Maimonides Medical Center Makes a Quantum Leap with Advanced Computerized Patient Record Technology Healthcare Information and Management Systems Society Electronic Poster Session
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) 2000-2002 1998 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
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
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
Implementation Planning and Process Infrastructure ATM enterprise network Leonia, NJ, data center OS 390/2.5 mainframe OC48 Sonet ring 2300+ desktops & wireless devices 113 servers New MIS site 5
Implementation Planning and Process 1996 1997 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
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
Implementation Project Governance Right Planning Environment HIS Executive Committee Physician Task Force Nursing Council Project sponsors break down barriers Project Teams -> user committees 8
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
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
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
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
CPR Return on Investment CPR s Ancillary; Enterprise Network Interface Engine Capital Reimbursement Grants Net Cost Ongoing Expenses (1997-2002) Savings and Efficiencies (1997-2002) Payback (years) ROI $ 43.909 (7.250) (4.962) $31.697 58,086 75,876 3.84 9.4% (000 s) 13
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 1999-2002 has remained below National Average 14
CPR Return on Investment Patient Safety Reduced Adverse Drug Reactions 2000 # Adverse Drug Reactions (ADR's) 1873 1800 # Pharmacy's Clinical Interventions 1603 1600 1450 1400 1200 1046 1000 800 619 600 400 435 436 325 200 0 1998 1999 2000 2001 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
CPR Return on Investment 6 Efficiency / Patient Focused Care Medication Turnaround Time 5 4 5.1 4.5 4.3 4.3 4.6 3 3.3 2.8 3 3 3.4 2 1 0 1.47 1.45 1.43 1 0.8 1 0.7 0.7 0.7 0.64 0.6 0.6 0.6 0.6 0.6 0.47 0.5 0.53 0.36 0.35 0.3 1992 1992 1993 1993 1994 1994 1995 1995 1996 1996 1997 1997 1998 1998 1999 1999 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
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% $11,158,487 11.5% 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 $8,000,000 1999 2000 2001 2002 CPOE Cost Avoidance Initiatives Medication Ordering Pathways Dosage Modifications IV to PO IV Push Therapeutic Interchange 17
CPR Return on Investment Efficiency / Patient Focused Care Laboratory Tests 1996-2001 Microbiology Serology Urinalysis Total Number of Test 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 80000 60000 49422 47491 48899 48623 1996 1997 1998 1999 2000 2001 Total Number of Test 12500 12000 11500 11000 10500 10000 9500 11900 11640 11433 11515 10884 10460 1996 1997 1998 1999 2000 2001 Total Number of Test 30000 25000 20000 15000 10000 5000 0 27000 20000 16288 15766 15551 16018 1996 1997 1998 1999 2000 2001 Hematology/Coagulation Chemistry Total Number of Test 300000 250000 200000 150000 100000 50000 0 280000 262936 246000 258466 262999 231807 1996 1997 1998 1999 2000 2001 Year Total Number of Test 1200000 1000000 800000 600000 400000 200000 0 990000 780000 443662 475458 490265 505174 1996 1997 1998 1999 2000 2001 Year 18
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 200 180 160 140 120 100 80 60 40 20 0 19 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)
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% 1997 2001 1997 2001 1997 2001 1997 2001 1997 2001 20 Information/Communication/ Education Transition and Continuity Satisfaction with Admissions / Registration Overall Medical / Surgical Patient Satisfaction Likelihood to Recommend
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
CPR Return on Investment Patient Access Year Length of Stay Reduction Discharges Incremental Discharges vs. Base Year Discharges Attributed to MACS 1995 28,356 0 0 1996.56 30,200 1844 461 1997.91 32,150 3794 949 1998.05 33,148 4792 1198 1999.26 35,493 7137 1784 2000.23 35,687 7331 1833 2001.17 35,626 7270 1818 Total 2.21 230,660 32,168 8043 22
CPR Return on Investment Fiscal Viability 200 180 160 140 120 100 80 60 40 20 26 POE 36 Cash 1996 2001 (in millions) PACS & RAD 43 TSI, Reinstallation of Patient Accounting 0 Dec-96 Dec-97 Dec-98 Dec-99 Dec-00 Dec-01 71 Med Admin 134 203 Ambulatory EMR Emergency EMR Obstetrical EMR 23
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