Data is Power: Making Your EDIS Work for You

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Data is Power Making Your EDIS Work for You

• A Multi-Site Experience

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Discussion Panel

• L. Albert Villarin MD FACEP
• CMIO Albert Einstein Healthcare Network
• Director. Medical Informatics Dept Emergency
  Medicine
• Albert Einstein Medical Center Philadelphia, PA
  
• Richard S. MacKenzie, MD, FACEP
• Chair Department of Emergency Medicine
• Lehigh Valley Hospital Health Network
• Chris DeFlitch, MD, FACEP
• Director Vice-Chair
• Department of Emergency Medicine
• Physician Director, Connected, CIS

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Discussion Panel

• L. Albert Villarin MD FACEP
• CMIO Albert Einstein Healthcare Network
• Director. Medical Informatics Dept Emergency
  Medicine
• Albert Einstein Medical Center Philadelphia, PA
  
• Richard S. MacKenzie, MD, FACEP
• Chair Department of Emergency Medicine
• Lehigh Valley Hospital Health Network
• Chris DeFlitch, MD, FACEP
• Director Vice-Chair
• Department of Emergency Medicine
• Physician Director, Connected, CIS

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Albert Einstein Medical Center - Background

• 600 bed teaching hospital in north Philadelphia
• Level 1 Trauma Center
• Approximately 75K annual emergency department
  visits
• Well established emergency medicine residency
  program
• PGY 1-4
• 48 residents
• Ten million dollar renovation completed in FY 04

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Emergency Department Renovation

• Renovation goals and challenges
• Maximize clinical space
• Reduce the perception of chaos and decrease
  noise levels
• Improve efficiency
• Improve patient flow
• Improve patient, staff, and referring physician
  satisfaction

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Emergency Department Renovation

• Renovation solutions
• Three contiguous Pods and an adjacent Urgent
  Care
• 3 nursing stations
• 48 Beds
• New equipment
• Advanced procedure capability
• Ultrasound
• Dialysis
• Respiratory isolation and decontamination
• Dedicated CT scanner and two plain film suites
• PACS system
• Portable telephones for physicians and other
  designated staff
• Staff lounge and locker rooms

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Emergency Department Renovation
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Renovation Challenges

• Renovation plans created questions and new
  challenges
• How to track real time patient status in the
  new environment
• How to improve efficiencies in triage, patient
  flow, lab, x-ray, and dispositions
• How to improve communication among the ED staff
  and between ED staff and other departments
• How to track important milestones for review and
  analysis
• How to do all of the above without increasing the
  work load of an ED staff already at or near its
  limits

The answer Passive Tracking
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Passive Tracking

• Amelior EDTracker
• Tracks real time status of patients, staff, and
  equipment
• Provides the ED staff with minute-to-minute
  knowledge of the entire department
• Allows staff to effectively communicate with each
  other and with other hospital departments (e.g.,
  admissions)
• Provides multiple layers of patient safety (e.g.,
  road blocks, physician call-ins, return visit
  warnings, delays in care warnings)
• Provides a vast amount of visit information
• Allows department administration to see where
  issues and problems lie
• Provides hard data to effect change
• Does all of the above passively

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Implementation
Training and go-live
Staff and hospital acceptance

• Excellent training materials and support
• Four hour training sessions
• Go-live went extremely well
• Exceptional support and real time problem solving
• Within about 1 month staff were not only
  comfortable using the system, but were relying on
  it for day-to-day patient care

• Quickly and easily accepted by the ED staff
• We do not track staff location outside of patient
  rooms
• Quickly accepted by the hospital staff and
  administration
• Resulted in the purchase of hospital wide bed
  tracking soft ware
• Extensively used during twice daily admission
  rounds
• Provided the impetus for additional funds/staff
  for the ED
• Resulted in a number of hospital wide initiatives
  to improve patient flow and the admissions
  process

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Amelior EDTracker The Results
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Amelior EDTracker The Results
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Amelior EDTracker The Results
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Amelior EDTracker The Results
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Amelior EDTracker The Results
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Amelior EDTracker The Results
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Amelior EDTracker The Results
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Amelior EDTracker The Results

• Amelior ED advantages
• Integrated system with Amelior EDTracker
• Interfaces with all hospital systems
• Customized for use in a teaching environment
• Allows for individualization and/or group
  defaults
• Allows any data element to be optional, prompted,
  or mandatory
• Allows self maintenance
• Built in patient safety software
• Discharge instructions and prescription writing
• Audit log (HIPPA compliant)

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Amelior EDTracker The Results

• Amelior ED in the teaching environment
• Allows prompts and mandatory information to
  assist junior residents, yet simultaneous
  provides autonomy for senior residents
• Types of orders can be adjusted based on level
  of training
• Allows residents to assign patients to their
  attending physician
• Allows diagnosis and procedure tracking for
  resident logs
• All of the above does not require repeated PCTS
  action or input

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Data is Power Making your EDIS work for You

• LVH Experience

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Discussion Panel

• L. Albert Villarin MD FACEP
• CMIO Albert Einstein Healthcare Network
• Director. Medical Informatics Dept Emergency
  Medicine
• Albert Einstein Medical Center Philadelphia, PA
  
• Richard S. MacKenzie, MD, FACEP
• Chair Department of Emergency Medicine
• Lehigh Valley Hospital Health Network
• Chris DeFlitch, MD, FACEP
• Director Vice-Chair
• Department of Emergency Medicine
• Physician Director, Connected, CIS

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Problems

• Intubation
• Time out verify Procedural Sedation
• QC Passed

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Opportunities

• Best of Breed Hospital
• How not can
• EDIS
• T-System EV
• IDX/LastWord HIS
• McKesson
• Horizon Performance Manager (HPM)
• Horizon Business Insight (HBI)
• Pervasive Data Parsing Tool with MS Access
• http//pervasivedatatools.com

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Hemoccult Quality Control Passed Documentation

• ESC PC.16.60 (Quality control documentation)
• All quality control test results are documented,
  including internal, external, liquid, and
  electronic.
• LVH- M (6017) 10/17 10/20/06 JCAHO
  accreditation survey

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Document that the Quality Control dot turned
blue on the Hemoccult Card when testing stool for
occult blood by typing QC Passed In the T-Record
QC pooh
Document QC Passed
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T-System Documentation


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Hemoccult Quality Control Passed Documentation

• Pervasive Program Used to Divide Text Document
  produced by T-system into sections
• MS Access used to find specific words or
  phrases-queries
• Query results sent to HBI to be presented in
  graphical and tabular formats.
• Providers notified via E-mail if there is
  documentation of hemoccult testing but no
  documentation of QC Passed

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Discussion Panel

• L. Albert Villarin MD FACEP
• CMIO Albert Einstein Healthcare Network
• Director. Medical Informatics Dept Emergency
  Medicine
• Albert Einstein Medical Center Philadelphia, PA
  
• Richard S. MacKenzie, MD, FACEP
• Chair Department of Emergency Medicine
• Lehigh Valley Hospital Health Network
• Chris DeFlitch, MD, FACEP
• Director Vice-Chair
• Department of Emergency Medicine
• Physician Director, Connected, CIS

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Department of Emergency Medicine

• 50,000 Visits
• 22 pediatrics
• 20 Admits
• 40 of HMC
• Front Door of Penn State HMC

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Key Concepts

• What Data Why
• Where is Data ?
• Data collection should Improve Process
• Data Results to Drive Process Outcomes

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Data Points of WHY

• Financial Defense
• ROI (if buying)
• Revenue
• Communication
• Universal Access
• Providers
• Patients
• Efficiencies

• Quality Measures
• Deficiency/complaint
• Clinical Outcomes
• Med Rec
• JC..
• National Patient Safety Goals

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Where is the DATA ?

• System Generated Reports
• Viewable?
• Exportable?
• Usable ?
• Self-Generated Reports
• Mining a parallel system
• Data Warehousing
• Multi-contributor Reports
• Interoperable
• Contextualized

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Penn StateInformation Technology

• Connected
• EDIS FirstNet (cerner)
• RIS/PACS (GE)
• CPOE (cerner)
• Lab (mysis)
• MUSE (cards)

• Others
• ADT (eclypsys)
• Facility Bill (eclypsys)
• Prof Bill (signature,SMS)
• ID tracking (MedMine)
• Filemaker PRO (s)

And DATABASES we have NO IDEA exist
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ED Lab order
Future State Redesigned Process
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Future State Redesigned Process
ED Lab order
ED Lab order
Future State Redesigned Process
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Metric for Management

• Time Goals
• Door-MD 20 min
• Door-D/C 70 min
• Door-admit 210 m
• Triage 3 minutes
• Door-EKG- 10min
• Door-lytics- 30 min
• Door-Abx 4hrs

• Personal productivity
• Pts per hour (2/provider)
• Visits/day/year
• Work-up variability
• wRVU production
• Systems Measures
• Bed availability
• Cost/case
• Diversion times
• Satisfaction

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Metric for Management

• Time UHC 2004 bench
• Door-D/C (ED LOS)
• 50ile 230min
• Top 25 - 180 min
• Top Decile 134 min
• Door-admit
• 50ile 354 min
• Top 25 - 289 min
• Top Decile 240 min

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OPEN - Discussion Panel

• L. Albert Villarin MD FACEP
• CMIO Albert Einstein Healthcare Network
• Director. Medical Informatics Dept Emergency
  Medicine
• Albert Einstein Medical Center Philadelphia, PA
  
• Richard S. MacKenzie, MD, FACEP
• Chair Department of Emergency Medicine
• Lehigh Valley Hospital Health Network
• Chris DeFlitch, MD, FACEP
• Director Vice-Chair
• Department of Emergency Medicine
• Physician Director, Connected, CIS