STAGE 7 SPOTLIGHT Duke Health: Using Telehealth to Treat Stroke Patients
Healthcare organizations all over the world have followed the HIMSS Analytics Electronic Medical Records Adoption (EMRAM) Model as their strategic roadmap for effective electronic medical record (EMR) adoption and maturity. The eight-stage model measures EMR functions against industry benchmarks and guides organizations as they move closer to an optimal technology-enabled healthcare environment.
Achieving Stage 7 EMRAM validation lends significant financial, clinical and operational benefits to any healthcare organization. Let's discuss the validation process of the Duke Health system of central North Carolina.
Duke Health is a massive healthcare system providing patient care for citizens of Durham County and the eastern and central North Carolina counties surrounding Durham as well. Duke's healthcare system includes:
- Three acute care hospitals
- Over 200 ambulatory Practices
- More than 1,700 attending physicians
- 1,000 physicians in training
- 5,200 nurses, and
- more than 16,000 employees.
Dedicated to teaching and advancing the science of medicine, Duke Health has a long history of clinical informatics and has had multiple iterations and extensions of EMR tools to support patient care. This conglomeration of tools proved difficult to fully integrate, so Duke decided to move to a single, integrated EMR platform; they started this effort with Epic in 2011.
The following year, Duke activated the Care Redesign initiative to update and coordinate disease management across the care continuum at a lower cost to an expanded population of patients. Additionally, they aimed to extend care options through the use of telemedicine technology.
The EMRAM Implementation
To achieve EMRAM Stage 7 status in its acute care facilities, Duke needed to make multiple improvements in their use of the EMR system, including standardizing numerous clinical workflows and consolidating IT platforms across the health system.
Duke replaced 135 disparate systems with one Epic EMR as its core platform, upon which they built their accountable care, population health and quality initiatives. Branded, Maestro (Medical Application Environment for System Transformation of Research and Operations) Care, Duke's EMR is a single comprehensive integrated clinical information system that also supports their organizational research commitment. Applications they built into the system include:
- Clinical documentation
- Computerized Provider Order Entry (CPOE)
- Emergency medicine
- Personal health record portal
- Infection Control
... and much more. One notable example is the Duke Telestroke program which connects Duke neurologists with regional care partners in real time to access and remotely examine potential stroke patients. To allow for the best functional outcome and chance for survival, stroke patients need to be treated as quickly as possible, and the goal of this program was to improve care for North Carolina stroke patients by extending access to state-of-the-art treatments in more rural areas.
Since the inception of the Duke Telestroke program in 2013, Duke has been able to use telemedicine tools to connect rural doctors and patients with neurologists who can support timely identification of patients who may need stroke care. By quickly sharing patients' medical records, radiology images and real-time remote examination by Duke neurologists, the program has led to over 2,200 neurology consultations, enabled community hospital partners to provide treatment at greater than three times the national average (with 21 percent of eligible patients getting treatment) and improved timely access to treatment.
In 2016, more than 700 patients with potentially catastrophic strokes were treated and experienced much better functional outcomes than what might have been previously possible. Overall, the number of patients getting transferred for more advanced stroke therapy increased from 7 percent in the first year of the program to over 16 percent in 2017.
By implementing a comprehensive and integrated EMR system, optimizing clinical workflows and leveraging healthcare technology for innovative and standardized care delivery, Duke Health was able to improve patient outcomes, extend the reach of timely and effective treatment, reduce the overall cost of care and gain strategic insights for continuous improvements to clinical and operational processes.
Duke's EMRAM implementation was only the first step in an on-going improvement process. Like Duke, healthcare organizations everywhere can use the EMRAM Stage 7 Achievement process to ensure that every member of the organization functions as a more efficient unit with patient satisfaction at the forefront of their day-to-day operations.