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Clinical Transformation, Part I

Clinical Transformation, Part I



This month's community call will focus on Clinical Transformation and Core Measures and is part one of a planned two part series on Clinical Transformation. ...

This month's community call will focus on Clinical Transformation and Core Measures and is part one of a planned two part series on Clinical Transformation.

We will start with a high level view of what Clinical Transformation can accomplish within an organization, then drill down to the Core Measures and the workflow within OpenVista.

What are Core Measures? Current and future Core Measures are a series of comparative performance measures developed by a number of quality forums and presided over by the Joint Commission (for details see: http://tinyurl.com/cv8zm9).

This topic is clinical in nature and will likely be useful to physicians, nurses and others interested in outcomes. Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.

What: Clinical Transformation (Part I)
- Stage 6 EHR Big Bang Effect
- Core Measures
- Primer
- Demonstration
- Future vision
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month

When: February 19, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/

The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.

Details and Recording is available here: http://medsphere.org/blogs/events/2009/02/19/community-call-february-2009



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    Clinical Transformation, Part I Clinical Transformation, Part I Presentation Transcript

    • Webinar: http://www.medsphere.com/infinite/ Voice: (888) 346-3950 Participant code: 1302465
    • Clinical Transformation, Part I February 2009 Community Call
    • Presenters • Edmund Billings • Janine Powell • Karen Small • George Lilly • Fay Struble • Jon Tai • Hartsel Bryant
    • Agenda • Clinical Transformation • Core Measures – Primer & Workflow – Demonstration – Future Vision & Discussion • Open Project Updates – CCD-CCR Project – OpenVista/GT.M Integration • Medsphere.org: Tip of the Month
    • Clinical Transformation Edmund Billings, MD
    • Clinical Transformation Using the HIT system to achieve clinical improvements: • Eliminate “Never Events” • Patient Safety • Quality Improvement • Population “Disease” Management 6
    • Legislation and Initiatives Never Events States-to-Date: 23 • 10/2008 “Never Events” – Starting 10/2008 Medicare & Major Payors will not reimburse for serious preventable events (E.g.Infections, embolisms, pneumonia) – Being adopted by 23 States with payers planning to not reimburse and/or hospital associations planning to not charge for these events. • 08/2008 - Mass quot;Healthcare Reform Actquot; – Implementation of EHRs in all provider settings, – By 2015. statewide interoperable Heath Information http://www.msnbc.msn.com/id/26140511 Exchange – A first year funding of $25 million, projected eight year $200 million investment. “ By 2012 for statewide adoption • 09/2008 - The Stark Law of CPOE would be required for hospital – The proposed bill would direct that EMR/EHR open-source licensure.” technology be developed and made available to health care providers at quot;a nominal cost.quot; “ …provision of an open source health information technology system that is either new or based on an open source health information technology system, such as VistA….” 7
    • Clinical Transformation Initiatives & Impact $1,500,000 Insurance providers est of saved life $20,000 Adverse drug event ($16,000-$24,000) $40,000 Cost of a VAP $750 Cost of a vent days 15% Medication reconciliation to reduce ADE (15%-20%) $25,546 Cost surgical infection $10,845 Cost of a pressure ulcer $25,000 Cost of a bloodstream infection $1.24 Cost savings from automating forms 25% Reduction in ventilator days through bundle compliance 8
    • 9
    • Industry Recognition 10
    • Why Stage 6 is Critical? • Supports Clinical Transformation “Stage 6 hospitals have achieved a significant advancement in their IT capabilities that positions them to successfully address many of the upcoming industry transformations we will be experiencing in the near future (e.g. HIPAA Claims Attachment, pay for performance, and government quality reporting programs)”. • Share Data with Stakeholders “Stage 6 hospitals are also well positioned to provide data to key stakeholders (e.g. payers, the government, physicians, consumer and employees) to support electronic health record (EHR) environments and regional health information organizations (RHIO’s).” Stage 6 Hospitals: The Journey and the Accomplishments, Mike Davis HIMSS Analytics, 2007. 11
    • Transformation ADOPTION IS NECESSARY BUT INSUFFICIENT not just adoption Value is shared goal, now the steps: 1. Implement to assure the technology is deployed and configured to support work processes. 2. The technologies enable the people to “use” the technology effectively. 3. Now, the people can use the system to change their processes and realize value. 12
    • 3 Transformation Steps 1. Adoption 1. Departmental automation - orders management - CPOE 2. Clinical usage 3. Necessary but not sufficient 2. Operational Transformation 1. System itself is closed loop and fills holes 2. Efficiencies, information access and accountabilities 3. Clinical Transformation 1. Use clinical content to address specific patient safety and clinical guidelines 2. Target specific outcomes with order sets, templates, clinical reminders 13
    • Medication Administration: CPOE & BCMA Automate Before After a Provider writes a Reviews Current renews, Reviews new, renews, Flag Patient Places Chart in Medications ,modifies, or DC’s Chart for Orders Rack 11 Steps an order Barcode Nurse Reviews Is medication Drug is dispensed Nurse Checks 5 Nurse Administers Nurse Reviews Medication Nurse Administers Nurse Pulls Chart Yes orders Floor stock? To patient Rights Medication orders Administration Medication Checks 5 rights No Unit Secretary or Unit Secretary Nurse faxes/tubes/ Pulls Chart or puts in pharmacy system Are there Any Drug Medication Order Medication Order Pharmacy Enters Pharamcy Verifies Pharmacy Tech Is medication Interactions or No No is Dispensed to Pharamcy Verifies Pharmacy Tech Order into System Order Fills Order Floor stock? is Dispensed to is this the Unit Order Fills Order Unit correct Dose Yes Yes Medication is on Notify Physician Unit 14
    • Stage 6: Operational Transformation Care Decrease time from Rx order to dispensing: 15-20 minutes Decrease Dx report turnaround: minutes, not hours Decrease Rx order errors Shift of RN time from documentation to patient care Order Result Decrease length of stay Charge Capture & Claims Increase in charge capture Reduction in uncoded account days Improved Case mix index improvement Discharged-Not-Final-Billed (DNFP): Dec AR days Decrease coding denials HIPAA Attachments Order/Doc Claim 15
    • How does it support clinical transformation? 1. Establish RN and MD usage 2. Plan: prompt for standard of care – Order Set – Template – Clinical Reminders 3. Measure outcomes – Midland 5 million Lives – Never Events – Core Measures – Safety Checklists – Big Seven Chronic Diseases – Oncology Regime Tracking 4. Benchmark & Scoreboard 5. Iterate 16
    • Central Line-Associated Primary Bloodstream Infection Rate 30.00 Central Line Primary Bloodstream Infection Rate 24.39 25.00 20.00 Per Thousand 88% Improvement 15.00 in 18 months 10.00 5.00 2.95 0.00 Jul-Sep 2005 Feb 2007-Jan 2008 Time Period The Central Line-Associated Primary Bloodstream Infection (BSI) Rate per 1000 Central Line-Days improved from a mean of 24.39 (1 of 41 Jul-Sep 2005) to 2.95 (4 of 1355 Feb 2007 – Jan 2008). 17
    • Key Transformation Components Roadmap Today • Richer CDSS at Point of Care • Integrated EHR – EBM Care Protocols • No interoperability excuses – Rules-based activity monitoring • CPOE – Interruptive alerts – Passive recommendations • Closed loop orders and – Contextual access to references BCMA • Clinical Dashboard • Clinical documentation – Population Management • Content – Benchmarking – Order Sets – Scoreboarding – Templates • Community Collaboration – Clinical reminders – Sharing content • CDSS: Rx Error Checking – Sharing best practices – Proving standards of care “Health Improvement Technology” “Its integrated and it works” 18
    • Core Measures Fay Struble Janine Powell Karen Small Edmund Billings, MD
    • Problem • Hospitals have to hire full time staff to monitor and manage collection of data needed for compliance with regulatory and billing issues. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has created Core Measures standards in order to increase patient safety, improve the quality of care, disseminate evidence based practices, and identify high reliability health care organizations.
    • What are core measures? • Core Measures are sets of clinical care performance guidelines that the Joint Commission has established From research Past reporting Current best practices and evidence based care • Used for reimbursement purposes (Center of Medicare & Medicaid Services) • Used for research activities directed to improve the quality of care • Help identify and distinguish high reliability health care organizations • Identify and disseminate evidence-based practices and to set national benchmarks
    • Overview • For 2008, hospitals are required to collect and transmit data to The Joint Commission for a minimum of four Core Measures sets or a combination of applicable Core Measures sets and non-Core Measures. The measure sets currently available for selection are: Acute Myocardial Infarction (AMI) Heart Failure (HF) Pneumonia (PN) Pregnancy and Related Conditions (PR) Hospital-based Inpatient Psychiatric Services (HBIPS) – (Beginning with October 1, 2008 discharges) Children's Asthma Care (CAC) Surgical Care Improvement Project (SCIP) Hospital Outpatient Measures (HOP)
    • Poll
    • Value Medsphere, in its attempt to keep their clients compliant with these new regulatory guidelines, has created a content-driven solution utilizing Clinical Reminders, health factors, and tailored templates. Clinical Reminders provide real time point of care assistance, as well as retrospective patient reporting. Core Measures content is designed to provide hospitals with real time capture and retrospective reporting on Core Measure regulatory requirements while reducing the time required to manage and monitor the initiatives increasing compliance and revenue
    • Core Measure Initiation Workflow
    • Demo
    • Poll
    • Core Measures • Future Vision • Discussion
    • Open Development Projects George Lilly & Fay Struble Jon Tai
    • Community CCR/CCD Project* Opensource CCR and CCD support for VistA based systems Project Update February 19, 2009 by George Lilly glilly@glilly.net * This project has been funded in part with Federal funds from the National Institutes of Health, under Contract No. HHSN268200425212C, “Re-engineering the Clinical Research Enterprisequot;.
    • Topics Definition Purpose Snapshot Highlight Contributors
    • Defintion Definition: The Continuity of Care Record (CCR) is a machine readable and human readable ASTM XML standard data set of a person's clinical status
    • Poll
    • Purpose The CCR dataset has many intended purposes including the exchange of medical records, synchronization with clinical repositories, and the transformation into clinical messages Exchange of medical records: Between two EHR systems (VistA<->VistA and VistA<->Other) With a Personal Health Record (PHR) – like Google Health or MS HealthVault Synchronization with clinical repositories: For clinical decision support For research and clinical trials – as with the Electronic Primary Care Research Network (ePCRN) Transformation into clinical messages XSLT transformation into a Continuity of Care Document (CCD) For use the the National Health Information Network (NHIN) For CCHIT Certification For HIPAA Claims Attachments Transformation into XML Web Service messages for ePrescribing
    • CCR/CCD PROJECT SNAPSHOT 2/19/2009 Picklist Web File CCD Transformation Processing Service ePCRN Connection CCR Batch Parameters Template Processing ePrescription XML Fileman Parameters Support Lab Date Limits CCR Meds Date Limits Fileman Template File Checksums Processor Menu Vitals Date Limits Template Import Options Codes XPath Library XML RPC Variables RPC MUMPS Temporary Globals Fileman CCR Elements Export Import (Accessioning) Family History Advance Directives Lab Results Vital Signs Alerts/Allergies Procedures Support Payers Medications Problems Actors Medication Advisories (ePrescribing) Encounters Functional Status Immunizations Alerts/Allergies Plan of Care Medical Equipment Social History GTM GTM Cache GTM GTM Cache WorldVistA OpenVista FOIA VistA RPMS EHR Legend Planned In Development Testing In Production Recent Change
    • Poll
    • Highlight Recently, we demonstrated the transformation of our CCRs into level 2 CCDs thanks to an XSLT transformation contributed by Ken Miller
    • Contributors HP George Lilly KRM John McCormack Medsphere Ben Mehling Robert Morris University Dennis Menor Seqeuence Managers Ken Miller University of Minnesota Kevin Peterson Christopher Anderson Chris Richardson Nancy Anthracite Mike Schendel Lee Castonguay Fay Struble Duane DeCorteau Thomas Sullivan Emory Fry Chris Uyehara Sam Habiel David Whitten Greg Woodhouse Jose Lacal JohnLeo Zimmer
    • OpenVista/GT.M Integration Project Jon Tai
    • Activity Numbers 28 bugs filed 51 commits in 8 branches 32 messages discussing 6 proposals Many more on Hardhats 6 blog posts
    • Last Month Settled on filesystem layout and Linux permissions scheme Wrote proof-of-concept code to create OpenVista instances, perform backups Identified areas in OpenVista that will require modification Wrote proof-of-concept code to allow M-based tools in OpenVista to start/stop TCP listeners Started developing test plans Started packaging various utilities, including GT.M itself
    • This Month Finalize design decisions Switching “namespaces” KIDS and “routine tiers” File more bugs Not just defects – includes task/feature bugs Having all tasks in the tracker will allow us to better track work completed and work remaining Makes it easier for others to get involved − Start on implementation
    • Get Involved Code is available on Launchpad Not production ready; for developers only Bugs are in Launchpad You can help! File a bug Comment on a bug with suggestions Create a branch and fix a bug yourself Not sure how to get started? Post on Medsphere.org with your interests; we'll find something for you!
    • Medsphere.org Tip of the Month Hartsel Bryant
    • Demo