Stage 7 to Step 1: Leveraging Technology to Drive Transformational Change Round Table Discussion

Transcription

1 Stage 7 to Step 1: Leveraging Technology to Drive Transformational Change Round Table Discussion Julie Vilardi RN MS Ann O Brien RN MSN CPHIMS 2013 HIMSS 1

2 Conflict of Interest Disclosure Julie Vilardi RN MS Ann OBrien RN MSN CPHIMS Have no real or apparent conflicts of interest to report. DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS HIMSS 2

3 Learning Objectives Describe real-world lessons learned for transforming care to improve quality, safety and efficiency in the clinical setting using clinical decision support, data mining and advanced analytics List examples of clinical transformation post implementation of the EHR Describe the concept of a socio-technical system and the relevance to the EHR 3

4 Health IT: Helping to Drive the 3-Part Aim Better healthcare Improving patients experience of care within the Institute of Medicine s 6 domains of quality: Safety, Effectiveness, Patient Centeredness, Timeliness, Efficiency, and Equity. Better health Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care. Reduced costs $ Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries. Health Information Technology 2013 HIMSS 4

5 Current State of HIT By Itself, the adoption of more health IT is generally not sufficient to produce significant cost savings Congressional Budget Office: Evidence of the Costs and Benefits of Health Information Technology (2008) We examined electronic health record adoption in U.S. Hospitals and the relationship to quality and efficiency. Across a large number of metrics examined, the relationships were modest at best and generally lacked statistical or clinical significance. Health Affairs: Electronic Health Records Limited Successes Suggest More Targeted Users (2010) Hospitals that adopted EMR between 1996 and 2008 did not experience a significant decrease in costs on average. In fact, [in many cases] cost rose after EMR adoption, particularly for advanced EMRs. 5 NBER: The Trillion Dollar Conundrum: Complementarities and Health Information Technology (2012) In 2 nd Look, Few Savings From Digital Health Records New York Times, January 10, 2013

6 Why Hospitals Don t Achieve HIT Benefits 2013 HIMSS 6

7 A Benefits-Drive Model 2013 HIMSS 7

8 IOM Report: Health IT & Patient Safety 2011 Technology has the potential to dramatically improve the quality & safety of care. It is changing the way we deliver health care. The evidence regarding the impact of health IT on safety is mixed; Computerized Physician Order Entry (CPOE) and Barcoding Medication Administration (BCMA) have been shown to improve medication safety. Safety is a property of a larger system including, not only the hardware and software, but how it is used by clinicians. The larger system, a socio-technical system includes technology, people, processes, organization and external environment. Comprehensive safety analysis needs to consider these factors as a whole and how they affect each other rather than one root cause.

9 icons indicating patient-specific precautions A-fib, CHF Fall icons No indicating food Hearing patient-specific No DNR precautions Age 57, Catholic risk by mouth aid Latex Dr. W, Dr. X A-fib, CHF Fall icons No indicating food Hearing patient-specific No DNR precautions Age 57, Catholic risk by mouth aid Latex 11am:! INR > 19.6 Dr. W, Dr. X Xray 2pm: Physical therapy New Orders: None A-fib, CHF Respiratory therapy Fall icons No indicating food Hearing patient-specific No DNR precautions Last visit from Dr. Age W: Yesterday, 57, Catholic 3pm risk by mouth aid Latex 11am:! INR > 19.6 Dr. W, Dr. X Xray 2pm: Physical therapy 30 Pain reassessment New Orders: None 45 Vital signs 22h Catheter A-fib, CHF Respiratory therapy Fall No food Hearing No DNR Last visit from Dr. Age W: Yesterday, 57, Catholic 3pm risk by mouth aid Latex 11am:! INR > 19.6 Dr. W, Dr. X Xray 2pm: Physical therapy Administer 30 Pain reassessment New Orders: None pain meds 10 minutes before 45 Vital signs procedure. 22h Catheter Respiratory therapy Pain Last visit from Dr. W: Yesterday, 3pm meds 1. Apply 4X4" duoderm with border to stage 1ulcer on coccyx 11am:! INR > 19.6 Xray Change every 3 days and prn per wound care protocol/n. 2pm: Physical therapy Administer 30 Pain reassessment New Orders: None pain meds 10 minutes before 45 Vital signs procedure. 22h Catheter 2. Irrigate stage 3 ulcer on 1t hip with saf-clens. Respiratory therapy Pain Apply Kaltostat 1. Apply rope, 4X4" duoderm cover Last with visit with Combiderm from Dr. border to 6X6"; W: Yesterday, stage change 1ulcer on daily 3pm coccyx and prn per wound care protocol/n. meds Change every 3 days and prn per wound care protocol/n. Administer 30 pain Pain meds reassessment 10 minutes before 45 Vital procedure. signs 22h Catheter 2. Irrigate stage 3 ulcer on 1t hip with saf-clens. Pain Apply Kaltostat 1. Apply rope, 4X4" duoderm cover with with Combiderm border to 6X6"; stage change 1ulcer on daily coccyx and prn per wound care protocol/n. meds 3am 7amChange 11am every 3 days 3pm and prn per wound Baseline care ECG: protocol/n. A-fib. Episodes of rapid HR: ventricular response. Last incident 7pm BP: 118/82 120/80 2. Irrigate 120/80 Administer stage 3 ulcer 118/82 pain meds 10 minutes on 1t hip with saf-clens. yesterday. before Lasted procedure. 10 mins. MD Pain O2: 95% 95% 95% 95% Apply Kaltostat rope, cover with Combiderm prescribed 6X6"; IV Cardiazem change daily and prn per wound care protocol/n. meds RR: Apply 4X4" 16 duoderm with border to stage 1ulcer on coccyx Lung: Rhonchi 3am Rhonchi 7am Rhonchi Change 11am Rhonchi every 3 days 3pm and prn per wound Baseline care ECG: protocol/n. A-fib. Episodes of rapid HR: Confirm ventricular response. Last incident 7pm 120/80 2. Irrigate 120/80 stage 3 ulcer 118/82 on 1t hip with saf-clens. yesterday. Lasted 10 mins. MD 95% 95% 95% 95% Apply Kaltostat rope, cover with Combiderm prescribed 6X6"; IV Cardiazem change daily and prn per wound care protocol/n am Rhonchi 7am Rhonchi 11am Rhonchi Baseline ECG: A-fib. Episodes of rapid HR: 67 ventricular response. Last incident 7pm 120/80 Confirm yesterday. Lasted 10 mins. MD 95% 95% 95% prescribed IV Cardiazem am Rhonchi 7am Rhonchi 11am Rhonchi Baseline ECG: A-fib. Episodes of rapid 67 ventricular response. Last incident 7pm Confirm yesterday. Lasted 10 mins. MD prescribed IV Cardiazem Lung: Rhonchi Rhonchi Rhonchi Rhonchi Confirm KP SmartCARE Priority Focus Areas Clinical Transformation Rapid Sign- On Eases the burden and repetition of logging-in to the EHR every few minutes Clinical Intelligence Provides cognitive support and real time contextual information Patient Name Patient Name Update Schedule 3:02 pm Patient Name Update 4pm:! Therapist Schedule running late 3:02 pm Patient Name Update 4pm:! Therapist Schedule running late 3:02 pm Wound Care (Est 30 mins) Update 4pm:! Therapist Schedule running late 3:02 pm Wound Care (Est 30 mins) 4pm:! Therapist running late Wound Care (Est 30 mins) Vital Signs Vital Signs BP: O2: RR: Lung: /82 Vital Signs 16 Rhonchi BP: O2: RR: Lung: /82 Important Notes Wound Care (Est 30 mins) /80 Vital Signs 16 Rhonchi HR: BP: O2: RR: /82 95% /80 95% 16 3pm /82 95% 120/80 95% Important Notes 3pm /82 95% Important Notes Important Notes Workflow Automation Manage tasks, schedules and events Mobility Biomedical Device Integration (BDI) captures patient data automatically resulting in real-time, accurate, easily available patient information. BDI is foundational to the KP SmartCARE Strategy HIMSS 9

10 Evolution of health care enabling total health in an efficient, convenient and continuous personalized engagement Centralized Health Services Computerized Health Care Digital Health Future CARE WHERE YOU ARE CONNECTED CARE INTEGRATED MODEL 2013 HIMSS 10

11 Instead of the current model of one patient accessing one provider at a time, people can access their care whenever and wherever they need it. Bernard Tyson COO Kaiser Foundation Health Plan & Hospital

12 Digital Health Vision Personalizing the health care experience Staffed Beds Bringing care to wherever you are Community YOU Work Face to Face Improving outcomes and promoting health Sustaining leadership in connected care through One KP Home School The new integration is not about the delivery system, it s about how you integrate with the member s life. Bernard Tyson, President Kaiser Foundation Health Plan & Hospitals 2013 HIMSS 12

13 Discussion Questions For further information contact: Ann.O 2013 HIMSS 13

14 Can you describe some examples of how you are successfully using decision support and analytics to improve quality & safety? 2013 HIMSS 14

15 What new roles are required to make this transformational change? 2013 HIMSS 15

16 What are the requirements for sustaining transformational change? Can you share an example? 2013 HIMSS 16

17 How do you define and measure business value? 2013 HIMSS 17

18 How will we transform to meet the new paradigms of care? 2013 HIMSS 18