Cleveland came away with two AMDIS award winners this year—the MetroHealth System and its chief medical informatics officer, Dr. David Kaelber.
County-run MetroHealth, which operates a 566-bed safety net hospital, MetroHealth Medical Center, has been climbing methodically up the health IT adoption wall since it began installation of its electronic health record system in 1999. The hospital is operating at high levels of clinician usage. Physicians consistently plug orders into the hospital's computerized physician order entry system at near-universal usage rates “well above” 90% of all orders in the emergency department and inpatient areas, Kaelber says.
But, over the past decade, more profound changes have occurred at MetroHealth than simply swapping paper for hardware and software. “Going back to 1999, we've been going through the cultural shift of understanding that an electronic health record is a powerful tool,” Kaelber says. Even beyond that, the IT system is regarded as “the nerve system” of the organization's clinical activities. “So now, if there is outcome that people want to change, the people come to me.” That's become something of mixed blessing, since an IT system can't remediate a colleague's lack of social skills or referee interdepartmental disputes. “So, some of my job now is saying I totally understand how that's a problem, but I don't know how this tool can help.” Clinical problems are its forte.
For example, last summer, when the hospital saw a spike in incidences of patient morbidity and mortality associated with a multidrug-resistant organism, acinetobacter, MetroHealth formed a systemwide coalition to address the problem that, of course, included IT systems people from the start. Over the next six months, the IT group developed a suite of tools to help everyone get a grip on the problem.
Some functions were geared toward clinicians and some developed for infection-control staff. They include, for clinicians, MDRO best practice alerts and the ability to electronically order MDRO screening cultures; and for infection-control staff, automatic paging for admitted patients with new, MDRO acinetobacter cultures and daily e-mails of rosters of patients with positive cultures.
The IT-enhanced approach enabled the hospital to drive the MDRO acinetobacter case rate from 27 a month at the top of the spike, back down to the hospital's pre-outbreak standard of five to seven cases per month, a shift that doubtless was noted by the AMDIS awards jury in naming MetroHealth as one of two institutional award winners this year.
“If you think about the stages of change management and adoption, the early adopters, the middle of the road, the laggers, the ones who don't want change, I think we're really beyond that at our hospital,” Kaelber says. “People have turned around and are embracing the technology.” At MetroHealth, “It's not just a tool we need to use,” he says. People are convinced, “If we think it through, we can totally transform healthcare.”