbed NINJA, or Nephrotoxic Injury Negated by Just-in-time Action, a new solution enables real-time identification and monitoring of pediatric patients at risk for acute kidney injury (AKI) from exposure to nephrotoxic drugs.

So far, the program appears to be putting a significant dent in the problem—a greater than 40% reduction in AKI, which the authors contend has reached epidemic proportions in the nation’s hospitals.

Nephrotoxic medication exposure is one of the most common causes of AKI in children. “We know that children need nephrotoxins. These are lifesaving medications,” said Stuart L. Goldstein, MD, the director of the Center for Acute Care Nephrology at Cincinnati Children’s Hospital Medical Center and primary developer of NINJA. “But children should only get the nephrotoxic medications they need for the duration they need them.

Three Ways Clinical Surveillance is Helping Prevent Patient Care Problems

Clinical surveillance can help healthcare systems more quickly identify clinical care problems, such as those related to medication errors and poor usage of antibiotics. But it can also help healthcare systems prevent problems from occurring in the first place.

That’s according to Bart Abban, PhD, director of analytics and data science at VigiLanz, who spoke about predictive analytics and clinical surveillance at the recent HIMSS Conference in Orlando.

“We’ve fully integrated a machine-learning platform into our real-time system,” said Abban, during his presentation. “We can look forward [at potential events], look in real time, and look back at historical data. It’s a fully closed-loop.”

Firm foundation needed

Much of the foundation of predictive analytics, Abban noted, comes from creating rules and alerts based on historical data. “You need a data repository,” he said. “We have vast amount of rich data, years and years of data.”

To view Abban’s full presentation, click here.

Health systems have many predictive analytics solutions to choose from. But Abban said VigiLanz stands apart because it provides a broader spectrum of alerts and customizations related to all types of patient care problems.

“With our platform you can do readmissions today, tomorrow you can start looking at mortality risk, you can look at adverse events, glycemic control,” he said. “We are currently developing a model on C. diff to alert clinicians to patients who are at high risk of getting C. diff. The sky is the limit.”

For more on how health systems are using clinical surveillance to enhance patient care, read “Clinical Surveillance: The Next Step in Value-Based Care.”

Three applications

Abban shared three examples of how VigiLanz is providing predictive analytics to health systems: 

  1. Sepsis

Since many hospitalized patients have symptoms that resemble sepsis, it can be difficult for providers to identify sepsis cases or identify patients who are most at risk. VigiLanz created a rules engine so that hospitals can use certain criterion—such as vital signs, labs, microbiology, comorbidities, and medications—to identify patients at risk. VigiLanz can then alert providers when patients are at risk, and providers can monitor these patients more closely and treat them proactively. Since data is updated in near real time, providers always have access to the most up-to-date information related to patients at risk.

  1. Acute kidney injury

Certain medications are essential for patients, but they can also lead to acute-kidney injury. The conventional approach is to monitor patients via labs, however, that means providers can only intervene after injury has already occurred. VigiLanz created a series of risk factors that can help providers more closely monitor patients, and proactively adjust medications as needed.

Risk factors include:

  • High risk nephrotoxic medications
  • Other drugs administered
  • Age, race, chronic morbidities, ICU stay or surgery
  • Specific labs
  1. Anomaly detection

VigiLanz created a rules-based engine to help health systems monitor the likelihood of a cluster or outbreak of hospital-acquired infections.. VigiLanz created alerts based on algorithms for various types of infections, and health systems are able to configure their own alert thresholds depending on their needs, areas of concern, and priorities.

Health systems using the VigiLanz platform to improve patient care and prevent patient care problems can rest assured that critical alerts won’t be missed by providers, said Abban. He noted that VigiLanz can track whether providers are taking actions related to the alerts they receive. If not, alerts can be reissued or the health system can follow up with providers directly. “It’s a whole ecosystem where you can extract the value of predictive analytics,” he said.

Top 4 Ways Health Systems Benefit from An API Approach to Clinical Surveillance

Speed is one of the most essential attributes of an effective approach to clinical surveillance. The faster patient data can be pulled from the EMR and sorted by clinical surveillance technology, the more quickly physicians and pharmacists can receive targeted alerts that lead to more optimal patient care decisions.

These alerts might be related to the identification of potential medication errors, the inappropriate use of antibiotics, or a possible outbreak of an infection such as C. diff.

To read about how health systems are using clinical surveillance to enhance patient care, read  “Clinical Surveillance: The Next Step in Value-Based Care.”

At the recent HIMSS Conference in Orlando, Adam Klass, chief technology officer at VigiLanz, and Dave Levin, MD, chief medical officer, Sansoro Health, spoke about how application programming interfaces (APIs) can be a gamechanger in clinical surveillance because they help data flow between EMRs and clinical surveillance solutions more quickly.

To view their full presentation, click here.

“We’re dealing with really important clinical problems here, and the sooner we can get these solutions in place and begin to impact the outcomes, the better for everyone,” said Levin.

APIs vs. HL7

For many years, most healthcare systems have transferred data from EMRs to outside solutions, such as clinical surveillance technology, via HL7 interfaces. But there are some drawbacks to this approach.

According to Klass:

  • The HL7 standard is interpreted in many different ways, which can raise confusion.
  • Hospital IT departments must spend time validating transferred data to ensure it is exchanging properly.
  • The approach requires building interfaces and maintaining them, which can be costly and time-consuming.

API data acquisition and transfer, on the other hand, provides a “more unified” data model, Klass said.  Information is pulled from the EMR in near real time, in a standard format, and it’s always sent to partners the same way, regardless of the EMR from which it originates.

“The value as you build out a full API footprint is getting that full clinical model from Day 1, so you’re not having to circle back to healthcare organizations to gather more data over time,” Klass said. “The hospital IT team involvement becomes significantly less as you use these APIs. The cost is also significantly less because you remove the maintenance and support that goes into supporting interfaces.”

Growing movement

More and more hospitals are recognizing the benefits of the API approach to data transfer. In fact, 30 health systems are already using APIs to exchange EMR data with VigiLanz’s platform, and many more are starting to implement the technology, said Klass.

He cited the following four benefits:

  • Less hospital IT department time spent on clinical surveillance.
  • Reduced hospital costs associated with clinical surveillance (hospitals no longer need to build interfaces, oversee numerous file transfers, or bring in consultants to assist with the work).
  • Faster implementations.
  • Broader accessibility for providers to clinical surveillance tools immediately after implementation.

Levin agrees. “An API approach to integration greatly reduces the amount of time that’s required to deploy the [clinical surveillance] solution and that translates into a cost savings,” he said. “But more importantly, it translates into a better user experience, a richer data set that takes a product that’s already really good and makes it even better.”

HIMSS Quoteables: Highlights from VigiLanz’s HIMSS Presentations

The 2019 HIMSS Conference, held February 11 to 15 in Orlando, shed light on some of the most exciting developments in the health IT space.

For us, the conference had many high points, including the unveiling of our latest report: “Clinical Surveillance: The Next Step in Value-Based Care.” The report, based on a survey of 100 healthcare executives, reveals where hospitals are in the journey to higher value care, and how they are using data analytics, EMRs, and clinical surveillance tools to support their efforts.

During the conference, several members of our leadership team presented on the topic of clinical surveillance, as did several hospital leaders whose health systems are currently using our technology. Here are a few of our favorite quotes from their presentations:

Nicholas Desai, MD

Nicholas Desai, MD, system chief medical information officer at Houston Methodist Hospital, on how physicians are responding to IllumiCare’s Smart Ribbon, which integrates alerts, such as those provided by VigiLanz, into the EMR. For more of Desai’s thoughts, click here.

“I can call [the Smart Ribbon] up when I want it. I can force it to be active or passive. I engage how I want it. We shared this [tool] with about 145 doctors and providers … at the end of the 90-day pilot, not only did we shift the curve, but 72% of doctors at the end of our pilot said, ‘This is not just valuable, finally you’re giving me a tool that is meaningful.’ In every one of those conversations, cost was important but not the only reason why they liked the tool. What they liked about it was that it allowed them to see things in a more holistic view in one place.”

We were able to shift the cost curve within the 90-day mark about $107,000. Overall, we believe that in 2019 for this hospital, we have an opportunity of 4.5% reduction in our costs, which will lead to $1.7 million and $2.8 million, just for one hospital. As an organization, this could be closer to in the ballpark of $18-, $19-, $20 million dollars. It did nothing but present information in a very consumable format.”

Bart Abban, PhD

Bart Abban, PhD, director analytics and data science, VigiLanz, also speaking about the value the Illumicare-VigiLanz partnership brings to providers. For more of Abban’s thoughts, click here.

“You can send this information straight into the purview of the doctor with our partnership with [Illumicare]. So if you want to stay in Cerner or another EMR tool that you use, you don’t have to enter our system, we can send it right to the system the physicians are working on.”

Dave Levin, MD

Dave Levin, MD, chief medical officer, Sansoro Health, on the benefits API integration is bringing his healthcare system related to clinical surveillance and data exchange. For more of Levin’s thoughts, click here.

An API approach to integration greatly reduces the amount of time that’s required to deploy the [clinical surveillance] solution, and that translates into cost saving. But more importantly, it translates into a better user experience, a richer data set that takes a product that’s already really good and makes it even better … We’re dealing with really important clinical problems here, and the sooner we can get these solutions in place and begin to impact the outcomes, the better for everyone.”

This is really not about APIs, it’s about solving important business and clinical problems. I think the VigiLanz-Sansoro partnership is probably one of the best examples anywhere in healthcare right now about how this can work.”

Adam Klass

Adam Klass, chief technology officer, VigiLanz, also speaking about the value of APIs in clinical surveillance. For more of Klass’ thoughts, click here.

“The value, as you build out a full API footprint, is getting that full clinical model from Day 1, so you’re not having to circle back to healthcare organizations to gather more data over time. The hospital IT team involvement becomes significantly less as you use these APIs. The cost is also significantly less because you remove the maintenance and support that goes into supporting interfaces.”

“We’re listening for things like your admissions, discharges, and transfers; your medication orders; your lab test reorders; preliminary and final micro susceptibility results, drug administrations, procedures, and surgeries. The more information that can come into the VigiLanz private cloud, the more types of things we can do around surveillance of that data.”

Bart Abban, PhD

Abban, speaking about how VigiLanz is providing physicians with predictive analytics that can improve patient care and prevent problems from escalating. For more of his thoughts, click here.

“There are several companies around here selling point-solution singular products [for predictive analytics]. With our platform you can do readmissions today, tomorrow you can start looking at mortality risk, you can look at adverse events, glycemic control. We are currently developing a model on C. diff to alert clinicians to patients who are at high risk of getting C. diff. The sky is the limit.”