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How a Clinical Focus Group and Electronic Medical Records Improved Post-Partum Outcomes

By Michael Marino, SVP and Chief Medical Information Officer, Providence St. Joseph Health

Michael Marino, SVP and Chief Medical Information Officer, Providence St. Joseph Health

In my role as Chief Medical Information Officer at Providence St. Joseph Health, my team and I are at the intersection of technology and clinical practice in delivering high-value patient care. As part of the Information Services (IT) organization at PSJH, my team and I wear our hats as technologists who are also medical experts around clinical processes. We marry the technology-based innovations to what our clinical leadership in each specialty area of medicine have identified as proven, evidence-based clinical best practices. When this merging of clinical best practices and technology works, we improve health outcomes for our patients and broader communities.

"Using Epic as a single record that aggregates multiple streams of data gives us a framework to match a patient’s history to specific known risk profiles"

One primary focus of my clinical informatics specialty is around the electronic medical records (EMR) technologies that collect the charting data and notes made by our physicians and nurses, and then follow the patient through all the touch points of their care in our system. We are in the process of moving to a single EMR system called Epic, across our large, multi-state health system. Using Epic as a single record that aggregates multiple streams of data gives us a framework to match a patient’s history to specific known risk profiles, and then help our busy clinicians identify high-risk patients and provide a recommended slate of tests and criteria to carefully follow.

One of the biggest—and frankly, most shocking— opportunities we still have in the U.S. is to improve health outcomes for new moms who are vulnerable to complications after giving birth that can result in postpartum hemorrhage. We are one of only 13 countries in the world where the rate of maternal mortality has actually increased over the past 25 years. Postpartum hemorrhage is a leading cause of maternal mortality. And it’s preventable. This is the perfect sort of problem for us at PSJH—solving an important health challenge, at-scale, applying technology in the most practical of ways.

This is the kind of health issue that we tackle head-on through bringing together our clinical experts across the system to share and collaboratively develop best practices. An OB Focus Group that is part of the PSJH Women & Children’s Institute, one of our six clinical institutes that connect providers and experts across our seven-state system, identified maternal hemorrhage as an issue we could move the needle on.

Our physician informatists worked with our OB hospitalist partners in our largest Portland, Oregon-area hospital and partnered together with the Epic team of Information Services to build out a pilot program using guidelines set by the California Maternal Quality Care Collaborative and developing a risk scoring process using our Epic EMR. I personally can remember a time in the not too distance past, where my physician colleagues were using paper checklists and having to make these many complex connections on their own without the seamlessness and prompting Epic allows.

The technology does not work without deep understanding of clinical process that supports research-based best practices. Epic provides a framework for workflows we build with our clinical partners, and in turn the technology and the processes work together to ensure the right information is being gathered at every step of obstetric and post-partum care. Risk factors such as such as active bleeding and a history of certain conditions allow Epic to calculate a risk score and flag moms who have a higher likelihood of complications. Then, when our clinicians both within our system and others using the Epic technology in the community encounter those patients, a unique list of orders of tests, medications, and even transfusion products are automatically queued up, making it simple for nurses to proactively take life-saving measures for patients at risk.

This approach is a perfect fit for our mission-focused approach to health at Providence St. Joseph Health. As much as I love the power of technologies like Epic, in health care, where large nonprofit systems like ours that are challenged to efficiently offer more care to increasing volumes of patients, we have to have a solid reason for implementing tech. We are focused on technology not for innovation’s sake, but for expanding the volume of those we can serve at scale to ensure the healthiest communities possible where we serve. And what better way to bring tech and clinical best practices together than to save moms.