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Bridging the (Wide) Gap Between EHR Data and Analytics That Drive Optimal OR Utilization

Jessica Kovash

OR Product Marketing Lead for iQueue for Operating Rooms

Hospital EHR systems – e.g. Cerner, Epic, Meditech, Paragon, deliver strong capabilities around their core intent: a single source of truth for each patient and each patient visit.  Because of the data collected, the EHRs are repositories from which historical usage, like operating room key performance data (turnover times, on time starts, block utilization, etc.) can be extrapolated.  

However, EHRs are insufficient when they are used as decision support tools. EHRs do not optimize asset utilization, forecast future events, or prescribe specific actions to transform scheduling and capacity management. Reality is, EHRs were never designed nor built to translate data into actionable insights that improve operational performance in a sustainable manner on both a day-to-day and predictive basis.

Limitations of EHRs in optimizing utilization of operating rooms

No proactive creation, communication and access to open OR time. Even within the best block allocation processes, demand for OR time fluctuates and is volatile. As a result, blocks are often abandoned or underutilized by their owners – on a daily basis there is often significant unused block time and yet no prediction of when it will happen. Furthermore, there is no proactive creation of more open time, no visibility or communication of available time, and no ability to electronically request such time, leaving significant amounts of unused block time that could have been utilized if it were released in advance. 

Limited actionable decision-making from tracked metrics. The metrics EHRs provide are mean- or median-based, and most healthcare systems track room and block utilization and drill down to individual surgeons to see other metrics: utilization, first-case on-time starts, turnover time, etc. However, a visible metric is not necessarily an actionable metric. Block utilization is a perfect example – if a surgeon’s block utilization is 53 percent, it does not mean that 47 percent of her allocated block can be taken away without it adversely affecting her practice. Likewise, even if all first-case delays were eliminated, those small periods of time are likely not sufficient enough to reclaim and insert new cases.

Lagging historical reporting lacks actionable insights. EHR reports, dashboards and business intelligence tools have lots of good information and maintain meticulous records of every patient encounter, but they only generate historical views and provide high level direction, leaving the optimization challenge as an exercise for the reader of the reports. Perioperative departments need abilities to easily, credibly and ubiquitously access fresh, relevant information and share it with administrators, surgeons, clinics, service line leaders and others.

Limited to no access on mobile, no proactive alerts or relevant transactional capabilities. While EHRs have mobile apps, they are mostly “descriptive” – displaying the schedule, but with limited interactivity and without timely push notifications and alerts common to solutions at airlines, transportation and delivery companies, or even banks. 

Limited cloud/hosted capabilities. EHRs are often on-premise custom installs. This fundamentally limits innovation because improvements and upgrades are slow, happen instance by instance, and usually require client-side maintenance and changes that are heavy on IT resources and difficult to scale.

 

Overview of iQueue for Operating Rooms

iQueue for Operating Rooms provides next-generation, high-value analytical tools that go beyond dashboards and alerts, and beyond the established capabilities of any EHR system. It provides a set of predictive analytics-based tools embedded in easy-to-use mobile and web (hosted) software that enable transformation of core scheduling processes.

Most hospitals have OR committees that try their best to fairly and equitably allocate blocks to the right surgeons on the right day of the week. However, no matter how good the allocation, when reality hits, the best-laid plans become obsolete, because some surgeons are not able to use blocks – whether it’s because there are not enough cases or vacations, clinic schedules, conferences, etc. – while other surgeons have large backlogs of cases for which they wish they had block time. The result is underutilized block time for some and others, who could have used that time, instead having a large backlog of cases each day.

iQueue for Operating Rooms’ Exchange module solves this problem by enabling surgeons and their offices to easily look for open time in the operating room, put a request in to reserve that open time, and easily release block time that would otherwise go unused. This is done through a simple Opentable©  -like tool that allows surgeons and their staffs to release blocks they won’t be able to use and request open time they could use from a master scheduling process with one click. The tool also predicts with high confidence which blocks look like they will go underutilized, and sends proactive reminders to surgeons encouraging them to release those blocks before the automatic release function. This creates open capacity, increases room utilization and streamlines the entire workflow for OR scheduling, and there is significantly less back-and-forth communication between OR scheduling and the physician offices.

When used properly, Exchange can aid in packing more cases within the normal business hours and help to reduce elective add on cases. While EHRs provide access to future schedules, none actually create and advertise open time in a seamless way that encourages clinics to release unneeded time, nor do they provide a simple marketplace for block release and time request while still keeping the control for the granting of time within OR scheduling.

Instead of solely using block utilization, iQueue for Operating Rooms provides intelligent decision support capability to specifically answer the big question, “From whom can we take allocated time away from without impacting their existing case volume by day of week and by location?”

iQueue for Operating Rooms’ Collect module mines the patterns of OR usage by block owner, surgeon and service line to identify “collectable time” as a means of providing perioperative leadership with the most actionable information to rightsize the block schedule. Information is surgeon-centric, actionable and reliable, and sophisticated analytics are continually updated so that the information in Collect is relevant and timely.

This way of looking at repurposing block time is really effective, but no EHR does it, stranding most perioperative leaders in the paradigm of reporting block utilization and other traditional metrics that can’t be meaningfully acted upon.

Lastly, iQueue for Operating Rooms monitors OR performance to help surgeons and administrators get a single source of truth with metrics and KPIs that are credible, well-defined and understood, making perioperative committees and clinics more efficient and effective in using data to drive decisions. Below are some key features of iQueue for Operating Rooms’ Analyze module:

  • Weekly text messages provide surgeons and administrators with details around the most recent usage information. A cloud-based web dashboard is accessible anytime, anywhere and provides both standard and adhoc reports. Surgeon efficiency scorecards and deep drill-down capabilities are available on demand. Predictive alerts are sent to administrators with pertinent anomaly detection so that deviations in trends can be brought to everyone’s attention in real-time, and historical paper-based reporting becomes easily accessible and virtual.
  • Timely mobile alerts help surgeons and clinics be more proactive and productive by informing them how they’re contributing to OR volumes, how their performance metrics are trending, and how they can improve their utilization.
  • OR managers gain access to objective data right at their fingertips, where they can easily understand utilization patterns and determine what’s causing first case delays, long turnovers or last minute cancellations, as well as the “20 percent who contribute to 80 percent of the problem.”
  • Mobile and web reports concisely break down individual and overall OR performance minute-by-minute, allowing OR managers to gain a full understanding of current gaps in 90 seconds or less.
  • Rich features in the web tool include the explorer, which enables slicing and dicing data to create ad-hoc reports, as well as surgeon scorecards that can be used to discuss performance with each surgical team and service line.

 

Summary

Bridging the gaps in the performance effectiveness of leading EHR systems, the capabilities of iQueue for Operating Rooms maximize OR efficiency, block and room utilization, lower the cost per case, and increase staff satisfaction through improved visibility, easier block exchanges, and more consistent OR utilization during regular hours. And, perhaps most importantly, surgeons gain greater control over their own OR schedules and drive both their satisfaction and utilization.

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