The American Hospital Association (AHA) recently determined that 75% of senior hospital executives endorsed the importance of digital innovation. This is incredible progress for the industry, but there are still key areas within hospitals that need to embrace the new technologies available, for both the health of the hospital and its patients.
One of the most underserved departments when it comes to innovation is the Neonatal Intensive Care Unit (NICU). The lack of investment might come from the assumption that it’s too small of a population, but these infants are one of the most expensive patients in a hospital, with some preterm infants staying in the NICU over 100 days.
Nutrition: The Overlooked Piece in Preterm Infant Health
More than 380,000 babies in the United States are born preterm annually, and according to the CDC, in 2018, one in 10 babies was born too early (before 37 weeks of pregnancy). Today, we can survive infants as early as 22 weeks gestational age.
Preterm infants require round-the-clock care in the NICU, including monitoring of their hearts, lungs and temperature. As survival rates for extremely preterm infants improve, attention is now being focused on improving the quality of survival. Optimal nutrition early in life can positively impact not only physical growth, but neurological development, as well.
However, nutrition is rarely taught in medical school and expertise is limited to dietitians, where present, or a clinical researcher who focuses on nutrition. Optimizing feeding and nutrition management in the NICU remains a major challenge for clinicians.
Implementing a standardized feeding strategy has been shown to improve growth outcomes in addition to reducing adverse events, however most NICUs are still using paper-based feeding protocols and require dieticians to make manual calculations using pen, paper and calculator.
This manual process has been the standard practice for decades. Not only does this provide room for error, it creates more work for clinical care teams and is a drain on hospital resources. While technology in support of life saving measures is rampant in the NICU, the utilization of software has been limited to the implementation of electronic medical record systems, such as Epic and Cerner. Investments in technological innovations have not extended to addressing feeding and nutritional support for the tiniest, most vulnerable patients.
By Brian Carter, senior vice president of product, Validic.
Clinicians, CIOs and virtually every person in a decision-making position in a health system is courted multiple times a week by third-party solution developers with amazing products to help them with some of their most pressing problems. The features look great, but at some point they have to ask: does it integrate with my existing clinical workflows in a way that makes it easy to use, hard to forget about, and actually save my team some time?
This question is extremely important; according to one study about clinical decision support (CDS), zero CDS interventions succeeded when they weren’t delivered automatically in the clinician workflow. By contrast, the same study showed that 75 percent of those interventions succeeded when they were automatically presented in clinical workflow. Workflow integration comes in a variety of flavors, with the value of that integration typically (and somewhat unfortunately) proportional to the amount of investment made in preparing for that integration.
Visual integration is the lightest-weight kind of integration. iFrames, SMART apps and “widgets” are all common technologies that come to mind when describing visual integration. Essentially, you are taking one application and layering it as a self-contained component inside another application. This ideally includes a single sign-on function so the person signed into the main application doesn’t have to sign into another widget on their screen.
A common example on the web is Disqus. If you scroll to the comments section of a web page to share your opinions, you’ll find a nicely-embedded component with other people’s comments. But, if you want to contribute a comment yourself, you have to sign in. This comment feature is actually a totally different application provided by another company called Disqus, which was visually integrated with a few lines of code.
Data integration is often what’s being talked about when interoperability comes up. Data integration simply means enabling the data from one application to flow meaningfully into another application. The concept is simple, but the application of this strategy can be highly complex. It involves getting two systems to not only get data from one place to another, but also to be formatted and codified in a way that the receiving system can actually understand it.
Technologies common in health care surrounding data integration include the emerging FHIR specification from HL7, legacy APIs provided by EHR vendors, health information exchanges that serve as intermediaries between different systems, as well as enterprise data warehouses and big data platforms. Data integration is a critical strategy whenever users of one system need information that users of another system have generated.
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
Wolters Kluwer’s Clinical Solutions provides integrated and comprehensive solutions in clinical decision support, drug information, patient surveillance, disease management and intuitive documentation, terminology and coding solutions at the point of care. Serving more than 150 countries worldwide, clinicians rely on Wolters Kluwer’s market leading information-enabled tools and software solutions throughout their professional careers from training to research to practice. Our offerings bridge multiple care settings, including hospitals, health systems, ambulatory surgery centers, physicians’ offices and retail pharmacies, and are integrated via common processes, systems and highly motivated and experienced people.
Market Opportunity & Problems Solved
Physicians struggle with the growing amount of data pouring into clinical systems and must often act upon more information than any one person can handle. In addition to EHRs, clinicians must make sense of information from multiple, disparate systems, including labs, pharmacies and others. The first solution to emerge from Wolters Kluwer’s Innovation Lab is POC Advisor, a comprehensive platform that aggregates, normalizes and codes patient data and runs it against clinical scenarios to deliver actionable, evidence-based advice at the point of care. The first application of POC Advisor aims to reduce the mortality and morbidity of sepsis (septicemia), a disease which claims an estimated 750,000 lives in the U.S. alone and costs hospitals $20 billion annually, making it the most expensive condition in the country.
A significant contributor to the negative outcomes involving sepsis – often the result of delayed or improper diagnosis that can rapidly lead to a cascade of events culminating in organ failure and death – is the siloing of crucial data in disparate clinical information systems. The inability of physicians to access and process the entirety of a patient’s data, forces them to make critical decision based on fragmented evidence. By utilizing a patient’s complete information, POC Advisor alerts care provides to potentially septic patients allowing clinicians to begin treatment long before the condition becomes life threatening.
In addition to the Sepsis Module, the Innovation Lab has already started work on applying POC Advisor to MEWS (Modified Early Warning Score) and future applications are expected to include heart disease, pneumonia, diabetes, CLABSI (central line associated bloodstream infection) and CAUTI (catheter associated urinary tract infection). Leveraging health IT to disseminate patient-specific, actionable, clinical knowledge across the care continuum results in a higher quality of treatment and more complete care. Ultimately, POC Advisor exemplifies Wolters Kluwer Health’s goal of providing an integrated suite of services designed to improve triple aim initiatives.
The Affordable Care Act supports healthcare providers in reducing costs and improving efficiency while delivering quality care. Accountable care organizations (ACOs) achieve these goals by enabling physicians, hospitals and other healthcare providers to create networks and share responsibility to deliver care to Medicare and other patients.
At the heart of the ACO model are three core principles:
ACOs are provider-led organizations with a strong primary care base, and collective responsibility for quality and per capita costs.
ACO payments are linked to improvements in quality that also reduce costs.
Performance measures that support improvement are sophisticated and reliable, and demonstrate that savings are achieved through improvements in care.
Joining an ACO is voluntary, but the federal government encourages participation to reduce unnecessary or duplicated services, prevent errors and keep patients healthier. When providers successfully coordinate services to meet a long list of quality measures, they become eligible for bonuses.
The Current Environmment
Medicare offers several ACO programs, including the Medicare Shared Savings Program, the Advance Payment ACO Model and the Pioneer ACO Model, but many other public and private models exist. Some are sponsored by physicians groups, while nonprofit organizations, hospital systems and health insurers sponsor others. The Pioneer Model was designed for early adopters of coordinated care, and is no longer accepting new members.
To date, more than 600 public and private ACOs have formed; in 2012, the first year of the program, they generated $87.6 million in gross savings. Government support is spurring considerable growth, and ACOs could well become the dominant model in healthcare.