1. Leveraging Data for Success: - Coring the Core Measures - Chasing Discrepancies Leveraging Data for Success: - Coring the Core Measures - Chasing Discrepancies n Richard S. MacKenzie, MD, FACEP l Chair : Department of Emergency Medicine l Lehigh Valley Hospital & Health Network n L. Albert Villarin MD FACEP l CMIO : Albert Einstein Healthcare Network n Chris DeFlitch, MD, FACEP l Director & Vice-Chair - Department of Emergency Medicine l Physician Director, Connected, CIS

2. Overcoming the Hurdles: Improving DTB in the LVHHN MI-Alert Program Richard S. MacKenzie, MD, FACEP Chair Department of Emergency Medicine Lehigh Valley Hospital & Health Network A HOSPITAL AND HEALTH NETWORK L EHIH V o LLEY

3. Problem at the Millenium n Inconsistency n Mortality 5-7% PCI n Mortality lytic 6-16% EUR HEART J. 2002 23 550

5. PSIMT n Plan l Problem identification & clarification l Solution identification & clarification l Presentation for input n Do l Implement - education precedes date l Presentation for understanding

6. PSIMT (2) n Study - Monitor for… l protocol violations l anecdotes l Trends n Act – Tweak the process

7. D2B Specifics – Road Show n Remove decisions l streamline by consistency – no artists n Reduce transitions or hand-offs n Challenge tradition n Dance the same dance l Order Sheets

8. Regional MI Alert The Core… n STEMI only n Definitive State-of-the-Art care n One call does it all n Parallel vs. sequential processing n Tight reporting of data for performance improvement

9. Faster is better

10. Reduction in Mortality! Overall Mortality: STEMI local and regional = 2.4%

11. Data Utilities & Application n Chris DeFlitch, MD, FACEP l Penn State Hershey Medical Center Connected (CIS) Physician Champion Founder, Penn State Partners for Healthcare Engineering l Director & Vice-Chair, Dept of Emergency Medicine

12. Using EDIS for Meds Rec n ONE system n Integrated Provider Information n Master Medication List n Drug-Drug Interaction n Documentation of Proces

13. Arrival n E-med list collected on Triage Powerform by RN n List autopopulated from prior encounters n Viewable in all Venues

14. Ordering n Meds Ordered l Individual l Order Sets n Interaction Checking n Auto-populates l E-Mar l Master Medication List

15. Physician Documentation n Person and Time Stamped at each step n Info and modification to all providers l All physicians l Nursing (e-mar & med list) l Pharmacy (if admitted) n Soon to pre-populate MD Note

16. Admitted Patient n Med List Carries to the Inpatient World n Same Interaction Checking n Automated Review at Key Stages l Admit orders l Transfer of service l Transfer of Location

17. Discharge n RULE generates required Review n Integrated in discharge Processing n Recon prior to printed discharge n Med List Printed on Discharge for patient n ALL updates Master List for future visits

18. Core Measures and EDIS n Community Acquired Pneumonia

19. Identification on Arrival n Advanced Nursing Protocol or PDQ TM n Tracking Board Identification n Order Set for Initial Orders l O2 Sat l CXR with pre-populated indications l IV & labs if criteria l Blood Culture …..

20. Tracking Board

21. Order Set

22. Evaluation & Treatment n Communication to Physician l Review RN doc & discrete data online n View Image On-Line n CAP Order Set l IV & Lab (dup check) l Blood Culture (dup check) l ABX recommendations l Allergy Checking

23. Decision Support n On-line Viewable Risk Stratification n Disposition by Criteria n Complete documentation of Process n SOON to integrate MD documentation

24. Core Measures n Albert Einstein Medical Center l Pneumonia – time to antibiotics l Acute MI – time to CATH Balloon Up / TPA n Penn State Hershey Medical Center l Pneumonia – time to antibiotics ( CPOE & Order Sets) n Lehigh Valley Hospital l Acute MI – time to CATH Balloon Up

25. Chasing Discrepancies by Medical Center n Radiology Re-Reads n Laboratory Re-Dos n Cardiology Alternative Interpretations

26. Core Measures / Discrepancies n OPEN DISCUSSION