Towards Zero Harm: Improving Continuity of Do Not Attempt Resuscitation (DNAR) Orders Near the End of Life

The commitment to respect patients’ life-sustaining treatment preferences is a cornerstone of quality end-of-life care. However, the number of care transitions near the end of life and the frequency of patient decisional capacity may make honoring patient wishes difficult. University Hospitals identified serious gaps in the continuity of DNAR across hospitalizations as death approaches. Using the EHR, UH built a system that identifies patients who have asserted a preference to avoid CPR and where providers receive clinical reminders to discuss State DNR Forms and enter DNAR orders as appropriate. Our early experience with this EHR solution has encouraged us to establish an IT-supported change in UH policy towards DNAR orders in our patient population.

University Hospitals (UH) has launched a precision medicine strategy, embedded within the clinical workflow, to equip providers with insights to personalize care for better patient engagement, satisfaction and outcomes. 

UH has used genomic tests on tumor tissue for years, but new point-of-care software made data readily available so patients could be helped sooner.  

With practical success realized, the organization extended precision medicine across the enterprise. Providers use pharmacogenomic testing to understand which drug-gene interactions might interfere with patient safety and symptom relief. 

This session will focus on what providers and their patients have experienced with precision medicine in the clinical workflow: Identifying patients at greater risk for genetic-based disorders for early intervention,  reducing adverse drug effects (i.e., safety issues and lack of therapeutic benefit) and improving accuracy of diagnoses and efficacy of therapies.

The speaker also will cover barriers that impede adoption of precision medicine (e.g., lack of IT infrastructure, poor physician literacy around genetics, consumer confusion re: genetic data).

Follow the journey of University Hospitals of Cleveland as they transition from a traditional data warehouse system into a modern cloud-based, real-time environment allowing the organization to be operationally nimble and agile to adapt to ever-changing needs.  This presentation will discuss the pros and cons of traditional vs real-time data warehouse environments, the migration to the cloud and its advantages and pitfalls, and modern techniques for leveraging traditional HL7 data within modern FHIR & web architectures.  It will also showcase several Use Cases demonstrating how University Hospitals has been able to transform its clinical operations by leveraging real-time data throughout the Covid pandemic to make critical decisions including ventilator utilization and reallocation, as well as the use of geospatial analysis for early detection and outbreak prevention.

Automation Effect: Ushering in an Era of Testing Innovation

In the age of digital healthcare, organizations need a new approach to ensure that EMRs work properly after every change and integrate seamlessly with other hospital systems. Traditional manual software testing methods simply cannot cover this vast scope, giving rise to a new approach: intelligent, automated testing. This session will outline how their organization shifted from an environment of solely manually testing to a hybrid approach encompassing automated technologies. Discussion points include the role of people and processes in ensuring automated testing success; how to obtain departmental buy-in for technology investment; and how to show continued return on investment to justify the spend.

University of Kentucky HealthCare’s Epic Journey

Dr. Phillip Bernard and Tammy Lloyd of University of Kentucky HealthCare will share their insights about making an enterprise-wide transition from Allscripts to Epic. In this engaging panel-style discussion, we’ll hear about best practices and lessons learned – from both clinical and technical perspectives – so others considering the move to Epic, or those already underway, can benefit from UK HealthCare’s experience.