Accurate medication reconciliation has a significant impact on patient outcomes and readmissions at CMC.
"When we're able to accurately identify the patient's home medications, the provider can more effectively order medications during the patient's hospitalization and on discharge. Accurate admission and discharge reconciliation positively impacts patient outcomes, and nursing is responsible for a large part of that." Fleming says. "Nursing does not perform the reconciliation, but the quality of the historical information they gather can directly impact the patient as well as the efficiency and accuracy of the provider."
The shift from paper to electronic records has transformed the process. "On paper, the nurse or provider was free to leave key prescribing information blank on the home medications list." Fleming says. "With electronic historical medication entry, the nurse is guided to complete all elements of a complete historical medication order. The nurses are now routinely following up with PCP offices and home pharmacies to determine the correct and complete home medication information."
CMC reports that the improvements are leading to better quality. For example, CMC has decreasing door-to-balloon times, and its key performance indicator scores have exceeded expectations, with 44 excellent and 28 notable scores. CMC achieved best practice thresholds in 72 KPI categories.
And improving clinical documentation has had a positive financial impact. By decreasing lost billable charges, the organization's emergency department increased revenue by 48% in the first 6 months, and continues to see appreciable monthly increases in expected revenue capture. Total overall charge capture for FY2011 showed an average monthly increase of 33%.
Unlocking the data
Oklahoma Heart Hospital bills itself as one of the nation's first all-digital hospitals. But like many organizations that are early adopters of electronic medical records and other health IT systems, the organization's leaders were struggling to figure out how to make better use of it.
"We had this great EMR that had all this data that we couldn't get out very easily," says CIO Steve Miller.
So the 145-staffed-bed Oklahoma City organization, which encompasses two campuses and 60 affiliated clinics, started investigating how to use technology to unlock that data, make it actionable, and get it into nurses' and physicians' hands.
Today, the organization uses a number of techniques and technologies to improve clinical quality, workflow, and patient satisfaction.
Getting alerts on the go
"A lot of hospitals spend a large amount of time and personnel around centralized monitoring," Miller says. "Most hospitals have a centralized monitoring room where you'll have dozens and dozens and dozens of monitors and a 24/7 staff who are just sitting there staring at the monitors waiting for critical alerts."
Instead, Oklahoma Heart Hospital sends near-real-time critical alerts from hardwired heart and vital-sign monitors directly to nurses' smartphones using an integration engine from Boulder, CO–based Connexall USA.
The mobile alerts include an image of the patient's heart rhythm so the nurse can evaluate the severity of the alert. (If for some reason the patient's assigned nurse does not respond, the alert automatically escalates to another caregiver.)
Of course, monitors still give alerts in patients' rooms and at nursing stations. "But in our facility, nurses could be in another room taking care of patients. So the idea was to give them the best possible way to know as quickly as possible that there's an alert. You don't want to wait till the next time you're at that nurses' station or rely on hearing it in the room," Miller says.