Russ Ricci, MD Moderator, President Emeritus, eHealth

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Introductions
Russ Ricci, MD - Moderator, President Emeritus,
eHealth Initiative Chairman, MEDITECH Advisory
Board Jane Englebright, PhD, RN, Vice President,
Quality Hospital Corporation of America (HCA),
Nashville, TN Denni McColm, CIO Citizens
Memorial Hospital, Bolivar, MO 2005 HIMSS Davies
Award Recipient Robert Dart, MD, Chief of
Emergency Medicine and Director of Medical
Informatics Quincy Medical Center, Quincy, MA
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Do You Remember the Year?
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Why Quality Reliability Must Also be
Improved,Even Though it May Cost Somewhat More
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Challenges

• Competition exceeds cooperation and trust
• Lack of
• standards
• interoperability
• personal identifiers
• funding
• physician support
• Rising health care costs

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• Mission To drive improvement in the quality,
  safety, and efficiency of health care through
  information and information technology.

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Vision Consumers, health care providers, and
those responsible for population health will have
ready access to timely, relevant, reliable, and
secure information and services through an
interconnected, electronic health information
infrastructure to support better health and
health care. Does this sound like your mission?

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Middle Class Voters Become Uninsured
Percent of working adults uninsured, by household
income quintile 1987-2003
Source Analysis of the March 1988-2004 Current
Population Surveys by Danielle Ferry, Columbia
University for the Commonwealth Fund. Adapted
from A Need to Transform the US Health Care
System Improving Access, Quality and
Efficiency. Compiled by A. Gauthler and M.
Serber The Commonwealth Fund, October 2005. 2005
A. Milstein, MD
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Crossing the Quality Chasm
1.5 million people harmed by medication errors

• Errors cost 3.5 billion per year in
• medical expenses

Necessary Actions

• e-Prescribing by year 2010
• Enhanced communication between patients and care
  providers
• Interoperable medication data

Source Preventing Medication Errors Quality
Chasm Series, Institute of Medicine, July 2006
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Current Status

• Expectation for quality initiatives and outcomes
  reporting
• Communication
• Nursing Documentation
• Medication Bar Coding
• Computerized Physician Order Entry
• Informed Decision Support
• EMR/EHR/PHR
• Comparative Performance Reporting

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Your Status on Quality Improvement Initiatives

• Interoperability?
• Bar Coding?
• CPOE?
• Physician Documentation?
• Decision Support?
• Links to Ambulatory Physicians?
• Performance Reporting?

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• The Challenge Today is the Sociology not the
  Technology

Change the Process, Don't Pave the Cowpath
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Panelists How Have You Succeeded in Your Quality
Initiatives?

• Governance
• What has changed in your culture?
• Critical success factors
• Challenges to success

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Jane Englebright, PhD, RN Vice President,
Quality HCA
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Who is HCA?
US 176 Hospitals 92 ASCs in 22 States
INTERNATIONAL 8 Hospitals
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HCA Mission and Values Statement

• Above all else, we are committed to the care and
  improvement of human life. In recognition of
  this commitment, we will strive to deliver high
  quality, cost-effective healthcare in the
  communities we serve.
• In pursuit of our mission, we believe the
  following value statements are essential and
  timeless
• We recognize and affirm the unique and intrinsic
  worth of each individual.
• We treat all those we serve with compassion and
  kindness.
• We act with absolute honesty, integrity and
  fairness in the way we conduct our business and
  the way we live our lives.
• We trust our colleagues as valuable members of
  our healthcare team and pledge to treat one
  another with loyalty, respect, and dignity.

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Through the Patient Safety Initiatives,
HCA strives to . . . .Create a Culture of
Patient Safety

• Establish patient safety as a visible commitment
  to putting patients first philosophy
• Move from blaming people to improving processes
• Improve use of technology to prevent and detect
  error
• Use data to identify and measure improvements

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Areas of Concern for HCA Arise from Four Main
Avenues
Areas of Concern are defined by HCA Senior
Management. Once identified, the Patient Safety
Department conducts the literature review, best
practice survey of HCA hospitals, and organizes a
Design Team. Design Team recommendations create
the core elements and approaches for the
resulting Patient Safety Initiative.

• Operational Concerns
• Emergency
• Surgical
• Critical Care

• HCI Claims Data
• Perinatal
• Emergency
• Surgical

Areas of Concern for HCA

• Regulatory Concerns
• Medication Safety
• Hospital Associated Infections
• Perinatal
• Surgical Care

• Public Policy Concerns
• Medication Safety
• Hospital Associated Infections

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HCA Definition of Quality is Derived from IOM
ReportCrossing the Quality Chasm

• Safe Avoiding injuries to patients from the
  care that is intended to help.
• Effective Providing services based on
  scientific knowledge to all who could benefit and
  refraining from providing services not likely to
  benefit
• Patient Centered Providing care that is
  respectful and responsive to individual patient
  preferences, needs and values and assuring that
  patient values guide all clinical decisions
• Timely Reducing waits and sometimes harmful
  delays for both those who receive care and those
  who give care.
• Efficient Avoiding waste, including waste of
  equipment, supplies, ideas, and energy.
• Equitable Providing care that does not vary in
  quality because of
• personal characteristics such as gender,
  ethnicity, geographic location or
  socio-economic status.

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HCA Patient Safety Implementation Model
Technology Change
Physicians
Hospital
Process Change
Culture Change
Patient Safety is Organizational Change for the
hospital and the physician. A key component of
each Patient Safety Initiative is to move the
hospital organization and medical staff toward a
common goal of saving lives. Cultural
transformation and process re-engineering are the
key work efforts. Technology tools are used to
embed the changes into the daily work of
clinicians.
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HCA Patient Safety Emphasis on Technology
Rank Order of Error Reduction Strategies
HCA Technologies
Forcing Functions Constraints Automation
Computerization Standardization
Protocols Checklists Double-Checks Policies
Procedures Education Information
eMAR ePOM EDM / TSystemEv OR Module Clin
Documentation Results Review PACS ICU Clin
Dashboard ED Dashboard
Meditech modules support clinical operations and
provide a mechanism for delivering protocols,
checklists, procedures, and information to the
point of care. Dashboards provide information
about the care of groups of patients that is
necessary for process improvement.
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HCA Patient Safety Initiatives
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Denni McColm, CIO Citizens Memorial Healthcare
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CMH Fast Facts

• 74 acute beds
• Level III trauma center
• 5 LTC facilities
• Residential care independent living
• Home care/hospice
• 16 physician offices
• 1,550 employees
• 98 physicians

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Project Infocare Vision

• Enable a patient to enter anywhere into the
  continuum of care and have a personal identity
  that is maintained across that continuum

• Physicians and other caregivers will have access
  to all of that patients medical information
  within the health care continuum

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Project Infocare

• EMR that crosses continuum
• 100 use of CPOE
• No paper charts

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Governance-What Changed?

• Desire to provide seamless care across the
  continuum
• Frustration with inability to do so with a
  paper-based system
• Acceptance of the fact that we could not
  efficiently or effectively manage care
  information across the continuum without
  information technology tools
• Commitment of resources

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Critical Success Factors

• Talk, Talk, Talk
• Listen, Listen, Listen

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Challenges to Success
RESOURCES
PROCESS CHANGE
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Robert Dart, MD Chief of Emergency Medicine and
Director of Medical Informatics Quincy Medical
Center
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Quality in the Emergency Department

• 91 patients per day
• 20 inpatient admissions per day
• 60 of hospital admissions
• Fully automated Emergency Department including a
  patient tracker and electronic physician and
  nursing note
• Patient chart easily accessible electronically

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Quality Improvement Drivers

• JCAHO
• Payers
• Internal QA
• Patient Flow
• Best Practices/Practice Guidelines

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Key Success Factors

• Goals clearly communicated to entire organization
• Support from all levels of the organization,
  beginning with the CEO
• Constantly encouraged physicians to embrace
  technology
• Instant workflow improvement with introduction of
  ED tracker

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Challenges to Success

• Project Funding
• Overcoming paper dependency

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Emergency Department Quality Summary

• Pay for Performance - the wave of the future
• Performance improvement - dependent on collecting
  and tabulating process and outcome data
• An ED tracking system and Electronic Medical
  Record simplifies data collection thereby
  facilitating process improvement

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• "It Takes a Culture to Raise a Technology"Caroly
  n Clancy, MD, Director, Agency for Healthcare
  Research and Quality