Pulse Heart Institute is the destination center for cardiac and vascular health in the Pacific Northwest, located in Pierce County, Washington. Launched in May 2016 as a collaboration between MultiCare Health System (cardiothoracic and vascular surgery) and Cardiac Study Center (cardiology), we have a fundamentally different approach to patient care—one in which physician leaders provide the strategic and operational direction for each of our six centers of excellence (COEs). Pulse now has over 50 providers and 600 staff members, with plans for expansion throughout the state.
At Pulse, we foster a culture of inspiration and creativity. One of the keys to our success is our dedication to using innovative technology developments. We continually seek out new technologies and partner outside of our organization with other innovators who help us focus on patient experience and data analytics; these partnerships help us to improve both quality and affordability of care to our patients. Our metrics-based approach drives continuous process improvement in our care delivery model in multiple ways, ranging from margin optimization and cost savings to readmissions risk tools and beyond.
Pulse has developed a Center of Excellence (COE) Margin Application tool that provides deep insight into costs, not just vertically, but horizontally across the organization. This app enables us to drill down into financial data to find opportunities for improvement ranging from provider variance and best practice to OR time to supply usage. This provides physicians at-a-glance insight into the cost of care they provide, prompting more thoughtful decision-making processes that result in more appropriate care as well as financial benefits. This app has driven $2.9 million in margin optimization in one year alone. We anticipate an additional $3.5 million in margin in year two.
Our partnership with Health Catalyst has enabled us to identify areas for process improvement in both chest pain and heart failure practices and protocols. The Chest Pain App is a tool designed to support leaders in making data driven decisions for ED patients with a chief complaint of chest pain. Use of this app has resulted in 7.2 percent fewer ED admissions and $122,000 in cost savings.
"Our metrics-based approach drives continuous process improvement in our care delivery model in multiple ways"
Pulse also developed a Heart Failure Readmissions Risk tool. Heart failure consistently ranks as one of the top five principle diagnoses causing readmissions within 30 days, and is expensive for hospitals. Working with Health Catalyst, we partnered to explore machine learning in healthcare to more accurately make readmission risk assessment predictions. Additionally, we now use machine learning to automate the prediction process and reduce the documentation burden on clinical staff. We now make approximately 150 daily predictions on currently admitted patients. This type of machine learning-based decision support goes beyond inpatient care to inform post-discharge interventions. For example, if one of the risk drivers is a socioeconomic issue, such as transportation to an appointment or help paying for medication, the tool will suggest social worker involvement. Depending on the issue, the care management team may include a physician, nurse practitioner, social worker, care manager, pharmacist, cardiologist, or other clinical specialist.
We have developed several other data tools in our work to reduce readmissions as well. Using these tools, we have been able to reduce our readmission rate from 22 percent to 18 percent system wide. These applications include:
Readmission Application—this app lets us know in real time who, how many and why our patients are readmitting
HF Collaborative Application—tracks processes that help us stay within our evidence based best practices
Pulse launched the Twistle patient app to engage patients more personally in their care. Through this app, patients can receive medication reminders, enter symptoms and communicate with their providers before and after their procedure. This app includes educational videos of actual Pulse providers that patients can review with their caregivers at home, after their appointment with their provider. 267 patients have signed up for Twistle since its launch. Patient appointments following discharge went up by 38 percent and readmissions were reduced by 50percent.
Pulse was designed with a fundamentally different approach to patient care—one in which physician leaders provide the strategic and operational direction for each of our six centers of excellence (COEs). This approach has enabled us to build on our combined expertise while further advancing research and innovation in cardiovascular health. We are physician governed, and led, and our physician and administration goals are closely aligned around simplified patient care.
Pulse saw a need to locate patients within our system who were being “lost”—receiving a diagnosis based on a test but not being sent on for specialty care. These patients were not receiving the necessary care based on their symptoms, sometimes receiving care only when their symptoms had progressed to severe, putting them at higher risk. One such group of patients are those with aortic stenosis. The Patient Discovery app mines echo data for certain criteria, identifying patients with moderate through severe aortic stenosis so that we can follow up with their primary care provider and ensure they’re getting the care they need. To date, we can “discover” both aortic stenosis and mitral regurgitation patients based on echo data that is pulled from their electronic medical record. In the future, this will be developed into a predictive tool that will be used to identify patients for procedures based on their diagnoses and other medical criteria.
Quality and Research
Pulse has a focus on improving quality metrics throughout our COEs. Many of the apps that have been developed were made with this in mind; from reducing readmissions to decreasing the length of stay to improving patient satisfaction. Additionally, our use of innovative technology has assisted us with the early stages of some unique research projects. One such project is the Cardiac Enhanced Recovery After Surgery (ERAS) work. The initial goal of this ERAS work is to decrease length of stay for all open heart valve replacements and coronary artery bypass graft surgeries. In partnership with Health Catalyst, an ERAS app was developed which mines the electronic medical record not only for length of stay, but for several other data points that will allow our team to research and write a unique paper in this groundbreaking area. The ERAS app is also being used to help the system wide length of stay work group monitor and steer their work, giving our teams access to the same data source, ensuring consistency in quality outcomes measurement. In 2016, the MultiCare Institute for Research and Innovation (MIRI) began an exclusive partnership with Pulse Heart Institute to expand its cardiac research portfolio. As a result, MIRI saw an increase of over 130 percent in the number of heart-related studies offered to patients.
Our ability to integrate technology into our patient centered care model has proven beneficial. In our first year of adopting technology as a business tool, we have experienced improved quality in all areas, as well as significant cost savings. When Pulse launched, only 7 of 22 COAP metrics were being met and now 18 of the 22 are being met. We are $2 million over margin budget YTD. Future work will include the integration of these apps to better serve patients through their entire care journey.