Using electronic medical records as the foundation for establishing local learning systems for more personalized patient care can deliver substantial cost savings.
That’s the chief take away from a recently concluded pilot project undertaken by the Nationwide Children’s Hospital and The Ohio State University in Columbus, Ohio. Over the course of a year-long project to develop a local learning system Nationwide Children’s and Ohio State dubbed “Learn from Every Patient,” researchers used the electronic medical records of 131 children being treated for cerebral palsy.
The idea of a local learning system is using a patient’s electronic medical to drive to develop personalized treatments based on data from patients with similar conditions and risk factors, says Dr. William Smoyer, vice president, clinical and translational research and director of the Center for Clinical and Translational Research at Nationwide Children’s.
For instance a study of electronic medical records revealed that not every children with a hip dislocation—a common malady among younger cerebral palsy patients—needed an x-ray to diagnosis the problem. “Children with cerebral palsy are prone to hip dislocation, so our practice had been to perform x-rays on every child every year,” says Dr. Garey Noritz, medical director of the Cerebral Palsy Program at Nationwide Children’s and associate professor at Ohio State. “An examination of our data revealed that this was excessive for children with mild CP. We have since changed our protocol for these patients, reducing their exposure to radiation, as well as costs.”
Local learning systems start with the integration of research, clinical care and quality improvement within a specific health service and then use the knowledge gained to systematically deliver quality improvement and cost savings, Smoyer says. “Those clinical improvements can be expanded to other programs within the hospital or across the health care network,” he says.
The cost of implementing the pilot program, including care coordination expenses, totaled approximately $225,000 over the first year, the hospital says. But the outcome of the pilot project also resulted in better outcomes and cost savings. Children treated in the Learn from Every Patient program during the 12-month study period experienced a 43% reduction in total inpatient days; a 27% reduction in inpatient admissions; a 30% reduction in emergency department visits; and a 29% reduction in urgent care visits resulting in healthcare cost savings of $1.36 million, Smoyer says. In addition, the clinicians working in the cerebral palsy clinic reported that the local learning system approach simplified their documentation, enabling more patients to be seen during each session.
“Introducing electronic health record-supported care that integrated clinical care, quality improvement and distinct, clinician-driven research resulted in large reductions in health care utilization, greatly reduced healthcare charges and improved care coordination,” Smoyer says.
Current efforts to establish learning health systems have been designed primarily around the integration of electronic health records among multiple hospital systems. While substantial progress has been made with this approach, the operational and technical barriers of bringing together such diverse hospital systems led Nationwide Children’s and Ohio State to consider an alternative based on the concept of a local learning health system.
“These results demonstrate that a learning health system can be developed and implemented in a cost-effective manner, and can integrate clinical care and research to systematically drive simultaneous clinical quality improvement and reduced health care costs,” says Dr. Peter Embi, associate professor and interim chair of Biomedical Informatics and chief research information officer at Ohio State.