HIMSS Davies Committee Site Visit

Transcription

1 HIMSS Davies Committee Site Visit Introduction 2017 Lehigh Valley Health Network HIMSS Organizational Affiliate

2 LVHN Case Studies and Presentations for the Davies Award Welcome and Introduction Mike Minear, MS, CHCIO Case Study #1 Ambulatory Care Process Improvement Mike Sheinberg, MD Jen Stephens, DO Case Study #2 - Daily Huddle Kim Jorden, RN Case Study #3 Reduce Sepsis Mortality Matt McCambridge, MD Don Levick, MD 2

3 Triple Aim Drives LVHN Strategy and Goals Triple Aim Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience [Care] of care, improving the health [Health] of populations, and reducing per capita costs of health care. Emerging 4 th aim: address clinician and staff satisfaction LVHN Mission: We heal, comfort and care for the people of our community by providing advanced and compassionate health care of superior quality and value supported by education and clinical research. Better Health, Better Care, Better Cost Berwick, D., Nolan, T., Whittington, J. (2008). The Triple Aim: Care, Health, And Cost. Health Affairs 27:3.

4 Lehigh Valley Health Network LVH-17 th Street LVH-Cedar Crest LVH-Muhlenberg Organizational Summary Key Metrics LVH-Tilghman LVH-Schuylkill E. Norwegian St. 8 Campuses Children s Hospital 250+ Physician Practice locations 17 Community Clinics 16 Health Centers 12 ExpressCARE Locations 81 Testing and Imaging Locations Regional burn center Level I trauma center Memorial Sloan Kettering Cancer Alliance member 1,700 beds 57,272 Inpatient admissions 212,897 ED Visits 2.9 million ambulatory visits 18,000+ Employees 2,005 Physicians 95 Medical specialties 3,400 Registered Nurses 400 Specialty certified nurses 243 Medical residents $2.8 B FY18 projected revenue LVH-Hazleton LVH-Pocono LVH-Schuylkill S. Jackson St. ExpressCARE Home Health Health Centers LVPG Group Practice

5 Long History of EHR Use and Innovation at LVHN PHAMIS EHR deployed 1994 (23 years ago) Major upgrades in 2000 Fully implemented CPOE with 93% compliance by 2005 Bar code medication administration Leapfrog CPOE compliant since 2007 Ambulatory EHR (1) Practice Partners, (2) NextGen, (3) GE in 2007, Epic is 4 th generation aicu Remote monitoring of initially 30 critical care beds implemented in 2004 GE PACS implemented 2005 Breast milk bar coding in 2008 Foundation for rapid deployment and optimization of Epic EHR Patient Profile roadmap LVHN ROADMAP daily summary Pioneering version of current Epic Bedside MyLVHN Bedside

6 Epic Electronic Health Record 1.9 million patient records 2.6 million records with new hospitals/clinics 25 Epic Software Modules LVHN Digital Clinical Record Infrastructure Digital Clinical Imaging Systems linked to EHR Filmless Specialty Clinical Software 151 Specialty Clinical Systems MyLVHN Patient Portal 170,000+ patients MyLVHN MyLVHN mobile Health Information Exchange Shared 1.7 million patient records with other care providers Share 160,000+ eprescriptions/month with community pharmacies LVHNLink MyLVHN Bedside 1,400+ Community Providers accessing LVHN EHR Genomic Content Early stages of integrating genomic content Clinical Implants Linked with Epic Medtronic implants All LVHN clinical encounters in the EHR: inpatient, ED, ambulatory, Telehealth Clinical Equipment interfaced to EHR 45+ million data points loaded to Epic each day ~700 devices Paper Clinical Records Scanned and Linked into EHR Paperless

7 Epic EHR Software Suite Core Software EpicCare Ambulatory EpicCare Inpatient Willow inpatient pharmacy ASAP Emergency Department Rover mobile medication administration Beacon Medical Oncology Stork OB Maternal Child Optime OR and Anesthesia Radiant Radiology Resolute Hospital Billing Resolute Professional Billing Grand Central Registration and ADT Cadence enterprise scheduling Health Information Management Patient Identity EMPI Bridges Interface Welcome patient kiosk Phoenix Transplant Cupid Cardiology Patient and Family Connections MyLVHN patient portal MyLVHN bedside inpatient mobile portal Health Information Exchange Care Everywhere HIE EpicCare Link Surescripts eprescribing and DIRECT LVHN Digital Clinical Record Infrastructure Clinical Digital Imaging GE Radiology PACS (sunsetted) Phillips Radiology PACS Terarecon 3D image viewer Hologic Mammography viewer Paper Medical Records Scanned and Linked to Epic EHR OnBase document management Genomic Content Foundation One Clinical Implant data Medtronic implants 336 total software applications 135 interfaces Legend Interface with Epic EHR In Production In Process Future Niche Clinical Software Sunquest Laboratory (HNL) Homebase Home Care GE DMS Cardiology Cath lab and EP Muse EKG Mosaiq Radiation Oncology QS1 Ambulatory Retail Pharmacy RL Solutions Incident Reporting TheraDoc Infection Control Press Gainey Patient Satisfaction OTTR Organ Transplant Endoworks GI 3M coding & Comp Assisted Coding Clinical Equipment Linked to EHR Pyxis Drug cabinets Omnicell Supply and Tissue Cabinets Phillips Hemodynamic monitors Drager Anesthesia machines Hamilton Galileo ventilators Drager Ventilators (NICU) Viasys CareFusion Ventilators (NICU) NOVA StatStrip Glucose Meter Philips Respironics CO2 monitors GE EKG, echocardiograms, stress echo TEE cardioversion Epiphany Holter Monitors Fresnius dialysis machines Varian LINAC (via Mosaiq) GE Connect Fetal monitoring B. Braun digital Infusion pumps

8 Online Clinical Knowledge Integrated with EHR # Online Knowledge Element Current status at LVHN 1 Clinical Order Sets 367+ clinical order sets created and maintained by LVHN clinicians in EHR 2 Online Drug Formulary 3 Documentation templates 5,500+ regular and investigational medications in pharmacy application and EHR as approved/monitored by the LVHN Pharmacy and Therapeutics (P&T) committee. 2,245+ clinical documentation templates based in multiple Epic documentation tools. Realtime documentation of Codes and Traumas. 4 Rules and alerts 5 Medical Oncology 6 Medication knowledge base 7 Referential linking to drug monographs 8 Care plan knowledge base 9 Patient teaching content 10 Clinical terminology 256 real time alerts (Best Practice Alerts) built into Epic EHR. Include 162 alerts active & visible to clinicians, and 94 silent/background alerts medical and radiation oncology treatment and therapy plans. Includes many researchbased clinical trial based protocols from across the United States, and as a member of the Memorial Sloan Kettering Cancer Alliance. Licensed from First Data Bank and integrated with EHR: drug to drug, drug to allergy, drug to diet, pregnancy/breast feeding, and dose range checking rules. Augmented medications dosing guidelines for end-organ function, specific to LVHN. Licensed from Lexi-Comp (Wolters Kluwer Health Clinical Solutions) online drug monographs are linked directly from the EHR. Supports Drug reference links to clinical information about medications for the EHR medication order entry and the Medication Administration Record (MAR). Licensed from Elsevier CPM CarePoints online patient center care plans and evidence-based clinical practice guidelines for nurses and other practitioners. Licensed from Krames - online health encyclopedia that offers thousands of explanations and tools on medical conditions, symptoms, tests, and treatments. Linked to flowsheets, generated with discharge summaries, etc. Licensed from Intelligent Medical Objects (IMO) provides clinical vocabulary datasets and services used with Epic to manage vocabularies and data creation.

9 AMOUNT Amount Legacy of Technology Investment Capital Investment $382 million dollars in capital investment for IT in last 14 years 250,000, ,000, ,000,000 Lehigh Valley Health Network IS Cost - Capital and Operating FY 2004 to FY ,000,000 50,000, Fiscal Year Capital Operating Lehigh Valley Health Network IS Cost - Operating and IT cost as a % of LVHN Revenue FY 2004 to FY 2018 Annual Financial Support $140,000,000 $120,000,000 $100,000,000 $80,000,000 $60,000,000 $40,000,000 $20,000, % 5.0% 4.0% 3.0% 2.0% 1.0% $124 million annual IT operational budget 4.2% of organization s revenues $ FISCAL YEAR 0.0% Operating % of Revenue

10 LVHN Support of Innovation 585 LHVN colleagues focused to leverage modern technology and data to deliver optimal patient care, patient service, economic value, and other organizational goals LVHN Team FTEs Information Services 441 Enterprise Analytics 25 Unit-based Analytics 70 Clinical Informatics 14 Software/process Training 16 Organizational Effectiveness 19 Total 585 Air Products Center for Connected Care and Innovation at LVHN Metrics driven Team based Strong goals and accountability

11 Engage and support patients & families with rich digital tools. Dramatic growth in MyLVHN use, over 170,000+ patients accessing, with 69% usage in studied cohort NOW MyLVHN Patient Portal evisits (with patient pictures) Video Visits echeck-in Patient Entered Questionnaires Secure messaging Test results Future and past appointments Self scheduling and Open scheduling Preventative care Patient collected clinical data Billing and payments Medications and refills Encounter details Proxy management FastPass waitlist management IN PROCESS NEAR FUTURE Consumer test device interface via Apple Health Kit Links to consumer search tools to find clinicians and self schedule a visit Video Visits Central Care and Scheduling Call Center MyLVHN Bedside Patients using MyLVHN Feb 2015 Jul 2017 MyLVHN Mobile Fastest initial MyChart rollout in Epic customer base

12 Health Information Exchange LVHN has an advanced infrastructure in place to share patient data with other care providers to support patients receiving clinical services across the continuum of care LVHN has shared 1.7 million+ patient records with over 500 other care providers Epic Care Everywhere share clinical records with other Epic EHR customers DIRECT interface via Surescripts share clinical records with other EHR providers Member of the Sequoia national HIE share clinical data with federal agencies, public health, and other providers Member of Carequality share clinical data with other care provides LVHN shares over 160,000 eprescriptions per month Via the Surescripts National eprescribing network LVHN shares immunization data with the Pennsylvania immunization registry PA Statewide Immunization Information System (PA SIIS) EMS units access the LVHN EHR to support patient care 17 EMS units across eastern Pennsylvania 12

13 LVHN HIT and Nursing Awards HIMSS Analytics created the seven level EMR Adoption Model (EMRAM) over 10 years ago to assess a care provider s use of the EMR in both inpatient and ambulatory environments Over 5,400 US hospitals and 41,000 US ambulatory clinics are tracked In May of 2017, LVHN has achieved Stage 7 in the EMRAM for both inpatient and ambulatory use of the EMR Only 5% of US hospitals and 9.6% of US ambulatory clinics have achieved Stage 7 For the 12 th consecutive year LVHN was awarded Most Wired designation Most Wired Advanced, one of 27 hospitals in the US Most Wired Innovator, one of 3 hospitals in the US LVHN has earned Magnet Status for Nursing, only 7% of US hospitals has attained this level