Improving patient safety through the use of real time clinical data, Mr Giulio Bognolo, Chief Medical Officer UK, Cerner
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  • When acuity/dependency is implemented, managing to level of care includes each patients acuity level. The ICU is expected to have patients in the level 8-12 range Dk brown to hot pink. The first patient, Melissa Daniels is a level 7 (based on the shade of brown in the pattern bar) indicating her nursing dependency requirements do not warrant a critical care bed. The other patients are within the expected range of variability for the ICU
  • Draws on data from FirstNet, SurgiNet, Capacity Management/Patient Flow and ClairviaReal-time operational dashboard designed for action
  • While a variety of retrospective models have entered the marketplace, Cerner in partnership with Advocate Health will be deploying a real-time surveillance algorithm to predict the likelihood for ‘all-cause readmission’. Run from the cloud, this predictive model uses longitudinal historic and clinical data that will be used to improve readmission prevention workflows by allow appropriate allocation of resources. Data Types: Demographics, Conditions and Diagnosis, Procedures, Medications, Laboratory, Encounter Characteristics, UtilizationNovel Discoveries: Identified prior utilization as leading predictorChange in lab values over time is a significant predictorAge potentially yields better prediction as a continuous or grouped variableProven value of clinical data vs. non-administrative dataFacility plays a significant role in predicting readmissions contradictory to current literatureMore specific identification of variables yields better predictability Additional condition specific algorithms for Heart Failure and COPD have been developed by Cerner Math and will be available on our Healthe Intent platform.
  • Project SPEARSafer Patients through Electronic ADR ReportingUK Medicines Health and Regulatory Authority, Newcastle upon Tyne Hospitals NHS Foundation TrustEconomic modelingThe economic value of primary prophylaxis using pegfilgrastim compared with filgrastim in patients with breast cancer in the UKApplied Health Economics and Health Policy. September 2009, Volume 7, Issue 3, pp 193-205UCLA, Imperial College NHS Trust
  • This is a significant stepping stone to population health management and joining up the care continuum. Our approach is flexible, the drive is to unlock data silos and provide broad access to the data. We believe that EMR vendors should not compete on the data they hold.CapabilityStandards-based but not standards limitedWe have extensive experience of HIE deployments spanning the globe, based on International standards such as Integrating the Healthcare Enterprise (IHE) and national standards such as US Continuity of Care Document (CCD) and NHS Integration Toolkit (ITK). We are not limited to standards and connect real-time or batch using HL7 or CSV files from multiple sources. We support CCD to facilitate data sharing and this typically contains the items listed, though this is not an exhaustive list:Conditions, Medications, Allergies, Lab Orders/Results, Radiology, Microbiology, Procedures, Immunisations, Vital Signs, Diagnosis, Visits, Discharge Summaries, GP Data (MIG), etc….Centralised, Federated and Hybrid models supportedFlexible data model. Mainly Federated models in the US, conversely in the UK deployments to-date have been Hybrid with Secondary data centralised and Primary data federated.Library connections with main vendors in the marketWe are engaged at some level with all main vendors in the UK with a focus of building a library of connected resource to the HIE. We are connected to the Medical Interoperability Gateway (MIG), provided by Healthcare Gateway Ltrd, that links to EMIS, INPS and shortly also TPP EMRs. We have direct links with EMIS and shortly with CSE’s Rio EMR. We plan to connect to social services but has to be driven by our clients.3 potential ways to access the data. Natively using IHE profilesWeb Service call from clinical application (worked with EMIS and others to provide this). Include as part of clinical workflow is preferred to encourage adoption.Web Portal if neither of the other options are available. Access can be customised depending on User. SafeguardsOnly with data sharing agreements in place with each local GPOnly coded data used with certain exemptions, such as sexual health status and other sensitive informationRequires patient permission to be obtained or reason stated for override with audit trailsBenefitsAbility to add external data to the Millennium patient recordThis is a key benefit of Cerner’s solution as it allows data reconciliation between data sources and Cerner Millennium saving time and reducing transcription errors.Making better clinical decisionsMaking better care decisions because more is known about the patients – treatments like Ibuprofen might otherwise be withheld not knowing whether the patient has a contraindication like asthma or gastritisLess reliant on patient memory Access to results is more up-to-date as reduce time delay to sharingEnables clinicians to deal with confused patients e.g. elderly patients who are very confused and do not have their medicationsPatient safetyAbility to do medicines reconciliation so patients on the right treatmentA more complete record will enable safer decisions to me made, avoiding drug drug interactions or drug contraindications because of allergy or medical conditionsReduce time spent chasing informationAvoid all the calls and requests to photocopy and fax clinical notesThis will also reduce Length of Stay as time chasing missing information causes delays to dischargeReduce unnecessary testsSeeing recently completed tests in other care settings reduces the need to repeat testsUK progress In the UK we are live at Barts Health and Wirral. “Clinicians say that just one month into the project, being able to view a ‘community record’ is already helping them to make better clinical decisions and reducing the amount of time they spend chasing information or ordering repeat tests.” EHI: The Exchange Factor“Having access to a GP record with more accurate information means that we have got quite clear, precise information about what we are dealing with.” Emergency medicine consultant Karim Ahmad, Barts Health EHI: The Exchange Factor
  • Let’s meet Virginia Johnson. Virginia is a 57 year old married mother of 1 & grandmother of 2. She works full time as an administrative assistant. Virginia sees providers at Baseline Health for her chronic conditions which include heart failure and high blood pressure. Engagement through a personal portal is an important part of involving Virginia in her own care. Virginia is able to log into the Portal and ensure that she’s doing everything she and her doctor, Dr. Thomas, have talked about during her appointments. Virginia is reminded about her diet, exercise, medication plan, has access to education about her conditions, and has quick ways to contact her health team so that she has confidence that she’s doing the right thing. She also has the knowledge and comfort that her health team is watching over her. Whether she’s started gaining weight, if her blood pressure is “out of whack,” or she’s lost the motivation or ability to get up and move around, she knows her team will reach out to help if something is wrong. This is made seamless by the use of smart devices, like her wireless scale and blood pressure cuff, which are connected to her record, updating every time she measures them. Lastly, she has access to all of the key services of our organization. Between scheduling appointments, paying bills, accessing her records, and sharing information with her health team, interacting with Baseline Health has never been easier. Here, we can see Virginia is logged into her member portal and can see that her weight has begun to increase and is reaching the weight that she was at when she was last admitted to the hospital with symptoms of her heart failure. The system has identified the risk presented by Virginia’s weight gain & a questionnaire has been queued up for Virginia to answer.
  • Virginia can quickly and easily answer questions about how she is feeling with a few clicks. When she submits her questionnaire it is immediately made available to her care team, including her Primary Care Physician, Dr. Thomas, and her Care Manger, Cindy Miller. Now that Virginia has submitted her questionnaire, we will move into the Care Manager’s office.
  • (Insert your client’s logo on this slide, to the left of Cerner’s logo) Together, as a team, we have the ability to make a profound difference in the life of a son, a mother, a friend and a neighbor.   We owe it to our children, our grandchildren – the generations of tomorrow – to deliver nothing but the best… because health care is too important to stay the same.

Transcript

  • 1. #CCIO
  • 2. #CCIO Improving patient safety through the use of real time clinical data Mr Giulio Bognolo Chief Medical Officer UK Cerner
  • 3. Improving patient safety through the use of real time clinical data Giulio Bognolo, MD Chief Medical Officer
  • 4. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 4 Improving patient safety with technology Communicati on Delivery Tracking and reporting
  • 5. clinical docs order comms EPMA EPR clinical core theatres maternity an integrated clinical core is required to deliver substantial benefits for patient care Integrated clinical core
  • 6. clinical docs order comms EPMA EPR clinical core decision support coding performance improvement theatres maternity connected devices analytics workforce management research acuity driven nurse staffing the research- able EPR personalised medicine real-time benchmarking patient safety managing capacity Leverage
  • 7. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 7© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 10 Connect the Devices
  • 8. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 8 Safety – harm free care Children's Hospitals of Pittsburgh of UPMC - Adverse drug reactions reduced by 50% Children’s Hospital Los Angeles - Medication errors causing patient harm decreased by 30% Marina Salud - Hospital de Dénia - 37.2% of prescriptions intercepted avoiding allergic reaction Truman Medical Center - 180 incidents per year avoided Eastern Maine Medical Center - Medication incidents reduced by 27%
  • 9. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 9 Integrated clinical core - discharge planning MPage
  • 10. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 10 Integrated clinical core – alerting
  • 11. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 11 Most recent risk level
  • 12. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 12 Risk level
  • 13. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 13 Recommendations
  • 14. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 14 Allergies
  • 15. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 15 Renal adjustments
  • 16. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 16 Real Time Monitoring VTE Core Measure Performance Tracked Real Time
  • 17. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 17 Right staffing through real time acuity
  • 18. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 18 Command Center: Patient Flow Management
  • 19. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 20 The research-able EPR around the world PowerTrials® Emory Healthcare Florida Hospital MCG Health, Inc. St. Jude Georgia Regents University Advocate Health Care Centre for Addiction & Mental Health Columbia St. Mary's Inc. George Washington University (UHS) Lafayette General Medical Center The Children's Mercy Hospital University of Missouri Health Care Health Facts® 64 systems, 329 facilities PowerTrials® TILAK (Austria) Barts and The London NHS Trust (UK) Wirral NHS Trust (UK) Discovere ® 8,200 researchers 1,600 clinical research sites worldwide 300 publications 150 academic and research partners 3 Clinical Research Organizations (CROs) 7 of top 20 pharmaceutical companies Helix® 21 live systems in USA + 2 implementing PowerTrials® Hamad Medical Corporation (ME) SIDRA Medical and Research Center (ME) 7 billion patient encounters 47 million unique patients 14 condition-specific datamarts Helix ® 5 live systems rest of world +5 implementing
  • 20. health information exchange smart registries & scorecards patient portal wellness services patient engagement patient activation patient safety & better care integrated value- based care Population health
  • 21. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 22 Health Integration Engine – connecting the continuum Add external data to EPR Make better clinical decisions Patient safety Reduce time spent chasing information Reduce unnecessary tests 2 live clients in UK, 2 going live. 25+ networks in USA “Having access to a GP record with more accurate information means that we have got quite clear, precise information about what we are dealing with” Emergency medicine consultant Karim Ahmad, Barts Health GPs seeing the hospital record Hospital clinicians seeing the GP record
  • 22. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 23 Wellness – activating patients in their care Patients taking responsibility for their care Integrating education into care processes Device connectivity • Health risk assessments • Patient health, exercise and nutrition trackers • Prescribe-able education programs
  • 23. © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 26 Health care is too important to stay the same. TM