Healthcare IT Adoption, Function, Value & Beyond February ... · Healthcare IT Adoption, Function,...
Transcript of Healthcare IT Adoption, Function, Value & Beyond February ... · Healthcare IT Adoption, Function,...
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Healthcare IT Adoption, Function, Value & Beyond
February 29, 2016 John H. Daniels, CNM, FACHE, FHIMSS, CPHIMS
Global Vice President, HIMSS Analytics
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Agenda • Challenge • Approach • Progress • Benefits realization • Q&A
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Learning Objectives • Recognize the clinical and business value that can be achieved from
the use of information technology in care delivery processes • Recognize stages of electronic medical record functionalities towards
improving care delivery processes • Identify the next great challenge to multi-stakeholder continuity of
care and the recommended strategic approach to address the challenge
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98K+ patients die annually in the United States
due to medical errors!!
Why?
Lack of Relevant Information
Kohn, Linda T. To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academy Press, 2000.
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Pre
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Medical Knowledge
Automate to optimize clinical decision making
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Information technology is a MUST Using information technology, we can
help make healthcare …
Crossing the quality chasm: A new health system for the 21st century. (2001). Washington, D.C.: National Academy Press.
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Ultimate Goal
Ensure the most relevant
information is available to the
decision maker at the right place
and at the right time
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How can we do this?
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Shared Vision
Better health through Information Technology
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Global HIMSS Analytics EMR Adoption ModelSM
N = 5439 N = 5449
Complete EMR, Data Analytics to Improve Care
Physician documentation (templates), full CDSS, Closed loop medication administration
Full R-PACS
CPOE, Clinical Decision Support (clinical protocols)
Clinical documentation, CDSS (error checking)
CDR, Controlled Medical Vocabulary, CDS, HIE capable
Ancillaries - Lab, Rad, Pharmacy - All Installed
All Three Ancillaries Not Installed
1.1%
4.0%
6.1%
12.3%
46.3%
13.7%
6.6%
10.0%
3.4%
16.5%
29.5%
14.5%
23.9%
5.3%
2.5%
4.4%
2011 Q2 2014 Q3
Data from HIMSS ® Database ©2015 HIMSS
… 7 Stages that lead to the
Highest Quality in Patient Care
Progressively sophisticated model …
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HIMSS’ contribution to the vision • Thought leadership
– Quality, Safety, Efficiency improvements • To reflect the market
– Where are the current trends • To inform government policy
– Contribute to national eHealth strategies – Used by governments for policy formulation
• To “drive the market” – Useful roadmap for C-suite, governance boards,
& policy makers
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It takes time to make “significant” national progress
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20.4% 17.4%
40.0%
18.7%
3.1% 0.5% 0.1% 0.0%
0 1 2 3 4 5 6 7EMRAM Stage
2006
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19.3%
14.0%
37.2%
25.1%
2.2% 1.4% 0.8% 0.0%
0 1 2 3 4 5 6 7EMRAM Stage
2007
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15.6% 11.5%
31.4% 35.7%
2.5% 2.5% 0.5% 0.3%
0 1 2 3 4 5 6 7EMRAM Stage
2008
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11.5% 7.2%
16.9%
7.4% 3.8%
1.6% 0.7%
0 1 2 3 4 5 6 7EMRAM Stage
50.9%
2009
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10.1% 7.1%
14.6% 10.5%
4.5% 3.2% 1.0%
0 1 2 3 4 5 6 7EMRAM Stage
2010
49.0%
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9.0% 5.7%
12.4%
44.9%
13.2% 8.4%
5.2% 1.2%
0 1 2 3 4 5 6 7EMRAM Stage
2011
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8.4% 4.3%
10.7%
38.3%
14.2% 14.0%
8.2%
1.9%
0 1 2 3 4 5 6 7EMRAM Stage
2012
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5.8% 3.3%
7.6%
30.3%
15.5%
22.0%
12.5%
2.9%
0 1 2 3 4 5 6 7EMRAM Stage
2013
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3.8% 2.0% 5.1%
21.0%
14.0%
32.7%
17.9%
3.6%
0 1 2 3 4 5 6 7EMRAM Stage
2014
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2.1% 1.7% 2.6%
16.4%
10.1%
35.9%
27.1%
4.2%
0 1 2 3 4 5 6 7EMRAM Stage
2015
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EMR Adoption ModelSM (2006-2015) United States
Stage 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Stage 7 0.0% 0.0% 0.3% 0.7% 1.0% 1.2% 1.9% 2.9% 3.6% 4.2%
Stage 6 0.1% 0.8% 0.5% 1.6% 3.2% 5.2% 8.2% 12.5% 17.9% 27.1%
Stage 5 0.5% 1.4% 2.5% 3.8% 4.5% 8.4% 14.0% 22.0% 32.8% 35.9%
Stage 4 3.1% 2.2% 2.5% 7.4% 10.5% 13.2% 14.2% 15.5% 14.0% 10.1%
Stage 3 18.7% 25.1% 35.7% 50.9% 49.0% 44.9% 38.3% 30.3% 21.0% 16.4%
Stage 2 40.0% 37.2% 31.4% 16.9% 14.6% 12.4% 10.7% 7.6% 5.1% 2.6%
Stage 1 17.4% 14.0% 11.5% 7.2% 7.1% 5.7% 4.3% 3.3% 2.0% 1.7%
Stage 0 20.4% 19.3% 15.6% 11.5% 10.1% 9.0% 8.4% 5.8% 3.7% 2.1%
N = 4,237 N = 5,073 N = 5,166 N = 5,281 N = 5,337 N = 5,458 N = 5,458 N = 5,449 N = 5,467 N = 5,460
Data from HIMSS Analytics® Database ©
This is how long it takes to make “significant” national progress
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Cross Regional EMRAM Score Distribution# (2015)
Stage Asia Pacific Middle East United States Canada Europe*
Stage 7 0.5% 0.0% 4.2% 0.2% 0.1%
Stage 6 3.9% 11.3% 27.1% 0.9% 4.6%
Stage 5 7.4% 21.1% 35.9% 3.4% 17.5%
Stage 4 1.7% 3.5% 10.1% 1.6% 5.5%
Stage 3 0.6% 19.0% 16.4% 31.2% 3.2%
Stage 2 32.7% 19.0% 2.6% 31.5% 30.2%
Stage 1 4.9% 9.9% 1.7% 13.9% 14.2%
Stage 0 48.2% 16.2% 2.1% 17.3% 24.1%
N = 770 N = 142 N = 5,460 N = 641 N = 2,395
Data from HIMSS Analytics® Database ©
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Belgium, Brazil, Canada, Chile, China, Denmark, France , Germany, India, Italy, Malaysia, Netherlands, Norway, Saudi Arabia, Singapore, Switzerland, Taiwan, Turkey, UAE, UK, USA
China, Korea, Germany, Saudi Arabia, Spain, USA
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Benefits realization from IT
HIMSS Analytics Database® correlation studies with other comprehensive data sources.
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Profile of a Stage 7 Organization • Use data to drive improved outcomes related to …
– Process, Financial, Clinical, Quality & Safety
• Are paperless, or near paperless (create no paper) – All clinically relevant data is in the EMR
• Are fully committed to continuous process improvement
through collaboration – Strong IT leadership and executive champions – Clinician / end-user champions
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Representation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage
1.9% 4.8%
10.1% 8.1% 4.2% 6.5%
7.9% 9.7% 0.4% 1.7%
6.2% 10.0%
6.4% 6.4%
12.8%
30.1%
0%
10%
20%
30%
40%
50%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
All h
ospi
tals
with
in ea
ch E
MRAM
Sta
ge
3 or less 4 or more Source: HIMSS Analytics
2.3% 6.5%
16.3% 18.1%
10.6% 12.9%
20.7%
39.8%
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Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage
0.0% 5.9%
12.8% 14.3% 20.1% 21.8%
30.8%
62.6%
0%
10%
20%
30%
40%
50%
60%
70%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
All h
ospi
tals
with
in ea
ch E
MRAM
Sta
ge
Source: HIMSS Analytics
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38.9
45.5 44.6 45.9 45.9 42.7
49.0
64.3
30
40
50
60
70
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
AVG
Pro
ject
ed V
BP
Clin
ical
Sco
re
Tipping Point
Tipping Point
Clinical Performance
Source: HIMSS Analytics
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Mortality Rates
0%
10%
20%
30%
Heart Atack Respiratory Therapy
Actual MortalityLow EMRAM
Actual MortalityHigh EMRAM
Source: HIMSS Analytics
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-1.52%
4.91%
-0.43%
6.19%
2.77%
7.95%
-2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
Aver
age
Ope
ratin
g M
argi
n
In 2011 In 2013 In 2015
Financial Performance (Profitability)
Data from HIMSS Analytics® Database ©
Source: HIMSS Analytics
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Stage 7 Case Studies
Actual case studies from validated Stage 7 hospitals
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Medication Administration Errors per 1000 CMI-Adjusted Pt Days
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
Jan 2011 Jan 2013 Jun 2013
7 10
Pt Scan: 96% Med Scan 93%
Pt Scan: 79% Med Scan: 76%
44% 62%
19
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Annual Incident Reports 2009 – 2013* per 1000 CMI-Adjusted Pt Days
0
0.5
1
1.5
2
2.5
0
5
10
15
20
25
2009 2010 2011 2012 2013*
Med
icat
ion
Even
ts
Oth
er In
cide
nt R
epor
ts
Other Incident Reports Medication Events
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Annual Incident Reports 2009 – 2013* per 1000 CMI-Adjusted Pt Days
0
0.02
0.04
0.06
0.08
0.1
0
0.5
1
1.5
2
2.5
2009 2010 2011 2012 2013*
Sign
ifica
nt A
DE
Med
icat
ion
Even
ts
Medication Events Significant ADE
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30
20
4 0
5.34
4.47
1.08
0.00 0
10
20
30
40
50
60
0.00
1.00
2.00
3.00
4.00
5.00
6.00
Jul 10 to Jun 11 Jul 11 to Jun 12 Jul 12 to Jun 13 Jul 13 to Sep 13 (3months)
# C
AU
TI
Rat
e pe
r 100
0 ca
thet
er-d
ays
Catheter-Associated Urinary Tract Infection (CAUTI) rate per 1000 catheter-days
# CAUTI CAUTI rate per 1000 catheter-days
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Central Line-associated bloodstream infection (CLABSI)
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Human (breast) milk administration through CLMA process
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% Antibiotics given within one hour
Attention to detail Some changes in the
pharmacy Reduction in the number
of unnecessary STAT orders
Great communication by the team
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• Grid/Order Set Form Approach for Chemotherapy • Reduced CPOE from 90 Minutes to 15 Minutes per Patient
Order Sets Process Improvement
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Questions
THANK YOU John H. Daniels, CNM, FHIMSS, FACHE, CPHIMS Global Vice President, Healthcare Advisory Services Group [email protected]
@JohnHDaniels
mailto:[email protected]:[email protected]:[email protected]
Healthcare IT Adoption, Function, Value & Beyond�February 29, 2016AgendaLearning ObjectivesSlide Number 4Slide Number 5Information technology is a MUSTUltimate GoalHow can we do this?Shared VisionSlide Number 10HIMSS’ contribution to the visionIt takes time to make “significant” national progressSlide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Benefits realization from ITProfile of a Stage 7 OrganizationRepresentation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage�Clinical Performance Mortality RatesFinancial Performance �(Profitability)Stage 7 Case StudiesMedication Administration Errors�per 1000 CMI-Adjusted Pt DaysAnnual Incident Reports 2009 – 2013* �per 1000 CMI-Adjusted Pt DaysAnnual Incident Reports 2009 – 2013*�per 1000 CMI-Adjusted Pt DaysSlide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46% Antibiotics given within one hourOrder Sets Process ImprovementQuestions