Escolar Documentos
Profissional Documentos
Cultura Documentos
Creating A S
Successful
ccessf l
Dashboard
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Disclosure
Bert Reese,
The University of Utah, MBA
Operations Research/Systems Engineering
Norwich University, Northfield, Vermont, B.S.,
Business Administration
Has no real or apparent
conflicts of interest to report.
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
1
2/16/2011
Outline
• Sentara Background
• eCare Project
– Go Live Dashboards
– ROI Dashboards
– Process Redesign Measures
• Welcome to the Starting Line
Q y
• Clinical Quality Goals and Dashboards
• Guiding Principles
Sentara Healthcare
Mission
We improve health every day.
Values
People, Quality, Patient Safety,
Service, Integrity
Vision
Be the healthcare choice of the
Be the healthcare choice of the
communities we serve.
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2/16/2011
Sentara Healthcare
• 123‐year not‐for‐profit mission
• 8 hospitals; 1,935 beds 3,000 physicians on staff
• 10 long term care/assisted living centers
• Extended stay hospital
• 520‐provider Sentara Medical Group
• 432,600‐member health plan Virginia
• Sentara College of Health Sciences
• $3 3B
$3.3B total operating revenues
l i North Carolina
• $3.7B total assets
• 19,225 employees
Sentara Healthcare
System Development
• Series of community hospital MILESTONES
1888 Retreat for the Sick – 25 Beds Norfolk
mergers 1892 S h l f N i
1892 School of Nursing
1972 State’s first merger of two non‐profit hospitals –
• Belief that integration would Norfolk General & Leigh Memorial
lead to better comprehensive 1982 Home Care formed
1983 Life Care division developed
care for patients 1984 Optima Health Plan started
1988 Hampton General Hospital
• Medical Group 1991 Bayside Hospital acquired
• Hospitals 1995 Sentara Medical Group formed
1998 Vi i i B h G
1998 Virginia Beach General Hospital
l H it l
• Nursing Home 2002 Williamsburg Community Hospital
2006 Obici Hospital
• Medical Transportation 2009 Potomac Hospital
2011 RMH Healthcare & Martha Jefferson Hospital
• Home Health (pending)
• Optima Health
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3
2/16/2011
Project Overview
Timelines:
– Sep 2005: Epic contract signed
– Nov 2005 – April 2006: Process redesigns
Nov 2005 April 2006: Process redesigns
– May 2006 – June 2007: Design, Build, Validate
– August 2007: First MD office implemented (150 MDs/Year)
– February 2008: First hospital implemented all but CPOM
– May 2008: First hospital implemented CPOM
– Sep 2008 – Oct 2008: 2nd & 3rd hospital go lives
– Mar 2009– Nov 2009: Three more hospitals implemented
– 2010: Epic 2009 release upgrade; 7th hospital go live
– 2011: 8th hospital go live; community focus
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2/16/2011
Annual Expected
Business Case Benefits
Hospitals Total $30.0 M
Improved Nursing Efficiency $ 4.9 M
Reduced IT Maintenance $ 3.6 M
R d d M di l R
Reduced Medical Records/Transcription
d /T i ti $36M
$ 3.6 M
Increased Outpatient Services $ 4.8 M
Reduced Length of Stay $ 3.8 M
Improved Pharmacy Process/ADEs $ 3.0 M
Reduced Paper/Storage $ 2.7 M
Other Improvements $ 3.6 M
Home Health Total $ 1.8 M
System Health Plan Total $ 2.3 M*
System Healthcare Total $ 35.5 M **
* 62% of health plan benefits will be passed on to employers
** Excludes $2.7 M in physician practice benefits which will accrue to physicians
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5
2/16/2011
®
eCare Costs and
Benefits by Year
$60,000.0
$50,000.0
$40 000 0
$40,000.0
$30,000.0
$20,000.0
$10,000.0
$-
$(10,000.0) 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
$(20,000.0)
$(30,000.0)
$(40 000 0)
$(40,000.0)
Note: 2010 data annualized
Net Impact (vs. Achieved) Net Impact(vs. Expected)
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®
Clinical Staff Became eCare Experts
Project Team Composition:
• 90
90 Information Technology Professionals
Information Technology Professionals
• 100 Clinical Staff (RN, LPN, RT, PT, X‐Ray Techs, Pharmacists)
®
Took Full Time Positions on the eCare Project Team
– Became Epic Trained & Certified
• Application Design
• Content Validation
• Workflow development and redesign
– Design, Build, Validate (DBV) & Implementation Leads
were Trained in Lean Principles
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6
2/16/2011
®
Clinical Staff Became eCare Experts
• All
All Venues of Care Represented (office, acute care hospitals
Venues of Care Represented (office acute care hospitals
and LTAC, etc)
• At completion of project Clinical Team to return to clinical care
sites as care givers
• Project Team Supplemented and Work Validated by over 300
“Subject Matter Experts” (direct care givers) from across the
h lth t
health system
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• 50+ Primary and Specialty MD’s
• Substantial Time Commitment (4+ hrs per week at peak)
• Developed/Designed MD specific parts of EMR
– Content (Order Sets & Clinical Documentation)
– Screen Formats & Custom Reports
– Workflows
• Worked collaboratively with other clinical staff to achieve
y
standardization on shared workflows
• MD’s Are Compensated
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2/16/2011
eCare
Go Live Dashboards
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2/16/2011
Go Live: Daily CPOE Tracking
80%
60%
%CPOE Goal should NOT be 100%
Sometimes Verbal/Telephone is better:
40%
Emergency situations (Code Blue)
20% During procedures
Small number of orders at 2 AM from home
Small number of orders at 2 AM from home
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Days Post Go Live
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Go Live: Monthly Dashboard
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2/16/2011
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eCare
ROI Dashboards
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2/16/2011
ROI Dashboard: Hospital ROI
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ROI Dashboard: System Rollup
2010 eCare Benefits Achieved (annualized)
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2/16/2011
eCare
Process Redesign Measures
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2/16/2011
®
eCare Process Innovations
• Redesigned18 major processes covering entire continuum of
care
• Lean Six Sigma Methodology
1.
2.
Arrival Management
Bed Management
10.
11.
MD Processes
Medical Records
D efine M easure
3. Case Management 12. Meds Management
4. Charge Capture 13. Monitoring/ Recording
5. Claims Processing 14. Order Sets V alidate A nalyze
6. Clinical Communications 15. Patient Care Transformation
7. Disease Management 16. Patient/ Member Satisfaction D esign
8. Emergency Department 17. Physician Practice
9. Home Health 18. Scheduling
• Complementary Technology: Bar‐coding; Document
Management; Device Integration
• Each process redesign defined measures of success
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26
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2/16/2011
• Avoided 117,400 potential medication errors due to medications
barcodingg
• Reduced meds administration time
Baseline Post-eCare
27
100
99
98
97
%
96
95 Goal
94
93
SBH SLH SNG SPA SVB SWR
28
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2/16/2011
100
400
90
350
80
300
70
250
60
200 50
150 40
100 30
50 20
0 10
We e k E nding We e k Endi ng
IP B e d R e a dy t o ED D e part E D D e pa rt t o IP Unit
% <= 4 5 m inut e s % <= 15 m inute s
100 100
90 90
80 80
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0
We e k Ending We e k Ending
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Sentara eCare®
• eCare® Today
EMR at 7 Sentara hospitals
87% CPOE (Computerized Physician Order Entry)
87% CPOE (C i d Ph i i O d E )
Realized benefits ($40.9M) exceed plan ($35.5M)
115 SMG locations
45,000 MyChart patients (patient portal)
SVBGH piloting EMS eCare connection
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2/16/2011
Patient
Centered
Care
31
31
Prerequisite Infrastructure
Divisional SI Technical Architecture
Reporting Sources of Data‐ Data Integration Data Storage Data Distribution Self Service ‐ User Access
Systems Divisional Systems Framework Framework Framework Excel Services & Power Pivot
Subject Data‐marts
Clarity Profitability
Reporting Workbench EPIC
Bus Objects
Durations
Warehouse Disease Mgmt
Data Load
(aka DW) Disease Mgmt
Care Discovery Sepsis
External
Diabetes Mgmt
Benchmark
Partners MEDai Population Mgmt
SHP CCS
ETG
Predictive Modeling
ETL of source data to Benchmark Partners Discovery
CDSS Analystics
Real‐Time via Web Service Oriented Architecture (SOA) Statistical
32 Analysis
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2/16/2011
Infrastructure Continues to Evolve
Continuous Improvement Loop
Order Sets
Smart
Alerts Pricing & Customer
Choice
Enriched
EDW EPIC Medical Health
EDW
Phase 1 Clinical Group Plan
Medicine
Surgery Data Data Data
Rx
Enterprise Informatics Architecture
Episode Treatment Grouper
Pattern recognition and
Best Practices & Outcome Analysis Predictive Modeling
Process Improvement
33
Data
Warehouse
34
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2/16/2011
KPI‐Based Quality/Safety Report
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2/16/2011
H1N1 Results
• MD’s USED order sets & Clin Doc Tools
• MD’s THANKED US – they “Got It”
– Felt reassured that they were practicing based on latest info
– Efficient documentation helped cope with large volumes
• KPI Reporting of Volumes
– Managed staffing
Managed staffing
– Materials Management (N95 Masks)
– Guided management decisions about more extreme measures (visit
restrictions, “tents on the lawn”)
37 37
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2/16/2011
39
Patient Safety
Sentara partnered with nuclear power safety experts to form HPI
as consultants to healthcare industry in high reliability
performance and patient safety
performance and patient safety
Methods based on science and facts
Science of human error and event prevention
Practical experience in high‐reliability industries including nuclear power
and aviation
Experienced‐based mentoring
Entered healthcare in 2002
E t d h lth i 2002
229 hospitals across 75 organizations
Consulting team with HRO experience and healthcare experience
(clinicians, non‐clinicians, and physicians)
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2/16/2011
Anthem CMS CMS Gap SH SH Goal SNGH SLH SBH SCH SVBGH SWRMC SOH SPH
Variance from
Goal Mean Top 10% top 10%
CY2009 CYTD 10 CY2010 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10
AMI
*** Early aspirin use 95% 100% 1% 99% 99% 98% 100% 99% 98% 100% 100% 100% 96% 100%
*** Aspirin at discharge 94% 100% 0.5% 99% 100% 98% 100% 100% 100% 100% 99% 100% 96% 97%
*** Beta-blocker at discharge 94% 100% 1% 99% 99% 98% 99% 100% 100% 100% 99% 99% 98% 100%
1*** ACEI or ARB for LVEF 100% 93% 100% 2% 96% 98% 98% 99% 100% 80% 100% 100% 100% 90% 100%
*** Angioplasty within 90 minutes of arrival 84% 100% 5% 90% 95% 90% 86% 90% 100% 97% 100% 100% 94% SNP
*** Smoking Cessation Counseling 97% 100% 0% 99% 100% 99% 100% 100% 100% 100% 100% 100% 100% 100%
2 AMI %Green (includes ***) = Appropriate Care Measure 94.4% 98.8% 1% 95% 97% 95% 98% 96% 94% 99% 98% 99% 92% 99%
Inpatient Mortality Rate 2% 1% Trend 0% 2% 3% 0% 2% 1% 2% 2%
NCDR Top
ACC-NCDR Metrics for PCI NCDR Mean 10%
3 Overall PCI within 90 minutes of arrival 86% 87.3% 100.0% 9% 86% 91% 86% 76% 83% 91% 95% 100% 100% 94% SNP
PCI Local Vascular Complications 1% 1.40% 0.0% 0.9% 0.34% 0.88% 0.4% 0.92% 7.46% 0.00% 0.00% 0.00% 0.00% 0.00% SNP
PCI Serious Complications 3.00% 2.0% -1% 2.12% 0.63% 2% 0.72% 0.00% 0.00% 2.30% 0.00% 1.43% 0.00% SNP
4 PCI Statins or Non-statins on DC (h/o dyslipidemia) 95% 92.20% 98.4% 95% 98% 95% 98% 98% 100% 99% 99% 100% 100% SNP
PCI Risk Adjusted Mortality (1Q 2010) 1% 1.46% 0.80% 2.19% 2.21% 1.00% 2.93% 0.00% 0.00% 0.00% 1.65% 0.00% 0.00% SNP
RAM O/E Ratio (1Q 2010) 1.00 1.19 1.00 1.99 0.00 0.00 0.00 1.12 0.00 0.00 SNP
Pneumonia
*** Antibiotic selection consistent w/ recommendations ICU 68% 100% 5% 84% 95% 90% 100% 100% 100% 100% 86% 86% 50% 86%
*** Antibiotic selection consistent w/ recommendations Non ICU 95% 100% 3% 96% 97% 97% 97% 96% 98% 100% 97% 100% 93% 95%
5*** 1st dose antibiotic given w/in 6 hours 99% 94% 100% 3% 97% 97% 98% 98% 95% 99% 98% 95% 100% 97% 95%
*** Blood cultures performed in ED prior to 1st dose antibiotic 93% 100% 2% 96% 98% 97% 98% 98% 99% 97% 97% 98% 98% 95%
*** Blood cultures performed on ICU Admissions 96% 100% 2% 97% 98% 98% 96% 100% 97% 100% 98% 100% 93% 92%
6*** Administration of Influenza Vaccine 97% 86% 100% 3% 95% 96.6% 97% 96% 91% 99% 100% 98% 98% 95% 80%
7*** Administration of Pneumococcal Vaccine 98% 88% 100% 4% 95% 96% 98% 90% 95% 99% 100% 98% 93% 93% 88%
*** Smoking cessation counseling 91% 100% 0.4% 99% 100% 99% 99% 100% 100% 100% 100% 100% 98% 93%
VTE Prophylaxis CYTD 99% 99% 98% 98% 100% 100% 100% 100% 99% 95% 97%
8 Pneumonia %Green (includes***) = Appropriate Care Measure 86.3% 98.6% 6% 89% 93% 95% 92% 90% 97% 97% 93% 93% 88% 80%
Heart Failure
9*** ACEI OR ARB at Discharge with EF <40% 100% 90% 100% 1% 100% 99% 98% 100% 100% 100% 100% 97% 98% 95% 100%
*** Documentation of Ejection Fraction 100% 91% 100% 0.05% 100% 100% 99% 100% 100% 100% 100% 100% 100% 100% 99%
*** Smoking Cessation Counseling 93% 100% 1% 100% 99% 99% 100% 100% 100% 100% 100% 100% 95% 97%
10*** Documentation of all discharge instructions 97% 80% 100% 4% 79% 96% 94% 96% 99% 100% 100% 93% 97% 86% 90%
VTE Prophylaxis CYTD 99% 100% 98% 100% 100% 100% 100% 100% 100% 97% 99%
11 CHF %Green (includes ***) = Appropriate Care Measure 86.4% 99.5% 4% 78% 96% 90% 97% 100% 100% 100% 94% 98% 86% 90%
41
Clinical Goals: Red Light Green Light
Percent Green vs. Percent Red
CMS Quality Measures: Cardiac; Pneumonia; Surgical Care; Infections, Patient Safety
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2004 2005 2006 2007 2008 2009 2010
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2/16/2011
Clinical Goals:
Serious Safety Event Rate
All Sentara Hospitals YTD November 2010
1.00
81% Reduction Since 2003
0.75
Event Rate
0.50
E
0.25
0.00
J-03
M-03
J-04
M-04
J-05
M-05
J-06
M-06
J-07
M-07
J-08
M-08
J-09
M-09
J-10
M-10
S-03
S-04
S-05
S-06
S-07
S-08
S-09
S-10
Serious Safety Events per 10,000 Adjusted Patient Day
43
44
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2/16/2011
500
400
300
200
100
-
SNGH SLH SBH SCH SVBGH SWRMC SOH
(100)
2002 2003 2004 2005 2006 2007 2008 2009
45
Clinical Goals:
eHospital Resulting Interventions
% of Alerts that led to an intervention Type of Interventions Resulting from Alerts
4%
RT Contacted 1%
MRT 4%
Intervention EKG 5%
Non Intervention
Meds 7%
MD Contacted 13%
Coaching 24%
96%
0% 5% 10% 15% 20% 25%
• 96% of all alerts result in some sort of intervention
• Interventions have led to 350+ additional coaching opportunities w/ staff
Interventions requiring MD Contact IInterventions requiring MD Contact
t ti i i MD C t t
1st Quarter 2009: Sample Population Nov 2009 ‐ Jun 2010
13%
MD Contacted MD Contacted
42%
58% MD Not
Contacted 87%
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2/16/2011
Clinical Goals:
ED Clinical Effectiveness Council
Dashboard
1 2,4,5
PATIENT FLOW CLINICAL INITIATIVES
2 2
VOLUME ACCESS LOS BOARDER AMI PNEUMONIA
2,6
Release % <= 180 mins
Patient Satisfaction %
3
Pre-Emptive Order %
Admit % <= 270 mins
Daily Median Volume
of patient arrival
Bed to Provider
% <= 30 mins
% <= 15 mins
% <= 15 mins
% <= 15 mins
ECG (mins)
Chest Pain
AMI (mins)
ACI (mins)
LWBS%
AMA %
Hours
AMI
ICU
BEST PRACTICE <=1% <=1% >=90% >=90% >=90% >=90% >=95% >=95% >=95% <=10% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94.3%
GOAL <=2% <=1% >=50% >=90% >=50% >=50% <=10% >=97% >=97% >=97% <=10 <=10 <=10 >=90% >=96% >=96% >=96% >=90%
SBH 100 97 0.5 0.6 63 96 55 79 37 70 50 663 60 4 100 100 100 8.5 10.0 10.0 NC 0 100 100 100 90.6
SCPH 175 172 1.4 1.0 44 79 57 46 25 39 21 1862 68 5 100 NC 100 NC 8.5 8.5 NC 100 100 100 95 86.4
SLH 131 131 1.9 0.8 46 99 52 60 21 44 40 1448 68 9 100 NC NC NC NC NC NC NC 100 93 100 85.3
SNGH 142 145 0.7 1.5 50 94 42 75 45 49 29 2444 69 8 100 NC NC NC NC NC NC NC 100 100 100 85.6
SOH 100 99 1.2 0.7 48 96 42 42 63 40 916 67 5 100 NC NC NC NC NC NC 100 91 93 92 83.5
SVBGH 133 133 0.5 0.8 51 97 63 55 55 44 43 1829 69 6 100 NC NC NC NC NC NC 100 93 91 94 81.4
SWRMC 97 98 0.3 0.5 73 98 89 63 58 60 51 833 78 4 100 NC 100 NC 3.0 3.0 NC 100 100 100 93 87.8
SBLH 57 58 0.2 0.5 70 96 96 85 57 0 0 0
SPA 127 130 0.8 0.6 59 94 68 62 78 40 249 67 2 92.7
SPW 110 109 0.9 0.8 56 88 70 55 81 41 56 86 0 95.3
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Guiding Principles
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2/16/2011
Lessons Learned
• What get measures gets improved
– Select appropriate data: Retrospective, Dynamic, Predictive
• Frequency depends on the expected interventions
– Daily, Monthly, Quarterly
• Embed goals into budgets and bonuses
– Physicians, Executives
• Involve process owners in impacted areas
• Build an industrialized organization
49
Industrialized Organization
Discovery Analytics &
Quality Research
Corporate Decision
Institute
Support
Sentara
Informatics
Sector Analytics
Sector Analytics – Informatics Technical
Informatics Technical
Clinical & Business Services – Design &
Informatics Support Development
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2/16/2011
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