Mount Sinai optimizes its EHR to create an effective seniors strategy

TORONTO – Older adults currently account for almost 60 percent of hospital days even though they only represent about 15 percent of the population. But most hospitals were designed in previous eras to care for younger populations.

To revamp its approach, Toronto’s Mount Sinai Hospital created a new strategy in 2010 to make improvements in senior care a priority. The hospital’s Acute Care for Elders (ACE) strategy saved the hospital $6.7 million alone in 2014 and has won several awards, says Dr. Samir Sinha, Mount Sinai’s director of geriatrics.

The hospital has implemented an integrated system to provide comprehensive care that networks family doctors, community providers, and its House Calls program with its hospital systems to deliver the right care in the right place at the right time.

Toronto’s downtown population is exploding, explains Dr. Sinha. “So we’re treating 37 percent more older patients now than we did four years ago. Yet we’re providing that care with fewer beds, and with a significantly shorter length of stay. We’ve been able tackle our elderly population’s medical issues earlier, before they become really serious issues requiring more complex interventions.”

At its core, the ACE strategy revolves around sharing meaningful information about their elderly patients’ conditions across all care-givers inside and outside the hospital, and ensuring the right protocols are in place for treating them. “They’re a small percentage of our population, but they’re the majority users of our acute care hospital services. So the starting point of our strategy was to think about how we can ensure the care we’re delivering is really tailored to the needs of an aging population.”

To support its strategic goals, Mount Sinai modified features of its Cerner Millennium EMR system and integrated it with add-on software to evolve a new approach over the past five years.

“These electronic tools have been massive enablers to help us provide better care,” said Dr. Sinha. “We created a series of new models of care and interventions, but we couldn’t have actually run those models efficiently if we didn’t have real-time opportunities to communicate better and to share data. We were able to really take advantage of our EMR.”

For example, the hospital uses Cerner’s automated e-mail notification system to alert members of the ACE team inside and outside the hospital when a high-risk, older patient is admitted to the Mount Sinai emergency department (ED).

“We have about 500 high-risk patients who are enrolled in our House Calls program, which provides geriatric home-based primary and specialty care to older homebound patients,” he said. “If they come to our ED in crisis, their medical record number is already designated to send out an alert to about 25 individuals involved in their circle of care. This allows instant case conferencing to occur, so all members know right away what’s going on and what changes in their care are needed.”

The hospital also used its EMR system to create a variety of geriatric order sets in 2011 to automate the protocols and procedures staff use when treating elderly patients. “That’s helped us reduce the risk of ordering the wrong medication, or improper doses, or protocols that would be less ideal for the care of frail, older adults. As a result, we now provide more consistent and proactive elder-friendly care throughout the organization.”

By integrating all these elements in its ACE strategy on top of its Cerner EMR, Mount Sinai has managed to achieve major improvements in geriatric care and has saved millions of dollars. “Within a four-year period, we reduced our lengths of stay for the elderly by 28 percent and our alternate care level stays by 20 percent. We’ve seen our readmission rates within 30 days decrease. The use of catheters has been reduced by over 50 percent, and our rates of pressure ulcers have decreased by 93 percent.”

Dr. Sinha says a critical success factor was a tightly integrated IT team that worked in unison with the clinical team. Barbara Duffey-Rosenstein, director of clinical informatics at Mount Sinai, has both an IT and clinical background, as do several other members of the IT group.

Jim Shave, president of Cerner Canada, notes that other hospitals are now following Mount Sinai’s lead. For example, there is an initiative underway at Island Health in Vancouver to implement a comprehensive ACE strategy across the entire jurisdiction using Cerner’s Millennium system.

Shave salutes the team at Mount Sinai for their work in geriatrics. “They’re doing what the system is designed to do, and I applaud the people at Mount Sinai for using it in that way. There are an awful lot of silos in healthcare and this is the way to connect them. People are starting to realize that they should and could be doing much better.”