Amer College of Cardiovascular Administrators March 2004

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We detailed our method for effectively implementing our cardiovascular information system

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Amer College of Cardiovascular Administrators March 2004

  1. 1. The Power of Data Integration Friday, March 5, 2003 Speakers: Pam Goepfarth, RN, CCRN, RCIS, MEd Director, Information Technology Saint Vincent Heart Center, Erie, PA                 Mark Kresse, MHS, PT Vice President Saint Vincent Heart Center, Erie, PA Executive Director Regional Heart Network
  2. 2. Mark Kresse, MHS, PT Mark earned his Bachelor of Science degree from Ithaca College, and Master of Health Science degree from the University of Indianapolis.  A physical therapist by training, his 24 year healthcare career includes both clinical and administrative positions that span hospital, private practice, consulting, and physician practice management settings.  As Heart Center Vice President, he is responsible for all inpatient and outpatient Heart Center operations, and serves as Executive Director of the Regional Heart Network. Pamela Goepfarth, RN, CCRN, RCIS, MEd Pamela Goepfarth is the Director of Heart Center Information Systems for Saint Vincent Health Center. She has a Associate degree in Nursing, a Bachelor’s degree in Science and a Master of Education degree in Speech Pathology and Audiology. Pam is a Registered Nurse with clinical background in cardiovascular services and has studied database management. Pamela has spoken publicly in numerous seminars about the power of data integration and has published multiple articles on the same topic. Saint Vincent Heart Center, ©2004
  3. 3. The Power of Data Integration 1 Saint Vincent Heart Center, ©2004 A “Defining Moment” “ Getting Acquainted with Your Data” “ Process Improvement” “ Driving the Work Process”
  4. 4. 2 A Logical Framework CHARACTERISTICS Saint Vincent Heart Center, ©2004 Driving the Work Process and Decision Support Process Improvement Getting Acquainted with Your Data Report Analyze Collect
  5. 5. 3 MEASURED RESULTS* <ul><li>Quality Improvement </li></ul><ul><li>Revenue Enhancement </li></ul><ul><li>Market Share Knowledge </li></ul><ul><li>Cost Reduction </li></ul><ul><li>Return on Investment </li></ul>for Data Integration *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. Saint Vincent Heart Center, ©2004
  6. 6. 4 Necessary <ul><li>I. Physician Champion </li></ul><ul><ul><li>Visionary for any integrated data system </li></ul></ul><ul><ul><li>Liaison to hospital administration </li></ul></ul><ul><ul><li>Champion for needed resources </li></ul></ul><ul><ul><li>Driver of the data process </li></ul></ul><ul><ul><ul><li>Physician peer-to-peer </li></ul></ul></ul><ul><ul><ul><li>Clinical areas </li></ul></ul></ul><ul><ul><li>The C.A.O. – Chief Accountability Officer </li></ul></ul><ul><ul><li>“ Maniac with a Mission” (Amy Charette, BosSci) </li></ul></ul>Saint Vincent Heart Center, ©2004
  7. 7. 5 Resources <ul><li>II. Database Administrator </li></ul><ul><ul><li>Visionary for the architecture of an integrated data system </li></ul></ul><ul><ul><li>Strong clinical background </li></ul></ul><ul><ul><li>Information technology training </li></ul></ul><ul><ul><li>Driver of data and work processes at the clinical level </li></ul></ul><ul><ul><li>Bridge the gap between clinical and information technologies </li></ul></ul>Saint Vincent Heart Center, ©2004
  8. 8. 6 Necessary <ul><li>III. Infrastructure </li></ul><ul><ul><li>Centralized data management system </li></ul></ul><ul><ul><li>Hardware </li></ul></ul><ul><ul><ul><li>Computers </li></ul></ul></ul><ul><ul><ul><li>Servers </li></ul></ul></ul><ul><ul><ul><li>Network backbone </li></ul></ul></ul><ul><ul><li>Interfaces </li></ul></ul><ul><ul><li>Development protocols </li></ul></ul><ul><ul><ul><li>Information flow </li></ul></ul></ul><ul><ul><ul><li>Clinical processes </li></ul></ul></ul><ul><ul><li>Implementation and maintenance protocols </li></ul></ul>Saint Vincent Heart Center, ©2004
  9. 9. 7 Resources (cont’d) <ul><li>IV. Support </li></ul><ul><ul><li>Hospital commitment </li></ul></ul><ul><ul><ul><li>Money </li></ul></ul></ul><ul><ul><ul><li>Resource commitment </li></ul></ul></ul><ul><ul><li>IT department commitment </li></ul></ul><ul><ul><li>Vendor support </li></ul></ul>Saint Vincent Heart Center, ©2004
  10. 10. 8 Entry Getting Acquainted <ul><li>Manual </li></ul><ul><li>Retrospective </li></ul><ul><li>Beginning Point of Care (POC) data collection </li></ul><ul><ul><li>Open Heart OR </li></ul></ul><ul><li>Beginning interfaces </li></ul><ul><ul><li>Cath Lab IF </li></ul></ul>ANALYZE COLLECT <ul><li>Absolute values </li></ul><ul><li>Manual data mining </li></ul><ul><ul><li>Sorting through data </li></ul></ul><ul><ul><li>Try to identify patterns and establish relationships </li></ul></ul>Saint Vincent Heart Center, ©2004 Saint Vincent Heart Center, ©2004
  11. 11. 9 Level with Your Data REPORT <ul><li>1. Quality </li></ul><ul><ul><li>Cath lab & Open Heart complications </li></ul></ul><ul><ul><li>Mortality, beginning registries (ACC, STS) </li></ul></ul><ul><li>2. Costs </li></ul><ul><ul><li>Unable to obtain on a case level </li></ul></ul><ul><li>3. Revenue </li></ul><ul><ul><li>Unable to efficiently track </li></ul></ul><ul><li>4. Market Share </li></ul><ul><ul><li>Begin to identify and validate referring physicians & develop market strategy </li></ul></ul><ul><li>5. ROI </li></ul><ul><ul><li>Hard to quantify related to manual data entry and analysis </li></ul></ul>Saint Vincent Heart Center, ©2004
  12. 12. Entry Getting Acquainted REPORT 1. Quality 10 A nice graph showing averages Saint Vincent Heart Center, ©2004
  13. 13. Level with Your Data EXAMPLES Operational Volumes 11 Executive Summary Saint Vincent Heart Center, ©2004
  14. 14. 12
  15. 15. The Power of Data Integration 13 Saint Vincent Heart Center, ©2004 A “Defining Moment” “ Getting Acquainted with Your Data” “ Process Improvement” “ Driving the Work Process”
  16. 16. 14 Intermediate Process COLLECT ANALYZE <ul><li>Still some manual </li></ul><ul><li>Some retrospective </li></ul><ul><li>Increased POC information documentation </li></ul><ul><ul><li>all non-invasive testing </li></ul></ul><ul><ul><li>EP </li></ul></ul><ul><ul><li>Inventory management at case level </li></ul></ul><ul><li>On-line physician case reporting </li></ul><ul><li>More interfaces </li></ul><ul><ul><li>Registration </li></ul></ul><ul><ul><li>Billing </li></ul></ul><ul><ul><li>Inventory </li></ul></ul><ul><li>Progress to examining Relative Values </li></ul><ul><li>Begin to identify trends </li></ul><ul><li>Information pattern analysis </li></ul>Saint Vincent Heart Center, ©2004
  17. 17. 15 Level Improvement REPORT <ul><li>1. Automatic report generation </li></ul><ul><ul><li>Daily inventory validation </li></ul></ul><ul><ul><li>Charging validation </li></ul></ul><ul><ul><li>Pharmacy reports increase efficiency and productivity </li></ul></ul><ul><li>2. Comparative data </li></ul><ul><ul><li>Year-to-year volume trends </li></ul></ul><ul><ul><li>Monthly referring physician volume trends </li></ul></ul><ul><li>3. Target specific audiences </li></ul><ul><ul><li>Physicians </li></ul></ul><ul><ul><li>Staff </li></ul></ul><ul><ul><li>External audiences </li></ul></ul>Saint Vincent Heart Center, ©2004
  18. 18. 16 REPORT Intermediate Process 1. Costs Wasted M & S Supplies: Simple Bare Metal Stent Cases M & S Supplies: Cost per case for Simple Bare Metal Stent Cases Measuring Outcomes 8% 24% Saint Vincent Heart Center, ©2004
  19. 19. Simple Bare Metal Stent Cost / Case (CY 2002) (CY 2003) Providing blinded physician data is a very effective way to impact process improvement 1. Costs (cont’d) Level Improvement EXAMPLES 17 $37 $1,900 1.2 1.4 0.9 1.6 370 Phys E $30 $1,910 1.5 1.6 1.1 1.5 315 Phys D $31 $1,475 1.2 1.4 0.75 1.4 220 Phys C $38 $1,510 1.1 1.3 0.7 1.4 280 Phys B $36 $1,790 1.2 1.4 0.8 1.3 266 Phys A Waste Cost Guide Wire Balloon Stent N $37 $1,900 1.2 1.4 0.9 1.6 350 Phys E $75 $2,115 1.5 1.6 1.1 1.8 281 Phys D $31 $1,475 1.2 1.4 0.75 1.2 199 Phys C $38 $1,510 1.1 1.3 0.7 1.3 270 Phys B $46 $1,818 1.2 1.4 0.8 1.6 259 Phys A Waste Cost Guide Wire Balloon Stent N Saint Vincent Heart Center, ©2004
  20. 20. Minutes Intermediate Process REPORT 2. Revenue 18 Physician response data proved otherwise Cath Lab staff claimed ongoing turn-around time delays due to physician response times Saint Vincent Heart Center, ©2004
  21. 21. Relative value analysis Pattern analysis with relative values 2. Revenue Level Improvement EXAMPLES 19 Saint Vincent Heart Center, ©2004
  22. 22. “ If You Can’t Measure it, You Can’t Manage it” -Peter Drucker Automation provided sustainability and drove billing errors to near zero Intermediate Process REPORT 2. Revenue (cont’d) 20 Began looking at charges, validating w/ Finance Department, & recovering revenue Saint Vincent Heart Center, ©2004
  23. 23. Cath: Billed Procedures in Apollo Name Description Stent Charge? # Stents 5/19/2003 Patient Yes 2 Stent PTCA Simple (5331015) ACT Levels (4010135) LHC LV-Gram Cors Perc (5331003) 5/19/2003 Patient 2 LHC LV-Gram Cors Perc (5331003) 5/19/2003 Patient 3 Yes 1 ACT Levels (4010135) Drug Eluting Stent Simple (5331090) 5/19/2003 Patient Yes 1 LHC LV-Gram Cors Perc (5331003) ACT Levels (4010135) Stent PTCA Simple (5331015) Automated charge validation in real-time 2. Revenue (cont’d) Level Improvement EXAMPLES 21 Saint Vincent Heart Center, ©2004
  24. 24. Intermediate Process REPORT 3. ROI 22 Decreased inventory value (decreased shelf inventory = increased cash flow) <ul><li>Decreased Shelf Inventory </li></ul><ul><ul><li>Partnering w/ physicians </li></ul></ul><ul><ul><ul><li>Only 2 interventional supply vendors </li></ul></ul></ul><ul><ul><li>Partnering w/ vendors </li></ul></ul><ul><ul><ul><li>One-for-one exchange for stents that won’t cross lesion </li></ul></ul></ul><ul><ul><li>“ Just In Time” inventory </li></ul></ul>DES technology Saint Vincent Heart Center, ©2004
  25. 25. 3. ROI Level Improvement EXAMPLES 23 DES technology Monthly monitoring of costs enables us to react quickly to unexpected fluctuations Saint Vincent Heart Center, ©2004
  26. 26. Intermediate Process REPORT 4. Market 24 Know your referral market to build & maintain your business Saint Vincent Heart Center, ©2004
  27. 27. 4. Market Level Improvement EXAMPLES 25 Referring physician detail enables prompt action when trends are spotted Saint Vincent Heart Center, ©2004
  28. 28. Intermediate Process REPORT 5. Quality 26 Vascular comp 1 SD above & below mean Case volume High risk, high volume procedures are monitored closely. Automated analysis : PV techs perform non-inv arterial studies on any suspicious access site. Data entered into CV information system. Automated reports created to scan for complications in real-time. Saint Vincent Heart Center, ©2004
  29. 29. 5. Quality Level Improvement EXAMPLES 27 5% 1% <ul><li>Improved outcomes related to </li></ul><ul><li>Peer Review </li></ul><ul><ul><li>Physicians’ reliance on information </li></ul></ul><ul><li>National Benchmarks </li></ul><ul><ul><li>External benchmarks validate data at a national level </li></ul></ul>Saint Vincent Heart Center, ©2004 CY 2003 CY 2002 ACC 2.2% 1% 3.5% 1.2% Physician E 3.6% .7% 3% 1% Physician D 2.9% .9% 5% 1% Physician C 3.6% 1% 0% 0% Physician B 3.6% 0% 3.8% 1% Physician A Compli-cations Mortality Compli-cations Mortality PCI Complications & Mortality per Physician
  30. 30. Intermediate Process REPORT 5. Quality 28 “ Customers feel variations, not averages.” - Dave Schulenberg Focused on holding the gain Saint Vincent Heart Center, ©2004
  31. 31. 5. Quality <ul><li>Process improvement not only includes data analysis, </li></ul><ul><li>but taking action to impact change: </li></ul><ul><ul><li>meet w/ ER to share data </li></ul></ul><ul><ul><li>propose process changes </li></ul></ul><ul><ul><li>timely feedback of data </li></ul></ul>Level Improvement EXAMPLES 29 Saint Vincent Heart Center, ©2004
  32. 32. Intermediate Process REPORT 5. Quality (cont’) BRIDGING the GAP in Coronary Care 30 <ul><li>Focuses on improving Quality of Care by: </li></ul><ul><li>Increasing adherence to the nationally recognized ACC/AHA evidence-based guidelines </li></ul><ul><li>Providing scientific rationale to validate practice choices </li></ul><ul><li>Implementing standardized treatment protocols thus reducing variability in care </li></ul><ul><li>Empowering patient and family education </li></ul><ul><li>Measuring performance and identifying areas of need. </li></ul>Guidelines Applied in Practice (GAP) Saint Vincent Heart Center, ©2004
  33. 33. SAINT VINCENT GAP Target Populations: Myocardial Infarction Congestive Heart Failure Atrial Fibrillation Tool Kit: Pocket Guidelines Standard Order Set Clinical Path for Caregivers Reminder Stickers for Charts Patient Education Binder MI Teaching Team Discharge Contract Hospital Report Card & Physician Report Card Go Live: March 2003 with MI, September 2003 with CHF, March 2004 with Atrial Fib Level Improvement EXAMPLES 31 Saint Vincent Heart Center, ©2004
  34. 34. The Evidence Scientific rationale validates practice choices Challenge - Physicians resist someone telling them “..how to practice medicine”. Example: initial ACLS implementation. Intermediate Process REPORT 5. Quality (cont’) GAP - AMI 32 1 Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, Weaver WD, “ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee on Management of Acute Myocardial Infarction)”. Saint Vincent Heart Center, ©2004
  35. 35. 5. Quality (cont’) GAP - AMI Level Improvement EXAMPLES 33 Performance measures Reducing variability in care Saint Vincent Heart Center, ©2004
  36. 36. <ul><li>Education & collaboration: 2 keys for project success </li></ul><ul><li>Staff education via inservices, bulletin boards </li></ul><ul><ul><li>new tools supplanted older tools </li></ul></ul><ul><li>Cardiologists took ownership of educating other physicians </li></ul><ul><ul><li>explained scientific rationale </li></ul></ul><ul><ul><li>showed improved outcomes </li></ul></ul><ul><li>Took about 1 month to educate staff, physicians in new GAP tools </li></ul>Intermediate Level Process Improvement REPORT 5. Quality (cont’) GAP 34 Saint Vincent Heart Center, ©2004
  37. 37. 35
  38. 39. The Power of Data Integration 36 Saint Vincent Heart Center, ©2004 A “Defining Moment” “ Getting Acquainted with Your Data” “ Process Improvement” “ Driving the Work Process”
  39. 40. Advanced Driving the Work GAP Population Identification Interfaces 37 Patient Registration Laboratory Central Data Mgmt tm Tom Allen 87498 John Smith 46165 Sally Jones 98994 Alan Riley 99849 Ann Smiley 10564 GAP Patients Bi-directional interface of qualifying patient info and patient treatment data drives Case Manager work process Saint Vincent Heart Center, ©2004 Pharmacy
  40. 41. Level Process GAP Discharge Contract 38 <ul><li>Patient: John Smith </li></ul><ul><li>Room 3220 MR#87654 </li></ul><ul><li>Early ASA </li></ul><ul><ul><li>contraindicated </li></ul></ul><ul><li>Beta Blocker </li></ul><ul><ul><li>contraindicated </li></ul></ul><ul><li>ACE Inhibitor </li></ul><ul><ul><li>contraindicated </li></ul></ul>next tm <ul><li>Patient Name: ________________ </li></ul><ul><li>Prescriptions </li></ul><ul><ul><li>ASA </li></ul></ul><ul><ul><li>Beta Blocker </li></ul></ul><ul><ul><li>ACE Inhibitor </li></ul></ul><ul><ul><li>Lipid Lowering </li></ul></ul><ul><li>Smoking Cessation Date </li></ul><ul><li>Dietary Counseling </li></ul><ul><li>Physical Activity </li></ul><ul><li>Physician follow-up </li></ul>Patient Signature: _____________ Saint Vincent Heart Center, ©2004 GAP AMI Discharge Contract Case Manager reviews Discharge Contract with patient, generates document for signature and downloads to data system
  41. 42. 39 Advanced Driving the Work COLLECT ANALYZE <ul><li>Data is collected in “real time”, either through point-of-care capture, or by electronic transfer. </li></ul><ul><li>Use of portable devices, such as handheld computers, scanners, etc. </li></ul><ul><li>Additional interfaces are implemented, and some become bi-directional. </li></ul><ul><li>On-line, template-based report generation </li></ul><ul><li>May incorporate DICOM compatible images/archiving </li></ul><ul><li>Greater use of relative values. </li></ul><ul><li>Analysis focuses on spotting patterns and/or trends, and projecting future activity. </li></ul><ul><li>Data from multiple sources is integrated to see activity across departments. </li></ul><ul><li>Patient: John Smith </li></ul><ul><li>Room 3220 MR#87654 </li></ul><ul><li>Early ASA </li></ul><ul><ul><li>contraindicated </li></ul></ul><ul><li>Beta Blocker </li></ul><ul><ul><li>contraindicated </li></ul></ul><ul><li>ACE Inhibitor </li></ul><ul><ul><li>contraindicated </li></ul></ul>next tm Saint Vincent Heart Center, ©2004
  42. 43. 40 Level Process REPORT <ul><li>Report Maturation </li></ul><ul><ul><li>Advance from serving as summaries of data to providing detailed analysis, or becoming an integral component of the work process </li></ul></ul><ul><li>Automatic Report Generation </li></ul><ul><ul><li>Daily work process activity validation </li></ul></ul><ul><ul><li>Medical record components </li></ul></ul><ul><ul><li>On-line availability </li></ul></ul><ul><li>Comparative data </li></ul><ul><ul><li>Trending, projections, analysis, and “what-if” models </li></ul></ul><ul><li>Further targeting for specific audiences and purposes </li></ul><ul><ul><li>Physicians (working documents, outcomes) </li></ul></ul><ul><ul><li>Staff (care process, operating efficiency) </li></ul></ul><ul><ul><li>Administration (forecasting and budgeting) </li></ul></ul><ul><ul><li>External audiences (quality, service delivery success) </li></ul></ul>Saint Vincent Heart Center, ©2004
  43. 44. Advanced Driving the Work REPORT 2. Cost Reduction 41 Projecting the Impact of Drug Eluting Stents Variables <ul><li>Historical Rates </li></ul><ul><ul><li>% Dx Cath to PCI </li></ul></ul><ul><ul><li>% Dx Cath to CABG </li></ul></ul><ul><li>PCI Factors </li></ul><ul><ul><li>Growth in Dx Cath Market Share </li></ul></ul><ul><ul><li>% of PCI Restenosis </li></ul></ul><ul><ul><li>Staging of 2 and 3 vessel cases? </li></ul></ul><ul><li>Open Heart Factors </li></ul><ul><ul><li>CABG + Valve </li></ul></ul><ul><ul><li>Valve Only </li></ul></ul><ul><ul><li>Other (VAD) </li></ul></ul><ul><ul><li>Conversions to PCI </li></ul></ul><ul><ul><ul><li>L Main </li></ul></ul></ul><ul><ul><ul><li>Re-do CABG </li></ul></ul></ul><ul><ul><ul><li>Previous PCI </li></ul></ul></ul><ul><ul><ul><li>>=2 Total Occlusions </li></ul></ul></ul><ul><ul><ul><li>Urgent/Emergent </li></ul></ul></ul><ul><ul><ul><li>Direct to CABG </li></ul></ul></ul><ul><ul><ul><li>>=5 Dist. Anastomoses </li></ul></ul></ul><ul><ul><ul><li>4 Dist. Anastomoses </li></ul></ul></ul><ul><ul><ul><li>3 Dist. Anastomoses </li></ul></ul></ul><ul><ul><ul><li>2 Dist. Anastomoses </li></ul></ul></ul><ul><ul><ul><li>1 Dist. Anastomosis </li></ul></ul></ul>Factors CABG Cases % BASELINE = 776 cases 9% 11% 2% 2% <1% 19% 11% 5% 2% 11% 2% 3% 8% 8% <1% 0% <1% <1% 71 86 12 15 5 144 86 42 18 85 13 22 61 59 2 0 5 5 A B C D E F G H I J K L M N O P Q R Model based on The Advisory Board Company, 2002 Saint Vincent Heart Center, ©2004
  44. 45. Level Process EXAMPLES* 42 Saint Vincent Heart Center - Drug Eluting Stent Impact Analysis *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. Saint Vincent Heart Center, ©2004 A “what if?” analysis to project the impact of multiple variables
  45. 46. Advanced Driving the Work REPORT 2. Cost Reduction 43 Model based on The Advisory Board Company, 2002 In Year 1, expect 51 cases to convert from CABG to PCI w/ DES *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. Saint Vincent Heart Center, ©2004
  46. 47. Level Process EXAMPLES* 44 5-year volume projections make budgeting easier and defensible DES use monitored by on-line, updatable query report Saint Vincent Heart Center, ©2004
  47. 48. Advanced Driving the Work REPORT 3. Revenue Enhancement 45 Saint Vincent Heart Center, ©2004
  48. 49. Level Process EXAMPLES 46 ACS Saint Vincent Heart Center, ©2004
  49. 50. Advanced Driving the Work 4. Market Share Knowledge 47 Saint Vincent Heart Center, ©2004
  50. 51. Level Process 48 Saint Vincent Heart Center, ©2004
  51. 52. Advanced Driving the Work REPORT 2. Market Share Knowledge* 49 *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. In-house DRG data provides current market share information Per capita data provides perspective on total market size External database provides DRG-based by-hospital admission data Saint Vincent Heart Center, ©2004
  52. 53. Level Process EXAMPLES* 50 *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. Knowledge of “out-migration” provides opportunity for volume growth Saint Vincent Heart Center, ©2004
  53. 54. Advanced Driving the Work REPORT 5. Return on Investment 51 Surgical patients discharged to home Monthly surgical case data review suggested increased incidence of re-admission for pleural effusion Saint Vincent Heart Center, ©2004
  54. 55. Level Process EXAMPLES 52 Saint Vincent Heart Center, ©2004 Moving P.O. Visit #1 to Day 10 reduced pleural effusion rates by 75% 75%
  55. 56. Advanced Driving the Work HEART CENTER 5. Return on Investment 53 Data is routinely updated by multiple sources across the network, avoiding an overload on individuals, and providing data accountability Saint Vincent Heart Center, ©2004
  56. 57. Level Process DASHBOARD 54 On-line “Performance Dashboard” provides easy access to key business indicators in an easily read, graphic format. OPERATIONS CLINICAL QUALITY SATISFACTION FINANCIAL <ul><li>Indicator Criteria : </li></ul><ul><li>“ High Altitude” perspective </li></ul><ul><li>Sufficiently sensitive and specific </li></ul><ul><li>Monthly or more frequent </li></ul><ul><li>Available by 15th day of next month </li></ul><ul><li>Sustainable (multiple contributors) </li></ul>Each tab represents one of the performance domains Graphs update with new data from source files automatically Pre-set “acceptable” data ranges trigger action Saint Vincent Heart Center, ©2004
  57. 58. Advanced Driving the Work REPORT 5. Return on Investment 55 Saint Vincent Heart Center, ©2004 <ul><li>Physicians build Cath, Echo and Stress reports on-line: </li></ul><ul><li>reducing variation </li></ul><ul><li>increasing accuracy & completeness (coding) </li></ul><ul><li>speeding report onto chart </li></ul><ul><li>eliminating transcription and “lost” reports </li></ul><ul><li>and… </li></ul>
  58. 59. EXAMPLES 56 $525,000 “ Automatic Electronic transfer of procedural information to offices expedites billing & lowers accounts receivable. Our cardiology group saw A/R Days drop from 47 to 39 days, improving cash flow by $525,000.” -Cardiology group President Level Process Saint Vincent Heart Center, ©2004
  59. 60. <ul><li>Accountability to the communities we serve </li></ul><ul><ul><li>demonstrate commitment to quality </li></ul></ul><ul><ul><li>building trust </li></ul></ul><ul><li>Consumer interest </li></ul><ul><ul><li>Era of accountability </li></ul></ul><ul><ul><li>The Baby Boomer Effect </li></ul></ul><ul><ul><li>Growing awareness of differences in providers </li></ul></ul><ul><li>Public Reporting - Current </li></ul><ul><ul><li>Pennsylvania Health Care Cost Containment Council (PHC4) </li></ul></ul><ul><ul><li>JCAHO performance measures </li></ul></ul><ul><ul><li>CMS/Premier “Pay for Performance” Demonstration Project </li></ul></ul><ul><ul><li>National Voluntary Hospital Reporting Initiative </li></ul></ul><ul><ul><ul><li>Voluntary data submission to CMS </li></ul></ul></ul><ul><ul><ul><li>10 measures in 3 conditions - AMI, CHF, and pneumonia </li></ul></ul></ul><ul><ul><ul><li>JCAHO specifications for JCAHO accredited hospitals, CMS specifications for non-accredited hospitals </li></ul></ul></ul><ul><ul><ul><li>Evidence-based measures </li></ul></ul></ul>WHY QUALITY? 57 Advanced Driving the Work Saint Vincent Heart Center, ©2004
  60. 61. <ul><li>Public Reporting - Future </li></ul><ul><ul><li>Section 501 of the Medicare Prescription Drug Improvement and Modernization Act (MMA) </li></ul></ul><ul><ul><ul><li>Fiscal year for payment differential begins 10/1/2004 </li></ul></ul></ul><ul><ul><ul><li>All subsection (d) hospitals </li></ul></ul></ul><ul><ul><ul><li>Public reporting of 10 ‘starter set’ of measures (same as in voluntary effort) </li></ul></ul></ul><ul><ul><ul><li>“ .. a hospital that does not submit performance data for the ten quality measures will receive 0.4% lower payment for FY 2005 than a hospital that does submit performance data.” </li></ul></ul></ul>This section 501 of the MMA is just the beginning of mandated public reporting Pay for performance is on the horizon!!!! WHY NOW? 58 Level Process Saint Vincent Heart Center, ©2004
  61. 62. 59 The Power of Data Integration Closing Observations <ul><li>Physician Champion and Database Administrator </li></ul><ul><li>A Strategic Vision for Data Integration </li></ul><ul><li>Long-term Hospital Administration Commitment </li></ul><ul><ul><li>Capital $ resources </li></ul></ul><ul><ul><li>Information Technology infrastructure </li></ul></ul><ul><li>Open Architecture </li></ul><ul><li>Vendor “partnership” </li></ul><ul><li>Define a Core Set of Performance Indicators </li></ul><ul><ul><li>High Level </li></ul></ul><ul><ul><li>Leading Indicators </li></ul></ul><ul><ul><li>Trend over Time </li></ul></ul><ul><li>Commit to using data systems to drive the work process which supplant out-dated procedures </li></ul>Saint Vincent Heart Center, ©2004
  62. 63. Mark Kresse, MHS, PT [email_address] 814/452-7888 Pamela Goepfarth, RN, CCRN, RCIS, MEd [email_address] 814/452-7263 Saint Vincent Health Center 232 West 25 th Street Erie, Pennsylvania 16544 814/452-5000 Saint Vincent Heart Center, ©2004

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