Creating Quality-Driven Operational Reports

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Creating Quality-DrivenOperational Reports

David Sinclair MDAssociate Professor of Clinical Anesthesiology

Associate Chief of AnesthesiologyCo-Director of Informatics

Epic UChart Physician Champion

Toyota Advanced Quality Information Center

“…a multimillion dollar computer system manned by 20 employees who compile repair reports from Toyota dealerships world-wide…and 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

Improving Quality Through Meaningful Use

Can AIMS Deliver?

Quality of Care

Electronic Medical Record PitfallsDesign-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.

Origins of EMR-driven Quality

1. Discovery2. Validation

3. Build 4. Training

5. Go-Live6. Optimization

How can AIMS deliver?

“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.

Structured DataInformationKnowledge

Decision supportImproved 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.

Quality?

PPO Perspective

Organization

Provider

Patient

Guideline-based care• Internal protocols

• National measures (PQRS, SCIP)&

Error avoidance• Interaction checking

• Avoidance of medication errors

Patient

Point-of-care Decision Support

• ACLS algorithms• MH protocol• Transplant protocols• Drug dose calculator

Guideline-Based Care• Timely administration of antibiotics• Periop temperature monitoring• Periop Beta-blocker continuation • Periop DVT and embolism prevention• PONV prophylaxis• Medication error prevention

Timely access to patient’s health information• Coordinated communication

• Data exchange

Provider

Patient

Automated screening and aggregation of data

• Surveillance and monitoring

Organization

Provider

• Anesthesia Clinical Leader

• System Administrator– System configuration – Log-in access– Security clearance

• Clinician • Clinical Analyst

Study Documentation Compliance

Measure Clinical Decision Support

Database Query

Nair 34%94% B-blocker • Pop-up• Hard-stops• Text pages

Smart Anesthesia Manager

O’Reilly 69%92% Antibiotic (p) • Auto-entry reminder• Email

programmer

Wax 82%89% Antibiotic (p) • Auto-entry reminder programmer

St. Jacques 20%57% Antibiotic (r) • Pop-up programmer

Kooij 38%73% PONV • Pop-up programmer

Patient

Quality ReportsReport Features Query Tool Web toolAnalytical •Report: set schedule

•Based: large data set

•Actionable: trends

•Focus: multiple

•Reporting Workbencho Crystal Reports

•Business Objectso WebIo Clarity

InfoView

Operational •Report: ad hoc in real–time

•Based: small data set

•Actionable: daily workflows

•Focus: single

•MS Project Builder Report Viewer

Real-timePatient Experience

Team AIMS Clinical Decision Support

Query Operational Report

Real-time Experience

RodriguezVigoda

Picis • Pop-ups• Text pages

program • Sterile barrier• Temperature • Antibiotics• B-blocker

• Yes

SinclairCooper

Innovian • Hard-stop• Auto-entry

reminder• Email

program • Antibiotics • No

• EmailSemi-automatic

Report Builder

• Sterile barrier• Temperature• Antibiotics• B-blocker

• Yes

Patient

Operational ReportsQuality Measure Report CDSPerioperative Care Timely 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

Hard-stop

Perioperative Temperature Management

Temperature 30 Min Before End of Surgery

Hard-stop

Patient

Organization

=IF(AND(OR(Antibiotics<>"vancomycin",Antibiotics<>"clindamycin",Antibiotics<>"levaquin"),(OR(incision_admin<0,incision_admin>60))),"missed","No")

Organization

=IF(AND(OR(Specialty="URO",Specialty="NEURO"),OR(Antibiotics="cefazolin",Antibiotics="ciprofloxacin",Antibiotics="ceftriaxone",………….”yes",IF(AND(Specialty="ORTHO",OR(Antibiotics="cefazolin",…………..Antibiotics="ampicillin sulbactam")),"yes","no"))))))

Organization

Microsoft Excel ® Worksheets

Visual Basic for Application Macro

Operational ReportsQuality Measure Report CDSPerioperative Care Timely Administration of

Prophylactic Parenteral Antibiotics

Email• Semi-automated

Missing Beta-Blocker Assessment

Email•Semi-automated

Hardstop

Perioperative Temperature Management Temperature 30 Min Before End of Surgery

Hardstop

Real-timePatient Experience

Organization

Operational ReportsQuality Measure “Report” CDSPerioperative Care Timely Administration of

Prophylactic Parenteral AntibioticsEmail• Semi-automated

Missing Beta Blocker Assessment Email• Semi-automated

Prevention of Central Line-associated Bloodstream Infections

Central Venous Catheter Sterile Insertion Protocol

Hard-stop

Patient

Operational ReportsQuality Measure “Report” CDSPerioperative Care Timely Administration of Prophylactic

Parenteral AntibioticsEmail• Semi-automated

Missing Beta Blocker Assessment Email• Semi-automated

Hard-stop

Patient

Structured Data Capture

Q4 2012 SCIP

Q1 2013 SCIP

Q2 2013 SCIP

Q3 2013 SCIP

Patient Experience

SSI Rate (%) - 2013 Q1 Q2 Q3 Q4 TOTAL

Surgical Site Infection Rate

3/4100.7

6/3921.5

7/3871.8

7/4011.4

23/11891.93

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD

0/2342

0/2175

0/2404

1/2440

2/2311

4/2494

1/2414

0/2431

2/2601

1/2277

3/2511

14/28804

CLABSI Rate (%) - 2013

Creating Quality-Driven Operational Reports

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