Using MEDITECH Data to Drive Clinical Decision Support International MUSE Conference

Transcription

1 Using MEDITECH Data to Drive Clinical Decision Support Co-presenters: Stephania Fregeau Jamie Gerardo 2015 International MUSE Conference

2 AGENDA Technologies used Objectives Surgical Scorecard reports Application functionality and how it applies to the report data Tips on setup Demo of Scorecard and related reports Overview of the MEDITECH data repository Briefly cover how we are gathering data for our reports Tables used Surgical Care Improvement Project Going from paper to an electronic dashboard Measure requirements Demo

3 TECHNOLOGIES USED MEDITECH Data Repository (or other technologies such as Open Gate from Blue Elm) Microsoft SQL Server SQL Server Management Studio Stored Procedures Reporting Services (SSRS) Report Manager Visual Studio (Business Intelligence Development Studio)

4 OBJECTIVES After this presentation, you will be able: To outline the elements on the Surgical Services Scorecard To apply a few tips on using the Meditech Operating Room Management module To describe how NMC is using the electronic SCIP Dashboard to drive clinical decision support To know the various reporting options available To state Meditech tables which can be used to create reports

5 NORTHWESTERN MEDICAL CENTER St. Albans, Vermont

6 NORTHWESTERN MEDICAL CENTER ST. ALBANS, VERMONT 70 bed hospital NMC staff have won 5 consecutive national Avatar awards for Overall Patient Satisfaction & Exceeding Patient Expectations. HIMSS Stage 6 achieved in 2014 MEDITECH 6.07 PP5d Per Year, NMC has: 1,900 inpatients 28,000 emergency room patients 400 babies born Performs 6,000 surgical and outpatient procedures

7 NMC s MISSION IS TO PROVIDE EXCEPTIONAL HEALTHCARE FOR OUR COMMUNIT Y 5 Star Caring Model

8 NORTHWESTERN MEDICAL CENTER Surgical Services 55 member staff 6 member Anesthesia team 20+ Surgeons w/ many Community providers Surgical Council & Shared Governance Councils Quality Research & Education Clinical Practice 16 Ambulatory rooms 2 Endoscopy rooms 4 Outpatient Treatment rooms 5 Operating Rooms 5 bay PACU Central Sterile Purchasing Specialist OR Scheduler Registration Office

9 SURGICAL SERVICES SCORECARD First Case On Time Starts Turnover Time Scheduling Accuracy Block Utilization

10 PAPER/MANUAL SCORECARD

11 ELECTRONIC VERSION

12 ELECTRONIC VERSION SURGEON COMPARISON

13 FIRST THINGS FIRST Define the measure and target Why is the measure important? Where does the documentation occur? How do I query the data in the DR and which tables do I use?

14 FIRST CASE ON TIME STARTS Definition A first case on time start occurs when the first patient of the day arrives in OR room within 5 minutes of scheduled start time Why? First case on time starts will improve patient satisfaction, productivity and staff satisfaction

15 FIRST CASE ON TIME STARTS Documentation OR Scheduler Desktop: report looks to first scheduled case of the day

16 FIRST CASE ON TIME STARTS Documentation OR Customer Defined Time Headers ORM>System Mgmt>View OR Customer Defined Time Headers

17 FIRST CASE ON TIME STARTS Staff & Physician Involvement

18 FIRST CASE ON TIME STARTS DELAY REASONS ORM>Dictionaries>Surgical>Delays

19 FIRST CASE ON TIME STARTS NURSE DESKTOP - DELAY REASONS

20 JANUARY MAY 2015 PIE CHART

21 FIRST CASE ON TIME STARTS

22 FIRST CASE ON TIME STARTS Notes/Tips Recommend using AppointmentDateTime SchAppointments table Use determine the first case Example Use for the calculation to determine if the case started on time (Example: DATEDIFF(minute, AppointmentDateTime, IntoOR) ) Define the timeframe You ll want to be specific on what counts as on time What if the surgery starts early? Within 5 minutes?

23 TURNOVER TIME Definition Time from prior patient out of room to succeeding patient in room time Why? Good turnover time helps maintain surgeon, anesthesia, staff and patient satisfaction Documentation Statistic driven by patient into & out of room times documented by the Circulator in the Operative Record.

24 TURNOVER TIME Staff & Physician Involvement To be efficient at operating room turnover, every player needs TO KNOW THEIR JOB & DO IT!

25 SET UP/CLEAN UP TIMES FROM PROCEDURE LEVEL ORM>Dictionaries>Schedule>Procedures>Proc/Resources

26 PROCEDURE DICTIONARY PURGE & PREFERENCE CARDS

27 TURNOVER TIME Notes/Tips Turnover time can be calculated based on the surgeon only (as we do here) or on the surgeon and the room. Example You ll want to filter out cases before or after a certain time of day as in example. From a reporting stand point this is fairly straight forward.

28 SCHEDULING ACCURACY Definition The percentage of all cases with an accurate estimate of case duration. A case is considered accurate when the estimated case duration is within 15 minutes of the actual case duration (time patient in room to out of room). Why? Accuracy of estimated case duration is essential in managing block time, productivity and staffing needs within Surgical Services.

29 SCHEDULING ACCURACY Documentation 1) Determined at the Procedure Level ORM>Dictionaries>Schedule>Procedures> Proc/Resources

30 SCHEDULING ACCURACY Restricted Routines 2) Restricted Routine: average case duration (surgeon specific) once the defined number of cases has been reached ORM>Dictionaries>Customer Defined Parameters>Parameter s

31 SCHEDULING ACCURACY Procedure vs Scheduling Restricted Routine Determined in OR Customer Defined Time Headers Procedure Length (Surgeon) Scheduling Length (Schedule): defaults into duration while booking the case when the defined number of cases has been reached ORM>System Mgmt>View OR Customer Defined Time Headers> Billing/Reports

32 SCHEDULING ACCURACY Restricted Routines 3) Run Restricted Routines directly from OR Scheduler Desktop while booking the case or thru Restricted Routines ORM>Restricted Routines>Default Scheduling Length

33 RESTRICTED ROUTINES FROM OR SCHEDULER DESKTOP

34 SCHEDULING ACCURACY Notes/Tips Estimated Time - There are many places where you can find the estimated time for surgical cases. SchAppointmentOrOperations is the correct table if you want only time In and Out of OR. - SUM(Duration) Actual Time You ll calculate this time. SchPatTimesOp contains custom defined dates in ORM. Op1DateTime AS IntoOR Op2DateTime AS SurgeryStart Op3DateTime AS Incision Op4DateTime AS Closed Op5DateTime AS SurgeryStop Op6DateTime AS OutofRoom

35 BLOCK UTILIZATION Definition Percentage of block time assigned to a surgeon (not released) that is used by the surgeon; includes turnover time Why? Helps determine staffing needs and patterns for nursing, Central Sterile and Anesthesia Reported to Surgical Council quarterly who make recommendations to Surgeons

36 BLOCK UTILIZATION Documentation ORM>Dictionaries>Schedules>Operating Rooms *Do not delete entries as this will affect the Scorecards past data. Use the from date & thru date fields.

37 BLOCK UTILIZATION

38 DAILY BLOCK UTILIZATION

39 BLOCK UTILIZATION Notes / Tips Reporting on Block Utilization is challenging!!! Most important pieces to get right Surgeon Profile Process for releasing a block Let s add patience and perseverance A good process for keeping profiles up to date A potential gotcha in MEDITECH on released blocks

40 SCHEDULER DESKTOP AND DR TABLES SchCalendarLogs SchCalendarTable SchCalendarOrProfileProviders

41 DEMO SCORECARD

42 MEDITECH DATA REPOSITORY ORM data mart is not real time Production Environment Report IIS Datamart Report Web-Server IIS Datamart SSRS Report Web-Server SSRS Generation Report Generation

43 TABLES USED IN ORM ANALYSIS AdmittingData AdmVisits DMisGroupResponseElements DMisProvider DSchAppointmentGroups DSchApptTypes DSchOrDelays DSchResourceDates DSchResourceOrProfileDoctor DSchResourceOrProfileDrGroups DSchResources MisQry_Main * OmOrd_HomeMedAccounts OmOrd_Main OmOrd_Main2 * OmOrd_Main3 * OmOrdDict_AmbulatoryMeds * OmOrdDict_Main * PcsAcctInst_Instances * PhaRx PhaRxAdministrations PhaRxAdminReasons PhaRxIvAdditives PhaRxIvCarriers PhaRxMedications PhaRxSplitMedications RegAcctQuery_Result * RegAcctQuery_Result_Value_Mult * SchAppointmentOrOperations SchAppointments SchCalendarLogs SchCalendarOrProfileProviders SchCalendarTable SchOrPatCaseActualOps SchPatDelaysOp SchPatOrCaseMain SchPatOrCaseStaff SchPatTimesHold SchPatTimesOp SchPatTimesPacu SchPatTimesPhase2 * Indicates 6.0 tables

44 SSRS REPORT DEPLOYMENT OPTIONS Reports can be ad-hoc (with or without parameters) Reports can be pushed to a file-share on a schedule Reports can be ed on a schedule Snapshots of report data at a specific time can be taken Reports can be rendered in web-format (html or xml), text, image format, Adobe, Excel, and more

45 SURGICAL CASE DASHBOARD Surgical Care Improvement Project Case Types Total Knee & Hip Arthroplasty Hysterectomies Colon Resections Hip Fractures

46 DATA ELEMENTS ON SCIP CORE MEASURE CHECKLIST/DASHBOARD Data Elements Antibiotic Selection, Timing of administration and Discontinuation within 24hrs of anesthesia end time Beta-blocker documentation in Home Medication Screen and administration on post-op day #1 or #2 Urinary Catheter Removal on post-op day #1 or #2 Pharmacologic or Mechanical Venous Thromboembolism (VTE) prophylaxis timing

47 SURGICAL CARE IMPROVEMENT PROJECT (SCIP) CORE MEASURE CHECKLIST

48 SURGICAL CASE DASHBOARD

49 DRILL DOWN TO DOCUMENTATION

50 ANTIBIOTIC SELECTION 1) Group facility procedure mnemonics to type of case 2) Determine facility formulary antibiotics mnemonic & group into class of drug Ancillary>Pharmacy>Dictionaries>Drug 3) Determine facility allergen (beta-lactam) mnemonic Ancillary>Pharmacy>Dictionaries>Shared MIS>Allergen 4) Map each type of case to correct antibiotic selection and all variations

51 BETA-BLOCKERS 1) Home Medications Beta-Blockers Clinical>Dictionaries>Ordering>Ambulatory Drug>Drug 2) Formulary Beta-Blockers Ancillary>Pharmacy>Dictionaries>Drug 3) Documentation on Medication Administration Record

52 URINARY CATHETER REMOVAL 1) Did the patient have a foley catheter placed in the operating room? If documented using Assessment in the ORM Nurse Desktop, look up query mnemonics. ORM>Dictionaries>Surgical>Assessments to find doc section Clinical>Dictionaries>Documents>Doc section to determine query mnemonic 2) Collaborate with PCS Informaticist to determine where documentation occurs on the inpatient unit for discontinuation of foley.

53 PHARMACOLOGIC OR MECHANICAL VENOUS THROMBOEMBOLISM (V TE) PROPHYLAXIS 1) Determine facility formulary pharmacologic VTE prophylaxis mnemonics Ancillary>Pharmacy>Dictionaries>Drug 2) Collaborate with PCS Informaticist to determine query mnemonics for mechanical VTE prophylaxis used by inpatient units

54 EXTERNAL LINK IN MEDITECH

55 EXTERNAL LINK How To 1) Add the link to the External Link Dictionary Info Systems>MIS>Dictionaries>Person/Profile>External Link 2) Add the link to the user in the person dictionary Person/Profile Dictionary>Person>External>External Link

56 GATHERING DATA FOR SCIP Patient list, home meds, medications ordered, and allergies are populated three times a day 6am, Noon, 6pm Medication administrations and catheter documentation is gathered at report run time Dashboard indicators - logic based on operation date and time, report execution date and time, and measure specific rules.

57 DEMO SCIP DASHBOARD