Hospitals, Quality and HIT: Important Issues and Intersections Gail E. Latimer, MSN, RN, VP, Chief Nursing Officer Siemens Medical Solutions

The Value of Health Information Technology By bringing IT tools, including EHR and content, to doctors and hospitals. Inform Clinical Practice Inform Clinical Practice By building an interoperable health information system so records follow patients. Interconnect Stakeholders Interconnect Stakeholders By using health IT to give consumers more access to and involvement in health decisions. Personalize Care Electronic Health Record By expanding the monitoring of public health and bringing research advances more quickly to medical practice. Improve Population Health Improve Population Health Personalize Care

Clinical Performance Drivers Targeted Performance Areas – The Nation is Monitoring Length of stay Patient falls Urinary tract infection Pressure ulcers Hospital-acquired pneumonia Shock or cardiac arrest Upper gastrointestinal bleeding Sepsis Deep vein thrombosis Central nervous system complications In-hospital death Wound infection Pulmonary failure Metabolic derangement Acute MI Heart failure Pneumonia Surgical infection prevention

Transparency in Hospital Public Reporting - Clinical Process Measures

EHR Business Office Physician's Office Dietary Environmental Services Patient's Home Environmental Services Laboratory Health Info Mgmt Pharmacy Medical Unit Radiology Emergency Department Scheduling

Incorporating Evidence Within Clinical Practice Accelerating role in today’s healthcare Provides improved quality and reduction in variation Serves as the basis for many quality management and performance initiatives Information technology will drive the use of knowledge with the EHR

Increase Accuracy and Efficiency of Clinical Processes Computerized Physician Order Entry

Incorporating the Capture of Core Measures Clinical Documentation

Incorporating the Capture of Core Measures Clinical Documentation

Knowledge-driven EHR

Knowledge Drives the Patient Plan of Care Smoking Cessation slide

Knowledge Drives the Patient Plan of Care

Acute Myocardial Infarction Workflow -

Workflow Engine – Listening, Monitoring, and Escalating…….

Workflow Engine – The Right Information, To the Right Person, at the Right Time……

Leveraging Technology to Measure Quality and Cost Technology provides real-time access to cost and quality Technology generates new knowledge to advance healthcare Technology deployment supports the care delivery process while measuring outcomes Technology can capture clinical practice, improve processes and quantify the impact on patient outcomes

AMI Aspirin at Arrival Goal 100% Aspirin Prescribed at Discharge 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile Aspirin Prescribed at Discharge Goal 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile

AMI ACE Inhibitor / ARB for LVSD Goal 100% MRMC HQI Top Decile 80% 15/15 8/8 9/9 10/10 13/13 11/11 13/13 13/14 15/16 13/14 12/14 13/14 9/10 60% 9/11 6/8 7/9 6/8 8/11 9/14 40% 20% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile Smoking Cessation Advice/Counseling Goal 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile denominator may change due to inclusion/exclusion criteria

AMI Beta Blocker at Arrival Goal 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63 MRMC HQI Top Decile Thrombolytic received within 30 Minutes of Hospital Arrival (Avg. Time in Minutes) 100 90 80 70 60 50 40 30 20 10 Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July 2003=52 2003=50 2003=63 2004=56 2004=42 2004=54 2004=50 2004=57 2004=39 2004=46 2004=36 2004=47 2004=60 2004=63 2004=56 2005=52 2005=70 2005=55 2005=52 2005=53 2005=60 2005=63

Nursing Dashboard - 5 East

Monitoring Clinical Outcomes

The Value of Health Information Technology -Monitoring Quality and Cost

The Value of Information Technology for Clinical Practice Achieved more than 90% compliance with regulatory standards for discharge education of stroke patients Reduction in medication to pharmacy review time from up to 24 hours to within 1 hour Reduction in prescriber errors by 71% Decreased harmful events to a six month average of 0.33 per 1,000 doses (compared to a national average of 2-8 harmful events per 1,000 doses)