SAN DIEGO — UC-San Diego Health System has been named one of the country’s “Most Wired” hospitals by Hospitals and Health Networks, a publication of the American Hospital Association.Â
This marks the 13th year that Hospitals and Health Networks has conducted its “Most Wired” survey and the sixth consecutive year that USCD made the list.
While most U.S. hospitals have stepped up their adoption of technology in response to federal meaningful use incentives and the federal health reform law, UCSD has been focused for years on what technology can do to improve patient care, said Ed Babakanian, UCSD’s chief information officer.
“We said all of our systems need to be integrated in a way that a particular clinician looking at a patient’s information and their file can make decisions about what needs to be done for that patient by speed of computer,” he said.
Eight years ago, UCSD implemented systems to automate care processes and provide information throughout the whole continuum of care. “Ever since then, we’ve been improving upon it,” Babakanian said.
Being an early adopter of technology has paid off for UCSD. The system already has met Stage 1 of meaningful use and is on track to meet Stage 2, according to Babakanian.
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicare and Medicaid incentive payments. In May, CMS began doling out incentive payments to physicians and hospitals that demonstrated compliance with Stage 1 meaningful use criteria.
UCSD also recently was awarded a Stage 7 HIMSS Analytics score, which recognizes hospitals for achieving the highest level of EHR adoption. That places the San Diego-based hospital system in the top 1% of more than 5,000 hospitals in the HIMSS Analytics Database for EHR adoption.
HIMSS Analytics developed its eight-stage evaluation tool in 2005 to track hospitals’ progress in completing the transition to EHRs.
A Focus on Clinical Operations
UCSD was one of 154 hospitals included on this year’s Most Wired list, a small group culled from 530 applications representing 1,388 hospitals.
As in years past, the 2011 survey was retooled, said Matthew Weinstock, senior editor of Hospitals and Health Networks, to reflect the ongoing changes in health care technology.
“Over the past few years, the survey has shifted to a slightly heavier focus on the clinical components, and certainly the last two years have changed to incorporate more meaningful use criteria,” he said.
The survey clearly demonstrated that clinical quality and safety is a top priority for hospitals around the country, according to Weinstock.
The use of computerized provider order entry, or CPOE, for instance, has quadrupled in all hospitals that participated in the survey during the past seven years. Of those making the Most Wired list, 59% enter physician orders electronically, which is up by 27% from just five years prior. Much of that increase has to do with the fact that federal meaningful use regulations have emphasize CPOE.
The implementation of systems to ensure medication safety also has become a top priority for hospitals and represents another area of tremendous growth. Two-thirds of hospitals on the Most Wired list use bar codes to manage medications at patients’  bedsides, a threefold increase since 2005. More than half of all survey respondents have point-of-care medication management systems, a rate that also has tripled since 2005, Weinstock said.
Implementing a point-of-care medication management system has made a huge difference in patient safety, as well as in efficiencies and cost savings for UCSD, Babakanian said.
UCSD nurses scan medication bar codes, themselves and the patient, all at the bedside, to make sure patients are receiving the correct medication and dosage.
“We’ve not only reduced the turnaround time from hours to minutes, but also along the way have guaranteed quality outcomes and patient safety,” Babakanian said.
Precious resources are being preserved as well.
“Because we’re in an academic environment, any medication that is ordered is reviewed by multiple pharmacists and nurses to make sure there is no error. That process is very time consuming,” Babakanian said.
Today, computer systems offer physicians clinical decision support capabilities, which dramatically reduce medication errors.
Pharmacists who once spent their days transcribing physician’s paper orders and entering them into the pharmacy system have given up that work altogether, allowing them to accompany doctors on rounds and lend their prescribing expertise at the point of care. The number of steps and people required to fill a prescription have been dramatically reduced in the process. Â
“The national focus on meaningful use is not only about improvement of quality of care, but also is to make the health care environment more efficient. And we have seen that here, specifically to the bottom line,” Babakanian said.
Communicating Across the Care Continuum
Another area in which hospitals must excel in order to make the Most Wired list — and meet the next stage of meaningful use — is the ability to share patient information across a continuum of care. “We look for pretty strong [EHR] function and exchange of information between hospitals and physician offices,” said Weinstock, referring to the selection process to develop the Most Wired list.
It turns out, Weinstock said, that California hospitals do well relative to hospitals in other parts of the country when it comes to the exchange of information, including offering a patient portal, disease management services at home and telemedicine. “We’re also seeing in the care continuum they do well at tracking and reporting to public health agencies, which is a piece we do ask about in the survey,” he said.
Both UCSD and Kaiser Permanente — which also made Hospital and Health Network‘s Most Improved list — are two California-based systems that excel in this area.
UCSD eliminated paper in its outpatient operations five years ago, according to Babakanian. Now its approximately 1,200 affiliated physicians operate in a fully electronic ambulatory setting. “Every physician and exam room has a computer. The nurse takes your information and inputs it, and your physician sees your entire history right there — allergies, images, labs. They don’t have to go anywhere else,” Babakanian said.
In addition, UCSD offers a patient portal called My UCSD Chart, where 30,000 patients can gain online access to their medical records.
Kaiser Patients Also Connected
Kaiser Permanente, one of the largest systems in Southern California, has been working to incorporate technology into clinical practice for decades. For several years now, all of Kaiser’s hospitals, clinics, clinicians and patients have been electronically connected.
“We have been working towards meaningful use for Kaiser Permanente decades before meaningful use legislation was passed,” said John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.
Every one of Kaiser’s members has an EHR and about 60% regularly use the electronic system. Not only does this allow for the free flow of information among all clinicians and settings, it also enables the system to send out care alerts to physicians and patients, another requirement included in meaningful use regulations.
“It is the foundation of our health records systems and our ability to apply automated rules that say, ‘It’s time. Come on in for your Pap smear, mammogram, whatever,’ so that we are actually intervening at an early enough stage so we can cure people who otherwise would not have been curable,” Mattison said.
Challenges Still Ahead
Even hospitals well on their way to meeting meaningful use requirements wrestle with certain aspects of their IT implementation.
“Quality indicators seem to be quite troublesome for many organizations,” said Keith Fraidenburg, vice president of education and communications with the College of Healthcare Information Management Executives.
The ability to capture and report real-time quality data to CMS will be important for hospitals to meet federal meaningful use criteria, as well as to adapt to shifts in reimbursement. The health reform law changes reimbursements to reward quality and outcomes.
The challenge for many organizations, Fraidenburg says, is that current IT systems are not set up to collect quality metrics and thus require hours of manual processing.
Among the Most Wired hospitals, 51% still manually enter such data, according to Hospital and Health Network‘s analysis of the survey results.
“The systems available today weren’t prepared and built to deliver these metrics,” he said. Fraidenburg expects that industry vendors are responding quickly to fill the gap and will do so down the road. “But it will take some time,” he said.
Mattison acknowledges this aspect of meaningful use is a challenge to meet, even for a system as far along as Kaiser Permanente. “There are a lot of reporting elements of meaningful use that are not in the formats we already use, so we have had to do a ton of work to get the reporting in the format that’s required for meaningful use,” Mattison said.
Even with systems in place, resistance on the part of physicians to enter information required for reporting can also sink an organization’s efforts. According to Babakanian, as with all other aspects of IT implementation, the key is to get ahead of the curve.
“I spend 90% of my time in committees and meetings to plan for the organization and improve our core business. My job is to translate future needs of the organization so it is there before you need it,” he said.
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