Hospitals, Quality and HIT: Important Issues and Intersections

1. Hospitals, Quality and HIT: Important Issues and Intersections • Gail E. Latimer, MSN, RN, VP, Chief Nursing Officer • Siemens Medical Solutions

2. By bringing IT tools, including EHRand content, to doctors and hospitals. Inform Clinical Practice Interconnect Stakeholders • By building an interoperablehealth information system sorecords follow patients. • By expanding themonitoring of publichealth and bringingresearch advancesmore quickly tomedical practice. ImprovePopulation Health Personalize Care • By using health IT togive consumers moreaccess to and involvementin health decisions. The Value of Health Information Technology Inform Clinical Practice Interconnect Stakeholders ElectronicHealthRecord ImprovePopulation Health Personalize Care

3. Targeted Performance Areas – The Nation is Monitoring Clinical Performance Drivers • Acute MI • Heart failure • Pneumonia • Surgical infection prevention • Sepsis • Deep vein thrombosis • Central nervous system complications • In-hospital death • Wound infection • Pulmonary failure • Metabolic derangement • Length of stay • Patient falls • Urinary tract infection • Pressure ulcers • Hospital-acquiredpneumonia • Shock or cardiac arrest • Upper gastrointestinal bleeding

4. Transparency in Hospital Public Reporting -Clinical Process Measures

5. Business Office Physician's Office Dietary Environmental Services Patient's Home Laboratory Health Info Mgmt Pharmacy EHR Medical Unit Radiology Scheduling Emergency Department

7. Incorporating Evidence Within Clinical Practice • Accelerating role in today’s healthcare • Provides improved quality and reduction in variation • Serves as the basis for many quality management and performance initiatives • Information technology will drive the use of knowledge with the EHR

8. Increase Accuracy and Efficiency of Clinical ProcessesComputerized Physician Order Entry

9. Incorporating the Capture of Core MeasuresClinical Documentation

10. Incorporating the Capture of Core MeasuresClinical Documentation

11. Knowledge-driven EHR

12. Knowledge Drives the Patient Plan of Care • Smoking Cessation slide

13. Knowledge Drives the Patient Plan of Care

14. Acute Myocardial Infarction Workflow -

15. Workflow Engine –Listening, Monitoring, and Escalating…….

16. Workflow Engine –The Right Information, To the Right Person, at the Right Time……

17. Technology provides real-time access to cost and quality Technology generates new knowledge to advance healthcare Technology deployment supports the care delivery process while measuring outcomes Technology can capture clinical practice, improve processes and quantify the impact on patient outcomes Leveraging Technology to Measure Quality and Cost

18. AMI Aspirin at Arrival Goal 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile Aspirin Prescribed at Discharge Goal 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile

19. AMI ACE Inhibitor / ARB for LVSD Goal 100% 100% 13/13 11/11 15/15 8/8 9/9 10/10 13/13 80% 15/16 13/14 9/10 13/14 13/14 12/14 9/11 60% 6/8 6/8 9/14 8/11 7/9 40% 20% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile Smoking Cessation Advice/Counseling Goal 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile denominator may change due to inclusion/exclusion criteria

20. AMI Beta Blocker at Arrival Goal 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile Thrombolytic received within 30 Minutes of Hospital Arrival (Avg. Time in Minutes) 100 90 80 70 60 50 40 30 20 10 0 Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63

21. Nursing Dashboard - 5 East

22. Monitoring Clinical Outcomes

23. The Value of Health Information Technology -Monitoring Quality and Cost

24. The Value of Information Technology for Clinical Practice Achieved more than 90% compliance with regulatory standards for discharge education of stroke patients Reduction in medication to pharmacy review time from up to 24 hours to within 1 hour Reduction in prescriber errors by 71% Decreased harmful events to a six month average of 0.33 per 1,000 doses (compared to a national average of 2-8 harmful events per 1,000 doses)