Leadership and the medical laboratory team at this Indianapolis, Indiana-based specialty hospital implemented a clinical intelligence system delivered via the cloud
Does clinical use of a business intelligence (BI) system give hospitals and their clinical laboratories a way to add more value to physicians and contribute to improved outcomes? If you ask the clinical laboratory team and leadership at one specialty hospital in the Midwest, their answer is a resounding “yes!”
St. Vincent Seton Specialty Hospital in Indianapolis, Indiana, was an early adopter of business intelligence at the time it acquired a clinical intelligence system in late 2012. Due to the acuity and patient length-of-stay at this hospital, leadership wanted to do something different and innovative that would contribute to measurable and significant improvement in patient outcomes.
Clinical Laboratory Tests Help Manage Medically Complex Patients
St. Vincent Seton Specialty Hospital (SVSSH) specializes in treating medically complex patients, such as those with renal failure, complex surgical patients, on ventilators, or in of need pulmonary or medical rehabilitation. In every case, medical laboratory test data is used to manage all aspects of patient care. Its medical laboratory testing services are provided by South Bend Medical Foundation.
For Troy Reiff, R.N., having access to real-time, comprehensive utilization data on physicians’ clinical laboratory test ordering is a critical part of managing quality of care and costs. Reiff is the Executive Director of Operations at SVSSH.
“Here we care for the sickest of the sick, and about 70% to 75% of our patients are on Medicare,” Reiff said. “Before we acquired our electronic data management tools, our lab team tracked lab test ordering on spreadsheets. Once we began using sophisticated data tracking systems, we were able to improve care delivery more efficiently.
Sets of Medical Laboratory Tests Routinely Ordered at Admission
“During the time that we used a paper-based system to track how individual physicians ordered specific tests and the frequency of those test orders,” explained Reiff. “With this paper-based approach, we had determined that physicians were routinely ordering a set of lab tests for each patient upon admission. Many of those same tests would be run automatically, even on day of discharge. Such an ordering pattern did not reflect the fact that most patients were getting better with each passing day.”
The paper-based tracking system was labor-intensive and took a significant amount of time. “We used to go through the physicians’ test orders manually,” he continued. “Sometimes we would ask the medical records department to go through spreadsheets to see which lab tests were being ordered and when.
“Armed with that information, we could start talking with clinical directors, program managers, and physician leaders,” added Reiff. “The problem was that collecting that information from paper records was not only a drain on our staff productivity, but once we finally received what we needed, that data was weeks or months old.
Goal Was to Improve How Physicians Utilized Clinical Lab Tests
“We believed there must be a better way,” he commented. “Many of our patients are here for 25 days at least. A number of patients are here for more than 30 days. In that time, our lab team could not always intervene in time to improve how physicians were using clinical laboratory tests. We needed a more effective and timely way to contribute to better management of patients. There was inadequate oversight,” observed Reiff.
In 2012 St. Vincent Seton activated a healthcare cloud computing solution offered by hc1.com to control medical laboratory test utilization and manage the ordering profiles and performance of individual physicians. The system also allows Reiff and other managers inside and outside the lab to access all business and clinical activities for each provider and patient from any computer or mobile device.
Clinical Intelligence Produced by Cloud-Based Solution
This clinical intelligence solution gathers information on providers’ interactions with patients and clinical diagnostic activities. It then converts that information into intelligence-rich profiles of all providers and patients.
These profiles then become the basis for both clinical intelligence dashboards and business intelligence dashboards that are instantly available throughout the organization. Armed with this information, directors, managers, physicians, and pathologists can identify potential problems and quickly take action that leads to improvements in how care is delivered.
“Once hc1.com showed us that physicians routinely ordered lab tests that didn’t necessarily match up with patients’ clinical presentations, we were able to use this insight to start a conversation with our doctors,” recalled Reiff. “Now when patients are admitted, we can order lab tests based on order sets tailored to each patient’s condition.
Pathologists Could Discuss Utilization of Clinical Laboratory Tests
“We also met with directors, managers, and physician leaders throughout the hospital,” he continued. “In these meetings we talked about what the data showed about how clinical laboratory tests were being used, both appropriately and inappropriately.
“Having timely and detailed healthcare insight supported our recommendation about the need to change the culture from ordering every possible test to ordering only those tests that would meet each patient’s needs,” Reiff explained. “A patient admitted for heart failure would certainly need a number of lab tests specific to that condition. But that patient is likely to have comorbidities as well. So we asked physicians to order tests that would be appropriate for that particular patient and his or her specific comorbidities.
Hc1.com Generated Decline in Lab Test Volume of 6.88% Per Patient
“Following activation of hc1.com’s clinical intelligence system in 2012 and the series of meetings with physicians about lab test ordering, we saw a drop both in lab test volume and in our costs,” Reiff said. “Our lab test volume declined by 6.88% per patient.
“In addition, our lab costs per patient, per day went down 4.15% from 2012 through the first quarter of 2014,” he added. “A drop of that magnitude may not seem significant, but every hospital and every hospital laboratory would love those numbers, particularly given the margins in hospitals today.”
Today, clinicians, managers, and the lab team at St. Vincent Seton have confidence—supported by real-time data—that all clinical laboratory test ordering is appropriate and that the cost of lab testing per patient is declining within the hospital, even as patient outcomes are maintained and improved. These two trends are important today given the emphasis payers place on improving patient care, while also driving down costs.
“Most of our patients are on Medicare and for that we get a DRG payment,” noted Reiff. “We also know that more aggressive payment plans are coming and that reimbursement for clinical lab tests is declining. Therefore, we want our clinical laboratory to be on the forefront of managing appropriate care and controlling costs. This will help us prepare for whatever reimbursement environment we will face in the coming years.”
Successful Use of Cloud-based Business Intelligence Solution
The measurable successes produced by the clinical laboratory team and leadership at St. Vincent Seton Specialty Hospital demonstrate why the use of healthcare cloud software plays a useful role in helping pathologists and lab managers deliver more value to the parent hospital, its clinicians, and its patients.
For clinical laboratory professionals interested in learning more about the relationship between healthcare cloud solutions and real-time healthcare insight dashboards, Dark Daily has produced a new white paper, A Laboratory Executive’s Guide to Intelligently Reducing Costs While Achieving Operational Excellence and Superior Client Service: Using the Healthcare Cloud to Remain Competitive in Today’s Environment.
The white paper also includes case studies from Alere, Inc. in Waltham, Massachusetts; Integrated Regional Laboratories in Fort Lauderdale, Florida; and PGXL Laboratories in Lexington, Kentucky. In these case studies, clinical lab professionals discuss how they are improving patient management, cutting costs, and increasing testing that is appropriate and matched to each patient’s needs.
—by Joseph Burns
A Laboratory Executive’s Guide to Intelligently Reducing Costs While Achieving Operational Excellence and Superior Client Service: Using the Healthcare Cloud to Remain Competitive in Today’s Environment