At the Hospital for Special Care, IT-Facilitated Care Management Breakthroughs

As complex and challenging as it can be to perform care management on mainstream patient populations, the challenges multiply when it comes to caring for patient populations with special and specialized needs. That certainly has been the overall set of challenges facing the Hospital for Special Care in New Britain, Connecticut. The Hospital for Special Care (HSC) is the only long-term acute-care hospital in the nation serving adults and children. HSC is recognized for advanced care and rehabilitation in pulmonary care, acquired brain injury, medically-complex pediatrics, neuromuscular disorders including ALS research, spinal cord injury, comprehensive heart failure and comprehensive inpatient and outpatient treatment for children and adolescents with autism spectrum disorder.

The Hospital for Special Care is addressing the healthcare needs of the growing segments within its community, such as people with autism spectrum disorders, chronic obstructive pulmonary disease, and Parkinson’s disease. Recently, HSC became the only patient care organization in the U.S. to receive level-three Patient Centered Specialty Practice recognition from NCQA, the National Committee for Quality Assurance.

In the past three years, HSC leaders have: created a single integrated clinical information system platform that spans both the acute and ambulatory care sides of the organization; achieved NCQA recognition in the area of autism, for all its medical practices, and in COPD (chronic obstructive pulmonary disease); and succeeded in optimizing workflow management for long-term acute care, specialized for spinal cord injuries, pulmonary rehabilitation, cardiac care, acquired brain injuries, stroke, ventilator management, and geriatrics. In this work, HSC leaders have been collaborating with the team from the Chicago-based Allscripts, for that company’s solutions in all those critical areas.

Recently, Healthcare Informatics Editor-in-Chief Mark Hagland interviewed Lynn Ricci, the president and CEO of the Hospital for Special Care, and Stanislaw Jankowski, its vice president and CIO, about the forward evolution of this work. Below are excerpts from that interview.

Can you describe the Hospital for Special Care, and its unique mission?

Lynn Ricci: Yes, we are a long-term acute-care hospital located in Connecticut, and our hospital serves the Connecticut region, as well as surrounding states. We operate 228-bed facility, and log 50,000 outpatient visits a year. We are a specialty hospital, not acute-care. Our specialty services encompass rehabilitative care; we have a number of areas of specialization, including autism, ALS, muscular dystrophy, spinal cord injury, brain injury, and complex pediatrics, and we have a huge pulmonary population.

How long has the organization been in existence?

Since 1941, so 77 years.

And your physicians and staff?

All of our 30 staff physicians are employed; we also work with consultant physicians. Altogether, we have about 1,200 employees.

Tell me about the ongoing evolution of this current work?

We started with an outpatient platform for an EMR, and we’re rolling that out on the patient side. Specifically, this has been very helpful to our autism program, which started on an outpatient basis. It’s the only patient-centered specialty practice recognized by NCQA. This platform allowed us to provide the data and coordination of care necessary for that designation. We’ve been working with Allscripts for about five years, and in October, we went live on our inpatient side, rolling out their solution in stages.

What elements are live right now?

What are live are with clinical documentation, and with major interfaces to our ancillaries—lab, radiology, and a pulmonary system that sends ventilator settings and information to our electronic health record, so that respiratory therapists don’t have to manually enter data.

Can you tell me a bit about the automation of your autism program?

The autism program started in 2012, and has grown significantly. We see about 7,000 visits in our outpatient center, and in October, we opened an inpatient program, one of only 10 in the country designated to support children and families with significant behavioral issues as a result of autism. We received $10 million in bond funding to expand the program. It’s the Autism Center at Hospital for Special Care. And the inpatient program is our Autism Inpatient Unit, which is our eight-bed unit that will go to 12 beds.

What are some of the specific dimensions of autism care related to healthcare IT concerns?

What we do in this specialty practice is that we’re able to use the data we gather through the Allscripts system to coordinate care with community-based providers at school systems, and with families, and to the clinic itself, which includes a psychiatrist, psychologist, nurse navigator, speech and occupational therapists, family skills care, to make it integrated into the community. We also work with a number of organizations in the community to help coordinate referrals into our outpatient program and now inpatient program. And the ability to gather this information was critical in showing our value to the state of Connecticut in order to obtain that funding.

Is there data complexity in that care management?

Stanislaw Jankowski: Behavior is the most specific metric that we look at that differentiates the center itself. So we’re looking at reducing problematic targeted behaviors, including self-injury, destruction of property, aggression towards family members or in the school setting. We work with behavioral specialists and psychiatrists to reduce those behaviors. So we’re able to use the Allscripts system to gather that data together, so that it’s all in one place, to use, and to be able to track and trend that data, and to show continued reduction in the targeted behavior, or for example, for the psychiatrist to be able to access that data to look at potential changes to medication.

The platform created for autism was able to be used after we had been certified for autism care, and now we’re certified for COPD, and are pursuing a third one as well. And at that point, all of our specialty programs will be certified for specialty practice. We’re looking at Parkinson’s or cognitive health.

What have been the challenges in implementing the system?

Jankowski: We went from being strictly paper-based to being electronic. To give you some context for that, when you walk into a clinic or a unit, there are many paper-based workflows. And so even before we had implemented the system, our opportunity was to identify the different workflows, forms, and documentation, and to customize each form for our particular unit. It took a long time to achieve that. Then we were able to implement a way to implement workflow in all our units using similar forms. Some units did require changes in their documentation.

What have been some of the benefits of these implementations?

Ricci: On the outpatient side, we’ve seen the benefits in our ability to in a very efficient way gather data and be responsive to treatment plans. On the inpatient side, our staff has been very excited to see the implementation. They’re very excited about the opportunity to streamline workflows. This is a highly resourced unit. We need to show our value to payers, so our ability to quickly and succinctly access data and share it with providers and payers.

Jankowski: And whereas previously, it took us days or weeks to collect data to report to outside organizations like payers, state and federal agencies, we can report it now very quickly and efficiently.

What have been some of the biggest learnings from this initiative?

Ricci: I think part of has been, and Stan could tell you—it’s making sure that you have the right stakeholders at the table. We spent a lot of time choosing the product, the platform. We chose the right partner, and Stan, as the project has rolled out, has made sure we had the right people at the table.

Jankowski: What we were looking for from a vendor partner is a long-term relationship. We looked at seven vendors, and ultimately, Allscripts was the vendor of choice for us; one reason was that the culture of Allscripts—they were willing to work with us and were very flexible. The majority of EMR systems are really designed for acute-care hospitals. We needed a partner that would be flexible and would configure a system that would work in our environment. Cost is a big factor. As you know, these types of systems cost millions of dollars.

Do you have any advice to share with CIOs, CMIOs, and other healthcare IT leaders?

Jankowski: It’s important to be mindful of and very conscious about the long-term relationship involved. Do your due diligence. Check your own references.