31 January 2017

Learning Health System (LHS) Pilot Saved Nationwide Children’s Hospital $1.36 Million in 12 Months

Researchers from Nationwide Children's Hospital and The Ohio State University (OSU) found that a learning health system (LHS) pilot program at Nationwide combining tailored electronic health records system entry, care coordinators and evidence-based clinical data and research reduced total inpatient days by 43%, reduced inpatient admission by 27%, reduced ER visits by 30% and reduced urgent care visits by 29% during the first year. Per a recent article in HealthLeaders Media, those reductions generated an impressive $1.36 million savings in health care costs during the 12-month period in 2010 and 2011.

The National Academy of Medicine’s Learning Health System Series defines a learning health system (LHS) as a system in which “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.”

The findings by the team of Nationwide and OSU researchers were published by the journal Developmental Medicine and Child Neurology. The study authors said they “developed, implemented, and evaluated a model of EHR-supported care in a cohort of 131 children with cerebral palsy that integrated clinical care, quality improvement, and research, entitled ‘Learn From Every Patient’ (LFEP).“ A multidisciplinary team of key stakeholders was recruited for this pilot program, which was designed to fully integrate research, clinical care and quality improvement. 

The findings were also cited in an editorial published in JAMA, which said the LFEP pilot included initial standardized care for all patients, both evidence-and expert opinion-based; routine clinical data collected in the EHR as discrete data fields and data elements (categories and choices within those categories, respectively); physician-inspired research data collection in the EHR; content-specific quality control of EHR data entry; and provision of standard care coordination. Per the HealthLeaders Media article, special data entered into the patients' EHRs was used to coordinate care, with the goal of reducing treatment duplication and errors. LFEP data were extracted into an Epic Clarity enterprise data warehouse, which also housed billing information, and providers used clinical documentation templates created in Epic that presented them with a prioritized list of research questions designed to drive specific improvements in clinical care.
 
The HealthLeaders Media article also said the total cost of implementing the pilot program, including care coordination services, was about $225,000 during the first year; but since that represented only 16% of the reduced health care costs during that same year, the program yielded savings of roughly $6 for every $1 invested. And the study authors believe that similar programs could yield even greater potential healthcare system savings in adult patients, since the chronic conditions of the children with CP resemble those of chronic multi-symptom conditions in adults.
 
For hospitals and health systems considering investing in learning health systems, the National Academy of Medicine discussion paper “Generating Knowledge from Best Care: Advancing the Continuously Learning Health System” provides strategies and examples of operational and research collaborations within U.S. delivery system settings.