EMR Adoption: Benefits Realization

Transcription

1 EMR Adoption: Benefits Realization John H. Daniels, CNM, FACHE, FHIMSS, CPHIMS Global Vice President, HIMSS Analytics

2 Pressurring / Overload Automate to optimize clinical decision making Medical Knowledge

3 Ultimate Goal Ensure the most relevant information is available to the decision maker at the right place and at the right time

4 HOW CAN WE DO THIS?

5 EMR Adoption Model (EMRAM) A progressively sophisticated roadmap that enables Quality, safety, and Operations efficiencies

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7 Physician Documentation with CDS Progress notes H&P Consult notes Problem / Diagnosis list Discharge summary CDS Examples VTE risk assessment, Order this prophylaxis Asthma dx, Start Asthma Action Plan at discharge Certain antibiotic orders, Order infectious disease consult CHF diagnosis, Want to order ACE or ARB? Stroke diagnosis, Want to order a statin? Diabetes diagnosis, Follow ADA rule for diabetes orders

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9 Closed-Loop Medication Administration Before the bedside Step 1: Physician enters order via CPOE w/cds NOTE: At Stage 7, 90% of all orders via CPOE for 4 months Step 2: Pharmacist (or other qualified & authorized professional, e.g., senior physician) verifies the order in system w/cds Step 3: Pharmacy dispenses barcoded medication

10 Closed-Loop Medication Administration At the bedside NOTE: At Stage 7, 95% of pts/meds scanned for 4 months Step 4: Nurse scans patient Step 5: Nurse scans medication Step 6: System verifies 5 Rights Patient, Medication, Route, Dose, Time with alerts Step 7: Nurse administers medication Step 8: Nurse verifies / documents administration in EMR

11 18,0% 16,0% 14,0% 12,0% 10,0% 8,0% 6,0% 4,0% 2,0% Closed-Loop Medication Administration: A Key Element of Patient Safety emar Manual 0,0% Timing related errors Non-timing related errors Errors with ADE potential Transcription errors in med admin documentation Source: Effect of Bar-Code Technology on the Safety of Medication Administration; Poon, Keohane, Bates, Lipsitz, et al, New England Journal of Medicine, 2010;362: , May 6, 2010

12 0,5 0,45 0,4 0,35 0,3 0,25 0,2 0,15 0,1 0,05 0 Medication Administration Errors per 1000 CMI-Adjusted Patient Days 19 Pt Scan: 79% Med Scan: 76% 44% 10 Pt Scan: 96% Med Scan 93% 62% Jan 2011 Jan 2013 Jun

13 Profile of a Stage 6 & 7 Organization Use data to drive improved outcomes related to Process, Financial, Clinical, Quality & Safety Are paperless, or near paperless (create no paper) All clinically relevant data is in the EMR Are fully committed to continuous process improvement through collaboration Strong IT leadership and executive champions Clinician / end-user champions

14 HIMSS Analytics LOGIC correlation studies with other comprehensive data sources. BENEFITS REALIZATION FROM IT

15 All hospitals within each EMRAM Stage 50% Top Performing Hospitals By Number of Quality Metrics Excelling In By EMRAM Stage 40% 39.8% 30% 20% 10% 2.3% 6.5% 16.3% 18.1% 10.6% 12.9% 20.7% 0% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 4 or more 0,4% 1,8% 6,2% 10,0% 6,4% 6,4% 12,8% 30,1% 3 or less 1,9% 4,8% 10,0% 8,1% 4,2% 6,5% 7,9% 9,7% Source: HIMSS Analytics

16 All hospitals within each EMRAM Stage Hospitals with an "A" Leapfrog Hospital Safety Grade By EMRAM Stage 70% 60% 50% 40% 30% 20% 10% 0% Tipping Point 62,6% 30,8% 20,1% 21,8% 12,8% 14,3% 0,0% 5,9% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Source: HIMSS Analytics

17 AVG Projected VBP Clinical Score Clinical Performance Scores 70 Tipping Point 64,3 60 Tipping Point ,9 45,5 44,6 45,9 45,9 42,7 49,0 30 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Source: HIMSS Analytics

18 Mortality Rates 30% 20% Actual Mortality Low EMRAM 10% 0% Heart Atack Respiratory Therapy Actual Mortality High EMRAM Source: HIMSS Analytics

19 Average Operating Margin Financial Performance (Profitability) 8,0% 7,95% 6,0% 4,0% 2,77% 6,19% 4,91% 2,0% 0,0% -0,43% -2,0% -1,52% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 In 2011 In 2013 In 2015 Source: HIMSS Analytics Logic Source: HIMSS Analytics

20 Actual case studies from validated Stage 7 hospitals STAGE 7 CASE STUDIES

21 Other Incident Reports Medication Events Annual Incident Reports * per 1000 CMI-Adjusted Pt Days Other Incident Reports Medication Events 2,5 2 1,5 1 0, * 0

22 Rate per 1000 catheter-days # CAUTI 6,00 5,00 4,00 Catheter-Associated Urinary Tract Infection (CAUTI) rate per 1000 catheter-days # CAUTI CAUTI rate per 1000 catheter-days 5,34 4, , ,00 1,00 0, ,08 0, Jul 10 to Jun 11 Jul 11 to Jun 12 Jul 12 to Jun 13 Jul 13 to Sep 13 (3 months) 20 10

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25 Central Line-associated bloodstream infection (CLABSI)

26 Human (breast) milk administration through CLMA process

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31 Attention to detail Some changes in the pharmacy Reduction in the number of unnecessary STAT orders Great communication by the team

32 Order Sets Process Improvement Grid / Order Set Form Approach for Chemotherapy Reduced CPOE from 90 Minutes to 15 Minutes per Patient

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37 Jan 2013 Influenza Immunization Screening/Vaccination Compliance Feb 2013 Mar 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 How did they do this?

38 Hard Stop at Patient Discharge Upon discharge, if the vaccine has not been addressed the system will not allow the AVS to be printed The nurse will have to click on the hyperlink this will take the nurse to the Core Measures activity the nurse will need to answer the Vaccine Administration question

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40 Breast Milk Process 0

41 Breast Milk Error Rate Expressed Breast Milk Error Rate per administration 0, ,0002 0, ,0001 0, ,00021 PEDS Go Live * Prior to PEDS, all reporting of errors were based on self reporting. After PEDS, alert reports reviewed. Error rate describes errors that reached the patient.

42 Extra drug/s prepared Wrong quantity prepared Wrong dosage form prepared Wrong dose/strength prepared Wrong drug prepared Omission Wrong quantity dispensed Wrong dose/strength dispensed Wrong drug dispensed Wrong drug dispensed Dispensing Errors Types - Prior to PYXIS Implementation 2015 Wrong dose/stren gth dispensed Wrong quantity dispensed Omission Wrong drug prepared Wrong dose/stren gth prepared Wrong dosage form prepared Wrong quantity prepared Extra drug/s prepared Series

43 Workflow Analysis : Post-Implementation Most items will come out of the ADM instead of having a cart fill. No need to physically print the Pick List.

44 Benefits Analysis: Number of Staff to Fill and exchange the Cart Fill Before PYXIS (2) Two Pharmacists After PYXIS (1) One Pharmacist (4) Four Pharmacy Technicians (1) One Pharmacy Technician

45 Benefits Analysis: Consumed Time to Fill and Exchange Cart Fill Before PYXIS After PYXIS Five Hours One Hour Saving Time = 4 hrs

46 When will your organization reach

47 Thank you! John H. Daniels, CNM, FACHE, FIMSS, CPHIMS Global Vice President, HIMSS Analytics