And how fast can you act on it?
The Emergency Department prided itself on its stroke care, especially as it raced to serve the increasing number of stroke patients due to COVID-19.
Consider this real-life scenario: the medical director of an emergency department dug into the data to understand her department’s response time—33 minutes from arrival to treatment, slightly above the national average and remaining stable despite the pandemic surge.
Her team had a deep commitment to healthcare equity, and she wanted to ensure that stroke care was being delivered consistently across gender, ethnicity, language, and race. She quickly broke down the data by those subgroups and the time it took her department to get tPA—the common injectable emergency stroke drug that breaks up blood clots—into arms.
She was dismayed by what she learned: it was taking an average of 20 minutes longer for Black patients to receive tPA. “I didn’t know that our Black patients had a delay in receiving tPA until we used AdaptX,” she said. “Our data opened our eyes, and we took action."
AdaptX, formerly MDmetrix, is a self-service technology solution that functions as an adaptable clinical management tool to empower clinical leaders to dive into key quality measures, easily break down metrics by all kinds of subgroups, and quickly identify variances in care. In a matter of minutes, users can make discoveries that could otherwise have taken months of data mining and manual analysis to determine—operations for which technical resources and time often simply aren’t available, leading to decreases in quality of care.
Prior to using AdaptX, the leadership of this particular ED lacked any practical way to look beneath the aggregate performance of their system of care—so they hadn’t uncovered the equity gap of Black patients taking 49 minutes to receive their tPA treatments, versus 29 minutes for white patients.
In this case, the organization’s leader used AdaptX to quickly examine the ED’s stroke workflow, including time-to-bed, time-to-physician, and time-to-CT. With time disparities piling up across this workflow, she could now measure the breakdowns causing the overall disparity: five minutes longer for Black patients to reach a bed, six minutes longer for them to see a physician, 13 minutes longer for a head CT. Armed with these actionable insights, she moved rapidly, addressing racial inequities at each stage of the stroke-care process. Once her team was conscious of the equity gap and was supported with resources, training, and awareness about racial bias, they actively worked to rectify it—and within 30 days, they had changed their tPA subprocesses and successfully shortened the time-to-tPA faced by Black patients to under 30 minutes, which also dropped the aggregate time-to-tPA for a system improvement of 10%.
Given the complexities involved in delivering healthcare, it’s incredibly difficult for clinical leaders to solve problems by relying on anecdotes and intuition—they need data, and they need the ability to continuously monitor and evaluate the subsystems underlying treatments and workflows. Fortunately, in the last decade, a treasure trove of data has become available. Thanks to the transition to electronic health records (EHRs) that collect and store patients’ medical histories in a digital format, a wealth of data is now stored by health systems across the country.
EHR data that tracks individual patients is useful for billing and improving communication across medical teams for that patient, but it isn’t useful for looking across multiple patients or quickly tapping and synthesizing that data into meaningful information about performance trends over time—from the efficiency of workflows to the effectiveness of protocols.
Dr. Dan Low, Chief Medical Officer of AdaptX and attending pediatric anesthesiologist at Seattle Children’s Hospital, has 20 years of clinical experience and saw first-hand how the transition from paper to electronic medical records, while crucial, didn’t go far enough. “EHRs were never architected to look across patients, so you have many of the same problems as before,” he said. “Say you implement a change in your department over the course of nine months. It then takes another 12 months to evaluate if that change is working.”
AdaptX was born out of that frustration. Its founders began building the technology for the solution five years ago and tested it in a live environment for two years before launching. It works by taking the data from hospital EHRs and making it accessible through a digital dashboard that gives clinical leaders visibility on where they have successes and where they have room for improvements in their care delivery.
Measuring clinical performance as it pertains to healthcare equity is only one of many ways the AdaptX solution is applied. Clinicians can also use it to evaluate, for example, how long routine surgeries take per provider, which provider has more successful outcomes regarding pain management, or whose patients spend less time in recovery. This kind of data allows clinical leaders to isolate best practices and manage consistency across providers. With the use of AdaptX, for example, the Bellevue Clinic and Surgery Center (BCSC) was able to eliminate the use of opioids for most pediatric outpatient surgeries, while dramatically improving patients’ surgery experience and satisfaction.
AdaptX users range from hospital department chiefs to front-line medical workers. In the case of BCSC, it was a nurse with access to AdaptX’s solution who pushed to develop opioidfree anesthesia protocols.
“The solution is an opportunity to speed improvement and reduce risk across the care environment,” said Warren Ratliff, CEO of AdaptX. “Now, clinical leaders can monitor, evaluate, and adapt care on a daily or weekly basis, enlisting clinicians in new ways to transform treatments and workflows. If we truly want to address equity in care, we need to empower our clinical leaders to assess and act on disparities in this way.”
Healthcare is a high-risk environment—patients can experience pain, lives may be at stake. As a result, Ratliff explained, physicians can be understandably resistant to change, and it can be hard to convince them to make changes when they can’t quickly verify whether a change really represents an improvement. Hence, medical progress has historically been slow. With a tool like AdaptX, the pace of improvement becomes dramatically faster, potentially dropping from years to weeks.
“AdaptX makes it easy for everyone to get actionable answers in seconds, so they can adapt and manage care every day,” Ratliff said. Some clinics can be hesitant to introduce a new technology tool, assuming it will be a burden on their IT team to get it up and running. Not so, Ratliff said. “It’s a matter of days, not months. That little bit of time on the front end enables them to maximize the tremendous investment of money and work hours that they put into electronic health records in the first place.”
To learn more about AdaptX, visit AdaptX.com.
Physicians Insurance members may receive a discount for AdaptX services; contact your Physicians Insurance representative to learn more.
TRAINING FROM YOUR LIABILITY INSURER
Once you are aware of issues within your organization, effective and accessible training is often the next step. To learn more about training resources available to our members around unconscious bias, social determinants of health, and cultural competence, visit: