March - April 2003 Boston Children’s Hospital e Quality Improvement in an Electronic World Enhanced by Automated Data Extraction & Analysis Denni McColm, CIO Renee Whitman-Teeter, Director of Performance Improvement Citizens Memorial Healthcare

2 Quality – What is it? Patient outcomes, did they get well? Short term? Long term? Patient perceptions? How often we followed evidence based protocols? Survival rates? Readmissions rates? Is it safe, error-free care?

3 CMS

4 HealthGrades

5 Leapfrog Group

6 JCAHO

7 How are they using that quality data? Publicizing it on the Internet Paying us for it

8

9 Deployment of Rapid Response Teams…at the first sign of patient decline Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack Prevention of Adverse Drug Events (ADEs)…by implementing medication reconciliation Prevention of Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle” Prevention of Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time Prevention of Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps called the “Ventilator Bundle”

10 CMH Strategic Initiatives Core/Regulatory Measures Pain Turnaround Times

11 Using IT to Improve Quality EMR CPOE eMAR Reduce errors of transcription/illegibility Give physicians more information with which to make care decisions Alert drug/drug interactions and allergies Improve the timeliness of results

12 Order prompting in the ED Order prompting in PCS Required fields Documentation templates for physicians OE Rules Evidenced based order sets Clinical alerts

13 Changing our thinking... FROM ONE AT A TIME CHART REVIEWS AFTER THE FACT TO: NPR Reports Required Fields Reporting Daily, end of shift BUILDING IN QUALITY & MONITOR IT CONCURRENTLY

14 But, Where should we focus our effort? Where are we doing the worst? We could write an NPR for every one of those measures (Core, ORYX, 100K Lives ) How many people would it take to write an NPR report for every quality measure out there? Just to determine where to focus... And then, How would we adjust for severity and compare to benchmarks?

15 The Institute for Health Metrics (IHM) is: A non-profit that helps us leverage our electronic systems for quality improvement Extracting data from MEDITECH for use in: Quality of Care Reporting & Benchmarking Physician Performance Analysis & Reporting A MEDITECH Strategic Ally

16 Recognizing that we need... Quality management tools to help us: Identify Analyze Target Track Tools that are: Automated Timely Use sophisticated analytics Give us a graphical presentation Case/provider drill downs and Trend analysis

17 AIES TM & PQMS TM Automated Indicator Extraction System Physician Quality Management System  279 Quality Metrics:  National Consensus Measures: CHF, AMI, CAP, L&D, SIP, ICU, Asthma, Stroke, AHRQ, IHI  System Measures: Hospital Acquired Infections, MRSA, etc.  Physician profiles:  50 procedures  20 diagnoses  279 quality metrics (integrated with AIES TM )  Real-time benchmarks  Risk adjustment  Graphical trend analysis  Provider and case drill downs

18 Extract Data Directly from Meditech Hospital HCIS IHM VPN Web Based Monthly Reports IHM: Clean Normalize Map Report

19 AIES: Quality Dashboard by Indicator

20 Total Case Matrix

21 Graphs for Trending

22 Resource Definitions & Links

23 Download Data to Excel for Analysis

24 Drill Down Into Text

25 What comes with AIES?

26 PQMS: Dashboards by Specialty or Physician

27 PQMS: Drill Down

28 Benefits Automates Data Extraction and Analysis Eliminates manual data collection, analysis and reporting Gives us an unbelievable number of measures Extracted Severity adjusted Benchmarked Presents and Analyzes Data in a Usable and Actionable Format Focuses Efforts on the True Causes & Drivers of Performance Supports timely Interventions and Improvement Strategies Helps Clinical Staff Focus on Improving the Quality of Care

29 Upcoming Releases Concurrent Case Management System (CCMS) Identification and scoring for high risk patients Daily reports for Core Measure case tracking Daily reports for concurrent quality improvement efforts Financial Analysis System Nursing Quality Management System

30 Thanks! Questions: Denni McColm, Renee Whitman-Teeter, Jeff Borkowski,