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Children’s National Health System

Children’s National honored with prestigious HIMSS Enterprise Davies Award

Children’s National Health System in Washington, D.C. has received one of the highest honors in health information technology (IT) — the 2017 HIMSS Enterprise Davies Award, which recognizes “outstanding achievement” in the use of health IT to “substantially improve patient outcomes and value.”

Working with the Bear Institute, a Cerner ITWorksSM collaboration, clinicians at the 313-bed hospital have reduced the use of computerized tomography (CT) scans, expedited clinical documentation and improved quality of care in the pediatric intensive care unit (PICU).

“We are so honored to receive this important recognition, which represents over 10 years of hard work from hundreds of staff here at Children’s National,” said Vice President, Chief Medical Information Officer and Chief Information Officer Brian Jacobs, MD. “Our investments in people, processes, technology and innovation are making a remarkable difference in the quality of care that we are providing to our children and their families.”

As part of the application process, Children’s National leaders submitted the health system’s workflow design, implementation and governance strategies, best practices, patient outcomes and lessons learned in three in-depth case studies.

Decreasing CT scan use for mild traumatic brain injuries

Each year in the U.S., five million children are diagnosed with head injuries, and more than 1 million visit an emergency department (ED) for treatment. Between 1995 and 2003, there was a 20-fold increase in the number of pediatric CT scans.1

When most children come into the emergency room with a head injury, they get a CT scan. These scans are expensive, and more importantly, they can expose children to unnecessary radiation.

In this context, Emergency Department Physician Shireen Atabaki, MD, added data around the necessity of a head CT scan into the electronic health record (EHR). Decision support helps prescribers “ask the right questions,” Dr. Atabaki said. “Is this CT scan really necessary? Can a CT scan be avoided today so I can save exposure of this child to unnecessary radiation, minimize cost and prolongation of their stay?”

Through this work, Children’s National achieved a 44 percent relative reduction in CT scan rate, translating to 556 avoided scans — saving the health system money and preventing patients from undergoing unnecessary, invasive testing.2

“When decision support is a part of the workflow built right into the EHR, the need for CT scans in those children is reduced,” Dr. Atabaki said. “Through our health information technology investments, that essential health data is allowing us to see a lot of opportunities to reduce variation in practice and waste, improve quality and lower overall cost.”

Improving safety in the PICU

Another case study described the use of highly visible digital dashboards called Quality Boards, which display near real-time quality and safety indicators based on live patient information. According to a 2015 study in The Joint Commission Journal of Quality and Patient Safety,3 the technology helped clinicians in the hospital’s PICU:

  • Decrease the average time from admission to treatment consent by 49 percent
  • Lower a statistically significant percentage of patients with urinary catheters in place for more than 96 hours
  • Improve completion of medication reconciliation to 92 percent from 80 percent

The clinicians at Children’s National care for some of the most complex critically ill children in the Washington, D.C. region, according to Pediatric Cardiac Intensivist Craig Futterman, MD, who has been pioneering this innovative work. Quality Boards are beginning to be used to engage parents in the child’s care.

“We’re actually educating the parents to look at the quality boards, give them license to go up to the nurse, physician or other clinicians,” Dr. Futterman said. Engaging parents “helps them be a part of that care.”

Minimizing transcription costs

In their application, Children’s National staff also described the organization’s success in minimizing transcription costs and expediting the availability of physician notes.

The project involved the implementation of an ambulatory EHR, including voice recognition technology (Dynamic Documentation™), as well as a number of other solutions.

Executive Vice President and Chief Medical Officer of Ambulatory and Community Health Services Denice Cora-Bramble, MD, said the Cerner-Children’s National collaboration has been instrumental in these and other successes.

Children’s National and Cerner strengthened their relationship in September 2013, when Children’s entered into a seven-year strategic alignment with Cerner called the Bear Institute — the first pediatric health IT partnership in the nation. The collaboration is focused on quality, safety and innovation.

“I don’t believe that we would have been able to accomplish as much as we have had it not been for the Bear Institute,” she said.

President and CEO Kurt Newman, MD, reflected on the organization’s progress.

“I’m thrilled that the Bear Institute has had such a big impact on our own organization, and I look forward to sharing our success,” said Dr. Newman. “There’s so much we can do.”

[1] Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, hospitalizations and Deaths 2002-2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

[2]Atabaki SM, Jacobs BR, Brown K, et al. Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support. Pediatric Quality & Safety 2017;2:e019. The time period studied was January 2010-January 2012, with the intervention occurring in March 2011.

[3]Shaw SJ, Jacobs BR, Stockwell DC, Futterman C, Spaeder MC. Effect of a Real-Time Pediatric ICU Safety Bundle Dashboard on Quality Improvement Measures. Jt Comm J Qual Patient Saf. 2015;41:414-20. Initial baseline was taken in May 2013 on 150 patients. Implementation was in June. Immediate post go-live data collection was in August on 150 patients, and researchers gathered data again in November.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.