Baptist Health South Florida Homestead Hospital was on a mission: to achieve HIMSS Analytics Electronic Medical Record Adoption Model Stage 6 and Stage 7, the highest certification level. (HIMSS is the parent organization of Healthcare IT News.)

THE PROBLEM

Homestead Hospital engaged health IT giant Cerner for help improving three key care areas: 30-day heart- failure-readmission prevention, decreased length of stay for C-sections and sepsis bundle compliance.

Located in the heart of south Miami-Dade and part of Baptist Health South Florida (BHSF), Homestead Hospital cares for thousands of patients each year. Homestead Hospital is the only place within a 30-mile radius where someone can deliver a child. 

As a result, Homestead Hospital providers see patients with hypertension and diabetes, which can be associated with higher rates of C-section deliveries.

Providers and hospital leadership teams wanted to examine how to improve the experience for moms in labor and delivery by looking at ways to decrease LOS following C-section procedures.

Another area of focus for Homestead Hospital was 30-day heart-failure-readmission prevention. 

Knowing that the Centers for Medicare and Medicaid Services assesses quality outcomes and has a fee specific to readmissions, Homestead Hospital staff examined its heart failure readmissions and explored various ways to reduce them.

Finally, Homestead Hospital teams had a desire to improve sepsis bundle compliance through the use of new innovative technology tools, said Kenneth Spell, CEO of Baptist Health South Florida Homestead Hospital.

"To other organizations trying to achieve HIMSS EMRAM designations, I recommend downloading the HIMSS Analytics Electronic Medical Record Adoption Model tool kit that contains robust resources about the methodology and requirements to begin your journey to certification."

Kenneth Spell, Baptist Health South Florida Homestead Hospital

"Homestead Hospital's percentage of sepsis cases meeting bundle requirements – a series of responses a medical team takes to treat sepsis – was below benchmark, and there were opportunities to improve both mortality and [length of stay]," he explained. "When Homestead Hospital staff initiated the sepsis program, the goal was to examine patient mortality and morbidity as it pertains to sepsis and trying to meet CMS sepsis requirements."

PROPOSAL

Homestead Hospital leadership teams began discussions with Cerner to learn more about PowerPlans, a solution within Cerner's electronic health record to help facilitate comprehensive multidisciplinary planning and coordination of care for the patient in the acute care setting. 

PowerPlans is designed to provide clinicians the ability to individualize patient-specific, problem-driven plans of care, including multidisciplinary clinical pathways, care protocols and nursing care plans.

"PowerPlans has many functions, including aiding with physician order sets, coordination of multiphase treatment plans, nursing and interdisciplinary care plans, outcomes and interventions, oncology protocols, and more," Spell noted. "PowerPlans is the Cerner technology solution proposed to help address our goals related to 30-day heart-failure-readmission prevention and decreased LOS for C-sections.

"We implemented something called an internal sepsis code in April 2017 to work toward improving sepsis bundle compliance," he continued. "Cerner developed a surge alert that triggers a notification to both the special sepsis unit and our own internal medical management team at Homestead Hospital's emergency department."

The sepsis project includes near real-time monitoring of the patient and tracking patients as they come in. If a patient comes into the emergency department with fever, tachycardia or two out of the many triggers, a sepsis alert will fire to the virtual sepsis unit. From there, the virtual sepsis unit is also in the background monitoring the documentation of fluid and lactic acid and that Homestead Hospital meets initial requirements for CMS guidelines.

MARKETPLACE

There are many vendors with electronic health records systems on the health IT market, including Allscripts, athenahealth, Cerner, DrChrono, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.

MEETING THE CHALLENGE

To help address concerns with care delivery and improve the standard of care and outcomes of patients undergoing C-sections and other procedures, Homestead Hospital providers implemented PowerPlans in 2017, Spell recalled.

Homestead Hospital also initiated an enhanced recovery after surgery (ERAS) pilot for elective C-sections. Analytics measuring the PowerPlans utilization helped support the measurement of adherence to the standard of care compliance.

"In addition to having excellent technology to work with, our providers, nurses and care teams stepped up to make sure they understood how to optimize the technology and use it to help improve care," Spell said. "Through examining C-section LOS, we also found ways to leverage PowerPlans to curb opioid use.

"We engaged pharmacists to work with patients to provide resources and medication for those who couldn't afford it so they could stay out of the hospital," he continued. "Additionally, our nurse practitioner is doing a great job in collaborating with transitions of care to reach out to these patients who have multiple admissions in the last six months to see how we can keep them healthy and at home."

The staff ensures that nurses and physicians are trained on how to use the technology, and they are doing a great job of integrating the technology into their workflows in order to improve outcomes, he added.

"After successful efforts in 30-day heart-failure-readmission prevention, a decrease in LOS for Caesarean section deliveries, and a decrease in sepsis mortality and patient LOS, we were able to effectively use data to apply for and earn one of the most prestigious awards in healthcare information technology," Spell said. 

"Homestead Hospital joins a small group of healthcare organizations who have won a HIMSS Davies Award, but an even smaller group who have reached HIMSS Stage 6, Stage 7 and Davies in the same year."

RESULTS

Beginning in 2011, with a blueprint for successful improvement in the 30-day CMS heart-failure-readmission rate, the continuous improvement process resulted in the 30-day heart-failure-readmission rate falling from as high as 33.3% to as low as 11.1%. 

Additionally, the utilization of PowerPlans increased the heart-failure-bundle compliance rate from below the organizational benchmark of 30% to rates as high as 60%.

"The PowerPlans technology has also proven to be a useful tool in helping reduce the stress response to C-section surgery and accelerate a patient's recovery," Spell noted. "The overall LOS for the C-section population following the implementation of PowerPlans decreased from 3.0 days to 2.30 days. We also experienced a large decrease in variable cost to the institution and patients who had the C-section."

The latest advancements in the obstetrics ERAS program were incredible, he added. "We're still reaping the benefits today, because we have one of the lower uses of opioids throughout the Baptist Health South Florida system," he said.

While the numbers are very encouraging, the hospital is most proud of the response from patients.

"Our improvements are seen both internally and externally, and those surveyed have reported improved satisfaction with their care," Spell reported. "This checked all the boxes for us, because we were decreasing our costs and length of stay and improving how patients felt about being in the hospital."

The sepsis mortality rate decreased from as high as 1.91 to as low as 0.45. Sepsis cases meeting the bundle compliance increased from as low as 52% to as high as 88%, and LOS also decreased from a high of 6.83 days on average to as low as 3.88 days on average.

"BHSF experienced more than $300,000 savings in sepsis variable costs and more than $630,000 in total costs," Spell said. "We believe reduced LOS contributed to savings, as in-hospital expenses are one of the biggest costs to patients. It's an overall team effort, because everybody's included.

"Not only the medical providers, but performance improvement, clinicians, the virtual sepsis unit," he continued. "On a global level, I think it's a win-win, not only for Homestead Hospital, but for us collaborating with Cerner, who harmonized the workflow."

ADVICE FOR OTHERS

"We're a small facility 30 miles from the nearest hospital where people can come for their medical needs," Spell said. "We care for patients who are very sick. And it is phenomenal we are able to shine, albeit [considering] all the challenges we have faced. Given our size and the challenges we faced, as well as other providers worldwide, to deliver care during the pandemic, this achievement is such an honor for our staff.

"To other healthcare provider organizations trying to achieve HIMSS EMRAM designations, I would recommend downloading the HIMSS Analytics Electronic Medical Record Adoption Model tool kit that contains robust resources about the methodology and requirements to begin your journey to certification," he continued.

"I would also recommend engaging in conversations with your EHR vendor to let them know your organization is interested in becoming certified, and see what tools they can offer to help your organization achieve that goal."

The process won't be easy. It requires a lot of data, collaboration and evaluations. But if one can push through the process, earning such a prestigious designation will greatly benefit providers, staff and, most important, patients, he concluded.

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