Leveraging Data for Success: - Coring the Core Measures - Chasing Discrepancies Leveraging Data for...
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Transcript of Leveraging Data for Success: - Coring the Core Measures - Chasing Discrepancies Leveraging Data for...
Leveraging Data for Success: Leveraging Data for Success: - Coring the Core Measures - Coring the Core Measures - Chasing Discrepancies - Chasing Discrepancies
Leveraging Data for Success: Leveraging Data for Success: - Coring the Core Measures - Coring the Core Measures - Chasing Discrepancies - Chasing Discrepancies
Richard S. MacKenzie, MD, FACEP Chair : Department of Emergency Medicine Lehigh Valley Hospital & Health Network
L. Albert Villarin MD FACEP CMIO : Albert Einstein Healthcare Network
Chris DeFlitch, MD, FACEP Director & Vice-Chair - Department of Emergency Medicine Physician Director, Connected, CIS
Overcoming the Hurdles: Overcoming the Hurdles: Improving DTB in the LVHHN Improving DTB in the LVHHN
MI-Alert Program MI-Alert Program
Overcoming the Hurdles: Overcoming the Hurdles: Improving DTB in the LVHHN Improving DTB in the LVHHN
MI-Alert Program MI-Alert Program
Richard S. MacKenzie, MD, FACEPChair
Department of Emergency MedicineLehigh Valley Hospital & Health Network
Richard S. MacKenzie, MD, FACEPChair
Department of Emergency MedicineLehigh Valley Hospital & Health Network
A
HOSPITALAND HEALTH NETWORK
LEHI H Vo LLEY
Problem at the MilleniumProblem at the Millenium
Inconsistency
Mortality 5-7% PCI
Mortality lytic 6-16%
EUR HEART J. 2002 23 550
PSIMTPSIMT
Plan Problem identification & clarification
Solution identification & clarification
Presentation for input
Do Implement - education precedes date
Presentation for understanding
PSIMT (2)PSIMT (2)
Study - Monitor for… “protocol violations”
anecdotes
Trends
Act – Tweak the process
D2B Specifics – Road ShowD2B Specifics – Road Show
Remove decisions streamline by consistency – no “artists”
Reduce transitions or hand-offs
Challenge tradition
Dance the same dance “Order Sheets”
Regional MI AlertThe Core… Regional MI AlertThe Core…
STEMI only
Definitive State-of-the-Art care
One call does it all
Parallel vs. sequential processing
Tight reporting of data for performance improvement
Faster is betterFaster is better
In-hospital Mortality * Age Crosstabulation
348 162 54 564
99.7% 96.4% 88.5% 97.6%
1 6 7 14
.3% 3.6% 11.5% 2.4%
349 168 61 578
100.0% 100.0% 100.0% 100.0%
Count
% within Age
Count
% within Age
Count
% within Age
No
Yes
In-hospitalMortality
Total
< 65 65-79 80+
Age
Total
Reduction in Mortality!Reduction in Mortality!
Overall Mortality:
STEMI local and regional = 2.4%
Data Utilities & ApplicationData Utilities & Application
Chris DeFlitch, MD, FACEPPenn State Hershey Medical CenterConnected (CIS) Physician ChampionFounder, Penn State Partners for Healthcare EngineeringDirector & Vice-Chair, Dept of Emergency Medicine
Using EDIS for Meds RecUsing EDIS for Meds Rec
ONE system
Integrated Provider Information
Master Medication List
Drug-Drug Interaction
Documentation of Proces
ArrivalArrival
E-med list collected on Triage Powerform by RN
List autopopulated from prior encounters
Viewable in all Venues
OrderingOrdering
Meds Ordered Individual
Order Sets
Interaction Checking
Auto-populates E-Mar
Master Medication List
Physician DocumentationPhysician Documentation
Person and Time Stamped at each step
Info and modification to all providers All physicians
Nursing (e-mar & med list)
Pharmacy (if admitted)
Soon to pre-populate MD Note
Admitted PatientAdmitted Patient
Med List Carries to the Inpatient World
Same Interaction Checking
Automated Review at Key Stages Admit orders
Transfer of service
Transfer of Location
DischargeDischarge
RULE generates required Review
Integrated in discharge Processing
Recon prior to printed discharge
Med List Printed on Discharge for patient
ALL updates Master List for future visits
Core Measures and EDISCore Measures and EDIS
Community Acquired Pneumonia
Identification on ArrivalIdentification on Arrival
Advanced Nursing Protocol or PDQTM
Tracking Board Identification
Order Set for Initial Orders O2 Sat
CXR with pre-populated indications
IV & labs if criteria
Blood Culture …..
Tracking BoardTracking Board
Order SetOrder Set
Evaluation & TreatmentEvaluation & Treatment
Communication to Physician Review RN doc & discrete data online
View Image On-Line
CAP Order Set IV & Lab (dup check)
Blood Culture (dup check)
ABX recommendations
Allergy Checking
Decision SupportDecision Support
On-line Viewable Risk Stratification
Disposition by Criteria
Complete documentation of Process
SOON to integrate MD documentation
Core MeasuresCore Measures
Albert Einstein Medical Center Pneumonia – time to antibiotics
Acute MI – time to CATH Balloon Up / TPA
Penn State Hershey Medical Center Pneumonia – time to antibiotics ( CPOE & Order Sets)
Lehigh Valley Hospital Acute MI – time to CATH Balloon Up
Chasing Discrepancies by Medical Center Chasing Discrepancies by Medical Center
Radiology ‘Re-Reads’
Laboratory ‘Re-Do’s’
Cardiology ‘Alternative Interpretations”
Core Measures / DiscrepanciesCore Measures / Discrepancies
OPEN DISCUSSION