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“Learning Health System” Pilot Cuts Care Costs While Improving Quality

Posted on January 11, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As some of you will know, the ONC’s Shared Nationwide Interoperability Roadmap’s goal is to create a “nationwide learning health system.”  In this system, individuals, providers and organizations will freely share health information, but more importantly, will share that information in “closed loops” which allow for continuous learning and care improvement.

When I read about this model – which is backed by the Institute of Medicine — I thought it sounded interesting, but didn’t think it terribly practical. Recently, though, I stumbled upon an experiment which attempts to bring this approach to life. And it’s more than just unusual — it seems to be successful.

What I’m talking about is a pilot study, done by a team from Nationwide Children’s Hospital and The Ohio State University, which involved implementing a “local” learning health system. During the pilot, team members used EHR data to create personalized treatments for patients based on data from others with similar conditions and risk factors.

To date, building a learning health system has been very difficult indeed, largely because integrating EHRs between multiple hospital systems is very difficult. For that reason, researchers with the two organizations decided to implement a “local” learning health system, according to a press statement from Nationwide Children’s.

To build the local learning health system, the team from Nationwide Children’s and Ohio State optimized the EHR to support their efforts. They also relied on a “robust” care coordination system which sat at the core of the EHR. The pilot subjects were a group of 131 children treated through the hospital’s cerebral palsy program.

Children treated in the 12-month program, named “Learn From Every Patient,” experienced a 43% reduction in total inpatient days, a 27% reduction in inpatient admissions, a 30% reduction in emergency department visits and a 29% reduction in urgent care visits.

The two institutions spent $225,000 to implement the pilot during the first year. However, the return on this investment was dramatic.  Researchers concluded that the program cut healthcare costs by $1.36 million. This represented a savings of about $6 for each dollar invested.

An added benefit from the program was that the clinicians working in the CP clinic found that this approach to care simplified documentation, which saved time and made it possible for them to see more patients during each session, the team found.

Not surprisingly, the research team thinks this approach has a lot of potential. “This method has the potential to be an effective complementary or alternative strategy to the top-down approach of learning health systems,” the release said. In other words, maybe bottom-up, incremental efforts are worth a try.

Given these results, it’d be nice to think that we’ll have full interoperability someday, and that we’ll be able to scale up the learning health system approach to the whole US. In the mean time, it’s good to see at least a single health system make some headway with it.

Industry Does Too Little, Too Late On HIT-Related Safety Issues

Posted on November 11, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

This week, a pair of HIT organizations — including a HIMSS-backed group and an alliance focused on HIT safety — came together to help track HIT-related patient safety problems. The two groups have broad-based vendor support, and they seem to have the right goals. Unfortunately for them, though, the HIT safety ship may have already sailed.

Participants in the current linkup include the iHealth Alliance, part of the  EHR safety group EHRevent.com run by the publishers of the Physicians’ Desk Reference, and the HIMSS EHR Association, a collection of 44 EHR vendors working together to work on key industry issues.

The safety group, which offers a quick form allowing people to report EHR-related safety concerns, is an official, federally-certified Patient Safety Organization. That gives providers the chance to report such events in a privileged, confidential manner.

That being said, regulators seem to have gotten the jump on the software folks. As some of you may know, regulators are already preparing to begin, well, regulating HIT safety results. The FDA, which issued draft guidance on mobile medical apps this summer, may cast its eye on EHRs at some point.

Another possible angle comes from the Institute of Medicine, which recently issued a report recommending that HHS create a new watchdog agency investigating health IT safety issues.  National Coordinator for Health IT Farzad Mostashari recently told reporters that his agency, the ONC, has already begun developing an EHR safety and surveillance plan which should be out within the next 12 months.

(If you want this process to be as painless as possible, you’d better hope that the IOM gets its way; vendors, you don’t want to face the kind of FDA struggles pharmaceutical companies do, right?)

Honestly, someone who’s watched regulators do their thing for decades, I’m betting this latest industry effort will be too little, too late.

Folks, as I see it the only way you’ll get the agencies off your back is to start reporting on safety issues with EMRs/EHRs and other health IT tools aggressively. But given that many organizations aren’t even at the stage where their EMR installation is stable, good luck!