STAGE 7 SPOTLIGHT MetroHealth: Saving Lives through Preventative Maintenance
The electronic medical record adoption model (EMRAM) is a globally recognized measurement framework for implementation and effective use of electronic medical records (EMRs) within healthcare organizations.
Healthcare organizations worldwide have used the EMRAM to innovate all aspects of patient care- from reducing emergency department overflow and preventing unnecessary testing, to treating clinical depression; all while saving lives.
EMRAM Stage 7 achievement is the recognition of a healthcare organization's commitment to improving the quality, delivery and cost of healthcare through the use of health IT. Let's dive into the implementation process of one such organization, MetroHealth.
MetroHealth is an essential public healthcare system in northeast Ohio. It has over 25 ambulatory sites, with more than 750 attending physicians and advanced practice nurses, close to 400 physicians in training, over 1,200 nurses and approximately 8,000 total employees. On an annual basis they provide nearly 1.25 million ambulatory visits and more than 100,000 emergency department visits.
MetroHealth was the first essential public healthcare system in the U.S to install the Epic electronic medical record system. MetroHealth has since aimed to bridge the communication gaps by extending their investment in health information exchange across the Social Security Administration, the Veterans Administration and the Ohio state-based health information exchange. They aimed to achieve better preventative maintenance for patients and to reduce operational inefficiencies that cost patients and the hospital unnecessary money.
The EMRAM Implementation
MetroHealth began implementing a multidisciplinary team of informatics, administrative, operational, clinical and technical staff to plan for the EMR implementation in the mid-1990s. Since then, they have progressed over 15 years to achieve and maintain EMRAM Stage 7 status. They implemented the wide scope of Epic's integrations including:
- outpatient scheduling, registration and billing
- clinical care documentation and ordering modules
- emergency department module
- inpatient pharmacy system and e-prescribing
- Epic in the operating rooms, anesthesiology and laboratory information system
- health information exchange and personal health record
- speciality Epic modules (Opthamology, OB/GYN and LGBTQ)
- An estimated 100 patients a week use self-scheduling through the MetroHealth personal health record on an average of 21 days earlier than usual. Each 1% increase in self-scheduled appointments generates $15,000 in revenue from decreased no-show rates and $10,000 annually in staff expenses.
- Patient engagement videos detailing sensitive procedures such as colonoscopies and sleep studies have decreased appointment no shows by 63% and 47% respectively, equating to $971,000 and $434,000 in recovered revenue.
- EMR opioid care plans, automated opioid scoring assessments and a one-click integration of multi-state prescription monitoring program has saved over 1,200 lives in northeast OH.
- Preventative maintenance alerts and active messaging for test and screening reminders have increased HIV screenings by 225% and increased known positive HIV tests by 11%. Hepatitis C screenings increased by 2500% and increased positive Hepatitis C tests by 560%.
- A suite of over eight different health information technology interventions over almost a decade has targeted process and outcome improvements in diabetes care which has led to an estimated ~$1,000 decrease in diabetic related healthcare expenses, or almost $1 million in decreased expenses annually in this population of 10,000 diabetic patients.
- MetroHealth is the first healthcare system in the U.S., to our knowledge, to implement code status reconciliation in their Epic electronic medical record at discharge.
- MetroHealth has shown that when robust health information exchange occurs, upwards of 80% of the time a test is not ordered that otherwise would have been ordered, and approximately 15% of the time, an inpatient admission does not occur that otherwise would have occurred.
MetroHealth's ability to offer preventative health reminders and ability to empower their patients with the information and control over their appointments has enabled them to provide their patients and community with better care.
As David Kaelber, MD, PhD, MPH, CMIO and Vice-President of Health Informatics and Patient Engagement at MetroHealth said, "We are proud to be leading the way toward high quality, patient-centered and technology-enabled care through the use of our health information systems. Stage 7 validation and now revalidation acknowledges MetroHealth’s leadership and commitment to pushing the use of electronic health records for the benefit of our patients, our healthcare system, and all of northeast Ohio."
Like MetroHealth, healthcare organizations around the world can use the EMRAM to drive innovation toward paperless and integrated information sharing initiatives that increase operational efficiency and prevent costly investments when simple process changes would suffice. This is just one more example of the proven benefit of electronic medical record systems and this progressive and sophisticated roadmap to EMR maturity.