- Ohio State University’s Wexner Medical Center (OSUWMC) is the first two-time winner of the HIMSS Nicholas E. Davies Award of Excellence, which recognizes health IT integration that substantially improves patient outcomes while achieving return on investment. The medical center earned its first Davies Award in 2001.
The award program promotes EHR-enabled outcomes improvement through sharing of case studies and practical lessons learned across a range of initiatives including implementation strategies, workflow design, best practice development and adherence, and patient engagement.
In its application for the 2015 award, OSUWMC highlighted a clinical data mart that monitors the use of antimicrobial medication. The program, launched in 2013, “has resulted in clinical initiatives leading to decreased use of particular antimicrobial agents and an estimated $7.7 million in savings,” OSUWMC stated.
OSUWMC established an antimicrobial stewardship program (ASP) in 2008 with the mission to “minimize unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic organisms with high morbidity and mortality, the emergence of resistant organisms, and extended costly hospital stay.”
A preliminary data mart monitored antimicrobial use in intensive care units. Later, after implementation of an Epic EHR system, the data mart was upgraded to measure and display actual drugs administered based on electronic medical administration records. That enabled ASP members to directly access and query data from the EHR and generate custom reports within OSUWMC’s enterprise data warehouse.
“The outlined goals of the new data mart were for ASP to utilize the information to monitor antimicrobial use in order to understand resistance patterns, prescribing patterns and antimicrobial cost burden. These data were deemed also to be invaluable in monitoring the impact of ASP interventions that affect targeted antimicrobial use. With access to these data, ASP can communicate the information to appropriate OSUWMC medical staff through email or other means. In addition, the information will be utilized to justify antimicrobial additions/deletion, susceptibility data and additional positions.”
In practice, if ASP restricts an antibiotic, a prescribing clinician must get approval and a corresponding code to be entered in the EHR at the time of ordering. Without the code, a pharmacist cannot process the order.
One such ASP policy intervention removed ciprofloxacin as a second empiric drug for serious Gram-negative bacterial infections. Tobramycin replaced ciprofloxacin as the empiric drug of choice in such cases, because it was deemed more effective and was not associated with development of C. difficile infections in hospitalized patients. OSUWMC reported a 50-60 percent decline in IV ciprofloxacin use as a result of the policy change, along with a corresponding reduction in C. difficile infection rates. Other ASP initiatives targeted reductions in use of expensive agents such as daptomycin, linezolid and ertapenem.
The Davies Award also recognized OSUWMC’s use of health maintenance alerts and care standards to improve chronic disease management, including a 5 percent increase in the number of diabetic patients with HgbA1c levels under control.
Additionally, OSUWMC’s IT department implemented a facility charge calculator within the EHR to code levels of service based on ED chart documentation. The calculator has identified approximately $50 million in gross revenue per year from charges that would have been otherwise missed under the prior system, according to OSUWMC.
“This award, which recognizes the intersection of health IT, patient outcomes and return on investment, is an indicator of the tremendous partnership at Ohio State’s Wexner Medical Center between all departments to impact the care provided to our patients through technology,” said CIO Phyllis Teater in a public statement. “It is an honor to be the first two-time winner of the Davies Award, and I am proud of the hard work teams across the medical center put in to make it a reality.”