Institute of Medicine Committee on Patient Safety & Health Information Technology Ellen Harper, RN, MBA Senior Director, CNO Cerner Corporation Doctorate Student, ASU
HIT Assisted Patient Safety Continuous Performance Improvement Data Capture Reduce Variance Pick lists verses free text Required fields Structured Nomenclature SNOWME CT, ICD-9, Multum Evidence Based/Best Practice Instruments & tools (Braden) Plans of Care, Orders, etc. Documentation Connect Clinical Devices Medication administration Increased accuracy Data Analysis Conditional Logic If/then logic Reduces noise Carry forward Patient Handoffs Reporting Real Time Dashboards Retrospective Ad-hoc Data Warehousing Comparative Effectiveness Evidence based Point of care Literature review Modeling Process Predictive Financial Simulations Patient throughput Productivity Condition Management Population Management Reporting Compliance Trending Genomics 2
Enabling Evidence Based Appropriate Care EHR Configuration Reference Knowledge Clinical Readiness & Change Management Transform Clinical Adoption ED Admission Chest Pain /NSTEMI/Unstable Angina ED Chest Pain Center Inpatient C hest Pain U nit ED Walk-in EMS Nurse triage, perform/ confirm EKG STEMI? STEMI Scenario No Test for Cardiac Biomarkers Admit pt for observation in CPU Invoke Risk Stratification Advisor Prep patient for Cath Prep patient for Cath No Cath Indicated? Cath in 2hrs? Observation in the ED Chest Pain Center No Disposition Stress Test No by ED Indicated? physicians Admit pt to ED CPC Conduct Stress Test No Return to ED Cath Chest Pain Indicated? Center Actionable Knowledge Integration into Workflow Cath Lab C ardiac Units Perform Cath Need Other IP Other OP Pt lives X Recover in Discharge to PCI? No CT Surgery No cardiac care No testing hrs from No OPC Home In X days? needed? needed? hospital? No Admit to Telemetry Stay at the Admit to Admit to Admit to Inpaient unit, use Inpatient Discharge to onsite Inn, Cardiac Short Telemetry Open Chest Pain Unit Chest Pain Unit as last Home nearby lodge, Stay Heart Unit for Scheduling * resort or return home Executable Knowledge TM Train, Manage Change & Adopt Measure, Monitor, Learn, Adjust & Analyze Value Based Payment - Appropriate Care - Quality Care - Cost Efficient Care 3
HIT Evidenced-Based Interdisciplinary Care anticoagulant therapy sedatives < CPOE > history of clotting disorder & mental instability unsteady gait Surveillance for Risk for Injury Risk for Falls Rapid Response Team (Risk for) VTE (Risk for) Delirium Admitted for Heart Failure 4
HIT Design Using Good Manufacturing Practices Quality System Requirements Design & Document Controls Identification and Traceability Corrective and Preventive Actions 5
HIT Design Using Good Manufacturing Practices Validation Implementation End-User Training Post Market Surveillance 6
What Can One Click Do? Real time decision support Aggregate information that support critical decision making Practice recommendations are transformed into a machine readable format with discrete data elements (data modeling) Discrete data elements are further coded with structured data for sharing and communication across health care systems 7
The Future Is Now The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn. ~Alvin Toffler 8
Questions & Discussion Ellen M. Harper Cerner Corporation 2800 Rockcreek Parkway Kansas City, Missouri 64117 eharper@cerner.com 9