- Leaders at Houston Methodist have added a toolbar to their electronic health record that helps clinicians access meaningful cost data.
- The toolbar also links to the state’s opioid prescribing database.
- Real-time data at the point of care can empower clinicians as the landscape transitions from fee-for-service to value-based payment.
In this interview, S. Nicholas Desai, DPM, chief medical information officer at Houston Methodist, discusses how his organization saved millions by providing clinicians with easy access to cost data.
How it all began. In 2016, leaders at Houston Methodist began rolling out a single-source electronic health record (EHR) platform to clinicians in their inpatient and outpatient sites of care.
After the rollout in 2018, Desai and his team wanted to take advantage of the new platform and offer clinicians tools to help in their decision-making. One tool they tested, and ultimately adopted, was a “floating toolbar” designed by a healthcare startup and the Texas Hospital Association. The toolbar floats over the regular EHR screen and includes a variety of apps that help embed actionable information into clinicians’ workflows.
How it works. “[The toolbar] aggregates various data points from the EHR and presents it to physicians in a simple way, so they no longer need to click several links for more data and get lost in the shuffling of screens,” Desai said. Specifically, the toolbar includes several apps, including one that integrates with Houston Methodist’s formulary and cost accounting software to provide more meaningful information to clinicians.
For example, the app shows the cost per day of the patient’s scheduled medications and dose-equivalent alternatives, if available. So, if physicians order an IV antibiotic, they can quickly see that an equivalent dose of a less expensive oral antibiotic might be a suitable substitute.
Lab information is also linked to the toolbar, so if a complete blood count has been ordered for three days in a row, the EHR will query the clinician to determine if a fourth one is needed. To help the clinician make the decision, the toolbar provides the latest lab results and the cost of the additional lab. It also shows the cost of imaging tests, as well as the cumulative radiation exposure and estimated cancer risk associated with the tests, if applicable.
On piloting the tool. To test the toolbar, Desai and his team constructed a pilot in 2018 with 145 providers and 30 pharmacists. During the pilot, the tool provided clinicians with the Medicare-allowable rates for lab and imaging tests as well as wholesale acquisition drug costs. But physicians demanded more clinical context, Desai said. So today, the toolbar app shows costs as well as relevant clinical information, such as the risk of adverse reactions and the fall risk associated with specific drugs. It promotes better decision-making.
“This is no longer just a cost-transparency tool, but it is also a clinical efficiency tool,” Desai said. “It helps us marry these concepts together to make it easy for physicians.”
On integrating opioid prescribing data. In addition to offering real-time, patient-specific cost and risk data on medications, labs and radiology within the clinical workflow, the toolbar also includes a link to the state’s prescription monitoring program (PMP), which tracks the prescribing of opioids and other controlled substances. By law, physicians in Texas are required to check each patient’s prescription history in the PMP before prescribing opioids.
Desai said Houston Methodist is the first hospital in the country to incorporate all 12 of the Centers for Disease Control and Prevention (CDC) recommendations for prescribing opioids for chronic pain within its EHR workflow. “It has pushed our providers to see the relevance and the need for having a tool like this,” he said.
On what it takes to change physician behavior. Having an EHR toolbar that links to cost data helps make cost transparency part of clinicians’ normal workflow, Desai said. “It minimizes the burden of having physicians search for information and allows them to quickly view the latest research and formulary information,” he said.
Houston Methodist clinicians can use or “snooze” the tool, but adoption has been promising so far. Currently, the highest utilizers are residents, hospitalists and pain management physicians.
The financial results confirm this as well. In just over a year, Houston Methodist has saved $15.5 million as a result of its cost transparency initiatives. This translates to a savings of $129 per admission on lab, imaging and drug expenses.
“When I think of the cost curve, we’re not just changing C players to B players or D players to C players, we’re moving everybody forward,” he said.
On getting finance involved. Desai said finance leaders at Houston Methodist have played a critical role in normalizing the cost data from their cost accounting software to make it accessible through the toolbar.
The finance team also has validated the cost savings for the initiative, which was implemented systemwide in early 2019.
On what it takes to implement technology to reduce costs. “I’d say with any technology implementation, you’ve got to know your audience first,” Desai said. “You need to be ready to anticipate the questions and be prepared for resistance, which is normal. That’s just change.” In the case of the toolbar, Desai and his team explained to clinicians that such a tool was designed to help — not hinder — their daily workflow.
Desai and his team also brought the right clinical and IT leaders to the table. “Stakeholder engagement was not intended just for a head nod or awareness, but for design and review,” he said. “This is not about the newest widget or about saving money. It’s about shifting the way we do business today, especially as we transition from volume- to value-based care.” This is important for a market like Houston, Desai said, which is still dominated by fee-for-service but is slowly shifting to reflect more innovative payment models.
Advice for finance teams working with clinicians. The finance leaders at Houston Methodist are Desai’s true partners. “We talk about physician champions, but we need finance champions, too,” he said. “These are people who understand providers’ struggles and appreciate what we’re trying to do. They help us articulate the value story.” Specifically, finance leaders can help validate cost savings achieved through clinicians’ variation reduction efforts.
On what’s to come. Desai said using data to empower clinicians is just one step along his organization’s transformational journey, which should be embraced by both clinical and financial leaders across the organization. “We all care about cost and the delivery of care equally, meaning my finance partners care about the care delivery just as much as I care about the cost,” he said. “So, we’re in this journey together, and we’re collectively identifying ways to help be the pulse of healthcare and keep it beating vibrantly into the future.”
Interviewed for this article:
S. Nicholas Desai, DPM, MBA, is chief medical information officer at Houston Methodist, Houston (firstname.lastname@example.org).