Transcript Improving Clinical Outcomes through Real

Improving Outcomes Through
Real-time Improvement Strategies
David Bordewyk, PA-C, MPAS
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Who Is My Next Opportunity!?
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
2
Who Do I Care About Right Now!?
Accuracy
Precision
Truven Health Analytics Puerto Rico Summit 2015
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3
Priority - Who Do I Care About Right Now!?
Clinicians
at the
Bedside
Improve
Care and
Save
Money!
Prioritizing workflow most limits the
Clinician’s ability to work to their full
capabilities
Promote uniform clinical practice
(synergy)
Empower all departments to be high
performing regardless of resource
quality and quantity
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
4
We Enable You to Harness Big Data by Enabling
Sophisticated Clinical Analytics at an Enterprise Level
 Tap into multiple data sources to convert patient data into
actionable insights
 Leverage an enterprise platform with user-specific views
 Intervene with precision before patient risk and costs increase
 Create meaningful, highly-accurate rules easily without IT
 Immediate access to Micromedex clinical knowledge resources
from within the user’s workflow
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
5
Centralized data serves up real-time information based on
specific needs of your team
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
6
Edit, Create, and Deploy CDS Rules –
Proven to be Clinician Friendly
• Editor designed by and for
clinicians
• Drag and drop interface to
build/edit rules
• Detailed – not complicated
• Comprehensive
library of nearly 300
reference rules
• Evidence-based
• Fully customizable
• Highly detailed filters
• Time associations
• Enables the precision needed
to ensure patient safety and
clinical efficiency
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Accurate Rules Enable Precise Lists
Detailed rule filters, e.g. –
 Medication filters –
 Administration detail – # of doses, time (since admission, last
administration, X time of other result or event)
 Components of the sig – name, form, strength, route, dose, frequency
 Order status – active, prn, held, discontinued
 Results
 Actual - <, >, =, contains
 Time – since test performed, since last update
 % change over X time – eg, INR Increase >= 30% in last 24 hours
 Documentation – Physician and Nursing
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Micromedex 360 Care Insights
Clinical Dashboard
User Workflow
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Focus on Patients Who Need Help Now
Quick view of critical values,
automated Interaction and IV
Compatibility checks, and
pharmacy tools and calculators
Real-time intervention
of at-risk patients:
• Decentralized – by
unit
• By clinical problem
or intervention
Comprehensive
view of
medication, lab,
vitals, and report
information
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
10
Context-specific Integration of Clinical Decision Support
Resources – Micromedex Drug, Disease, and Lab Databases
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
11
Document Clinical Interventions and Adverse Events
Easy documentation
of intervention within
the workflow
•Intervention-specific
documentation within
the workflow
•Fully customizable
•Auto-population of
results
•Export in standard
HL7 CDA format for
ingestion by EHR
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Example CDS Rules
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ED Sepsis Screen – CDS Rule
Decision support rule is configured
and runs in real-time to ID patients
showing early signs of sepsis…
Rule cont’d…
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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When a CDS Rule is met, alert is generated, and patient
is put on worklist…
Clinical User performing
assessment opens electronic
screening tool…
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
15
Clinical User documents assessment and action…
(Note – alert could go to ED staff, or direct to Rapid Response Team)
Rapid Response Team can review
real-time clinical data remotely….
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
16
Freeman Health
Malnutrition Intervention
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Freeman Health – 2014 Advantage Award Winner
Malnutrition Profile
Created a
clinical profile
within
Micromedex
360 Care
Insights to
identify
Malnourished
Patients
during
hospitalization
Created a clinical profile within Micromedex
360 Care Insights to identify Malnourished
Patients during hospitalization
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Freeman Health –
Benefit of Real-time Malnutrition Intervention
“Previously, even when we identified a malnourished
patient, it was typically not caught in real-time, while the
patient was still in the hospital and could have been
addressed by their physician,”
“Now, these patients are identified and presented
proactively on a daily basis so they can be treated
promptly.”
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Freeman Health – 2014 Advantage Award Winner
Results of Malnutrition Interventions:
 Improved patient outcomes and decreased
lengths of stay
 Time Savings –
 360 Care Insights automates the extensive clinical data
review required to accurately identify patients
 Increased Reimbursement
 Estimate > $115,000/year in increased reimbursement
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Infectious Disease Surveillance
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CDC Case Definition for Ebola Virus Disease (EVD)
 Suspected Case
 Illness in a person who has both consistent symptoms and risk factors
as follows:
1. Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or
101.5 degrees Fahrenheit, and additional symptoms such as severe headache,
muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage;
AND
2. AND - Epidemiologic risk factors within the past 3 weeks before the onset of
symptoms, such as contact with blood or other body fluids of a patient known to
have or suspected to have EVD; residence in—or travel to—an area where EVD
transmission is active; or direct handling of bats, rodents, or primates from
disease-endemic areas.

Malaria diagnostics should also be a part of initial testing because it is a common
cause of febrile illness in persons with a travel history to the affected countries.
 Confirmed Case
 A suspected case with laboratory-confirmed diagnostic evidence of
ebolavirus infection.
Source: Centers for Disease Control, Health Alert Network, August 1,
2014, HAN 00364 at: http://emergency.cdc.gov/han/han00364.asp
Truven Health Analytics Puerto Rico Summit 2015
Confidential — For Internal Use Only
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Ebola Surveillance Rule
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Malaria Surveillance
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More than Data. Answers.
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Confidential — For Internal Use Only
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