After the EHR: Improving Quality and Safety

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After the EHRImproving Quality and Safety

• Maryland HIMSS
• April 25, 2008
• William Buddy Gillespie
• VP CIO
• WellSpan Health
• York, PA

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Session Objective

• How to leverage existing EHR data by harvesting
  key clinical indicators to provide for
• Retrospective view of clinical performance
  measurements against established best-practice
  benchmarks
• Feedback to quality improvement teams to trigger
  proactive adjustments to established programs
• Real-time surveillance of clinical events
• Intervention at point of care relative to
  infectious disease and ADE's

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WellSpan Health At A Glance

• Geography
• Facilities
• Staff
• Patient Care

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Drivers of Change

• Patient Safety Quality of Care
• Transparency Reporting
• Regulatory Legislative Mandates
• Cost Reimbursement
• Patient Service Satisfaction
• Interoperability
• Disaster Recovery

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2008 Survey
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2008 Survey
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2008 Survey
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2008 Survey
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2008 Survey
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WellSpan Solutions

• CareScience
• TheraDoc

TheraDocIncorporated June 28, 1999
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WellSpan Quality Management
WellSpan Health Director of Quality Management
Public Communication
WellSpan Information Services
Quality Data Management Service
Regulatory Compliance (JCAHO, DOH, CMS)
Quality Management Education (Dean of PI
University
Clinical Project Management
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Quality Management

• Support WellSpan Healths staff in their efforts
  to achieve excellent patient care services by
  providing and promoting
• expertise in the theory and techniques of quality
  management
• a learning environment for process improvement,
  research, and excellence in individual patient
  care mentor staff projects
• individual case management services to selected
  patients
• access to clinical data to understand process and
  measure outcomes
• Changing behaviors and attitudes to enhance the
  quality of care

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Next Steps

• Deploy WellSpans QI Methodology
• WellSpan Quality College
• Deans develop curriculum and identify faculty
• Identify and develop Project Facilitators
• Begin to identify selected improvement projects
• Ambulatory Group
• Limited number of projects in Service Lines
• Implement data-mining tool (CareScience)
• Develop governance and leadership expertise
• Develop management expectations and expertise

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Clinical Effectiveness Teams

• Assist in the Measurement and Evaluation of
  Clinical Outcomes
• Nine CETs
• Focus ICU, Stroke , Pneumonia, Congestive Heart
  Failure, etc.
• Publish Guidelines
• Key User of CareScience

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• CareScience
• Quality Manager

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Care Management Suite
CareScience Quality Manager
Quick Reports Standard Analysis Advanced Analysis
Exploratory Analysis
Case finding, custom reports Ambulatory data
integration
National Comparatives
Comparative database of CareScience customers
JCAHO reporting (Atlas Today)
Standards of Care
Clinical Terminology Service
Standardization Hierarchy
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CareScience
We are Here
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Performance Measures Available in CareScience
Quality Manager

• Structure case types, volume, assignments
• Process
• Core Measures
• Resource utilization (ICU, blood, etc.)
• Outcomes (raw and risk-adjusted)
• Mortality
• Morbidity
• Complications
• LOS
• Cost/charge
• Readmissions (raw only)

Standard Reports
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WellSpans Implementation Team

• Clinical Project Lead SVP Care Management,
  Director QM
• Oversight of project report to executive
  sponsor
• Key go-to person
• Information Services Resources KM Architect
• Technical Project Manager
• Source-system experts
• Interface Programmer
• Quality Department Representatives Data Analyst
• Data analysts
• Improvement Coordinators, Team Facilitators,
  Outcome Managers, etc.
• Medical Records - Adhoc
• Knowledgeable in your Coding Policies/ Practices
• Adhoc Steering Group Project Team
• Include key clinical representatives from IS,
  CareScience, nursing, pharmacy, safety, risk
  management, CETs,etc.

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Implementation Project Team
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CareScience Quality Manager Framework for
Implementation Success
Phase I Preparation
Phase II Roll-out
Phase III Achieving Value

• Data SourceSystem Review
• Validation
• Core HardwareSet-up
• Test Data Load
• Historical DataLoad
• Data Integration

• Secondary Training

• Rollout Plan Priority Grid

• Quarterly Status withExecutive Team

• Test Cut Data Demo

• Client Management Support

• Clinical Terminology Roll-out

• Key User SkillsAssessment

• Ongoing Education
• Clinical Forum
• Key User Forum
• Quarterly EducationSessions

• Primary Key User Training

• Introductory Call

• Clinical Case Study
• Big Known Issues!

• Kick-off Meeting

• Grand Rounds

• Implementation Design

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WellSpan EHR Data Source
Cerner
GE/IDX
Exams performed(by day of stay, from revenue
detail)
Meds administered(by day of stay, from pharmacy
system)
Eclipsys GE Flowcast
Pharmacy
Radiology
Cerner

Tests
PCS Data Manager mds 7.x Remote Hosted
Admission/Discharge/Transfer ADT
Laboratory
Eclipsys
AllScripts TouchWorks
Eclipsys
UB-92
Resource (Charges)
Patient demographicsDx and Px codes
Ambulatory
(by day of stay, from revenue detail)

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WellSpan EHR Data Source

• Facility - Cerner
• Resource Master - Eclipsys
• Staff Master - Eclipsys
• Diagnosis - Cerner/Eclipsys
• Encounter - Cerner/Eclipsys
• Inpatient Event - Cerner
• Operating Room Cerner
• Payor Cerner/Eclipsys

• Pharmacy Dispensing Administration Cerner
• Pharmacy Order Cerner
• Pharmacy Order Dispensing Map Cerner
• Practitioner - Cerner/Eclipsys
• Procedure Cerner/Eclipsys
• Resource Cerner/Eclipsys
• Test Result Cerner
• Antibiotics Cerner

Phase II
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Eclipsys
Eclipsys DW
PCS Remote Host
Data Validation Report Report Selection
Cache
ETL
PCS mds 7.X
Monthly
SQL2005 Staging DW
Internet
Cerner
Xmit
Cerner DW
Oracle
SQL
Internet
MS Integration Services
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Implementation Design Objectives

• Assess the existing organizational infrastructure
  of WellSpan Health for readiness to support care
  management
• Identify strengths and potential barriers that
  will affect implementation of the CareScience
  Quality Manager (QM)
• Identify opportunities to leverage staff
  resources through the use of QM
• Initiate a roll-out plan for QM

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Clinical Case Study Objectives

• Demonstrate how CareScience Quality Manager (QM)
  can be used to accelerate clinical performance
  improvements
• Develop data mining skills of QM users
• Enhance ability of the CETs to use QM to identify
  care processes driving worse than expected
  outcomes
• Build knowledge and trust for QM capabilities and
  methodologies among physician, clinical, and
  administrative leaders

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Two Parallel Implementation Tracks

• STRATEGIC - Goal Setting, User Selection, Work
  Flow Analysis, Change Management Process,
  Training and Education
• TACTICAL - Data Transfer, Validation and
  Processing

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Project Milestones Strategic Track

• Implementation Design Clinical Staff
• Pre Go Live Training
• Analytic Methodology
• Navigation Training Primary Training
• Coordinated by Client Manager
• Primary User Training
• Coordinated by Client Manager
• Conducted 1-2 weeks after Go Live
• Key User Training
• Coordinated by Client Manager
• Conducted 2-4 weeks after Primary Training

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Project Milestones Strategic Track

• Ongoing Service and Support
• Client Manager
• Service Team (Service Center staff, data manager)
• Clinical Case Study Clinical Staff
• Scheduled 4-8 weeks after Key User Training
• Secondary Training
• Coordinated by Client Manager
• Scheduled 2 months after Case Study

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Project Milestones Tactical Track

• Master Data Specification (MDS)
• Conference call MDS Review
• On-site meeting Interface Planning
• Test data extraction (3 month cut)
• Validation reviews
• Data Audit
• Complete data extraction of 2 year Historical cut
  and go live
• Validation reviews
• Data Audit

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Key User Responsibilities

• Awareness of the organizations strategic goals
• How will CareScience Quality Manager (QM) be
  utilized within the system and/or facility?
• How will QM fit into the overall organizational
  PI goals and objectives?
• Disperse information to Primary Users
• Information from CareScience e-blasts
• Communications from Client Manager and
  CareScience Consulting
• Support Primary Users in use of CareScience
  Quality Manager
• For example, coordinate internal user group
  meetings to discuss what all users are doing.
  This can be a great forum for practicing data
  presentation and interpretation
• Train additional users (beyond those trained in
  the initial CareScience training)
• System navigation
• Report interpretation
• CareScience Analytic Methodology

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Key User Responsibilities

• System Administration
• Assign user ids and passwords (QM)
• Monitor utilization through monthly User Usage
  reports sent by CareScience
• Support the Query needs for the organization
• Support Clinical Terminology Mapping
• Resources that are unable to be mapped or need
  clarification will be sent to the Key Users in an
  Excel spreadsheet. Key Users should follow up
  with the appropriate internal staff for
  clarification and return the spreadsheet to the
  Client Manager.
• Monitor quarterly or monthly data transfers
• Ensure compliance to agreed upon update schedule
• Review validation reports
• Notification Primary Users of quarterly or
  monthly data update availability

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Key Analyst Skill Requirements

• Experience with generating, analyzing and
  interpreting data
• Ability to explain data to others in an
  understandable manner
• Ability to partner with clinicians to understand
  data needs through hypothesis formulation
• Well-developed critical thinking skills
• Knowledge and understanding of organizational PI
  goals
• Ability to train others in system navigation
• Knowledge of relational databases
• Understanding of CareScience Master Data
  Specification
• Knowledge of internal data sources
• Knowledge of Exploratory Analysis tool

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Key Clinical User Skill Requirements

• Experience with generating, analyzing and
  interpreting data
• Ability to explain data to others in an
  understandable manner
• Ability to formulate hypothesis based on clinical
  knowledge
• Well-developed critical thinking skills
• Knowledge and understanding of organizational PI
  goals
• Ability to train others in system navigation
• Access to avenues for disseminating information
• Ability to recognize strategic pitfalls
• Ability to achieve consensus on clinical issues
• Demonstrated change agent capabilities
• Ability to facilitate team meetings

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Outcome Profile Pneumonia To help the
Medical Service line get started with data for
the Pneumonia patients they follow i.e. How
many of the patients with pneumonia diagnosis,
also had a resource (charge) for a specific drug?

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Length of Stay Comparison Length of Stay
comparison for top 10 Principal diagnosis, and
all other diagnosis as a comparison group. This
spreadsheet has tabs at the bottom to allow
comparison between Standard Practice and Select
Practice. Standard Practice is a risk-adjusted
mode based on a significant number of acute
facilities that submit data to CareScience.
Select Practice is also a risk-adjusted mode,
but it allows us to compare ourselves to a set of
hospitals whose performance has been determined
by CareScience to be in a select or superior
group (i.e. these hospitals perform in the top
15 on both quality and efficiency measures).
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CareScience Summary

• Phase I Complete
• Clinical Effectiveness Teams Trained
• Data Load Complete March 1
• 24-Month Rolling Data
• Monthly Upload 120 Plus Data Elements
• Canned Report Training Complete
• Running 15 to 20 Canned Reports
• Adapting to Reports Data Blending
• AdHoc Report Training Next Week
• Data Validation On-going
• CETs to Identify Major Areas of Focus
• Phase II to Begin in May
• Phase II Cerner Millennium Pathnet/SurgiNet at
  Gettysburg

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What is TheraDoc?

• TheraDoc is a clinical informatics company that
  develops and implements electronic surveillance
  systems for injury detection and prevention to
  transform the quality, efficiency and safety of
  patient care through enhanced clinical decision
  making in real-time.
• 150 Hospitals in 27 States

TheraDocIncorporated June 28, 1999
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Infection Control Services
WellSpan Health Director of Infection Control
Adams County Facilities
York County Facilities
WellSpan Information Services
Apple Hill Surgical Center
Gettysburg Hospital
WellSpan Endoscopy Center
WMG Offices Ambulatory Care Sites
WMG Offices Ambulatory Care Sites
York Hospital
VNA
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Protected by US Patents 7,213,009 7,230,529
Eclipsys
Cerner
Cerner
Cerner
GE/IDX
Cerner
Cerner
Data Interoperability
Knowledge Integration
TheraDocIncorporated June 28, 1999
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TheraDocIncorporated June 28, 1999
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Knowledge Modules

• Infection Control Assistant -
  Infection/syndromic surveillance Reporting,
  Real-Time
• Antibiotic Assistant - Antimicrobial
  Stewardship Disease Management, Mobile,
  Handheld, Patient Specific
• ADE Assistant - Medication Safety Surveillance
  Real Time
• Clinical Alerts Assistant - Global trigger
  Adverse Event Surveillance
• Rules-Based, Real-Time

TheraDocIncorporated June 28, 1999
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Expert Systems Modules

• Intervention Assistant - Point-of-care patient
  safety documentation
• Rounds Assistant - CDS Workflow Gateway
• EZ Alerts Assistant - Clinician Rules and
  Knowledge Editor

TheraDocIncorporated June 28, 1999
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WellSpan EHR Data
Eclipsys
Cerner
Cerner
Cerner
GE/IDX
Cerner
Cerner
TheraDocIncorporated June 28, 1999
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Why is TheraDoc Important to WellSpan?

• TheraDoc complies with ACT 52 and
• provides solutions for
• Recent Medicare Medical Error Ruling
  Reimbursement Exclusions
• State Mandated HAI reporting
• MDRO Prevention Initiatives MRSA
• Infection Control Interventions
• Antimicrobial Stewardship
• Adverse Drug Even Prevention
• Critical Care Environments
• Patient Safety Quality of Care
• Reduced Length of Stay

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PLAN
LIVE
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Value Added Benefits for Infection Control
Department

• Produces an accurate patient flag report, save 60
  min/day.
• Eliminates the daily sort of paper lab results,
  saving 15-30 min/day.
• Reduces the number of possible healthcare
  associated infections that require investigation.
• Save hours of MRSA surveillance time by
  implementing the MRSA surveillance report of all
  completed cultures.

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Value Added Benefits for Infection Control
Department

• Produces specific criteria-based reports and
  work lists.
• Auto populates the census and formulates an
  infection rate. Graphing and trending capability.
• Creates a thorough electronic infection control
  report which was previously done manually. It
  captures and links microbiology, radiology, lab,
  bed trace, etc, and saves hours of time.

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WellSpan Implementation Resources
Summary (based on 4-6 month implementation)
(Approximate) Title Total hrs
needed for entire install Executive Sponsor
20 hrs Project Manager 200 hrs Clinical
Champion 40 hrs IS/Technical Staff 40
hrs Interface Engine Specialist 40
hrs Interface Specialist /Tester 40 hrs (per
ancillary ADT, RX, LAB/MICRO, RAD)
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TheraDoc Summary

• Contract Signed in November, 2007
• Plan Submitted to DOH in January
• Project Kickoff Scheduled for July
• Cerner Millennium PathNet a Prerequisite
• Cerner SurgiNet Implementation at Gettysburg
• Real-time Data Feeds From Cerner
• Desired Go-live December 2008?

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Closing Remarks
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WellSpan Contacts

• Pam Goodling
• Infection Control
• TheraDoc Contact
• pgoodling_at_wellspan.org
• Lisa Stough
• Knowledge Architect
• CareScience Contact
• lstough_at_wellspan.org

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