Maimonides Medical Center Makes a Quantum Leap with Advanced Computerized Patient Record Technology

Transcription

1 Maimonides Medical Center Makes a Quantum Leap with Advanced Computerized Patient Record Technology Healthcare Information and Management Systems Society Electronic Poster Session

2 CPR System Planning The Medical Center Staten Island Manhattan Mt. Sinai School of Medicine Top 100 Cardiovascular Hospitals (Solucient) Top 100 Most Wired Hospitals (H&HN) Computerworld Smithsonian Award Medicine 2002 Nicholas E. Davies Award 36,861 Inpatients 5.05 Length of Stay 1.87 CMI 253,316 Outpatients 77,118 Emergency Visits Ambulatory sites Voluntary physician practices with office MACS Hospitals: Coney Island Medical Center Brooklyn Lutheran Medical Center Note: Community physician offices too numerous to indicate on map $564.5 Million Revenue 4,612 Employees 277 Employed Physicians 401 Residents 978 Community Physicians 2

3 CPR System Planning Vision To improve the quality and effectiveness of patient care by providing real time access to comprehensive clinical information wherever and whenever needed. 3

4 CPR System Planning Strategic Priorities Clinical excellence & patient safety Humane, patient focused, patient centered care Strengthen physician collaboration & effective communication Supportive environment for physicians Fiscal viability 4

5 Implementation Planning and Process Infrastructure ATM enterprise network Leonia, NJ, data center OS 390/2.5 mainframe OC48 Sonet ring desktops & wireless devices 113 servers New MIS site 5

6 Implementation Planning and Process MACS Eclipsys 7000 Radiology Information System PACS Voice Recognition Document Imaging Transcription Blood Bank Laboratory Anatomical Pathology Patient Registration Master Person Index Patient Accounting Financial/HR/Payroll Decision Support 6

7 Implementation Planning and Process Physicians sought knowledge based decision support (1999) Eclipsys SCM to replace E7000 Purchased A4HealthSystems HMED CPR; NextGen CPR Ambulatory and Faculty Practices; E&C Intelligent Patient Record for Obstetrics 7

8 Implementation Project Governance Right Planning Environment HIS Executive Committee Physician Task Force Nursing Council Project sponsors break down barriers Project Teams -> user committees 8

9 Implementation Planning and Process Setting the right information-systems environment Establishing programs specifically focused toward physician participation, buy-in and ownership Reengineering processes and workflows Building the right MIS staff Just-in-time training and available references System go live support On-going support and monitoring 24x7 9

10 Impact on Operations Successful System Implementation Minimize adverse impact on hospital operations Three to six weeks of go-live support Closely managed phased implementation based on user tolerance Big Bang not always possible Patients come first! 10

11 Functionality Order / Clinical Practice Standardization Maimonides Access Clinical Systems (MACS) provides functionality that guides caregivers through recommended patient care practices and speeds order entry, results retrieval and clinical documentation. This is accomplished through the use of: Customized order sets and clinical protocols Common orders by service or department Knowledge-based order prompting Default drug doses Decision support Documentation templates Communication tools 11

12 CPR Value Prove return on investment: Demonstrate value of the application Provide qualitative and quantitative benefit statements Promote awareness of process redesign, cultural and organizational issues Integrate people, process and technology Initiate a smarter implementation 12

13 CPR Return on Investment CPR s Ancillary; Enterprise Network Interface Engine Capital Reimbursement Grants Net Cost Ongoing Expenses ( ) Savings and Efficiencies ( ) Payback (years) ROI $ (7.250) (4.962) $ ,086 75, % (000 s) 13

14 CPR Return on Investment Patient Safety Warns clinicians of safety checks required for High Alert medications Ensures safe selection of confusing look-a-like, sound-a-like drug names Verifies the selection of the correct patient Reduces the number of adverse drug reactions Improve medication turnaround time Reduces pharmacy s drug expenditure; drug spending for has remained below National Average 14

15 CPR Return on Investment Patient Safety Reduced Adverse Drug Reactions 2000 # Adverse Drug Reactions (ADR's) # Pharmacy's Clinical Interventions As the number of pharmacist s clinical interventions increases, the number of adverse drug reaction decreases (optimizing medication use reduces the number of adverse drug reaction reports) 15

16 CPR Return on Investment 6 Efficiency / Patient Focused Care Medication Turnaround Time Time from when order is initiated until Pharmacy acknowledges order T ime for prescription to be filled and delivered to patient area. Time for Pharmacist to process order TOTAL TIME REQUIRED 16

17 CPR Return on Investment Fiscal Viability $15,000,000 $14,000,000 $14,202,633* 15.4% $13,000,000 $12,000,000 $11,000,000 $10,516,953 6% $11,158, % 10.2% $12,296,652** $10,802,384 7% $11,562,929* $10,000,000 (7.8%) $9,692,496 MMC actual dollar expenditures $9,000,000 Adjusted expenditures that reflect annual budget increase on drug purchases experienced by Non- Federal Hospital * Projected expenditures for 2002 ** Projected expenditures based on data from first 6 months of 2001 $8,000, CPOE Cost Avoidance Initiatives Medication Ordering Pathways Dosage Modifications IV to PO IV Push Therapeutic Interchange 17

18 CPR Return on Investment Efficiency / Patient Focused Care Laboratory Tests Microbiology Serology Urinalysis Total Number of Test Total Number of Test Total Number of Test Hematology/Coagulation Chemistry Total Number of Test Year Total Number of Test Year 18

19 Sep-01 Oct-01 Nov-01 Dec-01 Jan-02 Feb-02 Mar-02 CPR Return on Investment Patient Focused Care Radiology Turnaround Time to Final Report Jan-99 Feb-99 Mar-99 Apr-99 May-99 Jun-99 Jul-99 Aug-99 Sep-99 Oct-99 Nov-99 Dec-99 Jan-00 Feb-00 Mar-00 Apr-00 May-00 Jun-00 Jul-00 Aug-00 Sep-00 Oct-00 Nov-00 Dec-00 Jan-01 Feb-01 Mar-01 Apr-01 May-01 Jun-01 Jul-01 Aug-01 Average Time Completed Exam to Final Report (hours)

20 CPR Return on Investment Patient Satisfaction 100% 90% 85% 84% 84% 80% 80% 70% 60% 50% 40% 30% 20% 10% 0% 70% 69% 63% 67% 72% 73% Information/Communication/ Education Transition and Continuity Satisfaction with Admissions / Registration Overall Medical / Surgical Patient Satisfaction Likelihood to Recommend

21 CPR Return on Investment Patient Safety / Regulatory Compliance The Ambulatory CPR: Improved compliance with problem lists from 67% to 97% Improved allergy documentation from 88% to 100% Improved pain assessment documentation to 95% Improved medication list documentation from 67% to 100% 21

22 CPR Return on Investment Patient Access Year Length of Stay Reduction Discharges Incremental Discharges vs. Base Year Discharges Attributed to MACS , , , , , , , Total ,660 32,

23 CPR Return on Investment Fiscal Viability POE 36 Cash (in millions) PACS & RAD 43 TSI, Reinstallation of Patient Accounting 0 Dec-96 Dec-97 Dec-98 Dec-99 Dec-00 Dec Med Admin Ambulatory EMR Emergency EMR Obstetrical EMR 23

24 Vision For Future Expand decision support and knowledge documentation Break Ground New Hospital planning to become a Digital Hospital OR/Anesthesia Records Virtual Imaging Radiology Clinical Equipment Integration CPR, physiological, images, audio Physical plant computers Expand patient safety initiatives including bar coding 24