How EHR Vendor Partnerships Fuel Healthcare Quality Improvements

A unique health IT partnership between University of Missouri (MU) Healthcare and EHR vendor Cerner has helped drive healthcare quality improvements.

MU Healthcare partnered with Cerner in 2009 to form the Tiger Institute for Health Innovation after using Cerner’s EHR for about a decade.

The collaboration originally sought to meet the first EHR meaningful use standards from the American Reinvestment and Recovery Act.

However, as MU Healthcare continued to progress in health IT implementation, the Tiger Institute decided expand its focus from meaningful use to improving quality outcomes, Bryan Bliven, MU Healthcare CIO, told EHRIntelligence in an interview.

“It was clear that the installation and adoption of the technology wasn't where the magic was,” Bliven, who is also vice president of the Tiger Institute, noted. “It was going to be more about, ‘Once we have the platform installed and we have the digitization available, what do we do with it?’ That changed the goal of the IT focus here at University of Missouri to be more outcomes driven.”

Most recently, the Tiger Institute worked to improve healthcare outcomes by implementing an automated intelligence algorithm that captures vital sign and lab data to provide earlier indications that a patient may be entering into septic shock.

Bliven explained that MU previously had an algorithm running in the background against EHR data to identify patients at-risk for sepsis. However, the health system was not satisfied with its effectiveness.

“We’ve done a couple of interventions around mortality and sepsis and we hadn't seen the improvement that we needed,” Bliven noted.

The Tiger Institute convened a cross-organizational group of clinicians, physicians, nursing leadership, informaticists, and engineers to brainstorm ways to improve sepsis outcomes.

Bliven explained that the group saw an opportunity to leverage the NEWS (National Early Warning Score) system to highlight patients at-risk for sepsis. MU integrated a NEWS algorithm into the EHR and then created an alert system that notified providers when a patients’ score indicated they were at-risk for sepsis.

However, Bliven noted that the Tiger Institute’s intervention was not just the alert, but who got the alert.

When scores reach a certain threshold, instead of alerting caregivers on the unit, the system alerts a quick response team, known as Tiger Teams at MU. This team serves as a fresh set of eyes for patient evaluation, Bliven explained.

Overall, the implementation of the NEWS system in combination with the quick response team alerts have contributed to a 22 percent reduction in sepsis mortality and saved an estimated dozen lives within the first nine months of adoption.

This integration is one of several other health IT projects The Tiger Institute has implemented recently in efforts to improve clinical quality.

For instance, the Institute has integrated embedded clinical decision support to help manage blood transfusions.

Additionally, Bliven noted that the Tiger Institute has been working on an EHR usability project.

“We wanted to look at the configurations that we had control of without needing more development from Cerner to see if we could better design how we implemented the technology,” he said.

Bliven noted that these efforts have led to sustained improvements in more accurate and complete screening documentation, which has helped improve data quality in the EHR.

This has a snowball effect, he noted, as higher quality EHR data provides clinicians with more complete patient health histories for clinical decision support.

HIMSS recognized MU Healthcare as a 2021 Davies Award winner for its thoughtful application of health IT to substantially improve clinical care delivery. MU also received the award in 2015.

Bliven noted that MU’s long-term relationship with Cerner has helped fuel these improvements in care outcomes. Unlike a typical vendor-client relationship where one organization manages the other, the Tiger Institute fosters collaboration between the two organizations.

“We have a governance structure that engages leadership from both organizations to sit down and think about what we're going to work on together,” Bliven said. “It allows for us to engage both organizations and get the clinical expertise from MU healthcare and then the Cerner knowledge on implementation and healthcare technology.”

He explained that transparency around health IT challenges is key in these kinds of relationships.

“It's inevitable as you're doing the level of change that we work to do and implementing technology, you’re going to face challenges,” Bliven noted. “You're changing workflows, you're changing how individuals spend their time of their day at work.”

He also stated that it is important to define the partnership from the start by outlining what each organization gets from working together.

“What we are attempting to do, and I think we have a good foundation for, is not about the specific projects,” Bliven explained. “It's about the process and the way that we work through it.”

This process includes forming a clear problem definition and then testing out interventions on a smaller scale before expanding the intervention.

“That sets us up with baseline data,” Bliven said. “You need to know what you need to measure as part of an intervention, and you need your outcome measures. If you have those, then it helps you build sustainability.”

“You need to be able to sustain and put things into a hardwired state rather than just kind of a short term focus, and that's the difficult work,” he added. “That's going to be a journey. It's never going to end. We have to keep getting folks engaged. It also builds relationships. It helps us become a better organization long term.”

Bliven noted that the Tiger Institute is looking at reframing the goals of the organization as things have developed in healthcare. He said that the organization is currently engaging with Cerner leadership, including the vendor’s new CEO, on planning the Institute’s health IT strategy for the next several years.