Transcript Document

March - April 2003
Quality Improvement in an
Electronic World
Enhanced by Automated Data
Extraction & Analysis
e
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?
2
CMS
3
HealthGrades
4
Leapfrog Group
5
JCAHO
6
How are they using that quality data?
•
•
Publicizing it on the Internet
Paying us for it
7
8
•
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”
9
CMH Strategic Initiatives
•
•
•
Core/Regulatory Measures
Pain
Turnaround Times
10
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
11
•
•
•
•
•
•
•
Order prompting in the ED
Order prompting in PCS
Required fields
Documentation templates for physicians
OE Rules
Evidenced based order sets
Clinical alerts
12
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
13
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?
•
•
14
•
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
15
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
16
AIESTM & PQMSTM
Automated Indicator Extraction
System

279 Quality Metrics:

National Consensus Measures:
CHF, AMI, CAP, L&D, SIP, ICU,
Asthma, Stroke, AHRQ, IHI

Physician Quality Management
System

Physician profiles:
System Measures: Hospital
Acquired Infections, MRSA, etc.

50 procedures

20 diagnoses

279 quality metrics (integrated
with AIESTM)

Real-time benchmarks

Risk adjustment

Graphical trend analysis

Provider and case drill downs
17
Extract Data Directly from Meditech
Web Based Monthly Reports
Hospital HCIS
IHM
VPN
IHM:
Clean
Normalize
Map
Report
18
AIES: Quality Dashboard by Indicator
19
Total Case Matrix
20
Graphs for Trending
21
Resource Definitions & Links
22
Download Data to Excel for Analysis
23
Drill Down Into Text
24
What comes with AIES?
25
PQMS: Dashboards by Specialty or Physician
26
PQMS: Drill Down
27
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
28
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
•
29
Thanks!
Questions:
Denni McColm, [email protected]
Renee Whitman-Teeter, [email protected]
Jeff Borkowski, [email protected]
30