1. Patient Safety & Clinical Quality: Information Technology at THR Internal Medicine Update Presbyterian Hospital of Dallas October 29, 2003

2. 10/29/2003Internal Medicine Update2 Overview Case study (Cleary 2003) Quality (IOM 2001) Safety (Bates 2003) Projects NOVA (IOM 2003) Key Success Factors (Berwick 2003)

3. 10/29/2003Internal Medicine Update3 Case Study Cleary (2003;138:33-39) A Patient’s Perspective on Quality

4. 10/29/2003Internal Medicine Update4 Case Study Cleary (2003;138:33-39) Admission experience Postoperative experience Teamwork failures Pain management Discharge services

5. 10/29/2003Internal Medicine Update5 Crossing the Quality Chasm IOM (2001) “Information technology has enormous potential to improve the quality of health care”

6. 10/29/2003Internal Medicine Update6 Crossing the Quality Chasm IOM (2001) Safety Effectiveness Patient-centered Timeliness Efficiency Equity

7. 10/29/2003Internal Medicine Update7 Efficiency and Timeliness Case study: PACS and voice recognition technology Ted Wen MD, Radiology Presbyterian Hospital of Plano

8. 10/29/2003Internal Medicine Update8 IT and Patient Safety Bates and Gawande (2003; 348:2526-2534) Prevention of errors and adverse events Facilitating a more rapid response to adverse events Tracking and providing feedback about adverse events

9. 10/29/2003Internal Medicine Update9 IT and Patient Safety Bates and Gawande (2003; 348:2526-2534)) Improve communication Access to knowledge Require key information Assist with monitoring Provide decision support

10. 10/29/2003Internal Medicine Update10 Communication Case study: electronic messaging Ed Goodman MD, Infectious Disease Presbyterian Hospital of Dallas

11. 10/29/2003Internal Medicine Update11 Communication

12. 10/29/2003Internal Medicine Update12 Access to Knowledge Case study: medical references and clinical data Robert Lilli MD, Family Practice Harris Methodist Fort Worth Hospital

13. 10/29/2003Internal Medicine Update13 Access to Knowledge

14. 10/29/2003Internal Medicine Update14 Assist with monitoring ICU monitoring Fetal monitoring

15. 10/29/2003Internal Medicine Update15 Decision Support

16. 10/29/2003Internal Medicine Update16 Decision Support Case study: Weight based dosing for intravenous unfractionated heparin Rashke et al (1993;119:874-881)

19. 10/29/2003Internal Medicine Update19 Impact of Decision Support Compliance with weight-based dosing for Heparin pre-CPOE: 15% post-CPOE: 85%

20. 10/29/2003Internal Medicine Update20 Projects NOVA Infrastructure Mainframe Network Common desktop Interface engine Applications Surgical management and scheduling Laboratory information system Physician portal (CareGate)

21. 10/29/2003Internal Medicine Update21 Projects NOVA Applications Clinical documentation Orders management Medication management

22. 10/29/2003Internal Medicine Update22 Selection Methodology NOVA Advisory Board IOM Report: Key Capabilities of an Electronic Health Record System (2003) THR functional requirements Vendor evaluations

23. 10/29/2003Internal Medicine Update23 Information Services National recognition

24. 10/29/2003Internal Medicine Update24 Challenges Cultural Administrative Technical

25. 10/29/2003Internal Medicine Update25 Change Leadership Berwick (2003; 289:1969-1975) Find sound innovations Find and support innovators Invest in early adopters Make early adopter activity observable

26. 10/29/2003Internal Medicine Update26 Change Leadership Berwick (2003) Trust and enable reinvention Create slack for change Lead by example

27. 10/29/2003Internal Medicine Update27 Discussion Roles of allied health professionals Achieving consistency of clinical practice (e.g., formulary, order sets) Using decision support to influence clinical practice Medical staff by-laws

30. 10/29/2003Internal Medicine Update30 Bibliography Cleary PD: Ann Intern Med. 2003;138:33-39 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21 st Century. Washington, DC: National Academy Press; 2001:1 Bates DW and Gawande AA: N Engl J Med 2003; 348:2526-2534 Institute of Medicine. Key Capabilities of an Electronic Health Record System. Washington, DC: National Academy Press; 2003:1 Berwick DM: JAMA 2003; 289:1969-1975

31. 10/29/2003Internal Medicine Update31 Presenter Contact Information Ferdinand Velasco, MD Chief Medical Information Officer Texas Health Resources 601 Ryan Plaza Dr., Suite 301 Arlington, TX 76011 (817) 462-6723 E-mail: FerdinandVelasco@texashealth.orgFerdinandVelasco@texashealth.org