Leveraging Data for Success: - Coring the Core Measures - Chasing Discrepancies Leveraging Data for Success: - Coring the Core Measures - Chasing Discrepancies.

Leveraging Data for Success: Leveraging Data for Success: - Coring the Core Measures - Coring the Core Measures - Chasing Discrepancies - Chasing Discrepancies

Leveraging Data for Success: Leveraging Data for Success: - Coring the Core Measures - Coring the Core Measures - Chasing Discrepancies - Chasing Discrepancies

Richard S. MacKenzie, MD, FACEP Chair : Department of Emergency Medicine Lehigh Valley Hospital & Health Network

L. Albert Villarin MD FACEP CMIO : Albert Einstein Healthcare Network

Chris DeFlitch, MD, FACEP Director & Vice-Chair - Department of Emergency Medicine Physician Director, Connected, CIS

Overcoming the Hurdles: Overcoming the Hurdles: Improving DTB in the LVHHN Improving DTB in the LVHHN

MI-Alert Program MI-Alert Program

Overcoming the Hurdles: Overcoming the Hurdles: Improving DTB in the LVHHN Improving DTB in the LVHHN

MI-Alert Program MI-Alert Program

Richard S. MacKenzie, MD, FACEPChair

Department of Emergency MedicineLehigh Valley Hospital & Health Network

Richard S. MacKenzie, MD, FACEPChair

Department of Emergency MedicineLehigh Valley Hospital & Health Network

A

HOSPITALAND HEALTH NETWORK

LEHI H Vo LLEY

Problem at the MilleniumProblem at the Millenium

Inconsistency

Mortality 5-7% PCI

Mortality lytic 6-16%

EUR HEART J. 2002 23 550

PSIMTPSIMT

Plan Problem identification & clarification

Solution identification & clarification

Presentation for input

Do Implement - education precedes date

Presentation for understanding

PSIMT (2)PSIMT (2)

Study - Monitor for… “protocol violations”

anecdotes

Trends

Act – Tweak the process

D2B Specifics – Road ShowD2B Specifics – Road Show

Remove decisions streamline by consistency – no “artists”

Reduce transitions or hand-offs

Challenge tradition

Dance the same dance “Order Sheets”

Regional MI AlertThe Core… Regional MI AlertThe Core…

STEMI only

Definitive State-of-the-Art care

One call does it all

Parallel vs. sequential processing

Tight reporting of data for performance improvement

Faster is betterFaster is better

In-hospital Mortality * Age Crosstabulation

348 162 54 564

99.7% 96.4% 88.5% 97.6%

1 6 7 14

.3% 3.6% 11.5% 2.4%

349 168 61 578

100.0% 100.0% 100.0% 100.0%

Count

% within Age

Count

% within Age

Count

% within Age

No

Yes

In-hospitalMortality

Total

< 65 65-79 80+

Age

Total

Reduction in Mortality!Reduction in Mortality!

Overall Mortality:

STEMI local and regional = 2.4%

Data Utilities & ApplicationData Utilities & Application

Chris DeFlitch, MD, FACEPPenn State Hershey Medical CenterConnected (CIS) Physician ChampionFounder, Penn State Partners for Healthcare EngineeringDirector & Vice-Chair, Dept of Emergency Medicine

Using EDIS for Meds RecUsing EDIS for Meds Rec

ONE system

Integrated Provider Information

Master Medication List

Drug-Drug Interaction

Documentation of Proces

ArrivalArrival

E-med list collected on Triage Powerform by RN

List autopopulated from prior encounters

Viewable in all Venues

OrderingOrdering

Meds Ordered Individual

Order Sets

Interaction Checking

Auto-populates E-Mar

Master Medication List

Physician DocumentationPhysician Documentation

Person and Time Stamped at each step

Info and modification to all providers All physicians

Nursing (e-mar & med list)

Pharmacy (if admitted)

Soon to pre-populate MD Note

Admitted PatientAdmitted Patient

Med List Carries to the Inpatient World

Same Interaction Checking

Automated Review at Key Stages Admit orders

Transfer of service

Transfer of Location

DischargeDischarge

RULE generates required Review

Integrated in discharge Processing

Recon prior to printed discharge

Med List Printed on Discharge for patient

ALL updates Master List for future visits

Core Measures and EDISCore Measures and EDIS

Community Acquired Pneumonia

Identification on ArrivalIdentification on Arrival

Advanced Nursing Protocol or PDQTM

Tracking Board Identification

Order Set for Initial Orders O2 Sat

CXR with pre-populated indications

IV & labs if criteria

Blood Culture …..

Tracking BoardTracking Board

Order SetOrder Set

Evaluation & TreatmentEvaluation & Treatment

Communication to Physician Review RN doc & discrete data online

View Image On-Line

CAP Order Set IV & Lab (dup check)

Blood Culture (dup check)

ABX recommendations

Allergy Checking

Decision SupportDecision Support

On-line Viewable Risk Stratification

Disposition by Criteria

Complete documentation of Process

SOON to integrate MD documentation

Core MeasuresCore Measures

Albert Einstein Medical Center Pneumonia – time to antibiotics

Acute MI – time to CATH Balloon Up / TPA

Penn State Hershey Medical Center Pneumonia – time to antibiotics ( CPOE & Order Sets)

Lehigh Valley Hospital Acute MI – time to CATH Balloon Up

Chasing Discrepancies by Medical Center Chasing Discrepancies by Medical Center

Radiology ‘Re-Reads’

Laboratory ‘Re-Do’s’

Cardiology ‘Alternative Interpretations”

Core Measures / DiscrepanciesCore Measures / Discrepancies

OPEN DISCUSSION