At TriHealth, a health system based in Cincinnati, Ohio, clinicians were feeling the pinch between balancing their actual jobs (in caring for patients) and administrative work, like electronic health record data entry.

THE PROBLEM

Staff members previously had to search through paper records to find the patient information they needed, thus hindering efficient and informed decision-making. Every transition in care is also an opportunity for a breakdown if there is no real-time and discreet sharing of information. The staff wanted a way to make transitions seamless, automatic and secure.

The hospital was sending a continuity-of-care form to the skilled nursing facility to alert them to patient needs, and then this document was manually entered into the EHR. This could have been an automated process to avoid any potential bumps in the road that could lead to a gap in care.

TriHealth originally started working on an integration with health IT vendor PointClickCare with the hope of automating the flow of all patient data between institutions, ultimately giving clinicians back precious time in their days and improving the quality of care that patients receive.

"With any integration, it’s not always 100% right away. We consider [83%] to be highly impressive, especially considering the large volume of patients that we were transferring at the time due to COVID-19."

Lori Baker, TriHealth

“So, it’s fair to say that prior to COVID-19, we definitely understood the innate value of having this depth of digital connectivity between our institutions,” said Lori Baker, director of ambulatory care management and senior services/post-acute care at TriHealth.

“Once the pandemic hit, it became clear that we needed to ramp up these existing operations quickly, in order to efficiently care for the number of patients being transferred between TriHealth hospitals and post-acute care facilities, all at the same time,” Baker continued.

PROPOSAL

PointClickCare is a cloud-based software vendor for the long-term and post-acute care market, supporting more than 21,000 skilled nursing facilities, senior living communities and home health agencies across North America. PointClickCare’s technology works to eliminate data silos among care settings and teams in order to enable clinical insights and mitigate risk.

“Harmony by PointClickCare facilitates the seamless, automatic flow of patient data between our acute and post-acute care institutions,” Baker explained. “This means that when a patient is transferred from the hospital to a skilled nursing facility, their data is sent with them, so there are no gaps in care or miscommunications between care teams. This continuity helps to make processes more efficient for our staff and provide families with accurate information to make the best transition decisions for their loved ones, through a single, secure platform.”

In this way, the patient gets the best, most-coordinated care possible and the clinician gets to spend more time with the patient and less time on administrative work. The result is shown to alleviate symptoms of burnout, she added.

“Improving outcomes for all stakeholders involved in the care journey has always been our goal, and especially while navigating the uncertainties of the COVID-19 pandemic, the software has helped us to realize that goal,” she said.

MEETING THE CHALLENGE

Because TriHealth had been working with the vendor on a larger EHR integration project, it was able to deploy a pilot project with five facilities when COVID-19 really began to hit in March. Those five facilities completed all communications between acute and long-term care via EHR for all transitions of care. TriHealth was so pleased with the initial results that it believed it could start the next phase of this work. It has now onboarded 20 more facilities in the past month.

“In order to accomplish this quickly and rather seamlessly, the TriHealth team engaged the pharmacy team, emergency department physicians and other clinicians on the medical floor to ensure they were aware of the information and [knew] where to find the information they needed in the medical chart,” Baker said. “We continue this education process to help ensure that we are making the right information visible and helpful to providers, when they need it.”

TriHealth also now holds bimonthly team meetings to identify any glitches, do a bit of root-cause analysis and then work with PointClickCare to refine the process and technology as necessary with all the providers who are using the new systems. This has proven to be a very helpful process, and a demonstrable sign of skilled nursing facilities and TriHealth working together to help sites be successful and grow stronger in the long run, Baker remarked.

RESULTS

“With any integration, it’s not always 100% right away,” Baker noted. “That said, 83% of EHR transfers using the PointClickCare integration were successful between March and April of 2020. We consider this to be highly impressive, especially considering the large volume of patients that we were transferring at the time due to COVID-19.”

Since integrating with the vendor’s software, TriHealth also completed a pilot readmission study with the first five skilled nursing facilities to be onboarded. The study compared readmission rates between April and May 2019 to readmission rates between April and May 2020. The health system found there was a 6.7% decrease in readmissions. While the denominators were relatively small in this pilot, TriHealth is excited about this early win, Baker said.

“We’ve definitely learned a lot from the pilot with the vendor and feel confident that we can work together to fine-tune the process even further,” she said.

“The next challenge we anticipate will be finding locations to house a potential second wave of COVID-19-positive patients who are ready for acute care discharge, but unable to enter a skilled nursing facility. Of our more than 200 skilled nursing facilities in the Cincinnati area, only five are able to take in COVID-19-positive patients. This is through no fault of the facility, but rather a reflection of just how vulnerable this particular population is.”

Everyone is stepping up to the challenge every day, she added. That said, TriHealth has seen an increase in the amount of skilled nursing facilities that offer isolation units. It continues to test each patient for COVID-19 prior to discharge from the hospital in an effort to mitigate the spread of the virus, she said.

ADVICE FOR OTHERS

“In attempting to alleviate the strain placed on our health system due to COVID-19, we’ve learned to implement and use digital care solutions more quickly and effectively during the past few months than ever before,” Baker noted.

“At TriHealth, had we already been further along in our EHR integration with PointClickCare at the time that the pandemic hit, we definitely would have experienced better connectivity between facilities at the onset,” she continued.

Regardless, the integration allowed TriHealth to better handle the complexities of the pandemic, she stated. Now the health system is trying to do what it can and leverage what it has learned to prepare for a potential second wave of COVID-19, she said.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.