From meaningful use to meaningful analysis
By Brad Savage, November 7, 2011
Near real-time analysis of information is critical to improving the quality and safety of care across the health delivery spectrum. Take a look at what Microsoft's Amalga solution has done for long-term healthcare provider Golden Living, its caregivers and its patients.
As a provider of post-acute care, Golden Living is not eligible to receive financial payment from the government for achieving the meaningful use of electronic health records (EHRs). But as a provider of care for more than 60,000 patients every day — spanning skilled nursing, rehabilitation therapy, home health, hospice care and assisted living — Golden Living is laser focused on meeting the very goals meaningful use is designed to address: improved care coordination; increased quality, safety and efficiency of care; and the active participation of patients and families in managing their health, to name a few.
In our efforts to attain these goals, we've learned that it's not just the exchange of data but the aggregation of data — and not just the meaningful use but the meaningful analysis of that data — that's critical to transforming care. The key to meaningful analysis is enabling a single, patient-centric view of information, whether in a post-acute or acute care setting.
With the move toward serving higher-acuity patients, post-acute healthcare organizations face challenges similar to those of acute-care hospitals. A higher rate of admissions, more complex patient conditions and more patients expecting to get treated and go home are just some of the factors requiring post-acute care facilities to evolve from long-term-care providers to continuum-of-care providers. To remain relevant and viable, skilled nursing facilities must have the flexibility and agility to handle a broader range of patient conditions efficiently, to manage care transitions smoothly and to provide the best possible patient care — to achieve the best outcomes and avoid costly hospital readmissions.
In this landscape, we asked ourselves, "What allows our patients to receive better, more efficient care? What allows our nurses to provide that care at the bedside?" The answer was clear: the right information at the right time. To provide the best services and arrive at the best outcomes, it's critical for Golden Living to provide caregivers with the information they need about patients when they need it — at the point of service.
To deliver this capability, Golden Living turned to a new category of software, a "health intelligence platform," designed to bridge the silos of data stored in separate IT systems across the organization and make it simple for nurses and doctors to view comprehensive patient information before and during treatment, not just retrospectively. The technology platform, Microsoft Amalga, doesn't replace our existing IT systems; instead, the software aggregates data of any type from multiple source systems and stores a copy of the information to provide a single, patient-centric view of information. Clinicians can obtain a complete patient history (including medications, allergies, observations, reports, demographics and hospital visits) at the point of care and drill down into specific information that's meaningful to them to do near real-time analysis. The meaningful analysis of patient data is enabling Golden Living to improve clinical performance and patient outcomes.
A new "clinical start-up" application, for example, is allowing nurses to more quickly and easily identify subtle changes in patients' conditions and needs, and to take action to prevent avoidable re-hospitalizations, discharging them to home instead of the hospital. Prior to using a health intelligence platform, each morning Golden Living nurses spent hours pulling patient information from charts and other offline and online systems from the previous night. Then, the process of prioritizing and distributing cases for follow-up was conducted in a meeting that relied on a variety of paper reports and handwritten notes. Now, Amalga pulls information from 15 different IT systems to populate views and alerts that call out significant clinical indicators for a resident under each monitored area. This allows the director of nursing services to manage by exception by reviewing just the detail of alerts. The information is then made available via a large touch-screen monitor for all to see in the meeting.
As a result, the time spent each day simply gathering data for the clinical start-up meeting has been reduced from 90 to 30 minutes, freeing up an additional hour for patient care at the bedside. Outliers are much more easily accessible, allowing us to make interventions earlier in the process and not have to send patients back to the hospital for treatment because their condition worsened or because alerts were not readily available. Shift hand-offs are much smoother and efficient due to more accurate and accessible information.
The ability to easily access and analyze data in near real time has opened up tremendous opportunity to improve not only clinical performance but operations as well. In just two weeks, Golden Living was able to create a regulatory compliance application, comprising 224,000 pieces of data, which enables us to provide accurate and timely information from more than 300 facilities to corporate-level administrators so they can ensure compliance with federal and state regulations across 21 states. Instead of performing analysis after the fact and taking measures reactively, staff are now able to view data from 305 facilities in near real time so that efforts to improve safety and quality can be made in the moment.
Working in partnership, Golden Living IT staff, clinicians and administrators can target a specific workflow (such as the morning clinical start up or regulatory compliance) and use a health intelligence platform to present users with the information that's meaningful to them in that context for near real-time analysis. It's this meaningful analysis that we believe is fundamental to the transformation of healthcare delivery.
About the author
Brad Savage is CIO of long-term care provider Golden Living.
For more information on the Microsoft Amalga solution: www.microsoft.com/en-us/microsofthealth/products/microsoft-amalga.aspx
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