How an AdventHealth medical group achieved 2020 quality goals in just six months

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This is the third post in our blog series called "The Quest for Quality", you can view our first post here and the second post here.

In 2018, one of the nation’s largest not-for-profit health care providers, AdventHealth, set an ambitious system-wide goal for all affiliated medical groups to achieve top quartile in care quality by 2020. They looked to those we’ve previously described as “Quality Heroes” to design and implement a system-wide quality improvement plan, which included pre-visit planning as a key initiative. Avhana was identified as a tool that could significantly improve paper- and EHR-based processes and was first deployed within AdventHealth’s largest medical group. Six months after beginning to use Avahna, the medical group met AdventHealth’s 2020 quality goals – two years ahead of schedule.

Learnings from AdventHealth Success With Avhana

  1. Health system leadership can develop a culture of quality with focused, system-wide quality goals

  2. Thoughtfully integrated technology enables behavior change that saves time and improves the health of patients

  3. Pre-visit planning is key to systematically closing gaps in care and improving quality

Health system leadership can develop a culture of quality with focused, system-wide quality goals

AdventHealth leadership set an ambitious system-wide quality goal for all affiliated medical groups to be in the top quartile of quality nationwide. Rather than focus on many quality measures, they prioritized six. These quality measures are understood to be the priority across the entire organization and have helped create a culture of excellence.

Adventhealth 2020 quality goals being managed with Avhana

Adventhealth 2020 quality goals being managed with Avhana

To achieve these goals, AdventHealth created a multi-state ambulatory physician committee that was tasked with reviewing supportive technology solutions and developing best practices. They knew that an important part of success was for the technology to be tightly integrated into the electronic health record (EHR) or it would not be used. After selecting Avhana to assist with pre-visit planning, they chose to first deploy it with their largest medical group.

Thoughtfully integrated technology enables behavior change that saves time and benefits patients

The goal of pre-visit planning, the process for gathering and organizing pertinent information ahead of a patient visit, is to make the visit as meaningful as possible. While the positive impact of planning visits ahead of time has been well described, broad-scale implementation of an effective process has been a challenge for many health care organizations. AdventHealth’s quality heroes decided to use pre-visit planning to help them meet their 2020 quality goals so they selected teams at Florida Health Medical Group (FHMG) to use the Avhana technology to enable pre-visit planning.

Before we brought Avhana into production at AdventHealth, we met with AdventHealth and FHMG clinical leadership to understand existing clinical workflows. We needed to understand how care teams were identifying appropriate services for each patient to satisfy key quality measures. We learned that most teams were reviewing patient records during the visit, taking up what is often limited patient-provider time.

We then configured Avhana to review patient records for gaps in care and recommend pre-written orders that would satisfy AdventHealth’s prioritized quality guidelines. We also configured the system so that pertinent patient information, such as medical problems and recent lab results were visible while staff or providers reviewed Avhana’s recommendations and queued orders for the next visit. This context made it easy for providers to review and approve of the Avhana clinical guidance, making the right thing to do the easy thing to so.

The EHR integration required no AdventHealth IT resources because as a member of athenahealth’s MDP program, Avhana is available as a turn-key application. “Go-live” occurred just six weeks after contract.

Realizing that use of Avhana would enable care teams to manage more than just their 2020 quality goals, senior leadership selected additional measures to be configured in the platform.

Beyond 2020 Quality goals being managed in Avhana

Beyond 2020 Quality goals being managed in Avhana

Pre-visit planning is key to systematically closing gaps in care and improving quality scores

Before using Avhana, FHMG group was meeting AdventHealth’s 2020 goals for three of the six prioritized quality measures. However, in measures where they had room to improve they were able to exceed their goals in just six months. One measure, Body Mass Index screening, improved twenty-two percent! Additionally, they saw dramatic improvements in Colorectal and Breast Cancer screening.

Improvement of AdventHealth 2020 goals, before and after using Avhana

Improvement of AdventHealth 2020 goals, before and after using Avhana

Even more exciting is the number of patients whose care was improved through use of Avhana. Over 12,650 gaps in care were closed with Avhana for about 6,500 patients in just six months!

The cumulative number of gaps in care closed with Avhana

The cumulative number of gaps in care closed with Avhana

Deployment of Avhana, as with any new technology, didn’t occur without challenges. By design, Avhana is meant to facilitate a more effective workflow for pre-visit planning. Some change management was required and product configuration required some tweaking. However, we worked hand-in-hand with AdventHealth’s team to incorporate their feedback and the current result has been positive.


Download the full case study here.

About Avhana Health

Our mission is to offer impactful, patient-specific support for healthcare teams. At the core of what we do is the Avhana Quality Improvement Software Suite which we embed into leading electronic health records (e.g. Allscripts, athenahealth, Cerner & Epic). Our team is located in Baltimore, Los Angeles, and Boston. Avhana Health was awarded “Best Provider Facing Company” during Health 2.0 in 2018.





Be A Quality Hero

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This is the second post in our blog series called "The Quest for Quality", you can view our first post here.

On February 17, 2009, President Barack Obama signed the American Recovery and Reinvestment Act. It included the Health Information Technology for Economic and Clinical Health (HITECH) Act which allocated $19.2 billion to stimulate the development of a nationwide network of electronic health records (EHRs).

With a stroke of a pen, the US government laid the groundwork to change American healthcare fundamentally. This change has created the need for a whole new type of healthcare leader within health systems and physician groups – the QUALITY HERO! These heroes quickly found that although EHRs laid a foundation for measuring and improving quality, they were built during a soon-to-be-gone era of paying for healthcare services without regard for the quality of service and outcome (aka fee for services). Overwhelmingly, we’ve heard our heroes say their EHR’s utility for improving and managing quality of care is terribly limited.

Quality heroes are struggling to adapt during the shift to value-based care. At Avhana, we strive to support these heroes and help them improve care for hundreds of thousands (and soon millions!) of patients per year.

Typical challenges we hear from our quality heroes:

  1. EHRs were not designed for improving or managing care quality

  2. Quality care guidelines change rapidly and are impossible to keep up with

  3. Quality tools should be systematic and scalable, yet flexible enough to address variable needs of care teams and patients at the local level

EHRs were not designed for managing care quality.

EHRs were built to replace file folders - then track and charge for the work being done by individual physicians. Most EHRs are built on a technical foundation from the 1980s & 90s when healthcare services were paid for regardless of quality and patient outcome. They are sophisticated billing systems designed around singular patient encounters. They are incredibly efficient at storing and retrieving information but cannot connect and generate insights from that information, especially across groups of people or larger populations.

As discussed in a previous post, quality heroes have found that quality improvement (and management) by one member of the care team at sporadic points in the clinical workflow is not practical. Every care team member should help to improve quality throughout a patient’s clinical journey. This requires EHRs to connect the right information for the right member of the care team at the right time. EHRs are structurally not set up to do this.

Guidelines are ever-changing and increasing in number

Clinical practice guidelines are changing at an accelerated pace and increasing in number as the volume of healthcare data exponentially increases. 5800 medical journals generate ~800,000 articles PER YEAR and growth of that data is accelerating. We hear every week in the news about a new or updated guideline. Here are just a couple of examples of long-accepted guidelines that have recently changed: aspirin and breast cancer screening.

At the same time, there may be different variations of one guideline that providers need to follow. For example, different health plans may choose different variations of a guideline and expect providers caring for their members to follow these changes.

Quality tools should be systematic & scalable, yet flexible

Quality heroes have realized that improving quality of care for an individual meant coordinating their care across multiple physicians, hospitals, and other allied care providers. This led health systems to the broad-scale acquisition of independent physician groups and allied care providers (e.g., skilled nursing facilities and physical therapy clinics).

Now, our heroes must improve the quality of care across multiple EHRs and hundreds of care sites. They need tools that can systematically identify gaps in care for individual patients but scale across their organization. This has been especially tough for managing care in the ambulatory setting, where over 80% of patient care takes place.

Most quality improvement tools have been designed for a narrow set of use cases and are therefore not applicable across an entire health system. When you mix in the rapid change and number of quality guidelines, this makes systematic and scalable quality improvement still very elusive for our quality heroes.

Quality Heros to the Rescue

At health systems and physician groups who have been preparing for a new future in healthcare, there is always a quality hero (and most often many of them). This person recognizes and adapts to the above challenges and guides their colleagues toward thriving in an era of value-based care.

They recognize that so many of the processes around them need to be changed, but it's an uphill battle.

They work tirelessly with clinical leadership to prioritize care guidelines and enable providers to follow them.

They work with their EHR team on reconfiguration and add-ons to improve and manage care quality.

And they know the definitions of quality care are constantly changing – so what works today may not work tomorrow and will likely change in the future.

We’re just getting started

We started our journey of supporting quality heroes several years ago. As you may be shocked to learn, getting EHRs on board with what we were doing was not an easy feat. Getting them to view us as partners and working with them to build out new data integrations took even more.

However, since 2018 when we started implementing our technology in large health systems, we have helped quality heroes and their colleagues improve and manage quality of care for over 55,000 patients. Over that span, we helped identify and close over 110,000 gaps of care. Later this year we are expected to cross the 500,000 and 1,000,000 patients and gaps of care respectively.

About Avhana Health

Our mission is to offer impactful, patient-specific support for healthcare teams. At the core of what we do is the Avhana Quality Improvement Software Suite which we embed into leading electronic health records (e.g. Allscripts, athenahealth, Cerner & Epic). Our team is located in Baltimore, Los Angeles, and Boston. Avhana Health was awarded “Best Provider Facing Company” during Health 2.0 in 2018.


The Wild Wild West of Improving Quality

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“Managing quality of care shouldn’t be “one MORE thing” our care teams have to do. With Avhana, I say, there’s “one LESS thing” you have to do.”

- Dr. Shelly Nash, CMIO of AdventHealth’s Physician Enterprise

Amongst the craziness of HIMSS (the country’s largest health technology conference, with over 50,000 attendees), Dr. Shelly Nash and Avhana Health held an intimate breakfast with senior leaders of leading healthcare organizations in the country. It was a riveting conversation about improving quality care in the disparate ambulatory care setting - or what the group deemed the “Wild Wild West of Healthcare Quality”.

Here are three key findings from the conversation:

  1. It is not enough to have a handful of individuals focused on quality and a “quality module” in the EHR. Quality improvement should flow through EHR workflows for all members of the care team.

  2. A top-down or centralized approach hasn’t worked. A local focus works best but is tough to execute and manage. Large organizations with clinicians in a wide array of locations must drive focus on quality initiatives at the local level and support care teams with resources from the national or central office.

  3. The greatest impact on quality results from coordinated initiatives before, during, and after patient encounters. Tools that streamline EHR workflows in support of these initiatives don’t just improve quality, they can reduce a clinical team’s time to manage care quality and understand where they  have opportunity to improve.

At Avhana Health we get a lot of fascinating insight into ongoing healthcare trends that are not well understood. To outsiders, a healthcare team’s focus on providing “quality care” is the most fundamental aspect of the job. However, healthcare teams and organizations who care for large populations know it is a big challenge to make sure that everyone who should get screened for colorectal cancer, breast cancer, or hundreds of other forms of “quality care”, gets them.

Coordinating the highest quality of care, especially in the ambulatory setting, is still very much the Wild Wild West. Avhana’s mission is to support the thousands of frontiersmen and frontierswomen across the country, like Dr. Shelly Nash, to bring order and prosperity to a rapidly evolving healthcare landscape.


Quality should be baked-in throughout clinical workflow

Many breakfast attendees agreed that the ways current technology focuses on quality are ineffective.  Quality improvement should not be a separate module inside of the electronic health record used by a select group of users.

Quality improvement should be baked-in throughout the entire clinical workflow for all members of the care team. Examples include:

  • Before the patient encounter, suggestions to help the care team plan efficiently and fill any outstanding gaps in care.

  • During the encounter, patient-specific advisories and order sets that help providers follow evidence-based protocols and feedback if they stray from best practice.

  • After the encounter, feedback for the care team on how they are doing amongst their peers and feedback for improvement to help understand breakdowns in the workflow.

How quality is measured should also evolve to incentivize the correct changes.  Currently, much of care quality is measured based on process (e.g. did I order a HbA1c screening for my diabetic patients?). In the future, quality will be measured on outcomes (e.g. what percentage of my diabetic patients have HbA1c < 9?).


Keep quality local but support and resource nationally

The most successful quality initiatives result from taking a local approach. However, it is critical that the national organization support local practices. The best indicator for a successful quality initiative is buy-in from a respected and local clinical leader (e.g. Chief Medical Officer) that serves as a conduit for the national or centralized organization. This critical champion emphasizes the goals of the national organization to their local clinical teams and funnels feedback on local challenges experienced by front-line care teams back to the national organization.

In the breakfast attendees’ experience, the organizations who developed local practice performance teams to help implement a quality strategy were most successful. Local organizations can be extremely competitive and competition has been a powerful driver in promoting quality. One health system discussed that not only did the competitions improve engagement, but it also led to open dialogue on specific ways to improve quality. The winning groups get bragging rights, however, the real winners are the patient.


Digital tools enable feedback

The most popular tools used for improving quality are still paper checklists, weekly promotions written on whiteboards, and ad hoc reporting to individuals and managers.  Many companies are developing products to help care teams improve quality with varying degrees of success.

Attendees agreed that coordinating these tools to support quality improvement before, during, and after patient encounters is the best way to implement a technology-enabled process. When done well, health systems are finding that they can actually reduce the time care teams are spending on managing care quality. Additionally, the data generated in a digitally-enabled system provide invaluable feedback that further enables quality improvement.



About Avhana Health

Our mission is to offer impactful, patient-specific support for healthcare teams. At the core of what we do is the Avhana Quality Improvement Software Suite which we embed into leading electronic health records (e.g. Allscripts, athenahealth, Cerner & Epic). Our team is located in Baltimore, Los Angeles, and Boston. Avhana Health was awarded “Best Provider Facing Company” during Health 2.0 in 2018.