Patient Safety Initiative To Leverage Health IT

Health IT Boosts Patient Care, Safety

A $1 billion public-private program aimed at reducing healthcare costs and improving patient safety likely will dovetail with federal efforts to push greater use of health IT, a major government contractor said, but the plan so far is scant on detail.

The U.S. Department of Health and Human Services (HHS) April 12 announced the formation of Partnership for Patients, an initiative to prevent harm in healthcare by asking hospitals to concentrate on nine types of medical errors and other care-related complications including bedsores, adverse drug reactions, injuries from falls, surgical-site infections, and urinary tract infections from catheters.

HHS said it will funnel as much as $500 million from funds authorized by last year's Patient Protection and Affordable Care Act to the nascent Innovation Center at the Centers for Medicare and Medicaid Services (CMS) to support demonstration programs that test ways of reducing hospital-acquired conditions. Another $500 million will go to a new effort called the Community-Based Care Transitions program to help reduce complications, and ultimately prevent hospital readmissions, when patients are transferred between care settings.

Federal officials expect the program to save 60,000 lives over a three-year period, prevent millions of adverse events, and save as much as $35 billion nationwide, including $10 billion for Medicare. "By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years," according to the Partnership for Patients website.

Success in improving care transitions would cut readmissions within 30 days of discharge by 20% by 2013, compared to 2010 levels, preventing the rehospitalization of 1.6 million patients, HHS said.

More than 500 hospitals have agreed to participate, according to HHS. An unspecified number of physician and nurses groups, consumer advocacy organizations, and employers also have signed up, government officials said.

"With new tools provided by the Affordable Care Act, we can aggressively implement programs that will help hospitals reduce preventable errors," CMS administrator Dr. Donald Berwick said in a statement. "We will provide hospitals with incentives to improve the quality of healthcare, and provide real assistance to medical professionals and hospitals to support their efforts to reduce harm."

"No single entity can improve care for millions of hospital patients alone," Berwick added. "Through strong partnerships at national, regional, state, and local levels--including the public sector and some of the nation's largest companies--we are supporting the hospital community to significantly reduce harm to patients."

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All this sounds great to Dr. David Classen, chief medical officer for consulting and government contracting firm Computer Sciences Corp's (CSC) healthcare group, except for one thing: "The details aren't there," Classen said in an interview.

In many ways, the Partnership for Patients echoes an earlier Berwick-led program, the 100,000 Lives Campaign. As president of the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI), Berwick in 2004 challenged hospitals to take specific preventive safety measures to prevent 100,000 unnecessary deaths in an 18-month period. A year and a half later, IHI reported that the campaign had saved 122,300 lives. Berwick then renamed the program the 5 Million Lives Campaign to focus on a wider range of adverse medical events.

Berwick was careful not to make IT a prerequisite for participating in the IHI campaign, but he did say when asked that the changes would not be sustainable over the long term without such technology as electronic medical records (EMRs) and clinical decision support systems. The same thing seems to be occurring here, at least so far.

However CSC believes that IT will have a significant role in the Partnership for Patients. In a statement emailed to media, the Falls Church, Va.-based firm said: "To meet these [patient safety] imperatives, hospitals must be able do the following--all in real time: Integrate patient data from your organization's electronic health record systems and supporting systems; analyze and connect this information; display consolidated clinical data focused on the specific condition found; and include alerts for patients showing early signs of high-risk conditions (such as sepsis or pneumonia) or interventions lacking from quality measure standards."

Classen said that analysis came from CSC partners Jane Metzger and Erica Drazen. He personally would like to know more "Without those details, I don't know how IT fits in," Classen said. "I was told the details would be forthcoming in the next couple of months," he added.

According to Classen, who is also a consultant in infectious diseases at the University of Utah school of medicine and has served on several IHI committees, the federal Office of the National Coordinator for Health IT believes that EMRs should be a key part of preventing hospital-acquired conditions.

But again, he awaits clarification. "You would hope they would tie this [Partnership for Patients] to meaningful use," Classen said. The federal government is offering an estimated $27 billion in Medicare and Medicaid bonus payments for private healthcare providers to adopt and demonstrate "meaningful use" of health IT between now and 2017.

Classen also hopes that HHS will link this safety effort to existing Medicare value-based purchasing initiatives, and that data reported from EMRs will help measure patient safety and care quality. "You should probably expect more of reimbursement to be tied to patient safety," Classen said.