Health IT Factors Into Leapfrog's Hospitals Rankings
Leapfrog Group's 2011 list of 65 top hospitals in U.S. highlights facilities that use health IT to prevent deadly dosing mistakes.
Although CPOEs can be great early warning systems, other technologies such as barcode systems used by hospitals such as Lehigh Valley can help clinicians follow other best practices for safety, including matching patients' identities at the bedside to orders before administering drugs, and making sure medications are dispensed to patients at the right time.
In Leapfrog's testing of CPOE systems at candidate top hospitals, "we look at orders that can lead to fatalities," said Binder, such as incorrect dosing in pediatric patients. "For a newborn baby, its weight in ounces matter greatly," she said. "A wrong decimal point can kill a baby," she said.
Leapfrog also ranks rural and children's hospitals. Although a CPOE isn't a requirement for Leapfrog's ranking of top rural hospitals, "having CPOE helps," said Binder. For 2011, among its 65 top hospitals, which included 10 children's hospitals, Leapfrog also named three rural hospitals: Mariners Hospital in Florida and two hospitals in Maine--Miles Memorial Hospital and Sebasticook Valley Hospital.
Rural hospitals also get extra points in their evaluations if they have 24-hour intensivist coverage using electronic ICUs, which allow ICU specialists to monitor patients from afar. Level of ICU staffing is another key area that Leapfrog considers in its rankings.
Lehigh Valley Health Network also got high ratings from Leapfrog for its coverage by intensivists--clinicians who specialize in intensive care. That's helped by technology, too, said Lukens. In 2005, Lehigh installed an advanced ICU system that allows remote monitoring of LVHN's 118 ICU beds. This allows intensivists and ICU nurses to monitor ICU patients 24 hours a day, including remote monitoring from 7 p.m. to 7 a.m. from a command center several miles away.
"Prior to installing it, when an intensivist went home at 6 p.m., you'd have minimal coverage, have to call the physician at home," he said. "Now we have an intensivist monitoring patients 24 hours a day." Not only does the around-the-clock ICU coverage help decrease mortalities, "it's also saved us an hour a day per shift per nurse in documenting" information that is now automatically captured from various medical devices and monitoring systems in the ICU and entered into patient records, said Lukens.
Although Lehigh Valley's use of health IT contributes to quality of care that's impressive enough for Leapfrog's rigorous measures, another major healthcare provider known for its use of technology also made the Leapfrog list. In fact, of the 65 hospitals that made the cut in 2011, 18 of them, or 27%, were Kaiser Permanente hospitals. Kaiser operates 36 hospitals nationwide.
"Kaiser Permanente is very tech savvy," Binder said. KP is a long-time user of CPOE and--with its KP HealthConnect system connecting digitized medical records for nearly 9 million patients--has the largest civilian EHR deployment in the U.S., outside of the VA, to boot. In addition, KP has solid intensivist coverage in its ICUs with staffing and technology at the hospitals making the list. "This makes a difference in reducing fatalities," Binder said.
Indeed, health IT's combination of connected EHRs throughout KP's organization--including its ambulatory care settings--and the use of CPOE at all KP hospitals plays an important role in KP's focus on delivering quality care, said Jed Weissburg, Kaiser Permanente senior vice president for quality and care delivery excellence.
All KP clinicians have access to a patient's full health data. "It's very easy to find records. It's all there and available for patient care," he said.
The digitized information also makes it much easier and quicker to do data extraction that's needed for quality reporting. In fact, EHR data for reporting can be extracted in such a timely manner that "data can get back to nurses and case managers before a patient leaves" a KP facility, whether the information is related to infections, best practices, or other situations that can be acted upon, said Weissburg.
Kaiser Permanente and Lehigh Valley Health Network both were also named top healthcare companies in the 2011 InformationWeek 500, respectively scoring 34th and 56th.