STAGE 7 SPOTLIGHT Hennepin Healthcare: Improving the Blood Ordering Processes

HIMSS Analytics

The Electronic Medical Record Adoption Model (EMRAM) has become the global standard for measuring the use and effectiveness of health information technology within healthcare organizations. Using the EMRAM as a guide, healthcare organizations have streamlined their clinical operations, reduced the overall cost of care and, most importantly, saved countless lives with the efficiency and insight that HIT can provide.

Hospitals around the world have helped prove the value of the EMRAM. To demonstrate the financial, clinical and operational benefits of the EMRAM, let's dive into the Stage 7 achievement process at Hennepin Healthcare.

The Challenge

Founded more than 130 years ago in Minneapolis, Hennepin Healthcare is an integrated care system that includes a flagship hospital and teaching program, clinics and pharmacies, home nursing, hospice and more. Dedicated to innovation, philanthropy and research, they train doctors who go on to practice throughout the state, as well as provide care for low-income, uninsured and vulnerable populations in the west metro area.

The challenge they were faced with while seeking Stage 7 validation was the improvement of the ordering process for red blood cells on Epic, their EMR software provider. Blood is expensive and often in short supply, so clinicians need to do everything they can to prevent ordering too much or too often. Introducing more concrete, evidence-based guidelines called transfusion triggers, would guide clinicians on when to place an order and how much to order. These transfusion triggers are set by the American Association of Blood Bank (AABB) guidelines. Modifying the ordering process would not only help Hennepin adhere to industry guidelines, but also minimize the risk of ordering more units than necessary.

The Implementation

The implementation began in August 2013 and was a part of an ongoing patient blood management effort to encourage an evidence-based model when ordering blood, aiming to reduce costs and preserve limited resources. The transfusion service at Hennepin Healthcare developed a new ordering practice for red blood cells that would require a transfusion indication, called a hard stop, in the EMR system. These hard stops are based on clinical evidence for when a blood transfusion is actually necessary, and when paired with the clinicians' expertise, they help determine more easily and accurately when to place an order. Additionally, they switched the default order to a single unit of red blood cells to prevent ordering more units than necessary.

Any delay in orders for emergency or massive transfusion could mean the difference between life and death, so Hennepin Healthcare put in safety nets to prevent delaying this process. Emergency transfusions were facilitated by a single clinician call, and massive transfusions required a separate Epic order set called the Massive Transfusion Protocol. With both hard stops and safety nets in place, Hennepin Healthcare was able to develop an ordering system that would help decrease their overall utilization of blood without sacrificing their ability to perform rapid transfusions when necessary to save lives.

The Results

After implementing the new red blood cell ordering practices, Hennepin Healthcare saw a dramatic reduction in the usage of red blood cells, from about 700 units per month to about 600 units per month post-implementation.

By collaborating with the IT they had on hand, physicians at Hennepin Healthcare were able to facilitate sustained ordering practice changes that would save resources, reduce risks and improve patient outcomes. They learned that by using technology to complement physician vigilance and ongoing education, they could coordinate the efficient roll-out and maintenance of practice changes for better outcomes. Once going through the initial implementation process, the organization realized the true benefits of the program and they incorporated their changes into resident onboarding teaching sessions.

“By using evidence-based practice regarding blood transfusion requirements, applying blood bar coding and analytical tools, and educating clinicians around the change, we not only had cost savings but also improved patient care," said Dr. Deepti Pandita, Chief Health Information Officer at Hennepin Healthcare. "The change was an example of people, process, and technology coming together for better outcomes for our patients.”

The Takeaway

Like Hennepin Healthcare, organizations around the world can use the EMRAM as a roadmap to efficiently and effectively roll out process changes and improve clinical and operational outcomes. The EMRAM serves to bring technology and physicians together for better insight into patient needs, more efficient use of hospital resources and more successful treatment.

There is always room for improvement when it comes to patient care. By using the EMRAM as a guide, healthcare organizations can make sure the care they provide not only meets industry standards, but exceeds those standards for the best and most effective care that technology will allow.