And at Virginia Mason Health System in Seattle, provider education failed to stop doctors from ordering unnecessary expensive advanced imaging tests, wasting lots of resources. So VM tried something else. It installed decision rules in the software used to order the tests, requiring the provider to specify the evidence justifying the scan.
Decision rules were installed in the software used to schedule studies. The MRI rate for headache decreased by 23.2%, the lumbar MRI dropped by 23.4% and the sinus CT rate declined by 26.8%, saving millions in costs.
For IT best practices, Geisinger has saved $1.7 million over the past years in reduced chart pulls, more than $600,000 in reduced printing and faxing and more than $500,000 per year from reduced nursing staff time and more than $1 million in reduced transcription time. They've done it through a health information exchange, an Electronic health record system, ePrescribing modules, a data warehouse, and document management.
For evidence protocols, Kaiser Permanente's orthopedists developed the "Healthy Bones" program and reduced hip fracture rates for at-risk patients by 50%. The program uses systematic bone density tests, osteoporosis medications, education programs among efforts to better manage high-risk patients.
And under embedded safeguards, Cincinnati Children's achieved an 85% reduction in ventilator-associated pneumonia and a 50% reduction in catheter-associated bloodstream infections and lowered costs by $5.6 million a year with a robust system that detects risks for hospital-acquired conditions.
For internal transparency, Denver Health nearly doubled breast cancer screening rates by developing registries for their community health center network, with real-time data and performance report cards. "An essential feature of the report cards has been non-blinded display of performance by site of primary care and by primary care provider, which drove reduced variation and improved overall performance," the report says.
James says healthcare systems must do not necessarily these same things, but these kinds of things, if they are to remain viable. The transition to these kinds of strategies "will have to accelerate even more than it has been. The reason is because it produces better patient outcomes at lower cost."