Post on 26-May-2018
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Hillestad et al, Health Affairs 2005
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2007
(GEERTS ET AL)
2007
(PAPER VTE
ORDER SET)
2010
(PRE-CPOE)
2010
(POST-CPOE NO
ALERT)
2012
(POST-CPOE
WITH ALERT)
17
65
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84
96
% Appropriate VTE Prophylaxis
\ Metro Edition Thursday Dec 13, 2012
In-Hospital Death Rates Down
Across Greater Toronto Area
• Annual CIHI Report demonstrated that
preventable in-hospital deaths were reduced
• NYGH – top performer in Greater Toronto
and second best in all of Canada
• CEO Tim Rutledge: “health information
technology has hard-wired quality and safety
into the hospital”
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Outcome Odds Ratio Confidence Interval p-value
Death 0.57 0.39 – 0.84 0.005
Death adj for
Probability of Death 0.57 0.38 – 0.85 0.006
Death adj for
Probability of Death
and CrCU Admission
0.55 0.36 – 0.83 0.005
Order Set Outcome Odds
Ratio
Confidence
Interval
p-
value
Diagnosis-appropriate Death .
0.48 0.26 – 0.90 0.022
Diagnosis-appropriate Death adj for Probability
of Death and CrCU Admission
0.44 0.21 – 0.90 0.024
Close to diagnosis Death .
1.47 0.71 – 3.01 0.30
Close to diagnosis Death adj for Probability
of Death and CrCU Admission
1.82 0.78 – 4.23 0.16
Any order set Death .
0.55 0.12 – 2.54 0.44
Paper Orders CPOE (eCare)
Percentage of patients for
whom a diagnosis-
appropriate order set was
used
Pneumonia 26.05% Pneumonia 60.43%
COPD 0.0% COPD 45.1%
Percentage of patients for
whom any admission
order set was used .
Pneumonia 37.90% Pneumonia 97.54%
COPD 35.11% COPD 97.35%
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Finance System (SAP)
Coded Health Record (Med2020)
HR Database (Infinium_HR)
EHR System (Cerner)
Patient/Employee Survey (NRC Picker)
IPAC Database (Quality & Safety)
Transcription Services
Hand Hygiene Audit System
Critical Care Information System
ED System (Wellsoft)
Bed Tracking System (TeleTracking)
Wait Time Information System
Incident Reporting System (Parklane)
Other Sources (MRI, CIRT, etc)
Outcomes Analysis
Patient Safety
Research
Physician Performance
Quality Improvement
Compliance Monitoring
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Snapshot of patient flow and organization pain points
Detailed view of organization census, and units with vacancy.
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91,06
67,05
127,8
66,73
104,44
66,35
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7 Canadian provinces
473 active users
1,544 evidence-based order
sets
6 contributing
organizations
57 member
organizations
Table of Contents
• CPOE Project Governance
• Change Management
and Physician Adoption
• Project Planning and Project
Management
• Order Catalogue Creation
• Electronic Order Set Development
• Electronic Medication
Management
• Clinical Decision Support
• Integrating Workflow
• Technical Implementation
• Training
• Go Live
• Maintenance
• Downtime
• Metrics and Quality Improvement