Always looking beyond the horizon: Lucile Salter Packard Children’s Hospital Stanford

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Lucile Salter Packard Children’s Hosptial Stanford  is both a pediatrics and obstetrics hospital with approximately 320 beds that support around 15,000 annual admissions. It’s also a quaternary care children’s hospital, taking referrals from all over the world. The facility performs more solid organ transplants in children than any other hospital in the country, and it has a top-rated pediatric cardiac program. It goes without saying that the slightest disturbance in the organization’s workflows can equate to tragedy.  

I spoke with Dr. Christopher A. Longhurst, Chief Medical Information Officer, Lucile Salter Packard Children’s Hospital Stanford to learn more about the organization and its most recent healthcare IT accomplishments since publishing the first decrease in hospital-wide mortality with an electronic health record implementation.

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article.)

Free: Our industry tends to speak in very broad strokes when discussing healthcare IT. Could you comment on how has health information technology impacted pediatric care in particular?

Longhurst: I would say that unquestionably the net overall impact of health information technology over the last 10 to 15 years has been to improve quality and safety of healthcare for children. We have a number examples of how that has been the case here and there’s also been peer-reviewed literature conclusively showing that in other places as well.

I think it’s important to acknowledge that there’s also unintended consequences of health information technology rollouts like electronic health records, and so we have to have our eyes wide open recognizing those unintended consequences and working to mitigate those. That being said, it’s clear that the reason that those projects were undertaken was to improve quality and safety.

Free: Your organization has experienced a great deal of success in areas where many others have struggled. Could you please describe some of those successes?

Longhurst: We implemented our first electronic health record in the fall of 2007. In the mid-2000s, there was a lot of controversy in the pediatric space in general about the efficacy of electronic health records because there was a study out of Pittsburgh Children’s which showed an increase in mortality when they converted to electronic orders. We implemented the same vendor and made a lot of different local choices in how we implemented it. So we were obviously very relieved in 2009 – 2010 as we saw a decrease in mortality in our hospitalized children. We actually looked into more detail on it and we found out that in fact the decrease in hospital-wide mortality was associated with the go live of our electronic orders at our hospital. We published and it was the first published description of a decrease in hospital-wide mortality with an electronic health record implementation.

The optimization of our electronic health record over the last five or six years has resulted in a number of benefits. We have published, for example, that we have dramatically decreased overutilization of blood transfusions. That was made possible through an alert in our electronic health record that saved the hospital both money and not unnecessarily exposing children to blood products. We also have found that we have increased our compliance of best practices for caring for children with asthma with forcing functions within documentation in their electronic health record. More recently, we have converted from one electronic health record vendor to another. We just recently published the approach that we use for training all of our medical staff and the value of having clinicians do that training rather than software experts for example.

Free: Your organization has a Clinical Informatics Department. How does that department function within your facility?

Lomghurst: The Clinical Informatics Department was launched with the foresight of our hospital leadership in 2007 when we went live with our first electronic health record. Its role is to serve as a bridge between the information technologists and the clinicians. The clinical informatists are interpreters who speak both languages. They help to bring the needs of the clinicians and patients to bear in the IT department. They work with the IT department to configure solutions, then they help to communicate solutions back to the clinicians for adoption.

Our clinical informatics group, for example, has led new workflows to make it possible to enter electronic orders on babies before they’re born because if you have to wait for babies to be registered after birth, then you can’t enter timely orders unless it’s an electronic system and you have to leave those orders on paper. We, for example, created a pre-born nursery where a premature infant was clearly going to be delivered, we do the registration prior to delivery, enter those orders and allow timely care to occur immediately after delivery. So that’s just one small example of the type of work that we support.