Antelope Valley and VigiLanz: Increasing Cost-Savings Enterprise Wide

Customer Profile

Antelope Valley Hospital (AVH), a 420-bed district hospital located in Lancaster, California, has been serving northern Los Angeles County for more than 60 years. The area’s only full-service acute-care hospital, AVH provides a full array of medical and surgical services, mental health services, cancer care, and more. It is a Level II trauma center, accredited chest pain center, advanced primary stroke center and comprehensive community cancer center.

Challenge

Hospitals and health systems across the country consistently seek methods to improve patient care and reduce costs due to an increased focus on value-based care and fee transparency. For Antelope Valley, that meant looking at the hospital’s pharmacy department and implementing a system that would go beyond cost savings and efficiency within this one department.

“There came a point when we were advancing services, staffing and activity that we were somewhat limited in what we could do, like running reports,” explained Jill Bennett, PharmD, BCPS, Clinical Coordinator, Antelope Valley Hospital. “[Our current system] really only enabled us to look at a certain subsection of our population and only provided a snapshot of activities throughout the day. It was limiting.”

Bennett and her staff needed to make a change to accurately capture their entire patient population and intervene as needed. The team moved through several different systems. While it was more than what most hospitals had at the time, AVH needed more. It required a solution that had a dedicated rules engine, 24-hour surveillance and the ability to grow beyond pharmacy. After researching multiple platforms, the decision was clear: It had to be VigiLanz.

VigiLanz empowered the team to automatically screen and monitor every patient, while streamlining dosing, testing and reporting—and appropriately intervene and adjust treatment per a patient’s tailored therapy.

Solution

Antelope Valley Hospital initially implemented VigiLanz to condense product line software in the hospital and assist with adverse drug reaction reporting (ADR) and medication safety monitoring, but Bennett and her staff saw the data-sharing potential in the VigiLanz solution.

Thanks to data-sharing through the VigiLanz platform, Antelope Valley is able to utilize the platform as the primary source for ADR information and data storage, helping to eliminate more manual processes.

“The Electronic Health Record (EHR) does provide alerts for us at the point of order verification, which is where the pharmacist is typically working, but we don’t always have the time to address all of those things…we [also] don’t get as many rules, or the complexity of the rules that we do with VigiLanz at the point of order verification.”
— Jill Bennett, PharmD, BCPS, Clinical Coordinator, Antelope Valley Hospital

As the use of VigiLanz in the pharmacy department expanded, Bennett and her staff prepared to pull in other departments. The goal from the onset was to use VigiLanz to help solve issues related to antimicrobial stewardship, formulary compliance, Centers for Medicare and Medicaid Services (CMS) quality indicators, National Healthcare Safety Network (NHSN) reporting, and direct budget initiatives. It was a tall order, but VigiLanz delivered on it all.

Today, Antelope Valley also uses VigiLanz to submit antimicrobial stewardship data via NHSN AUR (only the AU piece currently) and perform data abstraction and submission as part of the Public Hospital Redesign and Initiatives in Medi-Cal (PRIME) program in California. For the PRIME metrics, it assists Antelope Valley in the data abstraction for perioperative prophylactic antibiotics administered after surgical closure and captures a variation on the metrics of the National Quality Forum 2720: National Healthcare Safety Network Antimicrobial Use Measure, primarily focused on the MRSA drugs and antipseudomonal beta-lactams. This offers Antelope Valley the ability to track and assist in improving these metrics and provides an opportunity to recover funds.

The problem-solving doesn’t stop there. Bennett also works as a VigiLanz champion to engage other departments and show the solution’s ability to generate reports in a variety of settings.

“We wanted to pull dietary into the loop. Early on, I gave [the department] ways that they would be able to follow patients that were either on TPNs or warfarin. I’ve also reached out to respiratory services about monitoring isolation patients, respiratory orders or sputum cultures,” added Bennett. “Nursing has also used it, particularly related to patient education and anticoagulation and the tracking mechanism, so they have a report set up that they are using.”

Outcomes

With the help of VigiLanz, Antelope Valley staff can now create more accurate reports and utilize them more effectively, streamlining workflow and optimizing patient outcomes. VigiLanz’s ability to function at the enterprise level has allowed Antelope Valley to rededicate resources to other care improvement initiatives. It has also streamlined compliance with federal and state requirements, while generating financial rewards in the form of recovered funds from programs like PRIME that can be reinvested into the hospital.

Another core target for Antelope Valley was improvement related to antimicrobial stewardship. Its clinical pharmacists used VigiLanz to reduce illness by increasing the capture of grouped antimicrobial-related interventions, and their sum of cost savings went from $2.8 million in 2016 to more than $3.6 million in 2017. With intervention on the fired alerts and an increased focus on stewardship rounding, Antelope Valley has progressively eliminated inappropriate use and reduced its antimicrobial days of exposure per days present (risk for antimicrobial exposure per time unit of analysis stratified by location). A facility-wide analysis is also calculated and has improved.

Adverse event avoidance documentation capture in 2016 as a sum of cost savings totaled more than $576,232, and in 2017 it was $474,064, a rather significant contribution that is likely underestimated in terms of harm avoided and costs incurred. In the last two years, the Emergency Department alone documented more than $100,000 in savings.

Bennett acknowledges that there is still work to be done, but hopes exercises in cost-savings, interventions and reporting will show hospital leadership that the VigiLanz investment is—and will continue to be—an investment in themselves and the patients they serve.

“I’ve always said that pharmacy is the only department in the hospital that can actually save you money…the value derived from VigiLanz supports that.”
— Jill Bennett, PharmD, BCPS, Clinical Coordinator, Antelope Valley Hospital

Tri-City Medical Center and VigiLanz: Achieving a Middleware First Through VigiLanz Connect

Customer Profile

Located in Oceanside, California, Tri-City Medical Center has served its community for over 50 years and is a 388-bed full service, acute-care hospital, with a primary care clinic and over 700 physicians practicing in 60 specialties. Its Gold Seal of Approval® from the Joint Commission recognizes its commitment to safe and effective patient care for the residents of the community it serves. It operates the only Level III Neonatal Intensive Care Unit (NICU) in North County, as well as an Orthopedic & Spine Institute, a Cardiovascular Health Institute and a Neuroscience Institute along with the Tri-City Wellness Center in Carlsbad, California, recognized as one of the best wellness centers in San Diego County. It also specializes in women’s health, robotic surgery, cancer and emergency care.

Challenge

In the age of value-based care, it’s all about performance. Hospitals continually face increased financial pressure to reduce length of stay, hospital-acquired infection rates and hospital readmissions. The organization must improve healthcare analytics and core measures, avoid penalties and secure reimbursement, so it can continue to grow and thrive. This shift means hospitals must now consider cost avoidance instead of expecting direct reimbursement for patient care.

The challenge becomes how to support and enable next-generation healthcare providers to deliver real-time results from disparate platforms and technology. Sixty-two percent of hospital CIOs identify interoperability as a top priority, and 80 percent of accountable care organizations also cite data integration as a top challenge for their IT departments.

To help more healthcare providers deliver real-time results and to improve interoperability, medical facilities like Tri-City Medical Center require a services-oriented architecture and open application programming interface (API). The API must enable efficient aggregation, interaction and exchange of disparate data throughout the healthcare enterprise and across any of its software technologies, including EMRs and third-party single-point-solution vendors.

Solution

APIs fit the bill by allowing access to all of the data a digital health application and a health system would need in real time. Clinicians and administrators can now rapidly integrate new clinical and business information for better decision-making and, most importantly, for improved patient care with new interoperability services.

Tri-City Medical Center is the first VigiLanz customer site to utilize the company’s middleware API solution, VigiLanz Connect, to convert health data from its EMR into uniform, actionable intelligence in the VigiLanz Platform. Through VigiLanz Connect, the hospital turns its closed EMR systems into open platforms through robust services that do not rely on HL7 interfaces. VigiLanz handles connectivity and normalizes data structures across major EMR platforms, including Tri-City Medical Center’s Cerner platform, to quickly unlock the data. Benefits include shorter integration time (from months to days), elegant workflows, decreased maintenance costs and minimized risk.

“An API is definitely the way to go. Not only are APIs easy to use, but they are a no-brainer when it comes to rapid and successful implementation. Using VigiLanz’s middleware API helped us maximize the platform in a different, modern way. It is a simpler effort than using a solution like HL7, and it’s also stable and steady so it’s easy to maintain, despite the significant amount of data being pulled.” – Mark Albright, Vice President of Technology, Tri-City Medical Center

A middleware architecture has been shown to be the best technological solution for addressing the problem of EMR interoperability. The middleware platform facilitates the transparent, yet secure, access of patient health data directly from the various databases where it is stored. A hospital like Tri-City Medical Center no longer has to do all of the development itself. Instead, it can rely on off-the-shelf applications to solve problems. Middleware brings an application-agnostic approach to connecting EMRs to one another while allowing for specific development to enhance the significant investment by hospitals, health systems and physicians.

Palomar Health Leverages VigiLanz to Enhance Rapid Diagnostics for Antibiotic Resistance

Back Story

A healthcare system with breadth and depth

Palomar Health is a comprehensive healthcare system providing a full spectrum of healthcare services to communities in an 850-square-mile region, and a trauma center that covers more than 2,200 square miles of South Riverside and North San Diego County, the largest hospital district in California. In addition to three state-of-the-art hospitals—the 288-bed Palomar Medical Center Escondido, 319-bed Palomar Medical Center Downtown Escondido and 107-bed Palomar Medical Center Poway—the health system offers home health care, surgery, skilled nursing, ambulatory care, behavioral health services, wound care, and community health education programs.

At the forefront of technology, Palomar Health leverages the latest in medical technology without losing sight of the personal side of healthcare. This approach is why Palomar Health is nationally recognized for providing the highest quality of clinical care and access to comprehensive services.

Challenge

Fighting antibiotic resistance with rapid diagnostics

Antibiotic resistance is growing rapidly, with the Centers for Disease Control and Prevention reporting that at least 2 million people are infected with antibiotic-resistant bacteria each year, 23,000 die as a direct result, and many more die from associated complications. For hospitals, combating these “nightmare bacteria” requires, among other things, rapid diagnosis and appropriate treatment, and closely monitoring resistance patterns within the facility.

heartAT LEAST 2 MILLION PEOPLE ARE INFECTED WITH ANTIBIOTIC-RESISTANT BACTERIA EACH YEAR. 23,000 DIE AS A DIRECT RESULT.
“With blood infections, time is life because if you’re not getting the right antibiotic, that bacterium will kill you. It will cause you to go from a regular medicine floor to the ICU, or to progress towards death,” said Mike Kruse, Palomar Health’s manager of Clinical Pharmacy Services. “Keep in mind that bacteria have growing resistance, so we need to know what it is because it’s not going to stay the same over time, nor is it going to be the same between one patient and another.”

But it’s not as simple as accelerating the process. The blood cultures required to identify the correct bacterium, and therefore treatment, typically take 2–3 days. Until then, clinicians can only make their best educated guess.

heartIDENTIFICATION TYPICALLY TAKES 2–3 DAYS. UNTIL THEN, CLINICIANS CAN ONLY MAKE THEIR BEST EDUCATED GUESS.

Determined to reduce the severity of antibiotic resistance, Palomar Health began using the VERIGENE® System to enable rapid diagnostics with the VERIGENE® Gram-Positive and Gram-Negative Blood Culture Tests. Performed directly on positive blood culture bottles, rapid diagnostics rely on simultaneous screening to quickly detect infectious pathogens and drug resistance markers. This speeds detection of certain bacteria that are responsible for some of the most challenging and deadly infectious diseases, such as methicillin-resistant Staphylococcus aureus (MRSA) and gram negative rods such as E. coli. “It’s not quite Star Trek medicine, but it’s exciting enough that you feel as though you’re seeing Star Trek beginning to happen,” said Kruse. “It’s nucleic acid testing and that means at the genetic level, we are looking for pieces of genes that actually tell us what that bacterium is. We are even looking for pieces of genes that tell us the code for antibiotic resistance.”

Like any new technology, though, clinician adoption is imperative to the success of rapid diagnostics. It’s not enough to push the information into the patient’s electronic medical record, or even to push an alert to the clinician at the point of care. It must also be acted upon quickly and appropriately.

“We’d not used rapid diagnostics yet, so you’re not going to have every single provider knowing what to do with the information, or they’re not seeing it fast enough. So, then, what’s the purpose of rapid if it’s not really making rapid decisions?” said Kruse. “That’s where VigiLanz comes in.”

SOLUTION

Pair VERIGENE® with VigiLanz

Palomar Health had implemented the VigiLanz clinical surveillance platform approximately two years prior to adding rapid diagnostics. At the time, they sought a solution that would provide “a daily list of tasks for our pharmacists, but also let them tap into clinical decision support so that we could improve the care for our patients and find things that we would not otherwise have found,” said Kruse. “After we’d had it in place for about two years, that’s when we began to use it to innovate.”

Rapid diagnostics is a prime example of the innovation made possible by VigiLanz. There are approximately 30 different iterations of bacteria or resistance patterns identifiable by VERIGENE®. So Palomar Health’s pharmacy team worked closely with the VigiLanz team to build approximately 60 rules to match bacteria with antibiotics, as well as mismatch rules.

heartRAPID DIAGNOSTICS IS A PRIME EXAMPLE OF THE INNOVATION MADE POSSIBLE BY VIGILANZ.

“In some cases, it’s just an optimization of therapy, for example an antibiotic might be covered but it’s the most expensive one, or it is one that will cause more side effects,” said Kruse. “But the ones we really worry about are complete non-coverage, where you have bacterium growing and the current antibiotics are not going to cover it at all. That’s what’s exciting when you tie together VERIGENE® and VigiLanz.”

Cincinnati Children’s: Ensuring Safe Antibiotic Utilization Among Pediatric Kidney Patients

Customer Profile

Ranked by U.S. News & World Report as one of the nation’s best children’s hospitals, the 629-bed Cincinnati Children’s Hospital Medical Center is a leading medical research institution and teaching hospital caring for children from across the globe. Established in 1883, the healthcare system’s 15,260 employees engage in 1.25 million patient encounters each year, including approximately 34,000 admissions and 103,000 emergency department visits.

Cincinnati Children’s comprises the Department of Pediatrics of the University of Cincinnati College of Medicine, offering comprehensive clinical services ranging from treatments for rare and complex conditions to well-child care. It is the third-highest recipient of research grants from the National Institutes of Health among pediatric institutions and is among just 7% of hospitals in the U.S. to have earned Magnet-designation (2013-2017) by the American Nurses Credentialing Center.

heartCINCINNATI CHILDREN’S WAS DETERMINED TO DECREASE PROLONGED USE OF VANCOMYCIN

Challenge

With a growing body of evidence associating acute kidney injury (AKI) with an increased risk for development of chronic kidney disease, end-stage renal disease and mortality, Cincinnati Children’s was determined to reduce rates of AKI among its pediatric inpatient population. Baseline data indicated that, on average, six inpatients each week developed AKI during or within a week of discontinuing a vancomycin course. Additional evidence also suggested that extended courses of vancomycin—which when used beyond four days for empiric courses creates potentially unnecessary exposure to a nephrotoxic medication—may have been unintended.

Thus, vancomycin utilization was a natural target as the healthcare system embarked upon its mission to reduce the risk of AKI in pediatric patients. Specifically, Cincinnati Children’s sought to:

  • Decrease episodes of acute kidney injury associated with vancomycin use.
  • Decrease vancomycin exposure.
  • Decrease prolonged courses of vancomycin.
  • Increase oversight and approval for prolonged vancomycin exposure.

Success would require a close partnership between pharmacists and physicians that would enable implementation of an innovative, multistep quality improvement program focused on reducing the risk of vancomycin-induced kidney injury in pediatric patients. It also necessitated implementation of surveillance, clinical decision support and reporting technology capable of triggering interventions and educating clinicians on best practices.

Solution

Integrated within an existing antimicrobial stewardship program (ASP) and AKI reduction efforts, a core team of pharmacists, physicians, the chief medical resident and a quality improvement expert identified key drivers and implemented interventions including standardized orders, improved medical record documentation and integration of new processes into normal workflow. This enabled a stepwise approach using “plan-do-study-act” cycles.

Cincinnati Children’s also deployed the VigiLanz ASP solution to automate key processes, including screening and monitoring patients. The cloud-based platform leverages data collected from Cincinnati Children’s electronic medical record, physician order entry, laboratory and pathology systems to monitor patients in real-time for drug interactions and ineffective or inappropriate antibiotics. When potential issues are identified, alerts are triggered to enable clinical pharmacists and other members of the care team to take appropriate action.

Outcomes

Leveraging VigiLanz helped Cincinnati Children’s to create a sustainable and scalable framework that guides appropriate and safe use of antimicrobials while also promoting the safe and effective use of other medications. By enabling the provision of enterprise-wide guidance on the use of vancomycin in a matter of minutes each day, the technology helped drive significant improvements. These included:

  • Decreasing AKI associated with vancomycin exposure to an average of 4 per week from a baseline average of 6 per week, with sustained efforts likely to prevent an estimated 100 cases of vancomycin-associated acute kidney injury per year.
  • Decreasing vancomycin exposure (days of therapy/1000 patient days) by 43%, putting Cincinnati Children’s below the 25th percentile from a baseline near the 50th percentile.
  • Decreasing instances of prolonged courses of vancomycin by 44% hospital-wide.
  • Increasing ASP/ID approval in courses of vancomycin greater than four days to an average of 95% from a baseline average of 53%.

Cincinnati Children’s efforts to reduce AKI were recognized by the Association of Health-System Pharmacists, which gave the health system its 2016 Award for Excellence in Medication Safety.

“…We believe we can decrease the potential downside by choosing antibiotics that are likely to be just as effective but have less risk of increasing antibiotic resistance,” said David Haslam, M.D., an infectious disease specialist who joined Cincinnati Children’s specifically to launch its ASP initiative. “…Some hospitals just say ‘you can’t use that drug.’ Our approach will be ‘you might want to consider [another drug].’ We hope physicians will view this as bringing a lot of potential benefit.”– Silva, Mary. “Finding the Balance.” Research Horizons. Winter 2014.

San Juan Regional Medical Center Closes Resource Gap With VigiLanz

Customer Profile

San Juan Regional Medical Center, a 198-bed acute care hospital and Level III Trauma Center in Farmington, New Mexico, is the second largest trauma provider in the state. Its emergency room treats more than 50,000 patients each year and with nearly 10,000 admissions, coupled with the fact that its physicians perform thousands of inpatient and outpatient surgeries each year, the hospital has received recognition for its commitment to and success in implementing a higher standard of care for its patients.

In fact, the organization, a health care safety net provider for the entire Four Corners region, received the Healthgrades Distinguished Hospital Award for Clinical Excellence™ in 2014, and is ranked among the top five percent in the nation for overall clinical excellence. In addition to this national recognition, San Juan Regional Medical Center is also the only hospital in New Mexico and the Four Corners Region to receive this distinction.

Challenge

According to the World Health Organization, despite spending more on healthcare than any other developed country, the U.S. has consistently ranked poorly on measures of health outcomes. Ultimately, healthcare costs arise from doctors’ decisions about which services and treatments to prescribe. However, doctors generally lack clear insight into the data they need to improve outcomes and reduce costs.

Many hospitals and health systems across the country have the technological pieces in place to drive efficiencies and improve both care and the patient experience, but they still have room to further integrate systems and processes, to conduct disease surveillance and to collect necessary data from and about the patient population, among other tasks. San Juan Regional Medical Center was no exception.

“We first started looking for data mining technology four years ago because we didn’t have the resources to hire more people to help with surveillance,” explained Penny Hill, RN, MPH, CIC, Infection Control/Employee Health Manager for San Juan Regional Medical Center and APIC NM President 2017. “With a half-time nurse and half-time secretarial support, we had too much to do to keep up and do a good job. It was a struggle.”

Hill and her staff knew they needed outside help to surveil because they didn’t have the manpower to do it on their own. Through research, they found technology from VigiLanz that would automatically screen and monitor every patient in the hospital based on its own internal guidelines. With the capabilities to conduct more thorough, continuous medication oversight to anticipate and prevent Adverse Drug Events (ADEs), increase clinical pharmacy productivity and improve patient care SJRMC staff could spend less time gathering data and more time on clinical interventions that optimize outcomes.

Solution

San Juan Regional Medical Center (SJRMC) initially implemented VigiLanz solutions to help its staff conduct efficient, broad surveillance. From hospital surgical site (SSI) infection rates to flags for isolations, it’s a technology used every day, a tool that picks up anything that might not be reported or captured through manual methods.

“VigiLanz flags any irregularities, which is a lifesaver right now,” explained Hill. “If we don’t get something printed or if it’s not resulted correctly in the lab, VigiLanz finds it. What’s more, it’s very rare that there isn’t a rule already written to capture the data we need but if we need something added, it’s easy to customize.”

SJRMC also re-evaluated their pharmacy rules and implemented VigiLanz’s pharmacy module, which helps, among other things, identify suboptimal drug/bug combinations by immediately alerting staff when the culture results are finalized. This allows pharmacists to evaluate the antibiotic therapy and recommend narrowing the antibiotic spectrum or changing antibiotics if a resistant organism is identified much sooner.

“By having the conversation with our pharmacy department and showing them all of VigiLanz’s capabilities, our staff now know exactly where any drug bug mismatches are,” said Hill. “One clinical pharmacist we have on staff, who works with VigiLanz daily and speaks with providers, told me this technology has helped streamline his daily tasks because the alternative involved Excel sheets and a lot of manual work.”

With a small department and limited resources, Hill and her staff rely on VigiLanz to handle much of the heavy lifting and burden when it comes to disease surveillance for the hospital. Knowing San Juan Regional Medical Center needed a solution to help it report outcomes and results to the government, VigiLanz became the natural choice to fill in when manpower is lacking, so much so that Hill says she and her staff can’t operate at their highest level without it.

“When our CIO said hospital-wide we were going to get rid of a lot of our third-party solutions when we converted from one large EMR solution to another, that we’d be moving to one platform, I told her that we couldn’t possibly do the work we do, to the extent we do it, without VigiLanz. It’s critical to patient care.”

VigiLanz’s offering is so specialized and customized that if a radiologist dictates a CAT scan and sees an intraabdominal abscess, hospital staff receive an alert. San Juan Medical Center’s new EMR didn’t have those capabilities so while it did replace dozens of the hospital’s other technology products, VigiLanz remained in place.

Outcomes

Through automated, continuous surveillance of every patient at San Juan Regional Medical Center, Hill and her staff can rapidly identify Healthcare-Acquired Infection (HAI) threats and resistance patterns, control emerging infection risks and prevent further infections in real time. VigiLanz quickly identifies conditions needing attention, enables rapid reporting of state and federal requirements – including direct NHSN reporting – and facilitates robust and intuitive analysis and simplified report generation so staff have more time to spend working with patients and other clinicians on prevention activities.

“I do have to say we probably have one of the most robust surgical site surveillance programs around and I attribute that to VigiLanz,” noted Hill. “We’ve participated in a lot of validation studies and there is rarely anything that’s not picked up by VigiLanz and/or our manual lab reports that we get. I feel confident we are getting the information we need and not getting information we don’t need.”

San Juan Regional Medical Center still does a lot of work manually, on paper, but hopes to transition away from a paper system once its EMR transition is complete. Once Hill and her staff have validated all of the data and analysis and made any corrections, they hope to ultimately report everything directly through VigiLanz to NHSN, bypassing the current manual workarounds.

“With VigiLanz, we can validate C.diff and CAUTI in the ER and all inpatient areas, in addition to capturing all positive urine and blood cultures without having to wait,” explained Hill. “We’re able to validate 100 percent of our data with what’s in NHSN and what we’re able to extract out of VigiLanz. That’s significant and it’s why I’d love everyone in New Mexico to have VigiLanz!”