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?
EMR
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
Organization
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
Organization
Organization
Organization
Organization
Microsoft Excel ® Worksheets
Visual Basic for Application Macro
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
Hardstop
Perioperative Temperature Management Temperature 30 Min Before End of Surgery
Hardstop
Real-timePatient Experience
Organization
Organization
Organization
Organization
Organization
Organization
Organization
Organization
Operational ReportsQuality Measure “Report” CDSPerioperative Care Timely Administration of
Prophylactic Parenteral AntibioticsEmail• Semi-automated
Perioperative Beta-Blocker For Patients Receiving Therapy Prior to Arrival
Missing Beta Blocker Assessment Email• 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
Patient
Operational ReportsQuality Measure “Report” CDSPerioperative Care Timely Administration of Prophylactic
Parenteral AntibioticsEmail• 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
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
Total
0/2342
0
0/2175
0
0/2404
0
0/2404
0
1/2440
0.4
2/2311
0.9
4/2494
1.6
1/2414
0.4
0/2431
0
2/2601
0.8
1/2277
0.4
3/2511
1.2
14/28804
0.5
CLABSI Rate (%) - 2013
