Data: It's Not Just Numbers Presenters Katisha Harrison, MBA, BPM, Lean Six Sigma Yellow Belt, Medical Economics Analyst Victoria Richardson, RN-BC, Lean Six Sigma Green Belt, Clinical Informatics Manager October 2012

BSHSI EHR Deployment 2 February 2008 – The first BSHSI Hospital transitioned to EHR in Greenville, South Carolina April The first BSV Hospital transitioned to EHR in Richmond, Virginia October 2010 – St. Mary’s Hospital deployed EHR March Interim reports were established for some MU measures within the EHR reporting tool to provide a preliminary view of hospital performance Preparation for the MU 90 Day Attestation Process began. April BSHSI MU Dashboard was implemented and electronically distributed May Report development team finalized the official MU reports that aligned with the CMS Stage 1 MU Criteria August 2011 – Successful Attestation by 6 BSHSI facilities

Why Implement an EHR? 3 BSHSI deployed Connect Care, its EHR, to: Enhance positive patient outcomes including medical error prevention Remove non-value added activities Improve communication Add valuable timely data reporting and results Support the integration of care Promote Clinical Transformation efforts

Executive Summary 4 Today, we will share with you examples of reporting and analysis tools that are leveraged to monitor BSHSI’s Meaningful Use Performance in preparation for Attestation Submission. By utilizing official Redwood MU reports, the reporting and analysis tool enables BSHSI to evaluate performance at 3 levels to benchmark performance and, if necessary, begin intervention practices: BSHSI Organizational Summary: Provides a high-level overview of all facilities’ Month-to-Date Performance. Facility Summary: Provides a weekly and Month-to-Date Summary of Performance for a specific facility. Departmental Analysis: As MU Measure performance opportunities are identified, we evaluate each departments impact on the Meaningful Use Measure(s). The objective is to identify departments that require increased focus to drive performance improvements. We progress through each level of the analysis as the measure performance warrants. We believe that this analysis enables BSHSI to effectively monitor performance, identify opportunities, and implement action plans to mitigate performance risk.

BSHSI Summary

Department Distribution Each department is evaluated based on their impact on the measure..

Process Implementation & Improvement

8 Process Flow

Process Steps 9 1.Workflow Observations to identify “Why Behind the What” 2.Process opportunity identification 3.Creation of tip sheets to outline functionality 4.At-elbow training with clinicians 5.Communication in a variety of venues and methods 6.System change requests 7.Daily MU measure performance updates to leadership and clinicians. 8.Reconvening following process implementation to review and confirm that the “Why Behind the What” has been hardwired

Collaboration 10 X Workflow Observations Tip Sheets Training Weekly Huddles Communication System Changes Meetings Daily Performance Updates Closing the Loop

The EHR 11 Nurses were looking at the system linearly resulting in necessary system redesign to align with the workflow. The system is fluid. There were instances early on when system changes were being made multiple times a week resulting in continuous updates being provided. Understanding Meaningful Use is a by- product of doing what is needed for the patient. This enabled clinicians to provide feedback to drive system changes. Sometimes the system is working as designed, but needs to be redesigned.

Tip Sheets 12 Hospitalized patients need to have a current “Hospital (Problems being addressed during this admission)” entry on their problem list. If this is not in place, then a BPA will fire with an attached hyperlink that will allow you to go directly to the problem list activity. Tip sheets were developed for specific audiences to address specific recurrent opportunities to show system solutions to problems. They were provided with written and visual depiction to meet all learning styles.

Closing the Loop 13 Revisiting the “Why Behind the What” assisted in establishing end-user connectivity and identification of everyone’s role in providing quality patient care while improving MU measure performance. The asset to performance sustainability, PRICELESS!!!!

14 BSHSI Monthly Performance Graphs We evaluate each facilities performance on a monthly continuum. This assists us with identifying any changes in facility performance. **** We began leveraging the reporting and analysis tools in late April Note the dramatic performance change beginning in May ****

Lessons Learned 15 Designing executive dashboard demands collaboration among the various subject matter experts, clinical and administration leadership, data analysts, quality improvement leaders, and more. Dashboard management requires strong leadership, training, and commitment to accurate and timely EHR documentation. The executive dashboard promotes EHR documentation process standardization and evidence-based practices. More timely, traceable data and accurate communications lead to better decision-making. The dashboard helps stakeholders to monitor, improve, and report EHR attestation data. The dashboard allows verifiable comparative trend analysis among hospitals and at the department level. The EHR-centric dashboard is truly an integrating and collaborative tool for process improvement.

16 “If you can’t measure it, you can’t control it.” – Meg Whitman, Former ebay CEO Remember…

17 Questions or Comments