Tying It All Together: Informatics In Action Sherri Hess, MS-IS, BSN, RN, Director of Nursing Informatics, Denver Health System Andrew Steele, MD, MPH, CMIO, Denver Health System
Denver Health Integrated public safety net institution 5,300 employees Closed medical staff 500 bed hospital Extensive primary care network Level I Trauma Center Public Health Department
Denver Health Over 190,000 patients 25% of Denver population Payer mix 45% Medicaid 18% Uninsured 10% Medicare 27% Other $4B in unsponsored care since 1992 ~$400M in 2013
Clinical Technology Strategy Patient Portal Enterprise Master Patient Index Clinical Documen tation Results Repository Medication Administration Check Patient /Family and Provider Clinical Decision Support Analytics / BI Dashboard PACS/ Imaging System Data Warehouse CPOE Enterprise Document Management Dashboard Single Signon Immunization Tracking
Centers for Medicare and Medicaid Services: ACO "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care
ACO Original Core Principals Provider-led organizations Strong base of primary care Accountable for quality and total per capita costs Provide full continuum of care for a population of patients Payments that are linked to quality improvements that also reduce overall costs Use sophisticated performance measurement
Payment Reforms Will Motivate and Reward Innovation at a Whole New Level -Todd Park, Chief Technology Officer, U.S. Department of Health and Human Services Accountable Care Organizations Shared savings; redesigned care processes for high quality, efficient delivery IT Innovations Needed: Timely Clinical Data, Decision Support Patient Centered Medical Homes Bundled Payments Readmission Reduction Programs Organized outpatient care, coordination and team-based approaches Pilot program for episodes of care; incentivizes reduced costs around eight conditions Motivates hospitals to engage with care coordinators and better organize delivery systems Care Integration Tools Technology to Extend Physician Reach Consumer Engagement Tools/Platforms/Apps Data Mining/Analytics
Denver Health Clinical Informatics History
Denver Health Clinical Informatics History Pre 1998- rare nurse or physician on a committee 1998-2002: 0.5 FTE Physician Champion 2010-2011: slowly added Master level Informatics Manager 2012: added Director of Nursing Informatics added 7 informatics nurses added 8 physicians (0.2) FTE each
Denver Health Informatics Team 3 Physicians 12 RN s RN s - 6 Masters in Health Informatics/IS; 2 in Grad School; 1 in DNP School 2 Pharmacists PharmD Future: ~25 RN FTE s, ~6 MD FTE s, ~4 Pharmacy FTE s, ~4 ancillary FTE s
Ratio of RN Informaticists Item Number RN Ratio Hospital Discharges 25,000 1087 Employees 5,500 239 Outpatient Visits 600,000 26087 Oupatient Members 120,000 5217 Net Revenue $700,000,000.00 $30,434,782.61
Roles of Informaticists at Denver Health
Roles of Informaticists at Denver Health Order Sets Workflow/Clinical Decision Support Analysis of enhancement or new functionality Design Go-live support Testing Day to day clinical assistance Education Application support & build: new or upgrades Committee Participation
Denver Health Committees Provider/RN Engagement Physician Advisory (PAC) 10 physicians Nursing Informatics Council (NIC) ~35 nurses Clinical Champions, >100 Providers, 200 RN s, 150 HCP/Others
Accomplishments At Denver Health Over hauled EHR Class Communication: Tips and Tricks, Huddle, Doc Box Verbal Unsigned Orders from 3.5% to 0.1% Point of Care Decision Support 22 new clinical order sets 35 Live workflows
Verbal Orders
The Joint Commission Tracers
Huddle Sheets As Needed
Tips and Tricks Monthly
Doc Box News
Roles of Informaticists at Denver Health
Data Warehousing: Denver Health 1998 Financial Demographics Data Warehouse 2007 Pathology Pharmacy Pulmonary GI Lab Radiology Laboratory Encounter 2008 2009 Orders Ultrasound EDM Forms Med Administration Custom Interfaces Med Recon ED Fetal Monitoring OR 2010 Scheduling Nursing Documentation Workflow Wait List/Referrals Vaccinations
BI at Point of Care 5/15/2014 24
How Does the Clinical Decision Support Team Help? With Clinical Champions, Stakeholders, and Clinical Practice Committee, design, coordinate, test, implement and evaluation Clinical Order Sets. Care set Guides the care of a specific type of patient/diagnosis/symptom, or defines a certain aspect of care Admission Set Guides the care of newly admitted patients; can be specific to a unit, area, or subset of patients. Perioperative Set Guides the care in preparation for or recovery from surgery. Picklist Conglomeration of orders without clinical guidance created to help providers efficiently search for and choose certain orders.
How Does the Clinical Decision Support Team Help? Linking orders to improve efficiency & patient safety TPN-Couple PCO and Pharm Order Places notification order for pharmacy when TPN is ordered Respiratory-Notify RT with vent/cpap/bipap changes Notifies RT when vent/cpap/bipap, etc. are revised or discontinued RT-Blood Gas/Blood Draw Notifies RT when a blood gas is ordered, discontinued, or revised RT-RT Therapy/Med Treatment Notifies RT when a med with route INH or NEB is ordered, revised, or discontinued Behavioral Health Emeds Automatically places and discontinues nursing notification order when EMED meds are ordered or discontinued. RT Mini BAL When respiratory culture ordered, RT notified if sample is a Mini-BAL (which is a lab collected by RT), but does NOT notify RT if the sample is selected to be bronchoalveolar lavage (which is a lab collected when doing a scope procedure)
How Does the Clinical Decision Support Team Help? Real-time quality reporting alert examples Central Line Identify patients with eligible central lines and evaluate need for removal in order to assist in the reduction of central line associated blood infections. Urinary Catheter Identify patients with Foley catheters and evaluate need for removal in order to assist in the reduction of catheter-associated urinary tract infections. Infection Control Alert the infection prevention team of positive infection results for infections requiring isolation, VRE, Cdiff, MRSA. Rapid Response on End of Shift Report Alert Charge Nurses and Clinical Nurse Educators of significant changes in the patient condition and determine the need for an Adult Rapid Response at 0600 and 1800.
How Does the Clinical Decision Support Team Help? CMS compliance alert examples Heart Failure AMI Alert the Healthy Heart Nurses of potential Heart Failure (HF) patients. Alert the Health Heart Nurses of potential Acute Myocardial Infarction (AMI) patients >= 18 years of age.
Real Reason For Informaticists
Journey To A Career In Informaticist at Denver Health On the job training -> Super User Informatics Certifications Practicum/Internship Degree programs CU Denver Regis University of Denver
Is It Worth It?
Denver Health Childhood Immunizations
Denver Health Hospital Survival
Clinical Informatics in Health Care
mhealth Integration
Chronic Care Management: Using a Customer Relationship Management (CRM) Application 38 38
References http://www.amia.org/ https://www.ania.org/ http://www.himss.org/index.aspx McLane, S., Turley, J.P. (2011). Informaticians. The Journal of Nursing Administration, 41, 1. Jt Comm J Qual Patient Saf. 2011 Mar;37(3):99-109.