Creating Quality-Driven Operational Reports . David Sinclair MD Associate Professor of Clinical Anesthesiology Associate Chief of Anesthesiology Co -Director of Informatics Epic UChart Physician Champion. Toyota Advanced Quality Information Center.
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Creating Quality-DrivenOperational Reports David Sinclair MD Associate Professor of Clinical Anesthesiology Associate Chief of Anesthesiology Co-Director of Informatics Epic UChart Physician Champion
Toyota Advanced Quality Information Center “…a multimillion dollarcomputer system manned by 20 employees who compile repair reports from Toyota dealerships world-wide…and will be accessible on an as-needed basis.” Chester Dawson and Yoshio Takahashi, “Toyota Makes New Push to Avoid Recalls,” The Wall Street Journal, February 24, 2011
Quality of Care EMR
Electronic Medical Record Pitfalls Gill, J. M. EMRs for improving quality of care: promise and pitfalls. Fam Med, 2009; 41(7): 513-515. Heeks, R. Health information systems: Failure, success and improvisation. International journal of medical informatics, 2006; 75(2):125-137.
Origins of EMR-driven Quality • Discovery • Validation • Build • Training • Go-Live • Optimization
“Computerized support systems for decision making must present the right information, in the right format, at the right time, and without requiring special effort.” James, B. C. (2001). Making it easy to do it right. The New England Journal of Medicine 2001; 345(13): 991.
Structured Data Information Knowledge Decision support Improved quality Balust, J., Macario, A. Can anesthesia information management systems improve quality in the surgical suite?. Current Opinion in Anesthesiology 2009; 22(2): 215-222.
PPO Perspective Organization Provider Patient
Patient Guideline-based care • Internal protocols • National measures (PQRS, SCIP) & Error avoidance • Interaction checking • Avoidance of medication errors
Point-of-care Decision Support • ACLS algorithms • MH protocol • Transplant protocols • Drug dose calculator
Guideline-Based Care • Timely administration of antibiotics • Periop temperature monitoring • Periop Beta-blocker continuation • Periop DVT and embolism prevention • PONV prophylaxis • Medication error prevention
Provider Patient & Timely access to patient’s health information • Coordinated communication • Data exchange
Organization Provider & Automated screening and aggregation of data • Surveillance and monitoring
Anesthesia Clinical Leader • System Administrator • System configuration • Log-in access • Security clearance • Clinician • Clinical Analyst
Real-time Patient Experience
Organization =IF(AND(OR(Specialty="URO",Specialty="NEURO"),OR(Antibiotics="cefazolin",Antibiotics="ciprofloxacin",Antibiotics="ceftriaxone",………….”yes",IF(AND(Specialty="ORTHO",OR(Antibiotics= "cefazolin",…………..Antibiotics="ampicillinsulbactam")),"yes","no"))))))