Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"

Optimizing the EHR for Value in Today’s Health Care

Environment

Luis Saldana, MD, MBA, FACEP

CMIO

December 10, 2014

Learning Objectives

1.Provide an overview of THR’s strategy for improving patient outcomes and physician satisfaction through use of the EHR.

2.Share case studies from THR’s submission for HIMSS Stage 7 and 2013 Enterprise Davies Award.

3.Discuss strategies for aligning Governance with Organizational Strategy, and moving from Implementation to Optimization.

4.Share principles for adapting to a rapidly changing Healthcare environment.

5.Discuss future plans for ongoing use of the EHR in improving patient outcomes.

.

Link to Value

As indicated below, benefits of a fully deployed and adopted

EHR contribute to each category of the value chain

.

http://www.himss.org/ValueSuite

Patient Safety

Decreased med errors

Clinical decision support

Longitudinal data

ADE cost avoidance

Texas Health Mission To improve the health of the people in the

communities we serve

Texas Health Vision Texas Health Resources, a faith-based

organization joining with physicians, will be

the health care system of choice

Innovative Technology Solutions Innovate, transform, and serve

THR Value Proposition

• 2005 – 2006

– Implementation of the electronic health record across 14 THR entities was one of our largest investments.

– Created Value Model Program

• Performance Measurement

• (Value Model Realization) Project Objective:

To assure organizational focus on achieving the desired outcomes of improved quality,

safety, efficiency, and satisfaction.

Value Proposition Evolution

Past Approach

• Benefits Realization

• Direct Cost Savings

• HIM Efficiencies

• Forms Cost

• Cost Avoidance

• Falls

• ADE

• VTE

• Utilization

• CPOE

• Data-Defined Reporting

Current Approach

• Outcomes focused

• CAUTI

• Evidenced-based

• Order Set Management

• Predictive

• MEWS

• Increased use of CDS tools

• CBI for Outcomes Monitoring

• MU Dashboard

Future Approach

• Population Based

• Sepsis

• Diabetes

• CHF

• Transitions of Care

• PIECES

• Patient Engaged

• Portals, Interactive

• Care Continuum instead of episodic

• User-defined reporting/dashboards

• CBI for answering clinical questions

Implementation “The Primary Objective of the EHR Value Model Realization

Project and Steering Committee was to oversee the development, implementation and monitoring of a

framework for realizing and measuring the value of the EHR at THR”. – August, 2005

9

Baseline PHP Baseline PHD Baseline HMSW Baseline HMFW

Baseline

Little

H’s

….. Post

Measures HMSW Post

Measures PHD

Post Measures PHP

…..

2006 2007 2008 2009 2010

Identified Benefit Categories

Reduce paper forms usage and cost

Increase Efficiencies: HIM, Unit Clerk, and Nursing

Increase documentation compliance screening for Pressure Ulcers and Falls for improved patient outcomes

Increase Medication Safety – Adverse Drug Events (ADE) and Medication Errors

Decrease Postoperative Venous Thrombolytic Embolism (VTE) Incidence

$ Demonstrate Meaningful Use

6

CLINICAL VALUE

Medication Safety

• Demonstrated Reduction in ADEs:

– 53% reduction in medication errors through closed-loop medication administration process.

– 36% decrease in adverse drug events through universal use of CPOE by physicians, resulting in $1.8 million in cost avoidance.

– Current project to deploy smart pumps with “guardrail” software to alert the nurse when dosage parameters are exceeded.

THR Approach to Medication Safety

CPOE

Smart Pump Integration-Ongoing

BMV

Optimized CDS(FDB/Leapfrog)

© 2013 Epic Systems Corporation. Used with permission

Overall Medication Error Reduction

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

% Change

% Change

Represents an overall medication error rate decrease of

42% between 2010-2013

Modified Early Warning System- MEWS

• Evidenced-based predictive tool that indicates patients at

risk of clinical deterioration.

• Proactive management of patients before they

experience significant clinical events that negatively

impact their recovery.

• EHR facilitates clinician’s ability to aggregate patient

information to make care decisions sooner.

• MEWS project designed to bring relevant information to

the registered nurse with which to make immediate care

decisions in critical situations.

MEWS • Cardiac arrest decreased by 38% in the

first six months of use.

• Cardiac arrest decreased 65% within 1 year(represents 22 at-risk patients)

• Represents cost avoidance $640,000* per year from increased MEWS surveillance

So how does it work? *based on the Centers for Medicare and Medicaid Services average of ICU bed cost of $4,850, and an average ICU stay of three days).

MEWS Vital Sign Early Warning System

• Optimizes view of patient specific data

• Helps staff prioritize care

• Provides prompts to escalate concerns dependent on clinical judgment

© 2014 Epic Systems Corporation.

Venous Thromboembolism

• In 2008, Texas Health Resources launched a program

to prevent venous thromboembolism (VTE).

– We saw immediate change in practices, and by 2011, post-operative VTE rates were less than half of pre-program rates.

– Lowering post-op VTE rates has helped Texas Health to satisfy Surgical Care Improvement Project requirements, and to meet measures set forth by the Centers for Medicare and Medicaid Services.

– The VTE prophylaxis program was awarded a 2011 HIMSS Story of Success, which also was used as a case study to show the effectiveness of the Texas Health electronic medical record for EMRAM Stage 7 award designation.

Decreased Incidence of Deep Vein Thrombosis and

Pulmonary Embolus

• CareConnect provides standardized CPOE Order Sets and Clinical Decision support tools for appropriate VTE Prophylaxis.

• THR System VTE incidence steadily decreasing since implementation of CareConnect.*

• The Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Projects' estimates of inpatient cost are $10,000 per DVT and $20,000 per PE.**

* Data from CI DAM and VTE reporting

**Data from AHRQ website 4/2011

29

THR VTE Incidence Per Year

ITS key accomplishments - 2013

12/10/2014 21

Clinical EMR deployment

Meaningful use

Systems advancement

National and state

recognitions

• Continued to extend significant EMR advantage - Deployed integration of device monitoring with CareConnect systemwide - 2 of 4 THPR JV’s began the migration to CareConnect (complete in 2014) - Achieved Ambulatory EMR Adoption Model (AEMRAM) Stage 6 for THPG Clinics on CareConnect - 82% THPG providers on an EMR and 32% on CareConnect - 9 hospitals at HIMSS Analytics EMRAM Stage 7 (top 2.2% of U.S. hospitals)

• EMR deployment allowed THR to receive all of its allocated meaningful use funds

- 3 of 4 THPR JV’s successfully attested for MU year 2 - Third consecutive year of MU attestation for eligible hospitals (est: $13mm for 2013; $52mm to date) - THPG will receive approximately $2.8M MU funds and 72 % eligible providers are on track to attest for

2013

• Continued to expand quality of care through technology enablement - Deployment of population health dashboard - 96%ile physician satisfaction with IT in 2013 Press Ganey survey - Partnered with Healthways for deployment of population health technology - Rolled out significant technology in support of H&V service line (CVIS) - Went live with first deployment of THR’s Health Information Exchange

• Received national recognitions and accolades, - John E. Gall Jr. CIO of the Year Award – Edward Marx - 2013 Enterprise HIMSS Davies Award of Excellence - HIMSS EMRAM Stage 7 Award – THA, THAL, THAZ, THC, THDN, THFW, THSH, THS, THSW, THK - Information Week 500 – (Ranking – 168) - Health Care’s Most Wired Winner - Computerworld 100 Best Places to Work in IT – (Ranking – 31) - CSO40 Honoree

Current Focus –Transition from Hospital System to System of Care

Home

health

LTACH

SNF

Rehab

Urgent

care/ED

Diagnostics

JV

ASC

JV

Population

health

Independent physician

engagement

Ambulatory Plan Post-acute Services

Acute Care

MD expansion

IHC

Hospice /

Palliative

Supporting System Strategy

Guiding Principles • Focus on the tactical to be strategic • Be Protean, break down silos • Stay focused on the Important • Build teams you can trust to lead and execute • Communicate the Why • Remain sensitive to Clinical Operations-Workflows • Emphasize Measurement and Accountability • Celebrate victories and build on successes • Know Effective communication is elusive • Create Clarity

CHIO Leaders CIO

CNO

CMO

Governance • Restructured in 2013 to shift

to better support optimization

and Summit goals

• Identify problem areas early

and act

• Decommissioned all COPICs

• Create New User Groups to better serve the organization’s Strategy and stakeholders

• Allows for input by clinicians to recommend, approve, and manage optimization requests, and new functionality.

Optimization Process • Requests entered by user, entity, user group or

system initiative team (via a Service Ticket)

• Nursing Informatics reviews all requests initially and decides to deny or move forward.

• Request that move forward, then go to a User Group to be approved and defined.

• Then resource approval by Optimization Review Board.

• Then work completed, training, communication and implementation

Physician Satisfaction with IT Services

THR Data; Illustrative Only – 2014

Key Takeaways • CMIOs and CNIOs can bring the nursing and physician

communities together. Break down communication barriers between nurses and physicians.

• Be flexible and adaptable. It’s all about relationships and building relationships between disciplines. The process is important, not just the result.

• Break down silos- be protean, not territorial.

• Find a balance between strategic and tactical

• Align reporting structures and governance to facilitate collaboration.

Summarizing • Collaborating with clinicians is hard work, but pays

dividends; Keep showing up, be visible

• Nursing can play a pivotal facilitating role in optimizing clinical workflows; empower your nurses and build strong teams

• Clinical Informaticists have to be bridge builders for their organizations; Play a unique role

• Critical to build a culture of focus on measurement

• CMIO-CNIO collaboration can be key success factor for successful Healthcare organizations

In Summary

Implementing an EHR

• Big investment

• Gets you in the game

Value begins

• Closing care loops, gaps

• Informing, monitoring

Organizational Focus

• Evolves

• Leverage EHR to support

Its a continuing Journey we are privileged to be on

• To improve the health of the communities we serve

Questions? Thank You!

Luis Saldana, MD

[email protected] @lsaldanamd

Edward Marx

THAM, THD, THFW

THP, & THSW

HIMSS EMRAM Stage 6

designation at all

hospitals THA, THAL, THAZ, THC

THD, THDN, THFW, THSH, THS,

THSW, THK

Top Technological Innovators across

America for the 13th consecutive year

2008 Healthcare SIG

Project of the Year

2013 Enterprise Award

Innovator

State Advocacy Award

John E. Gall Jr. CIO of the Year

Award

Edward Marx

Edward Marx

Ranked 8

Large Company

Ranked 18

14 of the past 15 years Finalist