Dartmouth Health Children’s is partnering with C8 Health on a new information hub system that will put the latest research and guidance on medical care in one place for all its providers in New Hampshire and Vermont. (Courtesy)
Medical providers make dozens of clinical decisions a day with little time for researching the latest guidance. Which tests does a patient need? What drugs should be prescribed for an uncommon condition? How do you treat a newborn with low blood sugar?
Dartmouth Health Children’s is trying to make that up-to-date guidance and research easier to find for its providers as they care for nearly 60,000 children in New Hampshire and southwestern Vermont.
Dr. Keith Loud is physician-in-chief for Dartmouth Health Children’s. (Courtesy of Dartmouth Health Children’s)
This month, it rolled out a “knowledge management system” across all its locations that will put that guidance and latest research in one spot. It’s been a critical change, Dr. Keith Loud said, as Dartmouth has grown its footprint throughout New Hampshire and into parts of Vermont.
“When it came to specialized knowledge, even at CHaD (the Children’s Hospital at Dartmouth-Hitchcock), a lot of that specialized knowledge lived on bulletin boards, and in people’s email folders,” said Loud, physician-in-chief. “It lived on SharePoint or in a variety of different places that you’d need almost a directory to try to remind yourself where to find it.”
Knowledge management systems are not new, though they are to Dartmouth Health Children’s.
A 2017 study published in the National Library of Medicine called the benefits of this type of knowledge sharing “enormous” for not just patients but also providers.
It has led to fewer medical errors, faster decision-making, and more efficiency in a sector that is already struggling to keep up with demand. When a hospital or practice standardizes its best practices and provides all providers the same guidance, a patient’s care is less dependent on who they see and how much time that provider has.
“Imagine you are a physician or a nurse in a small clinic and you have access to all the knowledge base of the main hospital,” said Galia Rosen Schwarz, chief executive officer at C8 Health, the company Dartmouth Health Children’s is partnering with.
The challenge, Loud said, was finding a platform that could work across a broad geographic area like Dartmouth Health Children’s where each practice has its own email network and medical records platforms. Dartmouth chose C8 Health’s system for a three-year pilot.
“Some of the information and knowledge management systems are clunky, difficult to access, and difficult to access in real time,” Loud said. “And so discovering this platform that C8 Health developed is really sort of kind of a Shazam moment.” He added, “It’s another way to create a regional pediatric health delivery system that feels connected and can therefore serve a broader population, hopefully more effectively.”
Dartmouth Health Children’s controls what information is uploaded to the system, whether it be information and research developed internally or outside guidance a provider has used effectively. “The information is always vetted by someone in our system,” Loud said.
When providers access the information on a laptop, phone, or tablet, they can also see who uploaded or approved it. The people who upload or approve the information will also be prompted in the coming months to confirm it is still valid or update the material if needed.
“Therefore that also allows for a much more rapid cycle of quality improvement in terms of the things that may be missing in the information,” Loud said. “That feedback can come more quickly than the way we typically see in health care.”
Providers don’t have that same type of access or influence over the professional societies that issue practicing guidelines, Loud said.
Loud recalled seeing a post from someone in Dartmouth’s pediatric residency program about the challenge of accessing information on managing a newborn whose blood sugar was low.
“The promise of the connector is that for a resident in the middle of the night with a newborn with low blood sugar, there is a standard process or policy that we have on how to address that,” Loud said.
Rosen Schwarz at C8 Health said this is the company’s first foray into New Hampshire and Vermont. She said most clients have used the system at a hospital level but the goal is the same for any location: avoiding “unwarranted variables” in medical care.
“Unwarranted variables in care are a major cause of medical errors and are also extremely wasteful,” she said.
Loud said he hasn’t heard much feedback from providers since the platform went live in early September. He considers that a good sign.
“People have not come to me and said, ‘Hey, this thing isn’t living up to its billing,’ ” Loud said. “What I’ve been encouraged about is as we’ve met with our specialty pediatricians, even at the meeting we had last month, a lot of them were in the room uploading material. We’re not going to deem it a success or failure after a month, or even after four weeks. It’s an experiment, but it’s an exciting one thus far.”