Transcript Evidence-Based Care Delivery and Context

Evidence-Based Care Delivery and ContextAppropriate Decision Support within the Workflow
Ron Tyszko
Truven Health
August
13,Analytics
2015Puerto Rico Summit 2015
Confidential — For Internal Use Only
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I went to sleep in Puerto Rico….
And woke up in Paradise!
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Evidence-Based Care Delivery and “Context-Appropriate Decision
Support (CDS)” within the Workflow
 Agenda:
 Vendor Adoption of Clinical Decision Support and Patient Education
Integration
 Content Integration Methods and Access Points
 Proof points and Uses of Integrated CDS in Electronic Medical Record
Systems
 Integrated CDS – what is on the horizon?
Truven Health Analytics Puerto Rico Summit 2015
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Evidence-Based Care Delivery and “Context-Appropriate Decision
Support (CDS)” within the Workflow
 Neal Patterson, Chairman and CEO, Cerner Corporation - 1995
1. Align payment incentives with performance,
2. Drive variance out of care delivery,
3. Reduce care-giver reliance on “muscle – memory”,
4. Establish efficient means of checks and balances on healthcare
decision making,
5. Engage Consumers in their own healthcare.
 What do these 5 tenets for healthcare improvement have in
common?
All 5 can be supported through the deployment of Integrated
Evidenced-based CDS and Patient Education…
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Truven CDS and Patient Education Integration
 Meaningful Use continues expanding integrated content requirements
 In-workflow vendor deployment improves clinician adoption (usage)
 Vendors expand integrated content and user access to support CDS adoption
 Truven client adoption of integrated CDS content has increased 39% year over year
CHANNEL PARTNER
Allscripts
Cerner (Siemens)
CPSI
EMMI
Epic
GE Healthcare (ambulatory)
Healthcare Systems
McKesson
MEDITECH
SabiaMed
Zynx
INTEGRATED CONTENT OFFERINGS SUPPORTED
Patient
Education
In Process
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Consumer
Health
Clinical Decision Support
(Drugs, Disease, Laboratory)
In Process
Supported
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
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Surveillance
Formulary
Services
Yes
Yes
Yes
In Process
Integrated Client
Count (Licensees)
0
1
450
30
100
1500
100
245
585
4
25
Content Integration Methods and Access Points
 Content Access is being extended to the Consumer Portals
 Web-services access is prevalent methodology for enabling real-time CDS access.
 The EMR and Discharge Routine are the prevalent access points to content
CHANNEL PARTNER
INTEGRATION METHODS
ACCESS POINTS SUPPORTED
Web -services
Discharge
Electronic Medical
Flat Files (Infobutton) Planning/Depart Routine
Record
Allscripts
Yes
In Process
In Process
Cerner (Siemens)
Yes
Yes
Yes
Yes
CPSI
Yes
Yes
Yes
EMMI
Yes
Epic
Yes
Yes
Yes
GE Healthcare (ambulatory)
Yes
Yes
Yes
Healthcare Systems
Yes
Yes
Yes
Yes
McKesson
Yes
Yes
Yes
MEDITECH
Yes
Yes
Yes
Yes
SabiaMed
In Process
Yes
Yes
Yes
Zynx
Yes
 SabiaMed’s ClinNext Integration
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Order Entry
(CPOE)
In process
Yes
Yes
Clinician
Documentation
In Process
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Patient Portal
Yes
Yes
Integrated CDS and the Electronic Medical Record – Integrating
Patient Education to improve Care Delivery
Phelps County Regional Medical Center, is
south central Missouri’s leading regional referral
hospital serving over 250,000 residents for nearly 60
years. PCRMC has 242 beds, over 1500 employees
and more than 100 staff physicians.
 Use Case: Only 50% of patients were receiving
education/discharge instructions, discharge process
averaged 8-10 minutes per discharge, non-compliant with
MU stage 1 requirements.
 Solution: Deployed Truven’s Integrated CareNotes
using “context aware” Infobutton retrieval from the Chief
Complaint in the EMR
 Results: Emergency Dept. Manager, Ms. Marlene
Kleeschulte, RN, BSN indicated that the Integrated
Education resulted in the following Proof Points:
 4-6 hour nursing efficiency gain per shift
 Patients receiving education/discharge instructions
rose to 80% a 60% improvement
 PCRMC qualified for their MU stage 1 incentives.
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Integrated CDS and the Electronic Medical Record – Integrating
CDS to improve Patient Satisfaction
A prominent US Health System serving over 500,000
constituents with 3 facilities, providing a full range of acute
and specialized care services with over 700 beds, over 3,000
employees and more than 250 staff physicians, desired to
improve their Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) scores in the categories
of “Communication with Nurses” and “Communication
regarding Medication” at each of their facilities:
 Use Case: Scores for “Communication with Nurses”
ranged from 53% to 67%, while “Communication
regarding Medication” ranged from 35% to 54% across
their facilities.
 Solution: Deployed Truven’ Clinical Decision Support
(Clinical Teaching tool), using “context aware” Infobutton
retrieval from the Problem List in the EMR and deployed
Truven’ Medication Instructions using “context aware”
Infobutton retrieval from the Medication Administration
application.
 Results: In 6 months, achieved the following:
“Communication with Nurses” scores averaged 81.44 %
“Communication –Medication” scores averaged 63.55%
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Confidential — For Internal Use Only
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Integrated CDS – Additional Provider Utilization of Integrated CDS
 MedStar Health – Use case - Medication Error Prevention: deploy “Drug Indications” IB call for use
at time of each/every medication provider order to verify (prove) that drug is appropriate for patient
problem
 Pinnacle Health – Use case - Medication Error Prevention: develop shift reports to enable nursing
verification of “Drug Indications” for each patient medication prior to administration
 Brookhaven Hospital – Use Case – JCAHO compliance for Medication Education on first dose
administration. Developed IB call to Drug Notes from Medication Administration screen
 Bryan LGH – Use case – Required education compliance: deployed Integrated CareNotes access
from EMR problem list using “context aware” IB calls to increase usage. From 2,000 education
documents a month to 18,000 education document month
 Community Memorial Hospital – Use Case: deploying Care Plans and wanted to insure CMS and
JCAHO Core measures compliance – Used Truven’ Clinical Checklist by patient problem for top 40
diagnoses to verify full coverage of JCAHO/CMS core measure requirements were included
 University of Maryland – Use Case: increase market share in 2 ambulatory service lines. Integrated
Truven’ Consumer Health solution on system website to support patient assessment and locate
providers
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Integrated CDS – What is on the horizon ?
 Population Health Management and EMR’s
 Integrating Risk Stratification methodologies (disease staging, normalized risk scoring, and categorization) to
support analysis of “value-based payments” contracts
 Integrating data normalization methodologies into EMR’s for near-time clinical episodic care analysis
 Integrating financial and clinical benchmarks based on historic claims data for performance comparisons
 At-risk contracts
 Self-insured employer contracts
 “Pay-vidor” organizations
 Predictive Analytics
 In-house real-time predictive analytics based on clinical indicators (360 - Insights)
 Near-time Re-admissions analysis (who, what, why and when)
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More than Data. Answers.
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