Showcasing impressive work in blood transfusions, virtual care and urgent care, Phoenix, Arizona-based Banner Health earned a 2018 HIMSS Enterprise Davies Award. This prestigious industry award recognizes high achievement from organizations using health information technology to improve patient outcomes and value.
“We are truly honored. Since the beginning of Banner Health’s journey, high reliability and quality care have been our top priorities,” said William Holland, MD, vice president of care management and chief medical informatics officer. “With teams of physician leaders, engineers, informaticists, IT specialists and data analysts all working together toward a common goal, we’ve created an integrated EHR platform and achieved sustainable, industry-leading outcomes.”
Bundle compliance for blood transfusion
Banner staff saw an opportunity to improve safety and reduce waste by decreasing unnecessary blood transfusions during hip and knee replacements. These efforts also helped reduce costs.
“We brought together cardiologists and asked: ‘How do we get you to work together and make sure we’re providing the best and latest research?’” said Jill Howard, associate vice president for quality, design and reliability.
After discussions, staff created electronic order sets aimed at decreasing packed red blood cell transfusion during hip and knee replacements. From implementation in Q1 2013, clinicians used transfusions in 15.2 percent of these surgeries. By Q4 2016, that number dropped to 0.2 percent — a 98.7 percent decrease.
Virtual care: increasing capacity to save lives and deliver highly reliable care
Banner Health staff now can provide an additional layer of care to more than 700 patients per day after implementing advanced, third-party surveillance technology called TeleICU that integrates with the Cerner electronic health record. Telecare teams help ensure important plans of care — such as bundle compliance for sepsis and delirium and coma-free days — at the strategic initiative level.
“Telemedicine was the solution Banner undertook to address increasing acuity of patients in our critical care environment, as well as the need for greater staffing,” said Michael Simons, MD, medical director for virtual care.
Telecare teams leverage audio/visual technology, predictive analytics, data visualization and advanced reporting, allowing clinicians to increase critical care coverage. Banner provides this surveillance in the traditional model within the ICU and extends it into other areas of care, including emergency department and acute care spaces.
In 2015, Banner staff added measurement of lactic acid to the sepsis alert — branded as the "SaFE Alert" (Sepsis and perFusion Evaluation) — to help improve near real-time notification of sepsis or organ failure. The SaFE Alert is monitored on a dashboard view called MPages® as a by-product of EHR documentation. MPages is accessible from any location, even regarding patients outside the ICU, for staff to assist in monitoring. Alerts can be pushed to other devices.
The ability to drive a PowerPlan™ based on CDS from the EHR on the Safe Alert MPage is a key component in Banner's successful care management from the TeleICU. Near real-time, automated, continuous sampling of EHR data can help identify patients at risk for death and enable prompt, life-saving interventions.
Urgent care: integrating point-of-care service into a longitudinal health system
In 2017, Banner leaders moved from a paper-based patient record to a Cerner Millennium® EHR at more than 40 newly acquired urgent care centers. Staff implemented consumer-focused EHR capabilities, such as online check-in and scheduling. This helped optimize patient throughput, decreased time patients spent in the clinic, decreased clinician documentation time, and improved patient and clinician satisfaction.
The EHR implementation allowed staff to transfer important clinical data from the longitudinal record so patient information can be accessed at any visit or site.
These efforts helped decrease average length of stay (ALOS) in Banner’s 43 Arizona-based urgent care units from 42.2 minutes in April 2018 to 39.5 minutes in June 2018, surpassing governance structure requirements to keep ALOS less than 60 minutes and documentation time under two minutes. Net Promoter Scores — which gauge customers’ willingness to recommend products or services to others — trend upward, with 72.51 percent of patients willing to recommend Banner Urgent Care Services1.
“There was a conversation around a boutique, best-in-breed EHR that solved the value proposition for the patient in urgent care medicine,” said Rob Rohatsch, MD, CEO, Banner Urgent Care/Retail. “I was sure it was not possible to build an EHR for urgent care medicine that allowed the value proposition to shine through and meet the needs of the patient. I’m happy to say I was wrong.”
1 Average of all facilities’ Net Promoter Scores, April – June 2018