CMIO-CMO:Collaboration Strategies Abha Agrawal, MD, FACP Chief Medical Officer Kings County Hospital Clinical Associate Dean SUNY Downstate College of Medicine Brooklyn, NY CMIO Summit | Boston | June 10 2011
Kings County Hospital Center 650-bed academic tertiary hospital Level-1 Trauma Center 26,000 discharges 750,000 clinic visits 130,000 ED visits
New York City Health & Hospitals CorporationLargest municipal health system in thecountry11 acute care hospitals>100 diagnostic and treatment centers7,700 beds23,000 deliveries227,000 admissions
Failure of decision-support algorithm5 years 2 years
‘Kǘbler-Ross’ Stages CMIO to CMO transition I - Denial “My calendar is wrong” II - Anger “Who messed it up?”III - Bargaining “The calendar may be right; but someone needs to fix it”IV - Depression “The calendar is right; but there is no way I can live with it”V - Acceptance “I accept the reality of the CMO job” Adapted from Donald Berwick, MD, IHI 2004 Frontiers of Healthcare conference
Drivers in Healthcare: Triple Aim Better care + Better health @ Low Cost
“Waste, Danger, and Death” 1954 speech Appalling state of “waste, danger, and death” in nation’s highway system
Waste in US Healthcare• 40-50 % waste• Overuse • 7 services alone- $33 – 62 billion waste / yr• Preventable complications • HAIs, medication errors• Process inefficiency • locating and waiting, poor access
Medicare OIG study Nov 2010780 Medicare beneficiaries discharged inOct 2008– 13.5 %: adverse events– Additional 13.5% - temporary harm– 44% preventable– 1.5% - contributed to their deaths = 15,000 Medicare beneficiaries in a month (based on ~ 1 million in a month)
• 55% received recommended care for theircondition• Condition-specific rates varied from 10-79%
CMIO – CMO Intersection Medical staff information / Knowledge Quality Analytics – Data /EHR SafetyCPOE - DecisionSupport RegulatoryMeaningful Use ResearchE-documentation Care management Health reform - ACO/ PCMH
CMIO Role Has Evolved FromImplementation, Analytics, training of HIT Reporting, and Dashboard
Evolution of CMIO Role Knowledge Information Data
Evolution of CMIO Role 2009 AMDIS Gartner CMIO Survey
Collaboration pointsEHR implementationQuality and Safety: achievable onlythrough EHRsPCMH / ACO: EHR / health IT are criticalRegulatory requirements: achievable onlythrough HITPerformance and productivitymeasurement: achievable only throughdata analytics
“Smart” discharge summary MD documenting inpatient discharge summary Medical Service patient All Other ServicesHF anywhere in Problem List? HF as Principal Discharge Dx? No Yes No further Check for ACEI / ARB Rx action Yes No No further MD prompted to action write a Rx OR Document contraindication
Reducing CAUTI• 2009 – 7.3 per 1000 cath days• 2010 – 4.3 per 1000 cath days• total number of cath days also reducedto half.
Prevention of Retained ForeignBody: Electronic Delivery Note
CPOE: FondaparinuxTo order fondaparinux, patient must have a cr clearance of>= 30 ml/min, determined from the most recent weight andserum creatinine results. If any of these three are missingor not recent, enter or order the appropriate values.
CMIO - CMOBoth working toward the same goals /same strategic priorities of theorganization.Alignment is absolutely mandatory – evenmore so than now.