Preoperative and Postoperative Phases
Preoperative and Postoperative Phases
Although many EMRs are developing analytics platforms that embed some of these capabilities into their existing workflows, robust analytics must still overcome gaps in interoperability and the sharing of data between relevant health care systems to track data related to the health of a population. Guidelines developed along a patient- centric model ideally would be able to track metrics across systems, such as EMSC entities; however, current limitations in technology and culture for data sharing provide restrictions for understanding the complete value of clinical standards implemented across a system. Nonetheless, demonstrations of improvements in value likely understate the true impact across an entire health care system. At Texas Children’s Hospital, the integration of data across multiple entities linked to our institution (eg, health plan data, pediatric practice data, hospital data, and prehospital data) can be housed in our Enterprise Data Warehouse (EDW) to encompass the EMR, financial information and staffing data, and other sources of data across its infrastructure. Future integration of health information exchanges, government hosted databases, and other big data sources will aid in providing analytics support for identifying opportunities for driving, assessing impact, and iterating quality improvement initiatives driven by clinical standards.
When assessing the impact on quality of evidence-based guidelines and other clinical standards products clinical outcomes as illustrated above are important, but these may be linked to financial outcomes to establish value. At Children’s Hospital of Pittsburgh, a hospital aim to integrate actionable analytics into the broader framework of disease management targeted an existing appendicitis guideline (preoperative and postoperative phases) as its initial project. A self-service web-based tool provided measurement to provide clinical leaders and administrators analytics accessible in their offices or at the point-of-care. These interventions for guideline-driven care across the care continuum led to a 25% reduction in the median length of stay of patients with appendicitis, and also a significant decrease in the controllable (direct) cost per case.
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