Humber River goes beyond EMRAM for better patient outcomes

ORLANDO, FLA. – It drives Peter Bak nuts when hospitals tout their HIMSS Analytics EMRAM scores and make reaching Stage 6 or 7 the object of their I.T. strategies.

Not that he’s against the EMRAM program. It’s just that he believes there’s more to healthcare I.T. than dreamt of in the HIMSS Analytics philosophy. “EMRAM doesn’t cover what’s going on, above and beyond the patient charts,” he said. “It’s limited.”

Bak, CIO with Humber River Hospital in Toronto, gave an interview to Canadian Healthcare Technology while at the annual HIMSS conference, in Orlando.

For its part, Humber River Hospital – which calls itself North America’s first ‘Digital Hospital’ – recently invested in a predictive analytics Command Centre. It presents real-time data on screens at the front of the room, called tiles, and alerts the staff if too many patients are waiting for care in the ED, if there are delays in diagnostic tests for patients on the floors, and if patients are waiting to be discharged.

Once they are apprised of these delays, staff in the Command Centre can provide solutions. That’s made the hospital much more efficient. Since its opening at the end of 2017, the Command Centre has led to the creation of 23 “virtual beds”, which means extra capacity for the hospital without the cost of extra nurses or staff.

Yet, this kind of project isn’t part of the EMRAM ladder.

“Where’s the Command Centre in the EMRAM score?”, asks Bak. “It’s nowhere.”

Another example: outside of each patient room at Humber River is a large-sized computer monitor and a supply cabinet.

The computer screen is connected to the patient electronic chart, and it displays icons of note to the nursing staff. So, if the patient has special needs or conditions, like an infection or risk of falls, the nurse sees a warning right away.

Moreover, if there is a particular precaution that requires gloves or gowns, as indicated on the monitor, the nurse doesn’t have to trek to a supply station – the supplies are right there, in the cabinet.

“This saves time for the nurse, and saves steps,” commented Bak. “And it’s not in EMRAM.”

Neither are the integrated bedside terminals that are used throughout the hospital. They enable the patient chart to be displayed, and also connect the patient with a nurse, when needed. They allow the patient to control the lighting in the room, temperature and window shades, and also offer entertainment services.

They contribute to both better patient care and patient satisfaction. “But they’re nowhere in EMRAM,” reiterated Bak.

He observed that lab orders, which used to take two to four hours of turnaround time in the old hospital, are now completed in one hour, with zero labelling errors. “This is what digitalization is all about, and it’s not in EMRAM.”

Bak said that planning for I.T. should start with the healthcare and administrative improvements an organization wishes to make; it should then acquire the right technology to achieve these goals.

In the case of Humber River Hospital, the planning started with a strategic vision that included the elimination of “never events”. These are medical errors or adverse events that experts say should never happen.

The Canadian Patient Safety Institute says they include surgery performed on the wrong patient or body part; the wrong tissue of blood type given to a patient; an unintended foreign object left in a patient after a procedure; patient death or serious harm as a result of pharmaceutical errors; and several others.

On another note, Humber River is using technology to improve overall efficiency, quality and to reduce resource utilization.

“It’s a logical progression,” said Bak. “Everything we do is driven by these themes.”

He asserted the direction was originally set by former CEO Dr. Rueben Devlin and current CEO Barb Collins.

One of the ways in which communication has been improved in the hospital has been through the use of Ascom smartphones, which are assigned to staff when they start their shifts. Of course, one might think a personal phone would do the job, but Bak asserted that these devices are more than just phones, they are “tools of the trade” and thereby need to be well managed: devices must always be available and working.

Once nurses are on a shift, patients can reach them through the smartphones. There’s intelligence built into the system, too. For instance, the system knows if a patient’s primary nurse is occupied with another patient and cannot respond; it will automatically re-direct the call to the secondary nurse.

Moreover, the nurse must respond to the call. “You can’t just ignore it,” said Bak. “We’ve created service level agreements with the nursing staff, and they can’t let the patients sit there. There’s also a central dispatch centre that can see if you’ve responded.”

This is all part of a quality drive. “Whether the patient is in serious pain, or simply wants a blanket, we want to respond,” said Bak. “For this, the communication system is very valuable.”

While much has been accomplished in the past few years, Bak said, “We still have a lot to do.” In particular, more work is being done on the Command Centre. A set of “generation two” tiles are being constructed to provide alerts in new areas.

One of the focuses is on perinatal alerts, and Humber River is creating an early warning system for babies in distress during perinatal care. Bak stressed that Humber River’s strategic direction isn’t the only solution for improving care and efficiency in the hospital sector. “We’re not saying it’s the only way to go. But it’s how we’ve chosen to invest our money.”