How to get to Stage 7

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Rosa Stone
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1 HIMSS MIDDLE EAST 2011 LEADERSHIP SUMMIT 29 MAY 2011! How to get to Stage 7 Leadership Summit HIMSS Middle East 2011 Tom Smith, CIO NorthShore University HealthSystem Evanston, Illinois, USA May 29, 2011 Evanston Hospital Glenbrook Hospital Highland Park Hospital Skokie Hospital PAGE 1!

2 NorthShore Key Statistics Four hospitals 8,900 employees 2100 Physician medical staff 700+ Physician group practice 60,000 Hospital cases / year 1,200,000 office visits/year added to EMR 125,000 ED visits / year 900 Beds $100+ M Research Institute $1.6 billion in revenue University of Chicago principal teaching affiliate Gurnee Waukegan Round Lake Waukegan Grayslake North Chicago Libertyville Lake Bluff Mundelein Lake Forest Geographic locations of hospitals and offices Long Grove Lake Co. Cook Co. Vernon Hills Buffalo Grove Deerfield Arlington Heights Lincolnshire Wheeling Fort Sheridan Highwood Highland Park Northbrook Glencoe Techny Winnetka Prospect NAS Kenilworth Heights Wilmette Glenview Mount Prospect Morton Grove Des Plaines Evanston Niles Skokie C h i c a g o Lake Michigan Edgewater Norwood Lincolnwood Park Edgebrook North Town Rogers Park Uptown Ravenswood Irving Park PAGE 2!

3 General Corporate Direction systemness One Professional Staff covers all hospitals Quick decisions willing to take some bad decisions because of this IS has become a big part of how we do things IS/Telecom has allowed us to be a system not four hospitals and 80 offices Emphasis on EMR and Data Warehouse but high expectations for business systems as well. General IS standards Only one application for each function Try very hard to remove unneeded legacy systems quickly Senior IS Management close to projects and day to day activities Focus on change control, incident review and security exceptions Focus on employees functioning at highest level of their license PAGE 3!

NorthShore s Portfolio of Epic Products Patient Data Currently on version Summer 09 Red indicates initial install EMRAM Status by year HIMSS ANALYTICS EMR IMPLEMENTATION MODEL - NorthShore University

Data Warehousing: Data ConFnuity with ED, Ambulatory,OP Stage 6 Physician DocumentaFon with Structured Templates & Full CDSS, full R- PACS Stage 5 Closed loop medicafon administraton Stage 4 CPOE;

4 NorthShore s Portfolio of Epic Products Patient Data Currently on version Summer 09 Red indicates initial install EMRAM Status by year HIMSS ANALYTICS EMR IMPLEMENTATION MODEL - NorthShore University HealthSystem Evanston, IL USA Stage 7 Complete EMR: ConFnuity of Care Document transacfons to share data. Data Warehousing: Data ConFnuity with ED, Ambulatory,OP Stage 6 Physician DocumentaFon with Structured Templates & Full CDSS, full R- PACS Stage 5 Closed loop medicafon administraton Stage 4 CPOE; Clinical Decision Support (clinical protocols) Stage 3 Nursing / Clinical documentafon (flow sheets) CDSS (error checking), PACS available outside Radiology Stage 2 Clinical Data Repository, Controlled Medical Vocabulary, Document imaging OpFonal, Health informafon Exchange (HIE) capable Stage 1 All three major ancilliary clinical systems installed (laboratory, pharmacy, radiology) PAGE 4!

Entry IOM Reports To Err is Human & Crossing the Quality Chasm Allow

5 Copyright by NorthShore EMR System Selected in 2001 to: Improve patient safety through functions such as Computerized Physician Order Entry IOM Reports To Err is Human & Crossing the Quality Chasm Allow one patient centric database across hospitals and physician offices PAGE 5!

6 NorthShore EMR project summary Beginning in 2003, we have no paper charts in 4 hospitals nor in our 80+ employed physician office locations nor in 40+ independent office locations. Not the #1 IS project it was the #1 corporate project no conflicts with other priorities. Overall Epic Schedule Contract signed 2001 Workflow Redesign, Build, Test, Training 2002 Glenbrook Hospital 2003 Evanston Hospital 2003 Highland Park Hospital Medical Group Offices May, 2004 First Independent Office Go Live Medical Group Offices Beacon Oncology Module Independent Office Go Lives Barcoding Med Administration 2007 Stork OB Module 2008 Hospital Billing Module 2009 OpTime Peri-Op Module 2009 Skokie Hospital 2009 Home Health Module 2011 PAGE 6!

7 Leadership is Required Strong, continuous, visible leadership from C-Suite Focus Speed to implement Continuity helps in long term projects Strong support from Professional Staff and Hospital Board Visible leadership from multiple physician champions Success Clear Corporate Goal Only Corporate Goal PAGE 7!

8 Keys to success Training for project team Process redesign Physician adoption and behavior change Clinician input into priorities Software build/testing process User training Server hardware reliability Network reliability Maintain current level of infectious enthusiasm Emergency Department Patients NorthShore sees an average of 125,000 ED patients each year. More than 60% of these patients have a complete record in Epic prior to their arrival at the ED. Records include at least problem list, allergies and medications. This percentage has grown steadily from 45% in 2004 and is due to over 1,250,000 office visits we record in Epic each year. Our physicians indicate that this information allows them to provide better and safer care to our ED patients. PAGE 8!

9 Medication Orders We check each medication order for interactions with other medications, for allergies and for duplicate meds, while the physicians enter the order, giving them a chance to change the order if necessary. December 2005 audit at NorthShore 6565 allergy alerts fired 33% of allergy alerts result in a removal of the medication being ordered Alerts changed the behavior of the physician to increase patient safety. Each of those med orders could have caused a patient reaction and extended the length of stay or worse. Translates into more than 25,000 medication orders changed each year by the physicians due to alerts on allergies. Bar coding & Medications We are now bar coding medications and patients at the point of giving the med to the patient. This additional safety check allows us to remove one more potential source of error in giving care. During our pilot, we recorded 16 near misses on two 30 bed units over 2 months. This translates to almost 1000 such near misses over a full year at our three hospitals. Without the bar coding, these near misses would likely have been medication errors and possibly caused harm to a patient. A national study in 2003 put the average cost of a medication error at over $5,000 per error. PAGE 9!

140,000 patients enrolled to date Patient choice to take part View results over the internet Send secure messages to physician Request renewal of prescriptions Schedule

month Monthly statistics 16,000 messages to physicians 2,200 prescription renewals 7,500 appointments booked or cancelled 900 insurance updates 26,600 total monthly activities

10 140,000 patients enrolled to date Patient choice to take part View results over the internet Send secure messages to physician Request renewal of prescriptions Schedule appointments Pay bills Beginning patient data entry Patient Portal Patient Portal usage More than 140,000 patients signed up More than 30% of patients use their site in any one month Monthly statistics 16,000 messages to physicians 2,200 prescription renewals 7,500 appointments booked or cancelled 900 insurance updates 26,600 total monthly activities done on line All of these eliminated multiple phone calls and were at a more convenient time for the patients. Plus all of this is automatically documented in the EMR for future use. PAGE 10!

11 Annual Work Plan for EMR Split into three close to equal parts of the year Annual Upgrade» Build/Test/Train/Install Sixty big projects throughout year» Projects more than 2 man months RFS requests for service» Smaller projects and daily maintenance Enterprise Data Warehouse Data marts from financial systems Daily/Weekly/Monthly feeds from transaction systems Clinical Data Marts Nightly feed from EMR Report writers are distributed throughout organization Grouped in pairs for back up and support PAGE 11!

12 Summary of changes eight years out More focus on outcomes and less on transactions Data warehouse to assist in outcomes measurement More focus on Disaster Recovery Continuity issues More patient portal available Move from medsurg application to more specialized modules Oncology OB SureScripts/RXHUB OpTime What did not change User (clinician) driven for setting priorities with IT taking the responsibility to make it work Commitment to workflow improvements to drive IT changes Need for good IT staff Have continued with certified training with Epic Partnership with vendor Continued focus on driving out costs and improving quality top management support How we do business PAGE 12!

13 Positioning the projects Do not treat this as a purchasing process Do not treat this a vendor led project Need to deeply involve clinicians Biggest change in day to day work for clinicians It is more work for clinicians Need to give them some payback as soon as possible If not---this will be viewed as a IT project and staff will soon want to spend money on other projects Questions Tom Smith twsmith@northshore.org PAGE 13!

Presenter Disclosures

Presenter Disclosures Kathryn Swartwout The following personal financial relationships with ihcommercial ilinterests relevant to this presentation existed during the past 12 months: No relationships to