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EMR tools to Improve Quality Improvement. Paul St. Jacques, M.D. Quality and Patient Safety Director Department of Anesthesiology Vanderbilt University Medical Center. COI/Disclosure. I am a registered inventor of the VPIMS software per Vanderbilt University policies.

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emr tools to improve quality improvement

EMR tools to Improve Quality Improvement

Paul St. Jacques, M.D.

Quality and Patient Safety Director

Department of Anesthesiology

Vanderbilt University Medical Center

coi disclosure
COI/Disclosure
  • I am a registered inventor of the VPIMS software per Vanderbilt University policies.
  • I am a minority equity holder in Acuitec, LLC which markets a commercial version of the VPIMS Perioperative Software Suite.
for those who came primarily for the lunch
For those who came primarily for the lunch:
  • Take a deep breath
  • It will all be over before you know it
quality improvement
Quality Improvement
  • “Proactive”
    • Reducing the variability in the process
    • Shifting the process’ outcome in the desired direction.
  • “Reactive”
    • Non-routine events
      • Analysis and improvement
prevention
Prevention…
  • VPIMS Applications:
    • Whiteboard
    • GasChart / Decision Support
    • Vigilance / Situational Awareness
  • Tools for event detection
  • Tools for tracking/closing events
slide6

Preop

Case Board

CQI

Nurse Charting

GasChart

Vigilance

VPIMS Database-MS SQL Server

Hospital

EMR

VPIMS Web

Electronic Charge Capture

Billing

slide7

First things first:

Prior to surgery, ensuring we have the right patient, procedure, side, other items present in the OR.

decision support
Decision Support
  • Delivering timely information to providers
  • To help providers ‘do the right thing’
situational awareness
Situational Awareness

“Paying attention to all that is going on around you…”

  • VPIMS-Vigilance
  • Delivering OR Suite and patient status information to providers regardless of provider location.
  • Providing automated messages regarding changes in patient status/critical events.
that was suboptimal
That was…’suboptimal’

Detection, Reporting Structure and Event Analysis

Intraop – Providers

Postop – Providers

Post Discharge – Patients

Postop - Automated EMR scans

postop biochemical markers
Postop Biochemical Markers
  • Postop lab value analysis
    • Acute Kidney Injury (incr. Cr > 0.3)
    • Troponin
  • Screening  Chart review
slide29

Acute Kidney Injury Screening

  • 14,000 inpatient surgeries (FY12)
  • 10,500 with pre/post Cr lab values
  • 1,257 with increases >0.3
  • 1 Case reported to QI during same time period
slide30

VPIMS/Admin Data

Veritas

Direct Verbal/ Email Reports

Phone Reports to Quality Office

  • Automated:
  • Biochemical Markers
  • Chart Scanning

Morbidity, Mortality Improvement Committee

Quality and Patient Safety Director

Peer Review Committee

Project Development-

Assignment to individual/group

Departmental MMI Conference

Division Chief

VC Clinical, Dept. Chair

Joint QMMI Conference

Close Case

conclusion
Conclusion
  • QI Processes are complex but important
  • Informatics resources can be brought to bear on both preventing and detecting events, event reporting and analysis.
  • Thank You