Transcript of Creating Quality-Driven Operational Reports David Sinclair MD Associate Professor of Clinical...
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- Creating Quality-Driven Operational Reports David Sinclair MD
Associate Professor of Clinical Anesthesiology Associate Chief of
Anesthesiology Co-Director of Informatics Epic UChart Physician
Champion
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- Toyota Advanced Quality Information Center a multimillion
dollar computer system manned by 20 employees who compile repair
reports from Toyota dealerships world-wideand will be accessible on
an as-needed basis. Chester Dawson and Yoshio Takahashi, Toyota
Makes New Push to Avoid Recalls, The Wall Street Journal, February
24, 2011
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- Improving Quality Through Meaningful Use
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- Can AIMS Deliver?
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- Electronic Medical Record Pitfalls Design-Reality Gap
Detracting from prompts/reminders Time-consuming features
Suboptimum use Overwhelming learning process Gill, J. M. EMRs for
improving quality of care: promise and pitfalls. Fam Med, 2009;
41(7): 513-515. Heeks, R. Health information systems: Failure,
success and improvisation. International journal of medical
informatics, 2006; 75(2):125-137.
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- Origins of EMR-driven Quality 1.Discovery 2.Validation 3.Build
4.Training 5.Go-Live 6.Optimization
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- How can AIMS deliver?
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- Computerized support systems for decision making must present
the right information, in the right format, at the right time, and
without requiring special effort. James, B. C. (2001). Making it
easy to do it right. The New England Journal of Medicine 2001;
345(13): 991.
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- Structured Data Information Knowledge Decision support Improved
quality Balust, J., Macario, A. Can anesthesia information
management systems improve quality in the surgical suite?. Current
Opinion in Anesthesiology 2009; 22(2): 215-222.
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- Quality?
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- PPO Perspective Organization Patient Patient
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- Guideline-based care Internal protocols National measures
(PQRS, SCIP) & Error avoidance Interaction checking Avoidance
of medication errors Patient
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- Point-of-care Decision Support ACLS algorithms MH protocol
Transplant protocols Drug dose calculator
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- Guideline-Based Care Timely administration of antibiotics
Periop temperature monitoring Periop Beta-blocker continuation
Periop DVT and embolism prevention PONV prophylaxis Medication
error prevention
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- & Timely access to patients health information Coordinated
communication Data exchange Patient
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- & Automated screening and aggregation of data Surveillance
and monitoring Organization
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- Anesthesia Clinical Leader System Administrator System
configuration Log-in access Security clearance Clinician Clinical
Analyst
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- StudyDocumentation Compliance MeasureClinical Decision Support
Database Query Nair34% 94%B-blocker Pop-up Hard-stops Text pages
Smart Anesthesia Manager OReilly69% 92%Antibiotic (p) Auto-entry
reminder Email programmer Wax82% 89%Antibiotic (p) Auto-entry
reminderprogrammer St. Jacques20% 57%Antibiotic (r)
Pop-upprogrammer Kooij38% 73%PONV Pop-upprogrammer Patient
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- Quality Reports ReportFeaturesQuery ToolWeb tool Analytical
Report: set schedule Based: large data set Actionable: trends
Focus: multiple Reporting Workbench o Crystal Reports Business
Objects o WebI o Clarity InfoView Operational Report: ad hoc in
realtime Based: small data set Actionable: daily workflows Focus:
single MS Project BuilderReport Viewer
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- Real-time Patient Experience
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- TeamAIMSClinical Decision Support QueryOperational Report
Real-time Experience Rodriguez Vigoda Picis Pop-ups Text pages
program Sterile barrier Temperature Antibiotics B-blocker Yes
Sinclair Cooper Innovian Hard-stop Auto-entry reminder Email
program Antibiotics No Email Semi- automatic Report Builder Sterile
barrier Temperature Antibiotics B-blocker Yes Patient
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- Operational Reports Quality MeasureReportCDS Perioperative
CareTimely Administration of Prophylactic Parenteral Antibiotics
Email Semi- automated Perioperative Beta-Blocker For Patients
Receiving Therapy Prior to Arrival Missing Beta Blocker
AssessmentEmail Semi- automated Prevention of Catheter-Related
Bloodstream Infections Central Venous Catheter Insertion Protocol
Hard-stop Perioperative Temperature Management Temperature 30 Min
Before End of Surgery Hard-stop
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- Patient
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- Organization
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evaquin"),(OR(incision_admin 60))),"missed","No") Organization">
"clindamycin",Antibiotics"l evaquin"),(OR(incision_admin
60))),"missed","No") Organization"> "clindamycin",Antibiotics"l
evaquin"),(OR(incision_admin 60))),"missed","No") Organization"
title="=IF(AND(OR(Antibiotics"vancomycin",Antibiotics"clindamycin",Antibiotics"l
evaquin"),(OR(incision_admin 60))),"missed","No")
Organization">
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=IF(AND(OR(Antibiotics"vancomycin",Antibiotics"clindamycin",Antibiotics"l
evaquin"),(OR(incision_admin 60))),"missed","No") Organization
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=IF(AND(OR(Specialty="URO",Specialty="NEURO"),OR(Antibiotics="cefazolin",Antibiotics="cipr
ofloxacin",Antibiotics="ceftriaxone",.yes",IF(AND(Specialty="ORTHO",OR(Antibiotics=
"cefazolin",..Antibiotics="ampicillin sulbactam")),"yes","no"))))))
Organization
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- Microsoft Excel Worksheets
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- Visual Basic for Application Macro
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- Operational Reports Quality MeasureReportCDS Perioperative
CareTimely Administration of Prophylactic Parenteral Antibiotics
Email Semi- automated Perioperative Beta-Blocker For Patients
Receiving Therapy Prior to Arrival Missing Beta- Blocker Assessment
Email Semi- automated Prevention of Catheter-Related Bloodstream
Infections Central Venous Catheter Insertion Protocol Hardstop
Perioperative Temperature Management Temperature 30 Min Before End
of Surgery Hardstop
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- Real-time Patient Experience
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- Organization
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- Operational Reports Quality MeasureReportCDS Perioperative
CareTimely Administration of Prophylactic Parenteral Antibiotics
Email Semi- automated Perioperative Beta-Blocker For Patients
Receiving Therapy Prior to Arrival Missing Beta Blocker
AssessmentEmail Semi- automated Prevention of Central Line-
associated Bloodstream Infections Central Venous Catheter Sterile
Insertion Protocol Hard-stop Perioperative Temperature Management
Temperature 30 Min Before End of Surgery Hard-stop
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- Patient
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- Operational Reports Quality MeasureReportCDS Perioperative
CareTimely Administration of Prophylactic Parenteral Antibiotics
Email Semi- automated Perioperative Beta-Blocker For Patients
Receiving Therapy Prior to Arrival Missing Beta Blocker
AssessmentEmail Semi- automated Prevention of Catheter-Related
Bloodstream Infections Central Venous Catheter Insertion Protocol
Hard-stop Perioperative Temperature Management Temperature 30 Min
Before End of Surgery Hard-stop
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- Patient
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- Structured Data Capture
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- Q4 2012 SCIP
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- Q1 2013 SCIP
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- Q2 2013 SCIP
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- Q3 2013 SCIP
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- Patient Experience
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- SSI Rate (%) - 2013 Q1Q2Q3Q4TOTAL Surgical Site Infection Rate
3/410 0.7 6/392 1.5 7/387 1.8 7/401 1.4 23/1189 1.93
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- JanFebMarAprMayJunJulAugSepOctNovDec YTD Total 0/2342 0 0/2175
0 0/2404 0 0/2404 0 1/2440 0.4 2/2311 0.9 4/249 4 1.6 1/2414 0.4
0/2431 0 2/2601 0.8 1/2277 0.4 3/2511 1.2 14/2880 4 0.5 CLABSI Rate
(%) - 2013
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