Clinical Intelligence Solutions<br />Achieving High Quality Surgical Outcomes<br />
The Well Known Challenges Continue …<br />Variations in the quality of care and resulting patient outcomes <br />Technolog...
Current Challenges <br />NEED TO COLLECT DISCRETE DATA:<br /><ul><li>in a manner sufficient to affect core measure outcome...
with enough granularity to identify opportunities for improvement, leveraging data for automated reporting</li></ul>CHALLE...
Data is scattered throughout multiple, disparate sources resulting in labor-intensive processes ( including chart abstract...
The excessive timeframe to integrate, analyze, and report data prohibits “In-process” measures from benefiting current pat...
Lack of clinical data strategy for integrating multiple diverse sources to support analytics and clinical decision support...
Performance Goal – “Consistently High Compliance”<br />From: INCONSISTENT<br />“Manual <br />Process<br />Fatigue”<br />To...
Best Practice Alerts – Visibility into Execution<br />CNO, SVP, CMIO<br />5. Performance Review<br />6. Process Review<br ...
Clinical Scenario: Antibiotic Administration<br />Clinical Alert Processing<br />HL7 Messages<br />PICIS<br />OR Manager<b...
Antibiotic Alert Processing: SCIP 1a, 2a (Alert 5)<br />3<br /> Check Safety Considerations and Allergies<br /> Administ...
 If patient didn’t receive Antibiotic (Abx), document REASON</li></ul>Alert is sent to Anesthesiologist in PICIS Anesthesi...
Current State – Post-Discharge CPT-4 Coding<br />RECOMMENDATION<br />Concurrent Coding/Code at Booking<br />Medical Coding...
Too frequent use of the Picis memo field<br />Eliminates the ability to efficiently and automatically analyze the data<br ...
Alerts Application High-Level Architecture<br />Desktop AlertsClient (Yahoo Widgets)<br />Mobile Alerts Client<br />(Pager...
What does the alert notification look like?<br />Near-Real-time<br />Different colors<br />to indicate:<br /><ul><li> Normal
 Escalated</li></ul>Widget – Used to Notify Responders<br /><ul><li>The Alerts Client is responsible for the presentation ...
A rolling list of acknowledged and unacknowledged alerts for past 24-48 hours can also be viewed through the Alerts Client...
Alert Details by Department<br />ICU<br />Surgery<br />Colors indicate configurable threshold levels for alert counts<br />
Alert Details broken out by SCIP Core Measure<br />ICU<br />Surgery<br />
Alert Details with Rolling 12 Month view<br />ICU<br />Surgery<br />
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Clinical Intelligence: Best Practices in SCIP Compliance

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SCIP Compliance has been a major struggle for many Healthcare Providers. Specific quality programs are often inflexible in the data collection and reporting demands they place on care providers, which leads to poor documentation on care delivery and compliance.

Learn how to leverage near-real-time alerts to ensure compliance with best practices, driving the highest quality surgical care. In this 1 hour webinar you will gain valuable insight into how you can:

Facilitate more informed decisions by providing visibility into hospital-wide and cross-facility metrics and trends

Prioritize the need for corrective actions by benchmarking against industry standards, best practices and internal goals

Improve hospital performance by identifying and replicating demonstrable best practices across the organization

Increase staff productivity and data accuracy through automatic and embedded performance monitoring

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  • We anticipated and discussedextending these concepts (org impact, data collection, process reengineering, alerts and escalation, technical platform, analytics) to the other core measures, and to other performance improvement contexts.
  • The question “has incision been made?” is important because that’s the first point at which we start collecting “triggers” (basically we can’t tell them before this point because it will be telling them how to do their jobs). Also, you might as well put the actual trigger questions in this slide straight from the use cases for SCIP-1 – “has surgery finished?”, “has post anesthesia checkout list begun in PACU?”
  • Clinical Intelligence: Best Practices in SCIP Compliance

    1. 1. Clinical Intelligence Solutions<br />Achieving High Quality Surgical Outcomes<br />
    2. 2. The Well Known Challenges Continue …<br />Variations in the quality of care and resulting patient outcomes <br />Technology adoption to support clinical insights lags behind other areas <br />After the fact performance improvement programs often allocate scarce resources to “paper chasing” activities that have little value and almost no hope of impacting current cases<br />Regulatory bodies impose ever increasing reporting requirements that today’s solutions just can’t handle<br />Hospitals are paying too many punitive penalties and often fail to attain all available pay for performance quality incentives / performance-based rewards based on slow or poor reporting<br />
    3. 3. Current Challenges <br />NEED TO COLLECT DISCRETE DATA:<br /><ul><li>in a manner sufficient to affect core measure outcomes while still in-process and
    4. 4. with enough granularity to identify opportunities for improvement, leveraging data for automated reporting</li></ul>CHALLENGES<br /><ul><li>Culture of entering data via free form text (after the point of administration ) leads to inconsistent data collection and data
    5. 5. Data is scattered throughout multiple, disparate sources resulting in labor-intensive processes ( including chart abstraction for Core Measures) to satisfy reporting needs
    6. 6. The excessive timeframe to integrate, analyze, and report data prohibits “In-process” measures from benefiting current patient outcomes
    7. 7. Lack of clinical data strategy for integrating multiple diverse sources to support analytics and clinical decision support</li></ul> Each subject area investigated offers similar challenges with actionable alerting due to data quality and availability issues<br />
    8. 8. Performance Goal – “Consistently High Compliance”<br />From: INCONSISTENT<br />“Manual <br />Process<br />Fatigue”<br />To: CONSISTENT<br />“Automated<br />Process<br />Improvement”<br />
    9. 9. Best Practice Alerts – Visibility into Execution<br />CNO, SVP, CMIO<br />5. Performance Review<br />6. Process Review<br />7. Review & Revise <br />Process as Needed<br />Supervisor Dashboard<br />Clinician WorkStation<br /> Alerts: Relevant, Timely, Escalating<br />2. Notify Clinician<br />4. Notify Supervisor<br />Alert – <br />Document Care<br />3. List of Patients Approaching Escalation<br /> Compliance Threshold<br />1. Process includes:<br />  Antibiotics w/in 1 hr<br />  1 hr Clock Starts<br />Standard<br />Process<br />Patient <br />Registers <br />Pre-Op/Holding<br />Preparation<br />PACU & <br />Discharge<br />Patient <br />Surgery (OR)<br />
    10. 10. Clinical Scenario: Antibiotic Administration<br />Clinical Alert Processing<br />HL7 Messages<br />PICIS<br />OR Manager<br />Pre-Op<br />Nurse<br />Is it a surgical operation?<br />Has an incision been made?<br />Patient<br />PICIS<br />Anes. Manager<br />Anesthesiologist<br />
    11. 11. Antibiotic Alert Processing: SCIP 1a, 2a (Alert 5)<br />3<br /> Check Safety Considerations and Allergies<br /> Administer appropriate Antibiotic (Abx)<br /><ul><li> Document Antibiotic given
    12. 12. If patient didn’t receive Antibiotic (Abx), document REASON</li></ul>Alert is sent to Anesthesiologist in PICIS Anesthesia Manager while still in the OR<br />2<br />If HL7 message is “Surgery Finish” and NO message with Antibiotic (Abx) given (from PICIS)<br />1<br />
    13. 13. Current State – Post-Discharge CPT-4 Coding<br />RECOMMENDATION<br />Concurrent Coding/Code at Booking<br />Medical Coding (CPT-4 / ICD-9)<br />Quality Measures Analytics<br />Decision Support Systems<br />Discharge<br />Date<br />Opportunity<br />to change<br />core measure<br />results<br />Admission<br />Horizon Clinical Systems<br />Patient Records are Scanned Electronic<br />Physician Orders are 30-40% CPOE<br />2-3 days post-discharge<br />Medipac – Patient Registration<br />Patient Records in Picis (free text and discrete data)<br />Physician Orders are Verbal, or entered later<br />CURRENTLY<br />Arrival<br />Surgery<br />Medical Records Coding <br />(HDM)<br />Registration<br />(Medipac)<br />Pre-Op<br />(Picis)<br />OR Surgery<br />(Picis)<br />PACU / Admission <br />Orders with diagnosis<br />(PICIS/Horizon)<br />Arrival<br />Surgery Prep<br />Procedure<br />Recovery<br />Post-Discharge<br />
    14. 14. Too frequent use of the Picis memo field<br />Eliminates the ability to efficiently and automatically analyze the data<br />No standardized processes for collecting and documenting data<br />There are no consistent data collection points and locations for the data across clinical workflows; and no data owners responsible for its quality<br />No designated, authoritative sources for each piece of data collected<br />SCIP Chart abstractors have to look in up to 9 places for SCIP data<br />Like the Accountability Matrix, all data needs a trusted source and owner<br />Current State: Obstacles to Discrete Data Collection<br />Can’t analyze thefree-format text collected here!<br />
    15. 15. Alerts Application High-Level Architecture<br />Desktop AlertsClient (Yahoo Widgets)<br />Mobile Alerts Client<br />(Pager)<br />Mobile Alerts Client (Smart Phone)<br />Alerts Server<br />Alerts Rules Engine<br />Alerts Database<br />(Normalized / Integrated Patient Data)<br />Reporting<br />Data Mart<br />Data Abstraction Layer<br />HL7 Message Bus<br />
    16. 16. What does the alert notification look like?<br />Near-Real-time<br />Different colors<br />to indicate:<br /><ul><li> Normal
    17. 17. Escalated</li></ul>Widget – Used to Notify Responders<br /><ul><li>The Alerts Client is responsible for the presentation of the alerts to the targeted user. The Alerts Client uses a combination of sound and window pops to announce an alert to the user.
    18. 18. A rolling list of acknowledged and unacknowledged alerts for past 24-48 hours can also be viewed through the Alerts Client.</li></li></ul><li>Rules Engine: Main Alert Processing Logic<br />Visual Development Environment<br />Main processing loop<br />Componentized & easily extensible<br />
    19. 19. Alert Details by Department<br />ICU<br />Surgery<br />Colors indicate configurable threshold levels for alert counts<br />
    20. 20. Alert Details broken out by SCIP Core Measure<br />ICU<br />Surgery<br />
    21. 21. Alert Details with Rolling 12 Month view<br />ICU<br />Surgery<br />
    22. 22. Isolate Source of Alerts, Localize Response<br />Enterprise Compassionate Health Services<br /> FacilityBaywood Hospital, Metro North Clinic, …<br /> DepartmentSurgery, ED, Same Day, …<br />Unit North 1, West 2, …<br />Room 501, 503, 505, 502, 504, …<br />Case J.Smith,P.Jones, …<br />
    23. 23. <ul><li>Functionally:
    24. 24. Reduce manual effort and time to report quality core measures
    25. 25. Improve accuracy of reporting and SCIP compliance
    26. 26. Develop evidence-based medicine and education guidelines and resources
    27. 27. Improve productivity of staff
    28. 28. Better Return on People (Lean Six Sigma)
    29. 29. Help identify best practices from retrospective reporting over time
    30. 30. Create accountability through the use of best practice alerts
    31. 31. Technically:
    32. 32. A scalable, extensible framework for reducing the effort to implement additional subject areas after SCIP (CHF, AMI, Pneumonia, etc.)
    33. 33. Feasibility of open sourcetechnologies to meet the needs of the near-term business requirements, while still being in alignment with the long-term vision</li></ul>The Solution – Core Functions & Benefits<br />
    34. 34. Retrospective Reporting – This component includes the following functionality:<br />The creation of the underlying dimensional data mart<br />The creation of the Business Objects Universe to access the underlying dimensional data mart<br />The Xcelsius dashboard, WEBI reports and/or Crystal reports for retrospective reporting<br />This functionality is included due to:<br />Ability to demonstrate the value of the overall solution – Dimensional data marts, Business Objects Universes and Xclesius dashboards<br />Dashboards<br />
    35. 35. Main Points<br />Consistently high Core measure compliance benefits:<br />Quality of Care<br />Patient Satisfaction<br />Hospital Reputation<br />Financial Returns<br />Discrete data is essential for automating the reporting, analysis, and presentation of core measure compliance<br />An alert mechanism is scalable for future measures by simply expanding business logic/rules<br />Alerts can be delivered via text, email, page, widget prompt<br />An alert is as real-time as the systems holding the data<br />Alerts are clinician “Reminders” not “Dictators”<br />Superior Outcomes<br />Dollars Spent<br />= Value to the Patient<br />
    36. 36. Summary – Progressing From Paper to Automation<br />SCIP Core Measures:<br />OR Scheduling<br />Materials & Supply Mgr<br />Meds Admin<br />ALL Core Measures:Automated reporting;<br />All data sources required<br />Pneumonia Core Measures:<br />Paper Data Collection<br />Manually scanned document<br />
    37. 37. Questions?<br />Thank You!<br />
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