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Time to Reap: Improving Quality by Harvesting Data from the EMR Marie J. Eidem, BS Aaron A. Kurtzhals, BS James M. Naessens, MPH.

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Presentation on theme: "Time to Reap: Improving Quality by Harvesting Data from the EMR Marie J. Eidem, BS Aaron A. Kurtzhals, BS James M. Naessens, MPH."— Presentation transcript:

1 Time to Reap: Improving Quality by Harvesting Data from the EMR Marie J. Eidem, BS Aaron A. Kurtzhals, BS James M. Naessens, MPH

2 Mayo Clinic – Rochester, MN

3 Mayo Integrated Clinical Systems (MICS)

4 Measuring Quality External External JCAHO JCAHO CMS CMS Leapfrog Leapfrog National Quality Forum National Quality Forum Blue Cross Blue Shield Blue Cross Blue Shield Minnesota Community Measurement Minnesota Community Measurement Institute for Healthcare Improvement 100K Lives... Institute for Healthcare Improvement 100K Lives... Internal Internal Continuous Improvement teams Continuous Improvement teams Mayo Board of Governors Mayo Board of Governors Clinical Practice Quality Oversight Committee Clinical Practice Quality Oversight Committee Departmental Quality committees... Departmental Quality committees...

5 Study Question Can a computer algorithm match the accuracy of manual chart review for determining whether Pneumococcal vaccination was given to hospitalized pneumonia patients (as reported for ORYX Core Measures)? Can a computer algorithm match the accuracy of manual chart review for determining whether Pneumococcal vaccination was given to hospitalized pneumonia patients (as reported for ORYX Core Measures)?

6 Methods Population: Population: Inpatients from July 2004-March 2005 Inpatients from July 2004-March 2005 Discharge diagnosis of community acquired pneumonia Discharge diagnosis of community acquired pneumonia Age>=65 Age>=65 N=224 N=224 Compare measure manually abstracted (RN) vs. result electronically calculated (EMR) Compare measure manually abstracted (RN) vs. result electronically calculated (EMR) Second nurse reviewed sample of patients with discrepancies to determine “true” (T) immunization status Second nurse reviewed sample of patients with discrepancies to determine “true” (T) immunization status

7 First Step: Reliable Algorithm The very first attempt was not correct The very first attempt was not correct Previously collected data, the EMR’s audit trail, and the data generated by the algorithm helped to find errors Previously collected data, the EMR’s audit trail, and the data generated by the algorithm helped to find errors Developing the algorithm was an iterative process Developing the algorithm was an iterative process

8 Pneumococcal Vaccination Measure for Pneumonia Pneumococcal Vaccination Measure for Pneumonia 151 0 48 4825 Truth RNRN + + - - +- EMREMR + -197 3 222 PPV=151/151(100%) NPV=25/73(34.2%) PPV=197/200(98.5%) NPV=22/24(91.6%)

9 Pneumococcal Vaccination Measure for Pneumonia Pneumococcal Vaccination Measure for Pneumonia 151 0 48 4825 Truth RNRN + + - - +- EMREMR + -197 3 222 PPV=151/151(100%) NPV=25/73(34.2%) PPV=197/200(98.5%) NPV=22/24(91.6%)

10 Mayo Integrated Clinical Systems (MICS) Chart+ Chart+ Clinical Document Management Reports (CDM) Clinical Document Management Reports (CDM) Clinical Notes Clinical Notes Hospital Summary Hospital Summary Digital Dictation Digital Dictation Documents Browser Documents Browser History Location System, Mass (HLSM) History Location System, Mass (HLSM) Image Capture Environment (ICE) Image Capture Environment (ICE) Master Sheet Master Sheet Mayo Single Logon (MSL) Mayo Single Logon (MSL) Orders97 Orders97 Patient Appointment Guide (PAG) Patient Appointment Guide (PAG) Patient Provided Information (PPI) Patient Provided Information (PPI) QREADS QREADS Scheduling (GPAS, MSS) Scheduling (GPAS, MSS) Shorthand Shorthand LastWord LW Navigation (Home Screens & Chart Tabs) Allergies Chart Summary View Episodes Flowsheet Charting Immunizations InBox Medication Management Orders: Cumulative Orders97 Summary (COS) Inpatient Plan of Care Outside Film & Media Patient Check-In Locator (PCIL) Problem List/Service Recognition (PLSR) Results and Reports (Viewers/Labs, Documents Display, Printing, Patient List Manager)

11 Next Steps Proceed with pre-filling “positive” immunizations from EMR. Proceed with pre-filling “positive” immunizations from EMR. Manually review “negatives” until NPV becomes acceptable. Manually review “negatives” until NPV becomes acceptable. Reminders/education on use of Immunization Module. Reminders/education on use of Immunization Module. Repeat process with other common quality measures. Repeat process with other common quality measures. Develop method to ensure accuracy of EMR- based measurement. Develop method to ensure accuracy of EMR- based measurement.

12 Lessons Learned Initial algorithm will contain flaws– plan to revise. Initial algorithm will contain flaws– plan to revise. Computer can easily determine measure when service is performed and documentation standards followed. Computer can easily determine measure when service is performed and documentation standards followed. Verification of EMR-based measures extremely valuable. Verification of EMR-based measures extremely valuable. Large sample to establish accuracy Large sample to establish accuracy Buy-in from stakeholders to use EMR Buy-in from stakeholders to use EMR EMR has wealth of capabilities for quality measurement. EMR has wealth of capabilities for quality measurement.


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