Denver Health

Driving Quality With Lean HIT

Denver Health has been employing health information technology (HIT) to improve the quality of care it delivers for more than a decade. Today, the organization’s results oriented HIT initiatives and lean techniques are improving preventive care, decreasing mortality, and driving down costs.

“One of our first forays into HIT was about 15 years ago,” said Andy Steele, M.D., M.P.H., M.Sc., Denver Health’s director of medical informatics, referring to the organization’s immunization registry. The registry was built after Denver Health found low childhood immunization rates at its primary care sites, which put the community at risk of vaccine-preventable disease outbreaks. The organization developed a tracking database containing patient immunization information at all clinical sites. To aid the registry’s effectiveness, staff also generated standing orders, streamlined the vaccine delivery process, and developed reminder and recall lists for childhood vaccines at all primary care sites. “The registry helped us close missed opportunities for care because when a patient comes to any one of our sites, we can see the entire record and give needed immunizations on the spot,” Steele said.

Roughly 10 years after implementation, immunization rates had improved by 46 percent in 2 year olds and 26 percent in 1 year olds. In 2006, the program received an Ernest Amory Codman Award for performance measurement from the Joint Commission. Since then, Denver Health has slightly modified the program. “We now monitor for the more difficult to attain combo 3 vaccination series (4-3-1-3-3-1-4) by 24 months of age,” said Steele. And the program has maintained high immunization rates. September 2011 results data show a sustained rate of nearly 80 percent immunization for the combo 3 vaccination series for 2 year olds.

After the registry’s initial success, Denver Health began implementing its electronic medical records (EMR) system. “Having an integrated data system allows us to share information with other sites within Denver Health,” Steele said, “which gives us a more complete chart for each patient.”

Denver Health is using that complete chart to develop more patient engagement between medical appointments. The organization has combined customer relationship management software, which is used to monitor patient information such as appointments, prescriptions, and health goals, with messaging software that sends text messages to patients regarding their pertinent health issues. Messages can range from appointment or healthy goal reminders to more serious alerts. “We also have a nurse navigator who works with the system and helps manage patient care,” Steele explained. “The nurse can proactively reach out to patients who might be in need of medical care or even just encouragement in maintaining their wellness.”

Since the outset of Denver Health’s HIT initiative, the organization has applied lean techniques to streamline the process of providing care. But the organization has recently found that the same lean principles can help standardize the content of care, or clinical processes. According to Steele, “lean techniques identify the role IT can play.”

For example, the instance of postoperative venous thromboembolism (VTE) – the formation of blood clots in the body, which is a common illness that often affects hospital patients and can be lethal – was identified as an area needing improvement at Denver Health Medical Center. Even though the hospital allocated significant resources toward prophylaxis of VTE with low-molecular-weight-heparin (LMWH), which has been shown to reduce postoperative VTE, VTE risk factors were not consistently assessed and appropriate prophylaxis was not consistently prescribed. The organization held a rapid improvement event, during which a multidisciplinary group developed an evidence-based risk assessment tool and clinical practice guideline for VTE prophylaxis. The tool was implemented hospitalwide, and results showed nearly 100 percent compliance with the standard within 6 months. One year after implementation, Denver Health saw savings of $425,000 solely on VTE prophylaxis and a marked decrease in the incidence of VTE.

In 2011, Denver Health was awarded the Shingo Bronze Medallion for Operational Excellence. Denver Health is the first health care company to receive this distinguished award, which aims to be the global standard of excellence in every industry. And as the ultimate measure of quality, the organization recently boasted a 1.17 percent observed yearly mortality rate, placing it first out of 110 academic hospitals for lowest observed versus expected mortality rate. According to Steele, “It’s not just about implementing the technology but the process of putting it in and driving change with it.”

For more information about Denver Health’s HIT innovations, please contact:
 
Andy Steele, M.D., M.P.H., M.Sc.
Director, Medical Informatics
Denver Health
[email protected]  
(303) 602-9773