By Melinda Young
Hospitals and other healthcare organizations can improve patient navigation, quality, and efficiency by creating goals and a plan through data collection and a dashboard.
Health systems are successfully using analytics to engage with electronic medical records (EMRs) and in creating roadmaps for patients, says Julie Mirkin, DNP, MA, RN, chief nursing officer of Stony Brook Medicine in Stony Brook, NY. Mirkin has spoken about electronic data collection at national conferences and has worked with a data collection dashboard at a large health system.
“You want patients to navigate through the system effectively,” she says. “There’s a risk for hospital-acquired conditions. The sooner and faster we can get patients to migrate through the system, the better outcomes there are for patients.”
Electronic data collection helps health systems predict roadblocks more accurately. It also helps facilitate faster transitions, Mirkin says. “If someone is waiting for a physician consult, the system can send an electronic message to the physician, saying, ‘We’re waiting; the patient needs your services. Would you please come?’” she says. “Every step is tracked by time, so you could measure the response time and hold people accountable.”
The reminders are automatic, but case managers still are involved. “We still need the human element,” Mirkin says. “People have to document activities in the electronic medical record right after doing a consult.”
Mirkin offers these suggestions for best practices in making the most of electronic data collection and interdisciplinary dashboards:
• Create a plan. “We can create a roadmap for patients, saying, ‘On day 1, they need these things done, and on day 2, these things,’” she says.
The plan should include expected patient accomplishments for each day they are in the hospital. It is important to share daily activities and healthcare interventions with patients so they are aware of what will happen daily. No activity should be a surprise, she adds. If a patient needs physical therapy or a consult before a transition of care, these can be entered in the daily plan.
• Use a dashboard. “An interdisciplinary electronic dashboard can highlight patients’ daily milestones,” Mirkin says.
It can be color-coded and operate like a hospital version of an air traffic control board, she suggests. “If you have a nurse manager with 30 patients, each patient will need something done somewhere,” she explains. “The dashboard could turn green when patients get to where they need to be. This information is electronically transferred from the EMR.”
• Take charge. Case managers can run the meetings and manage the dashboard. Meeting goals might include analyzing avoidable delays and opportunities to be more efficient, Mirkin says.
“You can see delays in real time, like a patient was supposed to have the MRI yesterday, but didn’t have it until today,” she explains. “You can’t manage what you don’t measure, and you don’t know what your problems are until you really look at the data.”
For example, an analysis of electronic data might show that patient delays happen because specific tests are unavailable on weekends. This could lead to patients staying in the hospital for several days longer than needed. Providing that test on the weekend could save hundreds of days of delays and provide a quick return on investment, Mirkin says. “Plus, it’s the right thing to do for the patient,” she adds.
The switch from inpatient MRIs to more outpatient MRIs also can be accomplished by a health system adding additional capacity for outpatient MRIs. “Data can drive a lot of efficiency changes,” Mirkin says.
• Monitor orders. The dashboard also can be used to monitor tests and procedures, ensuring that testing is appropriate at the right time and in the right location.
Often, providers will order patients to undergo certain tests while they are already in the hospital because it is more convenient. But payers might deny these claims, saying the tests should have been performed in an outpatient setting, Mirkin says.
The dashboard can be used to indicate which tests should be inpatient or outpatient. If an MRI or another test is outpatient, then the patient should be discharged and asked to return for the test, she adds.
“A physician, who looks at data from patients whose MRI orders were changed from inpatient to outpatient, might see that this change has had a significant impact on patient outcomes and length of stay,” she explains. “It’s the right thing to do for the patient, and hospitals will see a financial gain — an increase in radiology revenues because you’re doing things in the more appropriate setting,” Mirkin says. “It was safer for patients to be at home because it’s not in anyone’s interest to keep patients in the hospital unnecessarily.”
• Enhance engagement. The dashboard can improve the hospital’s culture of collaboration. “The whole healthcare team becomes very engaged,” Mirkin says. “You can put the interdisciplinary dashboard in the lounge for the team to view.”
It is more engaging than a verbal report from providers, and it can transform the relationships between healthcare team members, she adds. “Everyone has a single goal, single focus, and everyone is held responsible for their work,” Mirkin says.
Creating an electronic dashboard aligns the healthcare team to achieve excellent patient outcomes. “It improves accountability of every team member, which, in turn, increases efficiency, leading to better patient outcomes,” Mirkin says.