When Steward Health implements a new electronic records system in September at Sebastian River Medical Center, physicians will be able to order medications by computer, a fact that should instantly raise the hospital’s safety scores in at least one category.
Having electronic medical records software, or EMR, that includes physician ordering creates a computer-generated layer of protection that can prevent errors such as over-prescribing opiates or overlooking drug allergies or adverse drug interactions.
When the most recent Leapfrog safety ratings were released in April, Sebastian River’s overall F grade included a worst-in-the-nation ranking on the question of whether doctors can order medications by computer. That grade was based on data from before Steward owned the hospital and will change with the new software.
So will another category not included in the Leapfrog rating, but part of Medicare’s Hospital Compare measure: so-called “double” CT scans of the abdomen – one without contrast and one with contrast, done at the same appointment. Sebastian had close to quadruple the state and national averages of such scans from 2015 and 2016, before Steward took over, but the new software could help correct that problem as well.
“We have made progress on many aspects of quality, and the implementation of the Meditech 6.1 EMR will continue to improve the quality of care we provide,” said Dr. Joseph Weinstein, Steward’s corporate-wide chief medical officer.
The Meditech software is being customized for Sebastian this summer and is expected to be introduced in September. It offers a feature that allows radiologists to check to see whether the referring physician has ordered a scan considered unnecessary for the condition being checked, exposing the patient to more radiation and higher costs.
Weinstein said that feature will be put into effect “soon,” in advance of a Medicare mandate that was recently delayed until January 2020.
The healthcare field has been slow to address the problem of excessive scans, even though it was 15 years ago that a study showed software in use at Massachusetts General Hospital helped physicians correctly order CT scans and MRI’s.
By 2011, an effort was underway nationally to reduce double scans by using such software. By then, CT scans were among the fastest growing procedures in healthcare, now estimated at 70 million a year, three times the rate in the early 1990s. Today, medical imaging is a $100 billion a year business.
On the plus side, increased use of scans has drastically reduced the need for exploratory surgery. But the scans are not harmless. In 2014, researchers projected – although not without controversy – that as many as 29,000 future cases of cancer could be attributed to CT scan radiation exposure in the U.S. in a single year.
“We are silently irradiating ourselves to death,” cardiologist Rita Redberg and radiologist Rebecca Smith-Bindman wrote in a New York Times opinion piece. “A single CT scan exposes a patient to the amount of radiation that epidemiological evidence shows can be cancer-causing.”
That year, 2014, Congress created a mandate that physicians use Medicare-approved guidelines and check electronically when ordering imaging for Medicare patients. Radiologists receiving the order to do a scan have to verify that the decision was properly vetted; if they don’t, they will not be reimbursed.
The requirement was set to go into place last year. With the delay pushing that up to the start of 2020, Medicare is urging that voluntary use of the guidelines begin next month, in the hopes that providers begin to familiarize staff with the new procedures. Reimbursement denials for non-compliance are scheduled to be imposed starting in January 2021.
Weinstein offered no explanation for the high double abdominal scan rate at SRMC prior to Steward’s ownership. The next scheduled update to the Hospital Compare data is due July 25, but that will only include a couple of months under Steward.
CT scans reveal different aspects of the body, with contrast and without, but most conditions can be diagnosed with just one or the other.
“Although combination CT scans are appropriate for some parts of the body and for some medical conditions, combination scans are not appropriate for the chest or abdomen for most patients,” Medicare’s website explains.
A doctor can still say he needs to have to look at both with and without contrast when utilizing the new software. “The question is, is it being ordered correctly?” said Miami radiologist Dr. Daryl Eber, president of the Florida Radiological Society, the state chapter of the American College of Radiology.
“We are probably of all the specialties the most forward-thinking on all this,” said Eber. “We’re very concerned about radiation exposure and very concerned about costs. We are not trying to order a bunch of scans willy-nilly. That’s not who we are.
“We lobby Congress and write our own bills on this,” he said. “We want to get this software implemented. Listen, it makes our lives easier, and there are plenty of studies out there to show that. It’s frustrating.”
Weinstein pointed out that Medicare data showed Sebastian River was “far superior to other Florida hospitals and the national average for hospitals in many categories of diagnostic imaging, including MRIs of the lumbar spine performed appropriately, duplicate CT scans of the chest, cardiac imaging prior to elective cardiac surgery, and simultaneous performance of CT scans of the brain with CT scans of the sinuses.”
New Medicare data on imaging and other quality and safety measures is scheduled for release July 25, though Medicare announced last week it will delay the planned July update to its star rating system for hospitals after complaints about how it weights data. The system assigns hospitals an overall rank of between one and five stars. In Medicare’s December ratings, Sebastian River scored two stars.