STAGE 7 SPOTLIGHT Mercy: Reducing Surgical Costs, Resulting in a Savings of $33.3 Million
Countless healthcare organizations have followed HIMSS Analytics's Electronic Medical Records Model (EMRAM) to improve the technology landscape throughout their organizations. The eight-stage model provides a standardized framework for EMR evaluation, adoption and optimization for better patient care and outcomes.
The EMRAM has the potential to transform the way you approach and deliver healthcare for the better — just like it did for Mercy Hospital in St. Louis County.
Mercy Hospital, an 859-bed hospital, which provides medical services acute care, trauma and other specialty services, was named one of the top five large U.S. health systems for the second consecutive year in 2017 by Truven, an IBM Watson Health company.
Performing approximately 190,000 surgical procedures annually, Mercy's second-leading expense in the acute care hospital setting was surgical supplies. Perioperative leaders at Mercy found that determining surgical costs was an unstructured, manual process managed by each individual surgery department. They had limited methods for determining the cost of surgical procedures.
However, the team at Mercy aimed to dramatically reduce costs, improve the quality of care, enhance the patient experience and find new ways of monitoring, measuring, comparing and improving all aspects of surgical procedures.
The EMRAM Implementation
In 2012, the perioperative team partnered with Mercy's IT team to create a set of custom dashboards for one-stop access to high-level metrics, reports and data exploration tools. To manage the development of these dashboards, Mercy established a charter and governance structure that included a perioperative governance chair person, members from each surgical location and a core development team to create the vision for the dashboards and organize workflows.
The dashboards provided specific visuals to make identifying variation in practice easy to see, and they provided the ability to explore details down to the case level to enable perioperative leaders and surgeons to quickly identify opportunities for improvement. Using specific metrics to tell a story about cost generation and quality outcomes, the dashboards helped providers drill down on metrics like:
- On-time starts: Provides a visualized display of both staff and surgeon results related to surgical procedure on-time starts.
- Operating room turnover times: Shows turnover times relative to each hospital’s size, giving leadership the ability to benchmark and find like opportunities.
- Block utilization: Measures the use of each operating room, as well as facilitates the surgeon’s standard working time in the operating room.
- Cost per case: Provides leadership a transparent view of case costing across each Mercy location.
Organizing the data in this fashion allows surgeons to work on improvements with real-time data, instead of pulling together data from multiple sources over a period of time. The dashboards include a self-discovery tool called Explorer, which gives clinicians the ability to interact with over 40 million records spanning several years in real time.
The dashboard is designed to accommodate the unique needs of three types of users to provide the right view of the data for the right person:
- For administration there is a 30,000 foot view.
- For the department director there is a 20,000 foot view.
- For surgeons there is an “on-scene view."
In 2015, Mercy standardized definitions of metrics across all of their locations for better benchmarking and transparency. The following year, they engaged surgeon specialty councils to create a balanced surgeon scorecard to reduce variation in surgical procedures, providing the best care and outcomes with the least amount of resources, supplies and labor.
Today, thanks to the rapid adoption of a mature governance council, advanced data analytics platform, perioperative dashboards and surgical best-practices, Mercy surgeons can better understand and reduce the cost and variation of surgical procedures. Since the implementation, their overall cost savings have totaled $33.3 million.
Mercy has also seen additional improvements in the quality and efficiency of service:
- Infection rates have remained stable in all specialties FY14-FY17.
- Reduction in retained surgical items FY14 -FY17 (22% decrease).
- Reduction in operating room turnover time FY14 – FY17 (12% reduction).
- Increase in block time utilization FY14 – FY17 (62% to 78%).
The dashboards have allowed for more immediate answers, faster decisions and more agile process improvements. Additionally Mercy has experienced significant cultural change and advancement toward data-driven healthcare.
"We had a bold vision to combine technology, data science, creativity and collaboration in ways that improve the lives of those we serve," said Betty Jo Rocchio, VP of Perioperative Performance Acceleration. "As a result, we have seen shorter lengths of stay, more satisfied surgical patients and $33.3 million in savings. It’s solid proof that the EHR, analytics and data turned into information can facilitate transparency, buying and smarter decisions in surgical care delivery so everyone does better — especially the patient."
Mercy utilized the EMRAM to help them foster a partnership between technology and clinical leaders, improve the accessibility, aggregation and quality of data, transform that data into actionable intelligence and dramatically improve the cost and quality of patient care. Like Mercy, healthcare organizations around the world can use the EMRAM to support them in their efforts to create sustainable change within their organization.