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Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month. March 24th Healthcare Reform Quality & Informatics. Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek

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slide1

Welcome to the MHQP & HealthForce MN Quality Brownbag Room

Monthly Noon Brownbag Fourth Thursday Every Month

March 24th

Healthcare Reform

Quality

&

Informatics

Questions?

Want to be a panel member?

Have suggested topics ?

Contact: Skip Valusek

MHQP Education Chair

skipvalusek@comcast.net

Slides are posted at:

http://www.healthforceminnesota.org/pages/Programs/courses.html

register your attendance
Hopefully you provided your name & organization when you signed in.

If so:

Just say Hi in the Chat Pod and we’ll capture your name and organization in the log.

If not:

identify yourself and organization in the Chat Pod to the

left of your screen.

Register your Attendance
poll who is attending this session
Rural / Outstate ?

Metropolitan area ?

Organization that has (or serves) both ?

Poll: Who is Attending this Session ?
poll who is attending organization type
Healthcare system

Hospital

Clinic or Clinic System

Long term care

Healthplan

Homecare / Hospice

A Quality Support Organization

Other ? (e.g. MCM )

Poll: Who is attending: Organization Type ?
poll what do you hope to gain by participating
I am a healthcare quality professional and am interested in additional education.

I am a healthcare professional interested in developing quality skills as a core competency.

I am a healthcare professional interested in learning more about healthcare quality.

Poll: What do you hope to gain by participating?
informatics and quality on the radar screen in the crosshairs of healthcare reform

Informatics and QualityOn the Radar ScreenIn the Crosshairs of Healthcare Reform

ASQ

Minnesota Section 1203

March 8, 2011

John R. (Skip) Valusek PhD CPHQ

Director Clinical Analytics

HealthEast Informatics Department

srvalusek@healtheast.org

Minnesota Healthcare

Quality Professionals

Education Chair

Minnesota Council for Quality

Evaluator

agenda
Agenda
  • A few thoughts from ASQ’s “Future of Quality” Study
  • Healthcare: A Decision Intense Industry
  • Healthcare Reform : A Catalyst for Quality
  • Healthcare Quality & Informatics
  • Change Management
asq s 7 key forces
ASQ’s 7 key forces
  • Globalization
  • Social Responsibility
  • New Dimensions of Quality
    • Innovation
    • Managing change
  • Aging Population
  • Healthcare
  • Environmental Concerns
  • 21st Century Technology: Driver of Change
asq s implications that resonated
ASQ’s Implications That Resonated
  • Culture of CQI:
    • The knowledge and ability to apply the tools of quality continue to be drawn out of the profession and into the hands of everyone in the organization.
    • As quality moves into areas less tangible than manufactured goods, it will increasingly become an issue of culture; a “quality mind-set” is needed.
  • Measuring waste and managing its reduction will continue to focus quality on the cost side of the equation.
  • Change and innovation are as much attributes of quality and how we manage as they are of products, processes, and services that are produced and delivered.
  • …… This plethora of data will serve only to pollute clear thinking and rational decision making if it is poorly designed, managed, and analyzed.
who accredits regulates a hospital

Supreme Court

Federal Circuit

Courts

Departmental

Congress

Appeals

CMS

Formerly Health Care Financing Admin

OIG

MIPS

State Survey &

PRRB

Survey

Certification

Regional Offices

Intermediaries

Carriers

PRO's

State & Local

Governments

JCAHO

DMERC

State Health

State Medical

Boards

Boards

Regional Home

Health Intermediaries

HIPAA

State

Medicaid

EMTALA

HHS/NIOSH

Leapfrog

HHS/OMH

HHS/HRSA

HOSPITALS

27 Nevers

HHS/OCR

State

CLAS

Licensure

FDA

DOT

OSHA

Labor/Justice

ADA

DOL/

Employment

OPO'S

DOJ

NRC

SEC

IRS

EPA

FTC

FCC

FBI

CDC

CARF

NCQA

Who Accredits / Regulates a Hospital ?
some of the reform drivers
Some of the Reform drivers
  • Care Across the Continuum

replaces fragmentation of care

    • Homecare / Hospice
    • Clinics
    • Acute Care (hospital)
    • Long term care; Skilled Nursing Facilities
  • Emphasis on Prevention , then treatment
  • Pay for outcomes rather than pay for procedure
  • Telemedicine
predominant metaphors used in organizations

Machine

  • Military Operation
Predominant Metaphors Used in Organizations:

The new, emerging metaphor of the decision paradigm:

Biological or Living Systems

healthcare a decision intense industry
Healthcare: A Decision Intense Industry

Input Process Output

Clinical Outcomes

Patient Satisfaction

  • Physicians
  • Nurses
  • Pharmacists
  • Respiratory therapists
  • Dieticians
  • Social workers
  • Rehab therapists
  • Etc
  • Judgments
  • Choices
decision making what is a decision

?

  • Can we model this process?
Decision Making : What is a Decision ?
  • Decisions commit resources through
  • judgment and choice processes
  • There is process in decision-making:
      • Opportunity/Problem Detection & Explanation
      • Alternative Generation
      • Analysis (Cost/Benefit judgments)
      • Selection among alternatives
      • Implementation
      • (Monitoring/measurement repeats the cycle)
decision categories

Demographic

C

U

R

R

E

N

T

H

I

S

T

O

R

Y

“Source”

Systems

Data

Warehouse

Decision Categories

RETROSPECTIVE / ANALYTICAL

TACTICAL & STRATEGIC DECISIONS

CONCURRENT

CLINICAL & OPERATIONAL DECISIONS

  • RESEARCH & PI ANALYSIS
  • ‘across’
    • patients
    • continuum of care
    • channels,
    • markets,
    • periods
  • Unstructured (little or no process)
  • Find key variables
  • Collaboration & sharing.
  • Refine protocols/pathways
  • ‘Quick Look’ JUDGMENTS
  • ‘within’
    • a PATIENT: Solve problem;
    • Exploit Opportunity
    • a PROVIDER: activity levels
    • a DEPARTMENT: staff scheduling
    • a REGION: assess event impacts
  • Empower employees (within limits)
  • Semi-structured process
  • Apply protocols/pathways
objective of decision support
Objective of Decision Support

in a single sitting.

to achieve closure

Unobstructed exploration

decision process modeling the requirements gap

Clinical/Business

Decision-Making

IT ARCHITECTURE

STRUCTURE

KNOWLEDGE MANAGEMENT

TRADITIONAL

DECISION SUPPORT

Retrieval

Math

Models

Data

Storage

Cross Referencing

Dialogue

Decision Process Modeling: The Requirements GAP

FLEXIBILITY

decision paradigm additional bridges required
Decision Paradigm: Additional Bridges Required

STAR

(MUMPS)

ORYX

6-digit coding

Pharmacy

Radiology

Lab

Med Staff

Inpatient Pharmacy

(STAR)

SYSTEMS/DATA

USERS

ADAC

Lab database

(Fortran)

Quality Indicators

Outpatient

Pharmacy

Pxyis

STAR

Lab

Radiology

(STAR)

HDM

(B-trieve)

Sungard

(Oracle)

OB

database

External/Regulatory

Relations

Eclipsys

(Sybase ?)

Neuro

database?

Oncology

EXTERNAL SOURCE SYSTEMS

OR Navicare

Ortho

Medline

MN Hospital Assoc

OB/

Womencare

SurgiServer

b-trieve

Care-effective

Cost

Payor

Relations

CV Lab

Abaton

(Oracle)

Micromedex

(drug info)

OLAP

Analytical

Decision Processes

Neuro

MICC

database

CV

IT MODELS

Provider

Relations

Allina KnowledgeQuest

USER’S

DECISION

WORLD

CV

MicroMedical

Behavioral

Health

Transaction

Process

(ERD; DFD)

OLTP

Logician (MedicaLogic)

(Oracle)

Patient

Relations

Ortho

Database

Demographic

C

U

R

R

E

N

T

H

I

T

O

R

Y

S

ED

OR

Outpatient/

Ambulatory

Cactus

(credentialing)

Warehouse

(Oracle)

Quality

Patient Safety

Picker (local)

DISC

Operational/Clinical

Decision Process

Storyboards

Complaints

RisKey

(AREV)

MediPac

Medica Claims

healthcare it informatics
Healthcare IT & Informatics
  • IT
    • Hardware and infrastructure
    • Backup and recovery
    • Transaction applications
      • Registration/scheduling
      • Coding
      • Billing
  • Informatics
    • Electronic Health Records: The Clinical applications
    • Clinical Decision Support & Documentation
    • “The most significant change a clinician will ever encounter”

Valusek

healthcare informatics
Healthcare Informatics
  • Clinical Applications Build
    • Orders
    • Nursing Documentation
    • Clinician Notes
    • Medication Reconciliation
    • Lab & Imaging integration
  • Trainers
  • Super Users
  • Pharmacy Informaticists
  • Reporting & Analytics
healthcare quality

Performance Improvement

Accreditation Readiness

Infection Control

Patient Safety

Patient Representatives

Care Management

Case Mgrs; Social Workers;

Utilization Review

Organizational Development

Healthcare Quality
  • Is everybody’s job
  • Is supported by the following departments (and many others)

Quality “Departments”

Clinical Care

Measurement & Reporting

Medical

Staff Office

Quality

IT

Informatics

Simulation

Center

HIPAA

Corporate Compliance

Medical

Records

Ethics

healtheast informatics conceptual model

view as of 12/31/10

(HBI)

Retrospective Analysis &

Operational Decision Support

?

?

REDCap

research data

Web

Registries

Horizon

Expert

Documentation

RL

Solutions

Implants

Registry

Benchmarks

(e.g. DataVision?)

Island

databases

MIDAS

Access

Islands

Excel

Islands

Horizon

Patient

Folder

Data

Warehouse

(HPM)

Horizon

Care

Record

(HCR)

Flowcast/Allscripts

Ambulatory

PMS/EHR

Clinics

Other

“Source”

Systems

Hospital real-time

decision support

Informatics

Analytics

Clinic real-time

decision support

HealthEast Informatics Conceptual Model

Operational

Reports

(e.g. patient lists)

“Integration”

(Transform & Load)

Extract

EMPI

Enterprise

Master Patient

Index

(Illuminate)

HealthQuest

(aka Medipac)

(aka Clinipac)

ADT & demographics

Ambulatory operational

reports and analytics

Homecare/Hospice

healthcare reform a catalyst for quality
Healthcare Reform : A Catalyst for Quality
  • Meaningful Use
  • Value-Based Purchasing
  • Accountable Care Organizations
meaningful use necessary conditions

+

Meaningful Use = Necessary Conditions
  • Meaningful Use
    • EHR’s (hospital and clinic) over next 5 years
    • Health Information Exchanges (HIE)
      • Continuity of Care Document (CCD)
      • Continuity of Care Record (CCR)

+ ICD-10

+ Master Patient Index

value based purchasing
Value Based Purchasing

VBP = Quality / $

Quality = .7 ( clinical outcomes) + .3 (satisfaction)

“First do no harm”

Quality = (Patient Safety) * (clinical outcomes +

satisfaction)

aco structure and financial models
ACO Structure and Financial Models

Key Elements of ACO

  • Defined legal entity
  • Financial Model
  • Payment Distribution
  • Payment predicated on
        • Quality
        • Care coordination
  • Standardized clinical reporting
  • Clinical re-engineering

Financial Models

  • Full Capitation
  • Partial Capitation
  • Symmetric Model
  • Asymmetric Shared Savings

Risk

Slide from Steve Heilman MD CMIO , Norton Healthcare Louisville KYScottsdale Institute presentation 03/17/11

information technology challenges supporting aco development
Information Technology ChallengesSupporting ACO Development
  • EMR – clinical integration/ CDS/ Standards
  • Data Warehouse/ Data Aggregation
  • Disease Registry Development
  • Health Plan Data/ Actuarial Analysis
  • Patient Health Data Across Health Plans/ HIEs
  • Home monitoring/ Web Presence
  • Clinical Analysis for Re-Engineering Processes
  • Remote Presence – MDs/ Case management
  • Business Intelligence/ Physician Feedback
  • Timeliness of Data is crucial to success

Slide from Steve Heilman MD CMIO , Norton Healthcare Louisville KYScottsdale Institute presentation 03/17/11

clinical re engineering
Clinical Re-engineering
  • Improved care coordination and communication
  • Improved access – physician extenders – email – phone call etc.
  • Prevention and early diagnosis
  • ED and Immediate Care Center visits
  • Increase generic medication utilization
  • Hospital re-admissions and multiple ED visits
  • Improved management of complex patients

Slide from Steve Heilman MD CMIO , Norton Healthcare Louisville KYScottsdale Institute presentation 03/17/11

change
Change
  • The only constant is change
  • (except from a vending machine)
  • Life is change . . . .
  • Growth is optional
  • It is not necessary to change.
  • Survival is not mandatory.
  • Deming
change management
Change Management

Identify the change occurring on your unit this week:

  • Professional partnership model;
  • medication reconciliation;
  • new staff starting/orienting/precepting;
  • new nursing students;
  • new hospital planning;
  • new equipment (SCD pumps, ceiling lifts);
  • focus on decreasing overtime;
  • focus on increasing team playing;
  • focus on patient Picker scores "would you recommend?";
  • telemetry training;
  • new protocol for insulin pens w/discharged patients;
  • added edunet modules (diabetes, moderate sedation, influenza);
  • management changes;
  • construction/detours outside and inside building;
  • EHR monthly updates;
  • relocation of our supply room;
  • focus on email as primary source of information/no paper postings;
  • daily medicare discharge notices;
  • patient room changes/ loss of private rooms.”
what are the implications of this much simultaneous change in a decision intense environment
What are the implications of this much simultaneous change in a decision-intense environment ?

Input Process Output

Clinical Outcomes

Patient Satisfaction

  • Physicians
  • Nurses
  • Pharmacists
  • Respiratory therapists
  • Dieticians
  • Social workers
  • Rehab therapists
  • Etc
  • Judgments
  • Choices
slide35

Re-Cap

  • Healthcare: A Decision Intense Industry
  • Healthcare Reform : A Catalyst for Quality
  • Healthcare Quality & Informatics in the crosshairs
  • Change Management and Innovation
  • A few thoughts from ASQ’s “Future of Quality” Study
review summary asq s 7 key forces
Review/Summary: ASQ’s 7 key forces
  • Globalization

HIE; CCD; CCR

  • Social Responsibility (STEEEP)

(Safe,Timely,Equitable,Effective,Efficient,Patient-centered)

3. New Dimensions of Quality

    • Innovation
    • Managing change

4. Aging Population

5. Healthcare

6. Environmental Concerns (e.g. medication disposal)

  • 21st Century Technology: Driver of Change

(EHR/EMR;diagnostics; telemedicine; predictive decision support)

slide38

Welcome to the MHQP & HealthForce MN Quality Brownbag Room

Monthly Noon Brownbag Fourth Thursday Every Month

April 28

Analyzing Study Results

Questions?

Want to be a panel member?

Have suggested topics ?

Contact: Skip Valusek

MHQP Education Chair

skipvalusek@comcast.net

Slides are posted at:

http://www.healthforceminnesota.org/pages/Programs/courses.html