focus Quality Outcomes ad Patiet Safety Stories of Success! Case Studies of Health IT i Support of the Natioal Priorities Partership Recommedatios ad The Joit Commissio Natioal Patiet Safety Goals By Louis H. Diamod, MB ChB, FACP, FCP (SA), FHIMSS; Kathlee A. Catalao, RN, JD, FHIMSS; David A. Collis, MHA, CPHQ, CPHIMS, FHIMSS; ad Patricia Johso, MAT Keywords Health IT, atioal patiet safety, atioal priorities, quality. Abstract The Stories of Success! project is focused o two goals: to solicit case studies demostratig the use of health IT i support of the Natioal Priorities Partership (NPP) recommedatios for atioal focus ad The Joit Commissio Natioal Patiet Safety Goals (NPSG); ad the use of the Stadards for Quality Improvemet Reportig Excellece (SQUIRE). The project is sposored by HIMSS, uder the aegis of the Patiet Safety & Quality Outcomes Steerig Committee. The Joit Commissio ad America Society of Quality are co-sposors. This article will describe the project; the backgroud of the NPP recommedatios ad the NPSGs; the backgroud ad basis for usig SQUIRE; how the case studies were solicited ad reviewed; how they are beig showcased; lessos leared; ad plas for the future. Natioal Priorities Partership Recommedatios for Natioal Actio We are faced with a triple threat coverig the uisured, bridgig the quality gap ad bedig the cost curve. How to cover the uisured is arguably kowable ad essetially to be determied through the federal ad state political process. Bridgig the quality gap ad bedig the cost curve are to some extet doable by the delivery system, with process beig slow o the former ad eve slower o the latter frots. There is a call for a atioal focus. To that ed, the Natioal Quality Forum (NQF) coveed a group, iitially of 28 stakeholders coverig all segmets cosumers, providers, accreditors, purchasers, isurers from both the public ad private sectors. The group is chaired by Doald Berwick, MD, Presidet of IHI ad CMS Admiistrator, ad Margaret O Kae, CEO, Natioal Committee for Quality Assurace (NCQA). Criteria iclude: a focus o high leverage areas; alig ad harmoize efforts; ad accelerate the eed to emphasize speed of chage. Some of the criteria for selectig the priorities are to reduce waste, reduce disease burde, elimiate harm ad eradicate disparities. These criteria were used to idetify high areas for focus. The six atioal priorities are: 1. Improve populatio health. 2. Egage patiets ad families. 3. Improve safety ad reduce harm. 4. Esure well-coordiated care. 5. Grat appropriate ad compassioate care for patiets with lifelimitig coditios. 6. Reduce overuse ad waste. www.himss.org volume 24 / umber 4 FALL 2010 jhim 39
The NPP also idetified a umber of drivers to achieve the best results, icludig paymet reform; ifrastructure issues, such as supportive health iformatio techology ad workforce capacity; accreditatio ad certificatio; performace measuremet; research ad iformatio dissemiatio, as well as public reportig. The Patiet Protectio ad Healthcare Accoutability Act of 2010, requires the US Departmet of Health & Huma Services Secretary to report back to Cogress i Jauary 2011, ad itermittetly thereafter, o atioal priorities. It is widely believed that the HHS Secretary will tur to the NPP to develop such a report. Table 1a: The Modified SQUIRE Tool/Applicatio Submissio Form Used i the Stories of Success! Project. The Joit Commissio s Natioal Patiet Safety Goals Established by The Joit Commissio i 2003, the Natioal Patiet Safety Goals (NPSG) program was desiged to help accredited orgaizatios address specific areas of cocer i regards to patiet safety. The NPSGs were first recommeded by the Setiel Evet Advisory Group (reamed the Patiet Safety Advisory Group i 2009) i 2002. The iitial six recommeded NPSGs were reviewed ad approved by The Joit Commissio s Board of Commissioers i July 2002. These six NPSGs were surveyed i Jauary 2003. The eighth set of NPSGs wet ito effect o Ja. 1, 2010. The Joit Commissio has log bee a propoet of patiet safety as evideced through their patiet safety trilogy. The trilogy bega with The Joit Commissio s cocer ad dedicatio to the idetificatio ad elimiatio of setiel evets. This resulted i the developmet of the setiel evet defiitio, publishig of reviewable setiel evets, setiel evet stadards ad Setiel Evet Alerts. The patiet safety stadards were the secod part of the trilogy ad the NPSGs the third. The purpose of The Joit Commissio s Natioal Patiet Safety Goals is to promote specific improvemets i patiet safety. The NPSGs highlight problematic areas i healthcare by providig evidece ad expert-based solutios to the safety issues preseted. Recogizig that soud system desig is itrisic to the delivery of safe, high quality healthcare, the NPSGs focus o system-wide solutios, wherever possible. The Joit Commissio will accept ay process the orgaizatio has i place electroic or paper as log as the purpose of the stadard is accomplished. Health IT ca be leveraged as a tool to meet requiremets. For istace, regardig acroyms, symbols, 40 jhim FALL 2010 volume 24 / Number 4 www.himss.org
Table 1b: The Modified SQUIRE Tool/Applicatio Submissio Form Used i the Stories of Success! Project. chaged for 2010, with much of the rigidity ad prescriptiveess removed. The orgaizatio must documet that a time out has take place, otherwise, they must documet accordig to their processes. Therefore, most perioperative departmets have a computer-based documetatio system ad this is hadled via that system. Lastly, of iterest is the ability to leverage health IT to serve as a secod verificatio; specifically, NPSG 01.03.01, Trasfusio Errors, which allows the ability to use barcodig, RFID, etc, i place of a idividual if two idividuals are ot available The 2010 Hospital ad Ambulatory Natioal Patiet Safety Goals are as follows: 2010 Hospital Natioal Patiet Safety Goals: Improve accuracy of patiet idetificatio. Improve the effectiveess of commuicatio amog caregivers. Improve the safety of usig medicatios. Reduce the risk of healthcare associated ifectios. Idetify safety risks iheret i the patiet populatio. Prevet wrog site, wrog patiet, wrog perso surgery The Uiversal Protocol. 2010 Ambulatory Natioal Patiet Safety Goals: Improve accuracy of patiet idetificatio. Improve the safety of usig medicatios. Reduce the risk of healthcare associated ifectios. Prevet wrog site, wrog patiet, wrog perso surgery The Uiversal Protocol. It is importat to ote that for each specific NPSG listed above, there are correspodig Elemets of Performace (EP) that explai how to comply with the NPSG. I other words, the EPs highlight what must be doe by a orgaizatio to be i compliace with the NPSG ad thus further patiet safety. Stadards for Quality Improvemet Reportig Excellece: SQUIRE dose desigatios ad abbreviatios ot to use, doctors ad staff could o loger use the abbreviatio ad had to choose the correct statemet fully writte out. This has become a Iformatio Maagemet Stadard IM.02.02.01-EP 2, ad o loger a NPSG. Aother example of leveragig health IT to meet TJC stadards icludes the Uiversal Protocol, which has bee sigificatly www.himss.org SQUIRE has bee developed to advace the scholarship of improvemet, facilitate dissemiatio of experiece i coductig quality improvemet projects (QIP).1 More recetly, Armistead ad Diamod have idicated the tool is of assistace i plaig a QI project ad used i the process of documetig attributio. 2 SQUIRE provides a structured tool to capture the fudametal dimesios of a QIP. The tool was modified for use i the Stories of Success project. (See Table 1a ad 1b) volume 24 / umber 4 FALL 2010 jhim 41
Some dimesios were elimiated, ad oe importat oe was added, i.e. a dimesio to capture the specific compoets of the health IT used to support the NPP priorities ad the TJC goals. The HIT dimesios outlied three sectios: the elemets of a EHR utilized, the HIT stadards icorporated, ad the data elemets captured. Table 2a: Fact Sheet Summary of Tier 1 ad Tier 2 Selected Case Studies. Marketig ad the Call for Case Studies The value propositio to promote iterest i the program was to provide applicats the framework that they would be helpig to icrease awareess that the adoptio ad use of health IT improves patiet safety, quality, effectiveess ad efficiecy; ad their efforts would be recogized i a variety of educatioal veues. As with ay effective marketig strategy, a variety of methods were used to create awareess for the all call for case studies: 1. Leveragig HIMSS e-ewsletters (HIMSS, ASQ ad The Joit Commissio). 2. 2. Social media (Twitter). 3. Web site promotio. HIMSS built a stadaloe dedicated Web page, ASQ Web site ad TJC Web site. 4. A press release aoucig the all call, ad a secod aoucig those who had bee selected. 5. Flyers set as liks ad hard-copies to key costituecies servig o the peer review body. 6. Word of mouth. Promotig the opportuity to submit a case study at a variety of cofereces ad idustry relevat meetigs, followed-up by e-mails with PDF flyers ad the case study submissio form. Review Process A peer review body was established icludig members of the HIMSS Patiet Safety & Quality Outcomes Steerig Committee, ad additioal diverse subject matter experts, icludig ASQ, The Joit Commissio ad The Natioal Committee for Quality Assurace. All applicatios were idepedetly scored by each member of the Peer Review Body, with a champio of each submissio to report out a gap aalysis of the submissio durig a votig call of the peer review body. Submissios were selected to be showcased based o how comprehesively they aliged with the SQUIRE applicatio criteria, that is, arrative backed by rich data metrics substatiatig the described processes, improvemets, ad outcomes, especially the key elemets of fulfillig a atioal patiet goal ad/or atioal priority based through 42 jhim FALL 2010 volume 24 / Number 4 leveragig of health IT. Submissios were divided ito Tier 1 ad Tier 2 recogitio. Results of the Call for Case Studies Six Tier 1 applicats (the most iformative submissios aliged with the Stories of Success! purpose) were selected, ad 10 Tier 2 applicats, additioal impressive successes to highlight ad share with the idustry. Table 2a ad 2b highlight the case studies that were selected, www.himss.org
Table 2b: Fact Sheet Summary of Tier 1 ad Tier 2 Selected Case Studies. measurably improves the quality ad efficiecy of patiet care i a teachig-hospital s outpatiet medical cliic preseted their case study as part of a HIMSS quality Webiar series. All case studies were featured as part of a Stories of Success! exhibit at the Jue 2010 HIMSS Virtual Coferece & Exhibitio. Lessos Leared ad Commets a example of oe of their successful outcomes, the health IT that was used, ad the related NPP recommedatios ad the TJC Patiet Safety Goals. Recogitio Each applicat received a certificate of recogitio for their participatio. A press release was set to the media ad posted to the HIMSS Stories of Success! Web site, with messages set o Twitter aoucig the selected submissios. A summary flyer (see Table 2) icludig a embedded hyperlik to each respective case study was posted to the website, ad as well distributed at the 2010 HIMSS Aual Coferece & Exhibitio i Atlata. The Greater Rochester Idepedet Practice Associatio (GRIPA) case study Electroic prescribig sigificatly ad www.himss.org We are i the early stages of explicitly utilizig health IT to improve patiet outcomes, bed the cost curve, facilitate electroic data exchage ad egage patiets ad their families i their care. The meaigful use of health IT requiremet, articulated by CMS i the NPRM, uder the aegis of ARRA. We are seeig the mergig of essetially two parallel worlds, oe previously dedicated to adoptig health IT, ofte without documetig the value i terms of improved patiet outcomes, ad the other demostratig improvemet, but without itegratig with the use of health IT i the various aspects of these efforts, like oe-time electroic data collectio, followed by electroic data trasmissio, aggregatio ad reportig. SQUIRE has the very potetial of facilitatig this process of the mergig of two cultures ad two previously somewhat separate activities ad processes. Based o the experiece of the first cycle of a call for case studies, some ext steps seem evidet: 1. The deploymet of professioal developmet opportuities for the quality measuremet ad improvemet teams ad the health IT professioals. 2. Coduct efforts to facilitate joit learig betwee these two groups of professioals. 3. Specific additioal guidace to all o how to utilize SQUIRE. 4. Modificatio to SQUIRE for the purposes of use i this type of project. Examples of these modificatios iclude: Item 3: Local problems. Emphasize the eed to documet the details of the local problem i regards the gaps i care that have bee demeted. Item 4: Iteded improvemet. Iclusio of specific measurable metrics, processes of care, patiet outcomes, cost reductio that are the focus of the itervetio. Item 6: Health IT dimesio. Needs more details ad the semblace of a classificatio system. Items 8a ad b: Outcomes. Needs details of process ad patiet outcomes. volume 24 / umber 4 FALL 2010 jhim 43
Item 13: Fiacial cosideratios. Need a framework ad additioal guidace for the submitters. A secod call for submissios is plaed for 2010, with some modificatio of istructios to the submitters. Note Special recogitio is give to the Stories of Success! peer review body: Louis H. Diamod, MB ChB, FACP, FCP (SA), FHIMSS, of Thomso Reuters; Pat Adamski, RN, MS, MBA, of The Joit Commissio; Kathlee A. Catalao RN, JD, FHIMSS, of Catalao ad Fich Compliace Advisors; Floyd Eiseberg, MD, of the Natioal Quality Forum; Joseph Fortua, MD, of the America Society for Quality; Trish Gallagher, RN, MSHS, CPHQ, of Credece Health; Pamela Graves RN, CNP, FHIMSS, of Childre s Hospital of Miesota; Pat Hale, MD, PhD, FACP, of the New York State Departmet of Health; Paul M. Schyve, MD, of The Joit Commissio; Mega Siears of Precisio Dyamics Corp. TimeMed; Joatha Teich, MD, PhD, FACMI, FHIMSS, of Elsevier; ad Ray Zielke of the America Society for Quality. Additioally, thak you to the support of HIMSS staff, icludig David A. Collis, MHA, CPHQ, CPHIMS, FHIMSS; Patricia Johso, MAT; ad Patricia B. Wise, MA, MS, RN, FHIMSS. JHIM Kathlee A. Catalao, RN, JD, FHIMSS, is a parter of Catalao ad Fich Compliace Advisors ad a accomplished atioal speaker/author o The Joit Commissio/NPSGs, regulatory compliace, core measures, CMS compliace, medical staff issues, setiel evets, risk maagemet, quality improvemet ad patiet safety. David A. Collis, MHA, CPHQ, CPHIMS, FHIMSS, is Director of Healthcare Iformatio Systems for HIMSS, overseeig the Davies Awards of Excellece ad the Patiet Safety & Quality Outcomes Steerig Committee. Patricia Johso, MAT, is Maager of Healthcare Iformatio Systems for HIMSS, maagig the Davies Awards of Excellece ad the Patiet Safety & Quality Outcomes Steerig Committee. Refereces 1. Davidoff F, Batalde P, Steves D, Ogric G, Mooey S. Publicatio guidelies for quality improvemet i health care: evolutio of the SQUIRE project. Qual Saf Health Care. 2008;17[Supplemet 1]:i3-i9. 2. Armistead ad Diamod; AJMQ. Accepted for publicatio, 2010. Louis H. Diamod, MB ChB, FACP, FCP (SA), FHIMSS, is Vice Presidet ad Medical Director, Thomso Reuters Healthcare (part-time) ad Presidet of Performace Excellece Associates. He curretly serves as Chair, Plaig Advisory Committee, PCPI; Chair,QMRI Coucil, NQF; ad Chair, HIMSS PS&QO Committee. 44 jhim FALL 2010 volume 24 / Number 4 www.himss.org