Center for Medicare and Medicaid Innovation (CMMI) Health Care Innovation Award Patient Centered Cloud-based Electronic System: Ambient Warning and Response Evaluation (ProCCESs AWARE) Patient-Centric Electronic Environment for Improving Acute Care Performance
Role: Leader Mayo Clinic
Lead Investigators: Ognjen Gajic, M.D.; Brian Pickering, M.B., B.Ch.; Vitaly Herasevich, M.D., Ph.D.
Geographic Reach: Minnesota, Massachusetts, New York, Oklahoma
Funding Amount: $16,035,264
Estimated Three-Year Savings for Government Programs: $81,345,987
Mayo Clinic, in collaboration with US Critical Illness and Injury Trials Group and Philips Research North America, is receiving an award to improve critical care performance for Medicare and Medicaid beneficiaries in intensive care units (ICUs). Data show that 27 percent of such Medicare beneficiaries face preventable treatment errors due to information overload among ICU providers. Mayo Clinic's model will enhance effective use of data using a Cloud-based system that combines a centralized data repository with electronic surveillance and quality measurement of care responses. As a result, Mayo expects to reduce ICU complications and costs.
Over a three-year period, Mayo Clinic will train 1,440 existing ICU caregivers in four diverse hospital systems to effectively use new health information technologies to manage ICU patient care.
Heightened concerns regarding the sustainability of high quality health care stem in part from an aging population and increasing demand for expensive critical care resources. Patients in the intensive care unit (ICU) are particularly prone to medical errors commission and omission due to the acuity and complexity of their care. A recent Department of Health and Human Services report highlights the high incidence of such errors in acute care hospitals resulting in measurable harm and nearly $324 million in CMS costs a month. While some institutions have overwhelming evidence points to a persistence of error and poor real-world compliance with best practices. Unexplained variation exists in health care expenditures for critical care.
Despite high expectations, the implementation of health care information technologies (HIT) in the acute care hospital setting has not decreased errors or reduced costs. On the contrary, in an extreme example, implementation of HIT in a pediatric ICU was associated with doubling of the mortality rate among critically ill children. Information overload with a delayed and out-of-context presentation of an enormous amount of data is an important cause of HIT failure in the ICUs. This current infrastructure was largely designed in the previous century and is based on workflows translated from the paper environment. As such it nurtures fragmented, provider-oriented care delivery and impedes effective communication, particularly during transitions of care (admission, transfer or shift change), leading to medical errors, inconsistent care, avoidable complications, poor outcomes and costly wastes.
The goal of this project is to develop and test a novel acute care interface with built-in-tools for error prevention, practice surveillance, decision support and reporting (ProCCESs AWARE - Patient Centered Cloud-based Electronic System: Ambient Warning and Response Evaluation). In preliminary studies, these novel informatics support builds on advanced understanding of cognitive and organizational ergonomics, have significantly decreased cognitive load of bedside providers and reduced medical errors. Using a cloud-based technology, AWARE will be uniformly available on either mobile or fixed computing devices and applied in a standardized manner in medical and surgical ICUs of geographically diverse acute care hospitals predominantly serving Medicare and Medicaid patients. The impact of ProCCESs AWARE on processes of care and outcomes in study ICUs will be evaluated using standardized step-wedge cluster randomized study design expected to enroll more than 10,000 critically ill patients during the three year study period.