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4/13/2017 SQWM Business Drivers

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Presentation on theme: "4/13/2017 SQWM Business Drivers"— Presentation transcript:

0 Introduction to the Surgery Quality & Workflow Manager (SQWM)
4/13/2017 Introduction to the Surgery Quality & Workflow Manager (SQWM) April

1 4/13/2017 SQWM Business Drivers Address the key issues of patient safety and wait times - Patient wait time for surgery may be lengthy - Patient surgeries are being canceled at the last minute for missing tests / results or lack of ICU beds Improve the efficiency and cost effectiveness of the surgery scheduling process, including alerting bed management and ancillary services of daily needs - Expensive staffed OR rooms may be unused - Regional and National view of resources and utilization Allow for day of surgery patient tracking, provide local management reports - Manual OR reporting processes result in lower information quality - OR documentation/reporting is not consistent Improve data availability for the national surgery quality programs - Allow relevant clinical data collection on all cases - Automate data collection to improve data quality and timeliness Business process change…. we have recognized that some OR’s are manual and going to electronic, also capturing quality outcomes on all cases, track wait time for surgery

2 SQWM Objectives Standardization of VA surgery
4/13/2017 SQWM Objectives Standardization of VA surgery Support business process change Streamline surgery workflow Improve efficiency Monitor wait times Track compliance with VA surgery complexity Provide interface capabilities to other VA systems Improve quality and patient satisfaction Details contained within slide.

3 4/13/2017 SQWM Overview The Surgery Quality & Workflow Manager (SQWM) software solution will allow the tracking of surgery patients through the pre-surgical process, scheduling of surgery, peri-operative period and post-operative assessment and disposition, including quality outcomes reporting. This solution includes GE Centricity, a Commercial-Off-The-Shelf (COTS) product, and development of system integration to the existing VA patient support applications. Details contained within slide.

4 SQWM Product Description
4/13/2017 SQWM Product Description End-to-End patient tracking and clinical documentation from consult to discharge Centralized management of all resources needed for surgery Configurable clinical manager component to allow standardization and updating of business processes across the VA in the shortest amount of time Maximize re-use of existing components to interface with VA information assets, such as standardized terminology services, Standard Data Services, Identity Management, etc. without the need for further development Industry best practices of quality monitoring and reporting built in the highly configurable product to meet the VA’s local, VISN, and national level quality assurance goals Optimized peri-operative workflow and surgical block time utilization to improve patient safety and Veteran access, increase overall patient and employee satisfaction, and reduce wait times, first-time late starters, and cancellations, improved efficiency = increase in capacity Details contained within slide.

5 SQWM Project Activities
4/13/2017 SQWM Project Activities PMAS Approval Granted 3/28/2011 Contract awarded for SQWM Solution on 9/13/2011 GE Centricity team completed walk through of Alpha Site, Portland VAMC, week of 9/26/2011 Training Recommendation completed in January 2012 SQWM Demonstration Presentation April 2012 Software Delivery, testing initiation August 2012 Begin use in Production (first site) April 2013 IOC roll-out in May 2013 National roll-out complete August 2014 Details contained within slide.

6 4/13/2017 SQWM Interfaces The slides shows the interfaces between SQWM and other VA systems. Some of the interfaces will be completed as part of the initial release of SQWM while others will be in future phases. Interfaces with a red triangle or gold oval will be included in the initial release of SQWM. Interfaces with a blue rectangle will be included as part of a future SQWM release. The following information provides information about each interface and the planned interaction with SQWM: Outpatient Scheduling - Manages patient appointments from initial consult through post-op follow-up; sends appointment information to SQWM. Legacy (VistA) scheduling shall supply SQWM with patient appointment information, including scheduled appointments and patient check-ins. The 21st Century Medical Scheduling (21CMS) interface manages scheduling of surgery resources once surgical procedures are planned (e.g., post consult through surgery complete); HeVS schedules initial consult and manages surgery follow-up appointments. Strategic Asset Management (SAM) - Tracks physical assets and inventories (equipment, instruments, and supplies at facilities) throughout their lifecycle. SAM assisting SPD with surgery case cart builds; SAM has the ability to track and report on all surgery related assets, including OR room and equipment utilization and down times. SQWM shall supply Surgery schedule information to SAM for case cart preparation. Bed Management Solution (BMS) - Manages bed allocations, including floor, Intensive Care Unit (ICU), PACU. BMS to report bed availability for all surgery needs, including priority overrides and changes in availability over time. SQWM shall send bed request to BMS when scheduling surgery to reserve inpatient bed with estimated length of stay and special instructions. CPRS Order Entry and Results Reporting - Clinical patient orders and results. CPRS Order Entry is used to create orders for a patient. CPRS Results Reporting is used to view results. SQWM will use CPRS APIs to order consults, test, meds, equipment, etc. SQWM will use CPRS APIs to review results. SQWM to CPRS Orders and CPRS Results to SQWM (CCOW for Phase 1, Application Programming Interface (API) for Future). VistA Integration - Allows views of labs, meds, radiology images, consent forms, allergies, problem list and health summary. SQWM will utilize one of the VistA integration tools (VistA Web) for display of the following information for a patient: labs, meds, radiology images, consent forms, allergies, problem list and health summary. Vets Implant Tracking & Alert System (VITAS) - Tracks implants, including support for safety recalls. SQWM will report implant surgeries to VITAS (initial and follow-on); VITAS will alert surgeons and SAM (implant inventories) to recalls and track recall actions. SQWM shall supply VITAS with information regarding equipment that has been implanted or removed from a patient. Clinical Info System Anesthesia Record Keeping (ARK CIS) - Provides reporting and analysis of patient (CIS) and anesthesia (ARK) data. SQWM will feed surgery schedule data to CIS ARK to capture and report on patient and anesthesia data related to surgeries. SQWM shall receive Anesthesia related information from ARK/CIS and ARK/CIS will receive Surgery Schedule information from SQWM. Clinical Assessment Reporting & Tracking System (CART) - Captures and reports cardiac operational data; program started with Catheterization Labs (CL) data; now including CardioPulmonary Resuscitation (CPR) data. SQWM will feed cardiac surgery data (diagnostic & interventional) to CART for tracking and reporting. SQWM shall receive diagnosis codes from Cardiac Cath CART-CL. Patient Identification / ADT - Used to properly identify the patient; Receive and process Admit, Discharge and Transfer transactions. SQWM will use approved MVI services to exchange information with IdM. SQWM will receive a filtered ADT feed and process admits, discharges, and transfers. Standard Data Systems(SDS) - Standardizes selection lists at VA (Manual import for Phase 1, Automated update for Future). Provides normalized data regarding location from top VA levels down to the Facility levels – SDS data is provided via standard file delivery and update routines. VistA Surgery - SQWM shall supply identified data elements to VistA Surgery at defined trigger points in the Surgery Scheduling and tracking process;  VistA Surgery will continue to supply data to other VistA modules per current processes. Supplies Data for these modules include the following: DSS Workload Integrated Billing IFCAP Nat’l Health Info Network Occurrence Screen Spinal Cord Injury Transplant Registry Text Integration Utilities (TIU) - Receives images and stores them for display to VistA users. SQWM shall supply TIU with surgery and consult notes using existing HL7 interface and specific note titles. Real Time Location System (RTLS) - Will allow for Bar code / wireless location of staff and equipment related to VHA business operations, including Surgery. Consult Management - Manages, tracks and communicates consult information and status. SQWM shall request Consults from Consult Management, initially via CPRS/Order Entry. In the future, SQWM shall receive Consult updates/completions from Consult Management. Vet Pro - Manages provider credentialing and will manage privileges. Bar Codes, UPC, GS-1, RFID - Read information about a person or thing from a code or sticker. Implementation of Bar Code and UPC included in Phase 1. GS-1 and RFID will occur in the future. VASQIP - Collection and reporting of quality data in regards to surgical outcomes that are required for VASQIP Reporting

7 Integration – Phase 1 Training
ADT SQWM will receive patient demographics, VA specific fields (e.g. service connected, radiation exposure, etc.) and admitting data for patients Scheduling SQWM will receive patient demographics, VA specific fields, and surgery Clinic Appointment data at the point of scheduling and checking in the patient TIU SQWM will send notes to CPRS at the end of documentation by the clinical provider (e.g. progress notes, procedure notes, operation reports, operative note, etc.). These will show on the appropriate tabs with signer, location, and date/time in CPRS as text. MVI SQWM will receive veteran demographic updates from MVI and utilize MVI during the ADT and scheduling process to confirm correct patient demographics prior to processing the ADT and Scheduling interfaces. VASQIP SQWM will send VASQIP data to the national report center VistA Surgery SQWM will send select data elements to VistA Surgery to allow for other downstream reports and systems to access data from the existing VistA Surgery data elements PCE SQWM will send PCE forms to PCE for workload accounting.

8 Integration – Common Questions
Training Will Medications integration be available in SQWM during phase 1? SQWM will not be integrating medications during phase 1 but is on the roadmap for future phases How are allergies integrated during Phase 1 in SQWM? Yes, allergies are received into SQWM via the ADT interface in Phase 1. Will Labs be sent to SQWM during Phase 1? SQWM will integrate labs during a future phase. What documentation is available to review about these interfaces? Each interface has an ICD that is available SQWM will have new note types. New note names and types are being rolled out with SQWM. This will allow for standardization across the VISN and Nation Will notes and documentation elements from SQWM be in CPRS? And on the correct tabs (e.g. surgery) Yes, notes and forms completed in SQWM will be in CPRS via the TIU interfaces. Surgery documentation (e.g. Operation Report & Operate Note) will be on the surgery tab. Notes will have signer, date/time, and location.

9 SQWM Project Team Members
VA Team Members: VA Initiative Lead – Craig Powell VA Deputy Initiative Lead/Budget Manager – Craig Powell VA Project Manager / IPT Chair – Daniel Reed Business Sponsor – Dr. William Gunnar Director of Surgery, Portland – Dr. James Edwards VA Requirements Representative – Dr. Jack Varga VA Health Systems Representative – Avaretta Davis National Training Manager – Scott Ridings ~75 other members of SQWM IPT Details contained within slide. Harris (Prime Contractor) Team Members: Harris Program Manager – Mark Merz Harris Chief Systems Engineer – Keith Bourke GE Centricity Program Mgr – Joe Smith LSI Training Lead – Charlie Houghton Integration Documentation – Amanda Peckham SQWM PMO Contract Team Members: SQWM Lead – Sarah Abdow Project Coordinator – Ashley Crews Risk Manager – Jeff Morris Lead Planner – Stephen Jones Functional/Business Analyst – Rosie Perez

10 SQWM - Where to get Information
SQWM Project Notebook – SQWM VA OIT SharePoint: SQWM Project Management Team Dr. William Gunnar, Business Sponsor – Dr. James Edwards, SQWM Medical Director – Daniel Reed, SQWM Project Manager – Details contained within slide.

11 SQWM Technology COTS: GE Centricity Perioperative
4/13/2017 SQWM Technology COTS: GE Centricity Perioperative Servers Hosted at AITC Access via Citrix All VA facilities are associated with one of the eleven SQWM Install Groups hosted within the AITC where Citrix XenApp and VMware technologies are used. This is a good background slide that will help understand the SQWM login sequence described later. The graphic represents the production environment but it is worth noting that a total of five SQWM environments exist at the AITC: - DEVelopment, SQA and TRAINing environments each have only 1 install group - Pre-Production and Production environments each have 11 install groups The Citrix gateway at the AITC is very important in providing users access and providing stable connectivity. Any problem experienced in the Citrix environment could easily and erroneously be attributed to SQWM.

12 SQWM Access – Citrix Login
4/13/2017 SQWM Access – Citrix Login SQWM users will select an icon on their desktop that will route them to the SQWM Citrix farm VA credentials are used to access SQWM capabilities When a user selects the SQWM icon on their desktop, they will be prompted to enter their VA credentials for access to SQWM via the Citrix portal at the AITC. Note: the access sequence is designed such that every user will have a single SQWM icon on their desktop; minimizing the need for on-going local desktop administration and support.

13 SQWM Access – Select Environment
4/13/2017 SQWM Access – Select Environment After valid entry of VA credentials, SQWM users will have selections to choose the appropriate SQWM environment DEV SQA Training Pre-Prod PROD SQWM users will normally be working in the Production environment. A number of SQWM environments exist at the AITC. Although most users will work from the PROD environment most of the time, they may need to work in one of the other environments on occasion. This approach facilitates all user types and greatly reduces administration overhead or the need to place multiple icons on the desktops.

14 SQWM Access – Install Group Selection
4/13/2017 SQWM Access – Install Group Selection SQWM Users will select the SQWM install instance associated with their hospital PROD Notional approach depicted that would enable users to identify their hospital location on a map. The user is then routed to the correct install instance associated with their selection. Alternatively, icons/list may be presented. Once a user identifies the environment, they can quickly identify the location of their facility. A notional implementation is depicted here using a map approach but the overall approach needs to be finalized with the AITC team. Note if questions arise regarding the number of choices: The complexity associated with the multiple environments and multiple install groups needs to be resolved somewhere. This approach was designed with two goals in-mind: 1) provide a single icon on the desktops for users that eliminates the need for on-going administration/support at the local level and 2) minimize/eliminate the day-to-day administrative effort on the part of the AITC.

15 SQWM Access – Centricity Functions
4/13/2017 SQWM Access – Centricity Functions Once a user has navigated to the instance of SQWM they want to use, they are presented with a number of icons Users are then presented with icons to access the various Centricity COTS functions.

16 SQWM Access – Centricity Login
4/13/2017 SQWM Access – Centricity Login Once a SQWM user selects a SQWM function, they log into the SQWM COTS Product Centricity Perioperative Role-based credentials administered by the SQWM business owners The user logs into the SQWM COTS package; their credentials are validated and used to determine if they have the privileges to access the selected function.

17 Centricity Perioperative
This shows the VA surgical process. The section to the left involves how the patient gets referred to a surgical clinic. This section occurs outside of SQWM. The screen sections to the right occur in SQWM and include the patients surgery clinic visit, tracking of surgical and medical readiness, scheduling, encumbering resources, the perioperative period, and post op follow-up. VistA Scheduling

18 SQWM Modules / Components
4/13/2017 SQWM Modules / Components Census – List of Patients vForm – Notes (H&P, Anesthesia, Nursing) Scheduler – Schedule Cases Nursing Documentation - Perioperative Tracker – Patient Tracking The following clinical user facing components are utilized as part of SQWM. A Census is simply a list of patients. We will discuss censuses in more detail shortly. A vForm is simply a note. We will discuss vForms in more detail shortly. Scheduler schedules cases. There is a module for Perioperative nursing documentation. And there is tracker board functionality for the OR Board, family waiting room, and ancillary areas such as Central Sterile Processing.

19 Censuses Surgery Clinic Census Miscellaneous Census
4/13/2017 Censuses Surgery Clinic Census Miscellaneous Census Pre-op Clinic Census OR Census Pending Work Census A Census is a list of patients. Five different types of censuses will be used with SQWM. The Surgery Clinic Census is the list of patient scheduled for a surgery clinic visit. The Miscellaneous Census is used to track medical and surgical readiness. The Pre-op Clinic Census is the list of patients scheduled for a Pre-op Clinic visit. The OR Census is the list of patients scheduled for surgery. The Pending Work Census is a list of outstanding items. Patients appear on this Census when for example they have an unsigned surgical H&P.

20 Surgery Clinic Census

21 Miscellaneous Census

22 Pre Op Clinic Census

23 OR Census

24 Pending Work Census

25 4/13/2017 vForm – Overview vForms are where notes are documented in SQWM. Once signed, vForms are written to VistA/CPRS via the TIU. The “v” in vForm stands for virtual since the forms can contract and expand. In the example shown the History and Cardiovascular panels are not expanded and the Pulmonary panel is expanded. When a panel is not expanded, as in the case of History and Cardiovascular, it shows a summary of the pertinent data in that panel. For example: The Cardiovascular panel shows the patient has hypertension. When a panel is expanded, like the Pulmonary panel, it shows all the fields available to document in that panel. When a field is clicked or touched, SQWM displays the list of possible answers for the field. Touch an answer could generate a list of other more detailed possible answers.

26 Pending Work Census

27 vForm – WNL = Default Values (1 of 2)
4/13/2017 vForm – WNL = Default Values (1 of 2) In SQWM WNL simply means default values. For example the Pulmonary panel has several unanswered fields: Symptoms, URI, etc. {GO TO next slide}

28 vForm – WNL = Default Values (2 of 2)
4/13/2017 vForm – WNL = Default Values (2 of 2) By clicking WNL default values populate the unanswered fields.

29 vForm – No Change (1 of 2) 4/13/2017
vForms also have the ability to copy data from previous notes. In this example, the previous note is shown on the left side and the current note being documented is shown on the right. By clicking the NC button… {GO TO Next Slide}

30 vForm – No Change (2 of 2) 4/13/2017
Information is coped from the previous note into the current note.

31 4/13/2017 vForm – Field Choices Fields can have drop down lists

32 vForm – Field Choices 4/13/2017
Fields can have several sub-fields that the user is “walked” through

33 vForm – Field Choices 4/13/2017
Trainee supervision is taken into account, only required at facilities with trainees

34 Anesthesia “Worksheet”
4/13/2017 Anesthesia “Worksheet”

35 Anesthesia “Worksheet”
4/13/2017 Anesthesia “Worksheet”

36 Anesthesia “Worksheet”
4/13/2017 Anesthesia “Worksheet”

37 Anesthesia “Worksheet”
4/13/2017 Anesthesia “Worksheet”

38 Anesthesia “Worksheet”
4/13/2017 Anesthesia “Worksheet”

39 4/13/2017 Tracker Board

40 Users (multiple - with role specific access)
4/13/2017 Users (multiple - with role specific access) Surgical Resident Attending Surgeon Facilitator Scheduler Pre-op Clinic Nurse Tracker User Anesthesia Resident Attending Anesthesiologist Pre-op Holding Nurse Circulating Nurse Administrator Biological Implant Tracking Coordinator Different types of users will utilize SQWM. This is a list of some of the users that will access SQWM. Each type of users has appropriate role privileges. For example a Scheduler can assign a date and time to a case but cannot sign a surgical H&P.

41 Reporting Crystal – Wait List* Crystal – Bed / Resources Report
4/13/2017 Reporting Crystal – Wait List* Crystal – Bed / Resources Report Crystal – Staff Privileges Report Crystal – Implant Reports Crystal – Multisite Report: Executive Summary Crystal – First Case Late Starts Crystal – Turn Over Times Crystal – Utilization Report Block & Room Crystal – Pathology Report Business Objects – Adhoc Reporting Etc. The following is a list of some of the reports available in SQWM.

42 Questions How can GEHC help address these concerns? Questions can be forwarded to the SQWM Implementation support team at:

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