March - April 2003

Quality Improvement in an Electronic World

Enhanced by Automated Data Extraction & Analysis

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Denni McColm, CIO Renee Whitman-Teeter, Director of Performance Improvement

Boston Children’s Hospital

!@ Citizens Memorial Healthcare

Quality – What is it?

• • • • • • Patient outcomes, did they get well?

• Short term?

• Long term?

Patient perceptions? How often we followed evidence based protocols?

Survival rates?

Readmissions rates?

Is it safe, error-free care?

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CMS

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HealthGrades

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Leapfrog Group

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JCAHO

How are they using that quality data?

• • Publicizing it on the Internet Paying us for it

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• • • • • • Deployment of Rapid Response Teams…at the first sign of patient decline Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack Prevention of Adverse Drug Events (ADEs)…by implementing medication reconciliation Prevention of Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle” Prevention of Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time Prevention of Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps called the “Ventilator Bundle”

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CMH Strategic Initiatives

• • • Core/Regulatory Measures Pain Turnaround Times

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Using IT to Improve Quality

• • • EMR CPOE eMAR • • • • Reduce errors of transcription/illegibility Give physicians more information with which to make care decisions Alert drug/drug interactions and allergies Improve the timeliness of results

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• • • • • • • Order prompting in the ED Order prompting in PCS Required fields Documentation templates for physicians OE Rules Evidenced based order sets Clinical alerts

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Changing our thinking . . .

• FROM ONE AT A TIME CHART REVIEWS AFTER THE FACT • TO: • • • NPR Reports Required Fields Reporting Daily, end of shift • BUILDING IN QUALITY & MONITOR IT CONCURRENTLY

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But,

• • Where should we focus our effort?

Where are we doing the worst?

• We could write an NPR for every one of those measures (Core, ORYX, 100K Lives . . . . . . . . . .) • • • How many people would it take to write an NPR report for every quality measure out there?

Just to determine where to focus . . . And then, How would we adjust for severity and compare to benchmarks?

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• The Institute for Health Metrics (IHM) is: • A non-profit that helps us leverage our electronic systems for quality improvement • Extracting data from MEDITECH for use in: • Quality of Care Reporting & Benchmarking • Physician Performance Analysis & Reporting • A MEDITECH Strategic Ally

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Recognizing that we need . . .

• Quality management tools to help us: • Identify • • • Analyze Target Track • Tools that are: • Automated • • Timely Use sophisticated analytics • • • Give us a graphical presentation Case/provider drill downs and Trend analysis

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AIES

TM

& PQMS

TM Automated Indicator Extraction System Physician Quality Management System    279 Quality Metrics: National Consensus Measures: CHF, AMI, CAP, L&D, SIP, ICU, Asthma, Stroke, AHRQ, IHI System Measures: Hospital Acquired Infections, MRSA, etc.

 Physician profiles:  50 procedures   20 diagnoses 279 quality metrics (integrated with AIES TM )     Real-time benchmarks Risk adjustment Graphical trend analysis Provider and case drill downs

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Hospital HCIS IHM VPN Extract Data Directly from Meditech Web Based Monthly Reports IHM: Clean Normalize Map Report

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AIES: Quality Dashboard by Indicator

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Total Case Matrix

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Graphs for Trending

Resource Definitions & Links

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Download Data to Excel for Analysis

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Drill Down Into Text

What comes with AIES?

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PQMS: Dashboards by Specialty or Physician

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PQMS: Drill Down

Benefits • Automates Data Extraction and Analysis • Eliminates manual data collection, analysis and reporting • Gives us an unbelievable number of measures • Extracted • • Severity adjusted Benchmarked • Presents and Analyzes Data in a Usable and Actionable Format • • • Focuses Efforts on the True Causes & Drivers of Performance Supports timely Interventions and Improvement Strategies Helps Clinical Staff Focus on Improving the Quality of Care

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Upcoming Releases

• Concurrent Case Management System (CCMS) • Identification and scoring for high risk patients • • Daily reports for Core Measure case tracking Daily reports for concurrent quality improvement efforts • • Financial Analysis System Nursing Quality Management System

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Thanks!

Questions:

Denni McColm, [email protected]

Renee Whitman-Teeter, [email protected]

Jeff Borkowski, [email protected]

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