Integration of BOOST Into an Electronic Health Record (EHR) Case Study: Northern Arizona Healthcare
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- Doreen Martha Little
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1 Integration of BOOST Into an Electronic Health Record (EHR)
2 Overview, a nonprofit healthcare system, provides healthcare services through two hospitals (Flagstaff Medical Center and Verde Valley Medical Center) and serves more than 700,000 patients in communities across the region. In October 2015, Cerner, a global leader in healthcare technology, and the Society of Hospital Medicine (SHM) announced the integration of SHM s Project BOOST into Cerner s Readmission Prevention Solution, available within the Cerner Millennium Electronic Health Record (EHR). The integration included: >A utomated early identification of specific readmission risk factors and corresponding interventions >G eneral Assessment of Preparedness checklist to help identify patient concerns about their readiness to leave the hospital >S implified patient-centered discharge instructions to help safely transition a patient home > Teach Back education process and documentation to help patients comprehend pertinent information related to their hospitalization and transition 1
3 The Problem Prior to the integration with Project BOOST, the transition team at had been disorganized, didn t have a multi-disciplinary approach and needed to identify a model to help guide them forward in a comprehensive way. The Timeline began implementing SHM s award-winning Project BOOST (Better Outcomes by Optimizing Safe Transitions) in A national initiative designed to improve the care of patients and reduce risks for medical complications as they transition from hospital to home, the BOOST program was instrumental in helping their team analyze their situation more deeply and ask the right questions. Tiffany Ferguson, LMSW, ACM, social work manager, stated, The program was great but we originally started with paper and were losing data and had a hard time tracking BOOST assessment. Then, in May 2014, became one of the first to pilot the Cerner EHR/Project BOOST integrated solution. The Solution The administration at made their case to be part of Project BOOST and received the C-level buy-in and support to move forward with this program. The program was great but we originally started with paper and were losing data and had a hard time tracking BOOST assessment. 2
4 The Experience Since the implementation of Project BOOST through the Cerner EHR system, many processes and work flows have changed in the institution. The health system was able to create a note addressing all of the 8 Ps. This is a risk assessment tool comprising of a checklist of risks that should be identified and addressed for each hospitalized patient. What was once a huge manual undertaking could now be integrated into the system. The team worked with readmissions and pushed to have BOOST incorporated into the platforms, and began to add risk scores and Patient Health Questionnaires (PHQ-2s) on every patient who screened to the care management team. The PHQ-2 or PHQ-9 processes were very beneficial, especially with ambulatory measures. It put Northern Arizona Healthcare ahead of the curve and helped with the behavioral health and depression scores. Teach Back is a patient-centered communication style in which providers confirm that patients actually comprehend what the providers say to them. Providers can accomplish this by speaking slowly with their patients, avoiding medical jargon and explaining important skills or new knowledge carefully to the patients. It is vital to take the time to ask patients to explain in their own words their understanding of what they learned. It takes practice and is an approach that every hospital should be doing as a routine process. Teach Back was implemented across the hospital in year one and continued with education the next few years until it became part of the organizational culture and part of the discharge and follow-up phone call process. With the implementation of interdisciplinary geographic rounds, we saw a decrease in LOS and increase in satisfaction of the care team. After several years, the rounds stopped for various reasons. We are hoping we can implement rounds again in the future as they did work well, said Lisa Brugh RN, MS, ACM System Director of Care Management at. The automation of Project BOOST workflow is saving our clinicians an average of one hour per patient, said Ferguson. This allows our clinicians to reach more patients and spend more time at the bedside, resulting in better patient care and outcomes. The implementation and automation of Project BOOST has helped to build up the hand-off and transitions of care especially on the inpatient side and has brought disciplines together. The system transitioned from being siloed to now having a multi-disciplinary approach. For example, pharmacy now has a focus on high medications, and a 9th P called Physical Limitations was added to bring therapy services into the interdisciplinary team. 3
5 Conclusion/Results Since having BOOST as part of the Cerner system, : >H as received 5 stars for quality within Medicare s Hospital Compare >N umber 31 in the country for lowest readmission rates >R ealized a reduction of all-cause readmissions by more than 45 percent >W as rated in the top 1 percent for all-cost readmission rate >H as not received a readmission penalty in the last three years ( ) >S cored in the top 10 percentile on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) illustrating that patient satisfaction has improved Cerner clients can take advantage of resources including a step-by-step instruction and project management Implementation Guide, the BOOST Online Community (equips) to learn from and collaborate with other sites, and the BOOST Data Center that allows users to sort and benchmark data against control units and other providers. In addition, provider sites, can elect to join the Project BOOST Mentored Implementation Program, which includes in-person training and a year of mentoring and coaching. Transitions Team celebrating their low readmission rate in
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