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DATAVISION IN THE REAL WORLD Betsy Stauffer Lancaster General Hospital Lancaster, PA
DATAVISION IN THE REAL
WORLD Betsy Stauffer
Lancaster General Hospital Lancaster, PA
LANCASTER GENERAL HOSPITAL
Presenter Name Presenter Title
Presenter Name Presenter Title
AWARDS
• Midas+ implemented in 1999
• DataVision implemented in 2003
• EMR – Epic – Implemented in 2011 – HAR-based
• J A Thomas for Clinical Documentation Improvement
• Advisory Board products – Crimson Clinical Advantage and Continuum of Care
– Crimson Realtime Readmissions
– Quality Compass
History of Midas+, DataVision, and
Other Applications Used with DataVision
Midas+ & DataVision Access
• Electronic Intranet form
• Midas+ Care Management Training
– Department-specific training
– Midas+ COW self-paced learning
• System Access and Conventions
• DataVision Server and Web applications
– Midas+ sponsored training WebEx participation
• Midas+ and DataVision access monitored
USER ACCESS REQUEST
Departments with DataVision Access
• Business Intelligence–Analytics
• Performance Improvement
• Quality and Patient Safety
• Case Management
• Health Information Management
• Heart and Vascular Institute
• Disease Management
• Financial Decision Support
• Medical Data Analysis
• Administration
• Nursing
• Stroke Coordinator
• Social Work
• Risk Management
4/2014
Primary Care &
HospitalistCEC
ED/Urgent Care CEC
Critical Care CEC
Surgical CEC
Trauma CEC
Heart & Vascular
CEC
Behavioral Health CEC
Women & Pediatrics
CEC
Oncology
CEC
Gen. Surgery CM team
Colorectal/GI CM team
Thoracic CM team
Orthopedics CM team
Neurosurgical CM team
Bariatric CM team
OB/GYN CM team
Pediatric CM team
NICU/Newborn CM team
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Vascular CM team
Cardiac Surgery CM team
System-wide Clinical PI Teams
PERFORMANCE IMPROVEMENT COMMITTEE (PIC)
PIC Membership to also include: • VP of Medical staff (chair)
• President, Medical staff
• Quality Medical Directors
• Chief Physician Executive
• Sr. VP, Hospital Operations
Journey – Quality Department to IT
• New Division of IT Department – Business Intelligence – Reporting
– Analytics – Clinical Reporting
– Database Services
– Several employees transitioned from Quality Department to IT – Business Intelligence
– Midas+ and DataVision transitioned from Quality to IT – Business Intelligence
• Business Intelligence Healthcare Data Analysts to the rescue!
• They receive a project and/or request – Validate request – Analyze request
• Determine which systems to use
• Explore DataVision Indicators
• Validate Indicators by using the DV Measure Definition
• Access DataVision, Toolpacks, Report Data Transfer
• Use Excel tools – pivot tables, filters, V-lookup, and so on
• Determine optimal method of display – delivery
• Request profiles of specific Indicators for trending
• Healthcare Data Analyst updates Quality
Indicator slide deck for senior leadership
trending (monthly) displaying historical
graphics
– 85 slides from various systems
– 57 of the 85 slides originate
from DataVision
INDICATOR METRIC INVENTORY
DataVision Functions Used at LGH
• DataVision 3M PPR Toolpack
• DataVision Navigator
• DataVision Provider profiles
• DataVision Readmission Toolpack
• DataVision SmartReport
• DataVision Value-Based Purchasing
• DataVision User-selectable Indicator Functions
Easy Access to Standard Reports
Report Toolpack based on
user-created Indicators
DataVision Reporting – Ongoing
• Pay-for-performance Metrics
• Senior Leadership Slide Deck – updated monthly
• Disease-specific profiles
• Hospitalist provider group volumes and metrics
• Scorecard data elements
• Bundled payment metrics
Reports Generated
by Healthcare Data Analyst
• DV Web Application
– Provide Stroke Program Coordinator with GMLOS data, as well as Comparative Database information for stroke population
• DataVision Toolpacks
– Update Quality Metrics for Senior Leadership
· 30-day All-cause Readmissions
· 30-day Unscheduled Readmissions
• Readmission Report for Transition of Care Committee
Reports Generated
by Healthcare Data Analyst
DV Server application (1) Update Quality Metrics for Senior Leadership including:
· Hospital-acquired pulmonary embolism
· Hospital-acquired pressure ulcer
· Major birth trauma
· Elective deliveries
· All-or-None Bundles for Acute MI, Heart Failure, Pneumonia, SCIP, Children's Asthma, Stroke, and VTE
· Clinical Processes of Care for AMI, Heart Failure, Pneumonia, SCIP
· AHRQ Patient Safety Indicators
· Median ED Times
· IQR Measures for Stroke, VTE, and Immunization
(2) Hospitalist Scorecard – VTE and Stroke Bundle (group specific)
(3) Highmark Quality Blue data for VTE
(4) ED Scorecard components – Core measures for AMI, Stroke, Pneumonia
DataVision Reports Used to Report
Pay-for-Performance Metrics
• READMISSION PERFORMANCE MEASURES
– Defined by payer – DataVision populations and
Toolpacks used for monthly reporting of
• Readmission rates for 3, 7, and 30 day readmissions
• Readmissions with present on admission infections
• Readmissions due to complications of care
• Principal DX of Heart Failure readmitted within 30 days to
inpatient or observation
DataVision Readmission Toolpack
DataVision Readmission Metrics
Adjusted for Specific Payer Report
• Standard Report – DataVision Readmission Toolpack
• CDB:009 – All Acute Care Inpatients – Denominator
• Separate numerator (readmissions) and denominator (All Acute Care Inpts)
• Delete cases under age 18
• Create a month column for the start date for readmission encounter
• Filter on MAPPED DISCHARGE DISPOSTION for first encounter – Exclude discharge disposition for first encounter per metric instructions
Use the column in the Toolpack entitled Days Between Encounters to determine the
3-day readmissions
7-day readmissions
30-day readmissions
AHRQ Indicators in DataVision
• MEASURE AND DEFINITION
• AHRQ Pt. Safety Indicator - Composite - ADULT (Rate per 100 Adult Discharges)
– Risk-adjusted ratio of observed-to-expected encounters that qualify for selected AHRQ PSI measures for potentially preventable adverse events
SOURCE
Midas+ > Function> DataVision >DV Navigator > Safety > Patient Safety > AHRQ Patient Safety Indicators - Adult ACA > PSI 90 Patient Safety Indicators Composite, Adult (CDRB:1408)
INDICATORS CHANGE
• AHRQ DEFINITIONS CHANGED – May 2013
– Historical values in DataVision change
• AHRQ PSI-90 – definition changed
– NOTE: PSI- 90 Indicators changed in May 2013 when AHRQ made modifications to adjust the risk-adjusted coefficients for these two PSIs. When Midas+ applied the values, a historical update was made (noted in DataVision Release Notes) modifying the historical trending.
Healthcare Infection Prevention
• DataVision Indicators utilized
– OP6 – Timing of preoperative antibiotics
– OP7 – Antibiotic selection
• Surgical Safety Indicators utilized • SCIP-Inf-9 – Urinary catheter removal
• SCIP-Inf -10 – Normothermia
• SCIP-Card 2 – Perioperative beta-blocker usage
Worklist Based on DV Indicators
Examples of Worklists Based on
DV Indicators
• Pulmonary Embolus NPOA – worklist created to
monitor DV Indicator
• DVT-NPOA worklist created to monitor DV
Indicator
In conclusion…
