Accountability Reform in Health Systems

2 minute read in News

As an informed patient, parent, husband, and son, nothing weighs more on my emotions, fears, and frustrations than being in a situation that I must take one of my family members or friends to the hospital and have a poor experience with the quality of care delivered.

The hospital is supposed to be where one can take a loved one when they are in need of emergent medical care. A place where one trusts that the highest quality of care will be delivered to all who enter through the doors.

This one particular evening an elderly male in his early 80’s, with dementia, experiences a seizure. The scene resembled something from a horror movie with him being contorted, frozen, eyes wide open, and a facial expression of something not of this world. His wife watched in horror. She quickly calls 911 and not 5 minutes later a couple of paramedics rush from their ambulance. By this time the man was regaining some normalcy, as far as an average 80 year male with relatively advanced dementia could regain normalcy.

So, as diligent paramedics, the team carted the man to the hospital to the Emergency Department for further assessment and investigations. They wheel him in, the wife and her husband wait (and wait, and wait, as we all do in Canada) and eventually the man is seen by a doctor. The doctor asked a handful of questions, and quickly sent the man and wife home, saying there is nothing really to do and that he’s out of it now. There were no tests ordered whatsoever. None. Zero. Not one. So the mans wife, and care advocate, was utterly confused and very suspect of the care that wasn’t delivered. So she called me for my advice.

I am not a doctor, but I happen to have founded and run Plexina, where we take standards of care and their implementation very seriously. Over the years I have amassed many friends in healthcare, and including many emergency physicians. In fact, my founding partner, Dr. Mike, is also an emergency physician. So I ask Dr. Mike, what is the standard of care for symptoms consistent with a seizure? It was clear from him, that there were several tests that should have been done. So why weren’t any tests ordered? A few days later, after I spoke to the lady about what Dr. Mike had said, the lady went back to speak with the physician and asked him why the tests Dr. Mike identified weren’t performed on her husband? The physician simply responded, as if it were a satisfactory response, that “We can’t do those in this hospital so we didn’t order them.” “Does the other hospital do them? Can’t we be referred there to get them?”, asked the lady. “Of course!” replied the doctor. “So then why didn’t you do that?”, asked the lady. The physician had no explanation.

This was probably the worst experience I have encountered personally to date. But it wasn’t the first mistake I encountered and it won’t be the last. Unfortunately, many patients, friends and family members have experienced much much worse care with much graver consequences.

On the other hand, many patients have had much better experiences with very serious issues with great outcomes. I am very much an optimist, and perhaps a tempered idealist. I do believe with the right technology with the right information we all can do better to improve care, if evidence hasn’t already proven that.

Patients need to advocate for their own health, but they should not have to direct their own care. Patients and their family should be confident that they are getting the highest quality of care. And that this quality of care should be delivered consistently to all that have access to it. How to ensure the highest quality of care is delivered has been a source of much debate and research.

Plexina has made its mission to ultimately understand and propagate the highest quality care experience to all patients. But to achieve this mission Plexina has to understand what it takes to get there. Plexina helps to support the EHR as a delivery vehicle of the guidance of evidence and best practice care. Plexina helps capture, understand, define, design, transform, and deploy high quality clinical knowledge into EHRs. By creating electronically actionable clinical decision support tools such as order sets, clinical documentation templates, rules, and assessment reports, physicians can make better decisions and patients can experience the best quality care.

Health systems are now well down the road of “accountability reform” and must determine how to define and manage the effectiveness of care and ultimately work to improve quality and reduce cost.

Somewhere in the health system are the clinical leaders, governance committees, and transformation professionals that work every day to combine evidence, best practice policies, observational data from patient records, and clinical expertise to develop tangible standards of care and electronically actionable clinical decision support tools at point of care to help their clinicians do an ever better job. This is a very complex, challenging and time-consuming undertaking. Over the past 10 years, Plexina has developed the tools to facilitate and automate this process.

The clinical transformation team, sometimes also known as the “content build team”, or the “Clinical Decision Support (CDS) implementation team”, has to enable new operational capabilities and overcome significant business transformation challenges to improve care. Business transformation, standardization and clinical improvement does not happen consequently, but through careful review of evidence and data. Expert clinical informaticists can identify opportunities and develop strategies to improve care. The team establishes and follows a quality controlled process, documents considerations and decisions, combines creativity with technical and clinical expertise, implements clinician engagement strategies, thoroughly reviews and tests all CDS, and manages the change at point of care by communicating and training users of CDS prior to activation of the CDS in the EHR.

After the CDS is deployed, it must be monitored and assessed for effectiveness. Key challenges and objectives with post activation management of CDS include data collection, measurement, analysis, formulating and providing feedback to clinicians, and maintenance.

Continuous clinical improvement and deploying and refining CDS tools is continuous. It requires leadership support, commitment to resources, organization, and ideally, an effective process and an effective tool such as Plexina to viably maintain the operation.

“Medical knowledge changes so fast and it must be shared among team members. The best way to update and share that information is with tools like Plexina that give us an explicit map of knowledge and support efficient order set development and maintenance.”

— Dr. Tom Rosenal, Medical Director, Clinical Informatics EHR Leadership

Plexina is a complete platform for end to end development and deployment of CDS assets across the enterprise. Whether implementing large scale, strategic clinical improvement opportunities, or responding to urgent issues with clinical practice or pharmaceutical formularies, Plexina simplifies all aspects of development, deployment, management and maintenance of standards deployed in the EHR systems of your enterprise. Plexina has recently developed the Real-time Applied Clinical Effectiveness framework providing the ability to capture data and provide continuous feedback on important clinical or administrative metrics related to the CDS.

Baylor Scott and White Health in Texas has implemented Plexina and uses it to efficiently manage over 1000 order sets in Allscripts Sunrise Acute Care.

“We have found developing order sets to be like a manufacturing process.  With Plexina, we dramatically reduced our turnaround times, improved our control over the process, and reduced the number of order sets we maintain by close to 50%.”

— Dr. Joseph Schneider, M.D., M.B.A., F.A.A.P

Vice President, Chief Medical Information Officer and Medical Director,
Clinical Informatics – North Texas

Plexina has achieved 50-70% acceleration in schedule and allows management of 5-20 times more assets with the same people. This in part enables a higher quality library of CDS to be deployed and maintained in the EHR, thereby offering many more opportunities to improve clinical effectiveness, and more rapid implementation of improvement opportunities.

Named a Favorite Vendor by the HISTalk Advisory Panel in November 2014, Plexina (formerly known as Wairever) has earned recognition amongst the giants of health technology vendors and EHRs, including Allscripts, and is the only CDS related vendor named.

“The tools they provide are fantastic and their responsiveness has been great.”

— HISTalk Advisory Panel

To learn more, join us for a webinar on Monday, August 25 at 1 p.m. Eastern time: “Plexina for Allscripts Sunrise™ Acute Care helps you manage order sets and clinical content effectively”

The link to the webinar: