Five years ago, Texas Children's Hospital in Houston faced a conundrum. The health records of thousands of young patients who were showing up in its three hospitals' ERs with asthma attacks and other emergencies weren't readily at hand for the attending physicians. They were housed not just in the 50-plus primary-care pediatric practices and seven urgent-care centers that were in its network, but in pediatric practices all over the city.
To create a more seamless EHR environment, the system, with the help of Salt Lake City-based Health Catalyst, built an enterprise data warehouse, which could pull information from their patients' health records and cull data from payment systems and pharmaceutical records.
The long-term goal was larger than having better records and improving care in the emergency room. They wanted a system that would allow its clinicians and outreach workers to identify children at risk of winding up in the ER—because they weren't taking their medications, for instance.
“As more value-based reform programs were emerging in Texas, this was all part of the solution for better managing populations of children,” said Dr. Charles Macias, director of the Center for Clinical Effectiveness and the Evidence-Based Outcomes Center at Texas Children's Hospital.
Children's hospitals are facing a slew of difficulties in transitioning to a world that puts a premium on delivering higher-value care at lower cost. Their young patients show up with their medical histories scattered across numerous clinics and hospitals. Sometimes they are locked within proprietary electronic health record systems or shielded by patient privacy laws.
Meanwhile, large payers such as Medicaid, which now covers about half the children born each year in the U.S., are pushing children's hospitals to show better outcomes and take on more risk. With most Medicaid programs now in the hands of managed-care organizations run by private insurers, high-cost children's hospitals are at risk of being thrown out of narrowing networks if they fail to show better outcomes.
They also face growing competition from big hospital systems that are opening their own children's facilities. These systems can offer less expensive pediatric care for a single procedure or consultation because prices at children's hospitals often reflect its specialized facilities and staff.
“It's a strategic imperative for children's hospitals to change the framework for which they are evaluated,” said Raphe Schwartz, a director with the Chartis Group, a consulting firm based in Chicago. Children's hospitals need to demonstrate they can deliver better outcomes over an extended period of time for large groups of patients—fewer readmissions, shorter lengths of stay, superior clinical results—rather than risk being evaluated on their higher costs for a single claim.
The overall experience at stand-alone children's hospitals matters too, said Amy Knight, chief operating officer at the Children's Hospital Association, which represents about 220 organizations. Children's hospitals need to empirically demonstrate they are better at allaying fear and anxiety for their young patients, which can have a big effect on outcomes, she added.
But before a children's hospital can demonstrate superior clinical outcomes, it needs to integrate electronic systems and make sense of the collected data. Despite the inherent challenges, some children's hospitals such as Texas Children's are starting to make headway. They are using data analytics to measure key processes, improve clinical outcomes and lower cost, not only within the hospital, but after patients leave the premises.