New MEDITECH Integrated Solu;on
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1 New MEDITECH Integrated Solu;on How The Rothman Index Score Improves Outcomes Kimberly Walsh, RN Chief Nursing Officer Vice President, Pa.ent Services, Signature Healthcare Steve Pennock VP Product Management, PeraHealth, Inc. Joe Beals, PhD VP Opera.ons, PeraHealth, Inc.
2 Agenda IntroducNons What is PeraTrend & the Rothman Index and how can it improve panent care? Leveraging exisnng MEDITECH data Lessons from Signature Healthcare IntegraNon of data & workflow with MEDITECH 2
3 The Story: The Rothman Index is Created Turning loss into meaning Florence Rothman: Avoidable death from undetected complicanon Michael and Steven Rothman: Engineers with expernse in big data analysis and stansncs EHR Data Available but untapped HeurisNc modeling techniques create a universal panent score Florence Rothman We didn t want this to happen to someone else s family. Michael Rothman, PhD., Co- Founder 3
4 Rothman Index (RI) is the New Universal Pa;ent Score RI is the evolu;on of leveraging data to understand pa;ent condi;on 1952 APGAR Score Newborns Simple, Repeatable Assessment Manual CalculaNon Criteria: 5 ObservaNons Used Widely Today 1985 APACHE II Adult PaNents Admiaed to ICU Admission Score Only Criteria: 12 Physiological Measures In Use Today, along with APACHE III and SAPS II 2005 All Pa;ents Automated Calcula;on 2001 Real 1987 Time Disease Agnos;c PEWS No Manual Data MEWS Entry Common Clinical Adult Language PaNents Braden Integrated Manual Scale with EHR CalculaNon Criteria: 50+ Measures Adult PaNents Criteria: 4 Physiological Risk of Physiological Measures and Pressure 1 ObservaNon Ulcers Clinical Assessments Built on Expert Criteria: Lab 6 Results Opinion ObservaNons - most Limited Use In Use Includes Today measures of previous Today score algorithms Built on Heuris;c Modeling Pediatric PopulaNon (up to age 18) Manual CalculaNon Criteria: Originally 20 physiological and observanon measurements hospitals use 4-7 Built on Expert Opinion In Use Today 2010 RI Score 4
5 RI Score is Rooted in Proven Science 11 Peer Reviewed Studies; Over 12 Oral and Poster Presenta;ons Key Studies* ValidaNon of RI for PredicNng 30 day readmissions PredicNng ICU readmissions RI Outperforms exisnng early warning systems (MEWS) Validity of Clinical Assessments for measuring panent condinon PalliaNve care trigger PredicNng Surgical ComplicaNons * 5
6 Visualizing Pa;ent Condi;on EXISTING EHR DATA PeraTrend Graph Labs Vitals Clinical Assessments 50+ Measures ROTHMAN INDEX Single Numeric Score Rothman Index Opportuni;es for Earlier Interven;on 6
7 Using PeraTrend - Mul;ple Pa;ent View 7
8 Using PeraTrend - Click Points To See Data 8
9 Using PeraTrend - Click Points To See Data 9
10 Using PeraTrend - Click Mul;ple Points To Compare Data 10
11 Using PeraTrend - Click Mul;ple Points To Compare Data 11
12 Signature Healthcare Brockton, MA Founded as Brockton Hospital in 1896, the Hospital is the oldest and largest inpanent facility in its service area, which is designated as the city of Brockton and twenty- one surrounding municipalines. We strive to be recognized as the "providers of choice" by staff, panents, and the community. We are a community- based non- profit teaching hospital, providing a full range of clinical services. The hospital has 245 licensed beds, including a In 2013, Signature Healthcare was named Top Performer on Key Quality Measures by The Joint Commission, the leading accreditor of health care organizanons in America. We were one of only 8 hospitals in Massachuseas to be recognized for exemplary performance in using evidence- based clinical processes shown to improve care in all four of the following measure sets: heart aaack, heart failure, surgery and pneumonia and the only hospital in Southeastern MA. 12
13 Kimberly Walsh, BSN CNO, Vice President, Pa;ent Services Employed since 1985 in various posinons ranging from Staff Nurse to Director of Nursing Chief Nursing Officer present Currently responsible for: Nursing, Laboratory, Radiology Services Clinical Programs InpaNent services, TransiNonal Care, Peri- operanve Services, Behavioral Health and Emergency Services 13
14 Signature Healthcare- Brockton Hospital Implementa;on Brockton Hospital IdenNfied PeraTrend as a tool that would help staff recognize changes in panent condinons A team worked for 3 months on an implementanon plan that included: Review of Nursing DocumentaNon EducaNonal Plan for Staff CollaboraNon with Physicians EvaluaNon of our Meditech documentanon system The tool is now being used to idennfy changes in panent condinons PotenNal uses include- early recogninon of sepsis, planning for transinons of care including pallianve care 14
15 Strategies for using PeraTrend at Signature Healthcare Physician & Nursing Champions Foster Broader ParNcipaNon Training methodology Strong Leadership involvement from CEO onward OpNmize workflow for physicians (rounds, phone calls re: panent condinon) Support roaming capabilines (i.e. ipads, virtual desktop) Emphasis on PaNent Safety 15
16 HOW PERATREND INTEGRATES WITH MEDITECH 16
17 System Architecture and Data Flow EHR PeraTrend Server ComputaNon of Rothman Index HOSPITAL FIREWALL HL7 Feed Vital Signs, Lab Results, Nursing Assessments, ADT EHR Interface IntegraNon PeraTrend Database Web Server Browser Based Viewer Work StaNon or Mobile Device Hospital IT system performance is not impacted User Work flow is uninterrupted No Addi.onal Data Entry Required Data Needs for Rothman Index ComputaNon Vital Signs Temperature Systolic Blood Pressure Diastolic Blood Pressure Heart Rate RespiraNon Rate Oxygen SaturaNon Heart Rhythm Braden Score Nursing Assessments Heart Paaern/Rhythm Braden Scale Cardiac Food GastrointesNnal Genitourinary Laboratory Results BUN CreaNnine WBC HGB Chloride Sodium Potassium Musculoskeletal Neurological Peripheral- vascular Respiratory Safety Skin 17
18 Meditech Integra;on Simple workflow for users PeraTrend Buaon 18
19 Interface View of Rothman Index Within EHR Unit Array View 19
20 Unit Based Visuals Maximizing integra;on into workflow Improved handoffs Nursing and quality surveillance improvement Nursing retennon and sansfacnon Improved post- acute care transinons 20
21 Mul;ple Ways to View PeraTrend Mobile Phone App Unit Monitor View Embedded EHR PeraHealth Secure Server PeraHealth Web Portal Tablet View 21
22 House- wide Monitoring: Seamless Surveillance Immediate interven;on at the first sign of pa;ent decline 22
23 Healthcare Leaders Join PeraHealth to Pioneer RI Score "We believe the real- ;me clinical decision support of PeraTrend integrated into our EHR will accelerate our performance on quality..." Dr. Barry Gross EVP, CMO Riverside Health System
24 CONTACT INFORMATION Steve Pennock VP Product Management, PeraHealth, Inc. 24
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