Achieving Organizational Excellence Through Health

Transcription

1 Achieving Organizational Excellence Through Health

2 Objectives Identify the various HIMSS Awards and their focus Determine the challenges and the opportunities of affecting organizational change Discuss those next steps that can define organizational

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4 Recap How did we get here?

5 1999 Challenge 98K+ patients die annually due to medical errors!! Why?

6 Disconnected care settings Self Community Care Home Care Secondary Rehabilitative Tertiary Primary Long Term Care

7 Silos Providers of care and patients do not have access to all relevant information required to make the most informed decisions at the right time in the care delivery process Health info. sharing Complete health picture Inefficiencies Errors Incorrect diagnosis Isolated Decisions Inefficient health system usage Redundant services Increased costs Un-coordinated Care Silo ed care & care episodes Lost efficiencies Lost opportunity

8 Pressurring / Overload Medical Knowledge

9 2001 Opportunity Use information technology to help make healthcare

10 Pressurring / Overload Automate to optimize decision making Medical Knowledge

11 Automate to optimize care coordination Home & Community Self Rehabilitative Long Term Care Primary Tertiary Secondary

12 2009 Solution? ARRA Meaningful Use

13 Rewarding successes Industry awards

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19 Success begins with a strategy Discover an EMR adoption roadmap

20 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration CPOE, Clinical Decision Support (clinical protocols) Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed Q Q % 2.9% Progressively sophisticated 1.0% 12.5% 4.5% steps 22.0% that track the 3.6% 15.5% accessibility 38.4% 30.3% of information 31.6% 7.6% within an 7.2% 3.3% EMR All Three Ancillaries Not Installed 13.4% 5.8% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5167 N = 5458

21 Why? Provide thought leadership Reflect the market Inform government policy Drive the market

22 Vision Ensure the most relevant clinical information is available to the clinician at the right place and at the right time

23 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP ARRA Q Q % 3.6% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration 1.0% 4.5% 17.9% 32.8% CPOE, Clinical Decision Support (clinical protocols) 3.6% 14.0% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 38.4% 31.6% 7.2% 21.0% 5.1% 2.0% All Three Ancillaries Not Installed 13.4% 3.7% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5167 N = 5467

24 Q MU Payments Q Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 1.1% 3.6% +227% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 4.0% 17.9% +347% Closed loop medication administration 6.1% 32.8% +437% CPOE, Clinical Decision Support (clinical protocols) 12.3% 14.0% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 46.3% 21.0% CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 13.7% 5.1% -62% Ancillaries - Lab, Rad, Pharmacy - All Installed 6.6% 2.0% -69% All Three Ancillaries Not Installed 10.0% 3.7% -63% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5441 N = 5467

25 Q MU Payments Q Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 1.1% 3.6% MU Stage 3* Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration 4.0% 6.1% 17.9% 32.8% MU Stage 2 CPOE, Clinical Decision Support (clinical protocols) 12.3% 14.0% MU Stage 1 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 46.3% 21.0% CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 13.7% 5.1% Ancillaries - Lab, Rad, Pharmacy - All Installed All Three Ancillaries Not Installed Data from HIMSS Analytics Database 2014 HIMSS Analytics 6.6% 2.0% 10.0% 3.7% N = 5441 N = 5467 *Anticipates Emphasis on Information Exchange

26 This is how long it takes to make significant national progress Stage 7 0.0% 0.0% 0.3% 0.7% 1.0% 1.2% 1.8% 2.9% 3.6% Stage 6 0.1% 0.8% 0.5% 1.6% 3.2% 5.2% 7.3% 12.5% 17.9% Stage 5 0.5% 1.4% 2.5% 3.8% 4.5% 8.4% 11.5% 22.0% 32.9% Stage 4 3.1% 2.2% 2.5% 7.4% 10.5% 13.2% 14.0% 15.5% 14.0% Stage % 25.1% 35.7% 50.9% 49.0% 44.9% 41.7% 30.3% 21.0% Stage % 37.2% 31.4% 16.9% 14.6% 12.4% 11.4% 7.6% 5.1% Stage % 14.0% 11.5% 7.2% 7.1% 5.7% 4.8% 3.3% 2.0% Stage % 19.3% 15.6% 11.5% 10.1% 9.0% 7.5% 5.8% 3.7% # of Hospitals N = 4,237 N = 5,073 N = 5,166 N = 5,235 N = 5,281 N=5,337 N=5,310 N= 5,458 N=5,467 Source: HIMSS Analytics Database

27 So, What Makes a Stage 7 Organization? Summary profile

28 IT implementation success characteristics Documented goals for vendor & organization Achieving end-user buy-in Strong organizational sponsorship Adequate systems acceptance testing Well-planned end-user training Minimal business and service disruptions Plenty of data conversion time

29 They are paperless, or near paperless Create no paper ALL clinically relevant data are accessible & available to the clinician in one location

30 They are fully committed to continuous process improvement through collaboration Strong IT leadership and executive champions Clinician / end-user champions

31 They use data to drive improved outcomes related to Process Quality Finance Safety Clinical Access

32 For example Who are your most efficient surgeons? A. Those that use the least resources B. Those that have the best outcomes

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34 Are Stage 7 organizations achieving results? EMRAM studies on a Macro Scale (correlations with EMRAM Stages)

35 All hospitals within each EMRAM Stage TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In 50% 40% 30% 20% 10% 0% 2.3% 0.4% 1.9% 1.7% 4.8% 6.2% 10.0% 10.1% 8.1% 6.4% 4.2% 6.4% 12.8% 6.5% 7.9% 30.1% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Source: HIMSS Analytics 6.5% 16.3% 18.1% 10.6% 3 or less 4 or more Tipping Point 12.9% 20.7% 39.8% 9.7%

36 Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage 70% All hospitals within each EMRAM Stage 60% 50% 40% 30% 20% 10% 0% 62.6% Tipping Point 30.8% 20.1% 21.8% 12.8% 14.3% 5.9% Stage 0.0% 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7

37 Value-Based Purchasing (VBP) Program* + = 70% 30% TPS 100 = High Value Performance TPS 0 = Low Value Performance *Program from U.S. Medicare to earn additional reimbursement

38 Clinical Performance AVG Projected VBP Clinical Score Tipping Point Tipping Point Source: HIMSS Analytics TM Database Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7

39 Patient Experience 70 AVG Satisfaction Score Source: HIMSS Analytics TM Database Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7

40 Total Performance Score (TPS) Source: HIMSS Analytics TM Database Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 AVG Clinical Score AVG Satisfaction Score TPS

41 Association between EMR capabilities and hospital mortality? In General the more advanced the hospital s EMR capabilities the more likely the hospital is to have better risk-adjusted mortality rates when treating Heart Attack Heart Failure Stroke Several types of GI surgeries Pneumonia Sepsis Respiratory failure

42 Association between EMR capabilities and staff perceptions of hospital safety? In General the more advanced the hospital s EMR capabilities the more positive the staff are about their hospital s patient safety culture Hospital Survey on Patient Safety Culture

43 Association between EMR adoption pace and staff perceptions of hospital safety? In General the faster the hospital implements an EMR the less positive the staff are about their hospital s patient safety culture Grouped hospitals by the number of EMRAM stages they passed in a four year period and then analyzed AHRQ s Hospital Survey on Patient Safety Culture scores

44 What About Cost Efficiency? Research on the Effect of EMR Deployment

45 Average Operating Margin Financial Performance (Profitability) 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% -1.0% -2.0% 1.62% 2.84% 2.25% 1.53% -0.43% -0.34% -1.52% -0.58% Source: HIMSS Analytics Database 2.35% 0.77% 1.79% 3.53% 2.56% 2.32% 1.47% 4.06% 3.91% 2.55% 1.66% 2.52% 2.20% 6.19% 4.91% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 In 2008 In

46 What s your EMRAM Score? Moody s wants to know!!

47 Bond Ratings Multi hospital system case study during 2009 / 2010 recession Bad debt up, cash flow down All hospitals were Stage 6 Bond rating did not change

48 Advanced EMR adoption = Good vision Good execution Commitment to excellence

49 Fewer malpractice claims One study found the rate of malpractice claims when EHRs were used was about onesixth the rate when EHRs were not used!!! The Relationship Between Electronic Health Records and Malpractice Claims Mariah A. Quinn, MD, MPH; Allyson M. Kats, MSc; Ken Kleinman, ScD; David W. Bates, MD, MSc; Steven R. Simon, MD, MPH Arch Intern Med. 2012;172(15): doi: /archinternmed

50 Summing it up

51 ROI is possible There are benefits to advanced EMR capabilities but the ROI requires persistence and patience Work on the high touch AND high tech EMR adoption is NOT just an IT department initiative it requires an Organizational Development orientation

52 Value is achievable Health IT Value Suite S T E P S Satisfaction Treatment/Clinical Electronic Information/Data Prevention/ Patient Education Savings

53 The Road Ahead towards advanced EMR capabilities will lead you to a STEEEP place but the journey requires thought and strong leadership

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59 Thank You John H. Daniels, CNM, FHIMSS, FACHE, CPHIMS Vice President,