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North York General

North York General Hospital wins HIMSS Enterprise Davies Award for EHR excellence

The 5,000+ staff and physicians at Toronto-based North York General Hospital (NYGH) have a history of adopting advanced technology to improve the patient experience. A mission to provide exceptional health care has led the organization to receive one of the most prestigious awards in health information technology, the 2016 HIMSS Enterprise Davies Award.

“This success is a reflection of the commitment to excellence of the people at North York General, where we put our patients first in everything we do,” said Tim Rutledge, MD, president and CEO. “This means exceeding expectations every day. Receiving a Davies Award puts us among a select group of healthcare organizations that have realized the significant quality and safety benefits that health information technology makes possible.”

For the better part of the past decade, the 419-acute care bed community academic hospital has worked with Cerner to design and implement patient-centric solutions that help clinicians achieve the best outcomes. The multi-year project, known internally as eCare, has prevented errors, saved lives, increased efficiency, and avoided costs.

As part of the Davies Award application, NYGH leaders provided detailed case studies on four of its most successful initiatives. HIMSS published the full case studies here.

Mortality reduction

NYGH’s eCare project team felt strongly that the implementation and broad adoption of electronic evidence-based order sets would be foundational to improving quality and safety. For this reason, the team engaged NYGH clinicians in a two-and-a-half year carefully managed clinical transformation process to redesign clinical workflows and create a library of more than 350 standardized, evidence-based electronic order sets.

“Since eCare, over 97% of medical patients receive an electronic order set on admission, compared to only 36% of these patients when we used paper,” said Jeremy Theal, MD, chief medical information officer. “The result of all this effort is not just adoption of eCare, but also a significant culture change where we are leveraging health IT to continually improve the quality of care we provide.”

Utilizing computerized provider order entry (CPOE) and evidence-based order sets, NYGH reduced preventable mortality rates across its medical inpatient population and became a national leader in this important quality metric. NYGH reduced the probability of inpatient death from pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation by as much as 56%, saving an estimated 120 lives from these conditions between November 2010 and December 2015.

Medication reconciliation

Prior to eCare, clinicians recorded a patient’s best possible medication history (BPMH) on paper. Physicians reviewed and documented which medications to stop, continue or change for each inpatient stay. The cumbersome paper process made it difficult to accurately track a patient’s home and new medications. This led to poor adoption, with only 7 percent of medical inpatients having their medications reconciled at admission and only 9 percent at discharge.

With eCare, clinicians now complete all steps of medication reconciliation electronically. Because the process is now integrated into the ordering workflow, compliance immediately improved. Within the first month after implementing (November 2010), an average of 70 percent of medical inpatients had their medications reconciled at discharge and 45 percent at admission.

As NYGH added more custom-designed clinical decision support and physicians became more comfortable with the system, compliance grew to 87 percent at admission and 90 percent at discharge by December 2016. By eliminating medication errors that might have occurred without medication reconciliation, NYGH estimates a total cost avoidance of approximately $31 million over six years (2010-2016).

VTE reduction

NYGH’s venous thromboembolism (VTE) prophylaxis strategy took tremendous strides with the addition of evidence-based order modules and CPOE. Together, they propelled VTE prophylaxis rates from 50 percent (on paper) to 84 percent (with eCare). However, it wasn’t until targeted, real-time electronic alerts were embedded within the physician workflow that the rate jumped to over 96 percent.

“As a hospitalist, my daily routine is chaotic because I manage many complex patients,” said Roland Mollanji, MD. “NYGH’s custom-designed VTE alert helps me remember to order prophylaxis at the right time for the right patients. It’s a partner in providing safer care.”

In addition to increasing the appropriate VTE prophylaxis rate to 97 percent, NYGH prevented approximately 40 VTE cases, inclusive of averted episodes of deep venous thrombosis (DVT), pulmonary embolus (PE) or DVT+PE in the same patient. This translates to a calculated reduction in VTE incidence of 39.2 percent, and an estimated cost avoidance of about $1 million.

Closed-loop medication administration

In 2010, NYGH implemented a closed-loop medication administration (CLMA) process, which allows clinicians to use Cerner’s fully integrated electronic health record (EHR) to ensure the right dose of the right medication is given to the right patient at the right time.

By leveraging information technology solutions, like Cerner’s PowerChart®, WorkFlowMonitor, PharmNet® and CareMobile® , at every step in the process, CLMA eliminates manual entry and fires an alert if a medication does not match the active orders in the EHR. From 2010 to 2015, NYGH detected and avoided more than 11,000 potential medication errors using CLMA, an estimated cost avoidance of more than $5.7 million.

“The Canadian Adverse Events study identified that 23.6 percent of adverse events in hospitals are related to medications, and that many of these events are preventable,” said Theal. “CLMA is a prime example of how health information technology can reduce the risk of medication errors and make it easier for clinicians to deliver high-quality care.”

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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.