TECHTalks Breakfast Symposium Data for Patient Safety

1. © CGI Group Inc. CONFIDENTIAL
Data for Patient Safety
Canadian Association of Paediatric Health Centres Conference
Camille Poulin PT, B.Sc.P.T., CPHIMS-CA, PMP
October 24 and 25, 2016
Halifax, NS, Canada

2. Topics
Improving patient safety - methods and mechanisms
• Trigger tools
• Patient safety indicators, reporting, and actionable insights
The data behind patient safety
• Problem
• Opportunity
Example use case and demo
New use cases? What’s coming next?
2

3. 3
Methods and Mechanisms
Care is provided
As planned? How do you know?
Detection & Reporting
Voluntary
Reporting
Chart Audit
Interviews
Surveys
Patient or Family
Report
Trigger Tools -
Global
Trigger Tools -
Interventionist
Indicators and
Reporting

4. Trigger tools
4
• Trigger Tool for Measuring Adverse Drug Events
• IHI Skilled Nursing Facility Trigger Tool for
Measuring Adverse Events
• Trigger Tool for Measuring Adverse Drug Events
in a Mental Health Setting
• Surgical Trigger Tool for Measuring Peri-
operative Adverse Events
• Intensive Care Unit Adverse Event Trigger Tool
• Pediatric Trigger Toolkit: Measuring Adverse
Drug Events in the Children’s Hospital
• Perinatal Trigger Tool
• Trigger Tool for Measuring Adverse Events in the
Neonatal Intensive Care Unit
• Outpatient Adverse Event Trigger Tool

5. Review of the evidence – key points for trigger tools
• Sampling strategy generalizable across an organization
• Guided decision making encourages consistency
• Pragmatic approach to record review
• Can focus on high risk areas
• Standardized methodology
• Rate of harm amenable to organizational monitoring
In general, there is widespread support for use
of trigger tools

6. Results: using trigger tools
6
Canadian Paediatric Adverse Events Study
• Used the CAPHC Paediatric Trigger Tool - rate, type,
severity, and preventability
• Compare adverse event epidemiology - academic
paediatric centres and community hospitals
9.2% of children hospitalized in Canada experience
adverse events
• Academic paediatric centres: more surgical AEs
• Community hospitals: more AEs related to clinical
management
Attention to surgical safety is the single most effective strategy
for improving overall safety for paediatric care in Canada

7. Part of the patient safety answer
Plan
Do
Act
Study
Research
Detect
Report
Train
& Learn
Improve
Process
Align Culture
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8. Filling the trigger tool gaps
8
Small sample
Analytics approaches can sample
whole populations
20 minutes limits what you can find
Automation reduces the time to
detect triggers to a few seconds
Medical record doesn’t contain all
the information
Patient self report
Trigger tools don’t pick up all types
of adverse events
Patient safety indicators, patient self
report, additional big data analysis
Errors of omission missed by most
trigger tools
Rules engines to identify missing
pieces from known best practices

9. Coded data and indicators
• Coded/structured data in trigger tools
• ICD-11
• Clustering, diagnostic timing indicators
• AHRQ patient safety indicators
• Hospital harm – CIHI and CPSI
• Hospital acquired conditions
9

10. The data reality
10
OTN
A
B
C
C
B C
K
K
K
S O
A
S H

11. Alternate data reality
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12. The data opportunity
12
COLLECT
Clinical
Administrative
FOCUS DETECT
Potential
adverse events
Other
deviations from
expected care
trajectories
Meaningful and
Relevant Data
Points
CONFIRM
Qualify
Classify
COLLATE
Aggregate
Report
ANALYZE
Describe
Predict
PrescribeUnstructured
Coded

13. The ecosystem – are we ready?
• Data
• Culture
• Public needs and perceptions
13
https://www.england.nhs.uk/ourwork/tsd/care-data/
https://www.nih.gov/news-events/news-
releases/survey-shows-broad-support-national-
precision-medicine-study
….NHS England has taken the
decision to close the care.data
programme. https://www.england.nhs.uk/
ourwork/tsd/care-data/
http://www.zdnet.com/article/brandis-to-criminalise-
re-identifying-anonymous-data-under-privacy-act/

14. Use case: automated detection of triggers
Patient
admitted
Diagnosis Treatment
plan
Procedures &
Interventions
Patient
discharged
Data captured regarding care provided
34
25
16
Review & Classify
AE awareness and prevention
Adverse event detection
Automated identification
of IHI triggers
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15. Trigger tool automation demonstration
15

16. Trigger tool automation demonstration
16

17. Creating solutions
17
OCR
ECM
NLP, Analytics

18. Expanding the use case: real time detection of triggers
Patient
admitted
Diagnosis Treatment
plan
Procedures &
Interventions
Patient
discharged
Data captured regarding care provided
34
25
16
Review & Classify
AE awareness and prevention
Adverse event detection
Automated identification
of IHI triggers
18
Adverse event preventionD1 D2 D3

19. Contact Information
Camille Poulin PT, B.Sc.P.T., CPHIMS-CA, PMP
Director, Consulting
camille.poulin@cgi.com
780-409-5522

20. References
1. Anne G Matlow, Catherine M G Cronin, Virginia Flintoft, Cheri Nijssen-Jordan, Mark Fleming, Barbara Brady-Fryer, Mary-Ann Hiltz, Elaine Orrbine, G Ross
Baker. Description of the development and validation of the Canadian Paediatric Trigger Tool, BMJ Qual Saf 2011;20:416e423.
doi:10.1136/bmjqs.2010.041152
2. Canadian Patient Safety Institute, Canadian Paediatric Adverse Events Study, 2013
3. Health Quality & Safety Commission. 2016. The global trigger tool: A review of the evidence (2016 edition). Wellington: Health Quality & Safety Commission.
4. Persephone Doupi, Karolina Peltomaa, Mika Kaartinen, Juha Öhman. IHI Global Trigger Tool and patient safety monitoring in Finnish hospitals - Current
experiences and future trends. 2013.
5. Schildmeijer K, Nilsson L, Perk J, et al. Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus
group interviews with team members. BMJ Open 2013;3:e003131. doi:10.1136/bmjopen-2013-003131
6. Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, Massachusetts:
Institute for Healthcare Improvement; 2009. (Available on www.IHI.org)
7. Department of Health and Human Services, Centers for Medicare & Medicaid Services: Adverse Drug Event Trigger Tool
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/Adverse-Drug-Event-Trigger-Tool.pdf
8. Agency for Healthcare Research and Quality – Patient Safety Indicators http://www.qualityindicators.ahrq.gov/modules/psi_overview.aspx
9. Ghali et al ICD-11 for quality and safety: overview of the who quality and safety topic advisory group. International Journal for Quality in Health Care 2013;
Volume 25, Number 6: pp. 621–625 10.1093/intqhc/mzt074.
10. Danielle A. Southern, Marc Hall, Deborah E. White, Patrick S. Roman, Vuaya Sundararajan, Saskia E. Droesler, Harold Pincus, William A. Ghali,
Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data. International Journal for
Quality in Health Care, 2015, 1–7. doi: 10.1093/intqhc/mzv096
11. Southern DA, Pincus HA, Romano PS, Burnand B, Harrison J, Forster AJ, Moskal L, Quan H, Droesler SE, Sundararajan V, Colin C, Gurevich Y, Brien SE,
Kostanjsek N, Üstün B, Ghali WA; World Health Organization ICD-11 Revision Topic Advisory Group on Quality & Safety; World Health Organization ICD-11
Revision Topic Advisory Group on Quality & Safety. Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International
Classification of Diseases (ICD-11).Int J Qual Health Care. 2016 Feb;28(1):136-42. doi: 10.1093/intqhc/mzv099. Epub 2015 Dec 10.
12. Canadian Institute for Health Information and Canadian Patient Safety Institute, Hospital Harm Project, https://www.cihi.ca/en/health-system-
performance/quality-of-care-and-outcomes/patient-safety/key-projects-on-patient-safety http://www.patientsafetyinstitute.ca/en/toolsResources/Hospital-
Harm-Measure/pages/default.aspx
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21. Supplemental

22. 22
Diagnoses
Medications
LabTests
Procedures
Clinical
Notes
Radiology
Discharge
Summary

23. 23
NLP

24. 24
National Coordination Council for Medication Error Reporting and Prevention Index
for Categorizing Medication Errors