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rea ng uccess uDashboard
Bert Reese, CIO and Senior Vice President,
DISCLAIMER: Theviewsandopinionsexpressedinthispresentation arethoseoftheauthoranddonot necessarily represent officialpolicyorposition ofHIMSS.
ConflictofInterestDisclosure
BertReese,TheUniversityofUtah,MBA
OperationsResearch/Systems Engineering
NorwichUniversity,Northfield,Vermont,B.S.,
BusinessAdministration
Hasnorealorapparent
conflictsofinteresttoreport.
DISCLAIMER: Theviewsandopinionsexpressedinthispresentation arethoseoftheauthoranddonot necessarily represent officialpolicyorposition ofHIMSS.
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Outline
SentaraBackground eCareProject
GoLiveDashboards
ROIDashboards
ProcessRedesignMeasures
WelcometotheStartingLine
ClinicalQualit GoalsandDashboards
GuidingPrinciples
3
Sentara Healthcare
MissionWeimprovehealtheveryday.
ValuesPeople,Quality,PatientSafety,
Service,Integrity
Vision
e e ea carec o ceo ecommunitiesweserve.
4
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Sentara Healthcare
123yearnotforprofitmission
8hospitals;1,935beds3,000physiciansonstaff
10longtermcare/assistedlivingcenters
Extendedstayhospital
520providerSentaraMedicalGroup
432,600memberhealthplan
SentaraCollegeofHealthSciencesVirginia
3.3Btota operatingrevenues
$3.7Btotalassets
19,225employees
5
North Carolina
Sentara Healthcare
System Development
MILESTONES
1888 RetreatfortheSick 25BedsNorfolk Seriesofcommunityhospital
1892 Sc oo o Nurs ng
1972 StatesfirstmergeroftwononprofithospitalsNorfolkGeneral&LeighMemorial
1982 HomeCareformed
1983 LifeCaredivisiondeveloped
1984 OptimaHealthPlanstarted
1988 HamptonGeneralHospital
1991 BaysideHospitalacquired
1995 SentaraMedicalGroupformed
Beliefthatintegrationwouldleadtobettercomprehensive
careforpatients
MedicalGroup
Hospitals rg n a eac enera osp a
2002 WilliamsburgCommunityHospital
2006 Obici Hospital
2009 PotomacHospital
2011 RMHHealthcare&MarthaJeffersonHospital(pending)
6
NursingHome
MedicalTransportation
HomeHealth
OptimaHealth
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Sentara and Epic
SentarasCareTransformation:eCare
e are a s
EpicImplementation
Asharedmedicalrecordforpatientsacrossthecontinuumofcare
OpportunityforProcessRedesign Reeva uatean optimize18major
processes
eCare isbiggerthanEpic7
Project OverviewTimelines:
Sep2005:Epiccontractsigned
Nov 2005 A ril 2006: Process redesi ns
May2006 June2007:Design,Build,Validate
August2007:FirstMDofficeimplemented(150MDs/Year)
February2008:FirsthospitalimplementedallbutCPOM
May2008:FirsthospitalimplementedCPOM
Sep2008 Oct2008:2nd& 3rd hospitalgolives
Mar2009 Nov2009:Threemorehospitals implemented
2010:Epic2009releaseupgrade;7th hospitalgolive
2011:8th hospitalgolive;communityfocus
8
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Total Cost of Ownership
10 Year Overview
Capital $ 67M
OperatingExpenses $170M
HardwareMaintenance $ 15M
SoftwareMaintenance $ 50M
DisasterRecovery $ 3M
WorkRedesign $ 36M
Training $ 16M
Implementation $ 22M
OngoingSupport $ 22M
OtherNonSalarySupport $ 6M
TotalCostofOwnershipover10years $ 237M
9
Annual Expected
Business Case BenefitsHospitalsTotal $30.0M
ImprovedNursingEfficiency $4.9MReducedITMaintenance $3.6M
e uce e ca ecor s ranscr p on . IncreasedOutpatientServices $4.8MReducedLengthofStay $3.8MImprovedPharmacyProcess/ADEs $3.0MReducedPaper/Storage $2.7MOtherImprovements $3.6M
HomeHealthTotal $ 1.8MSystemHealthPlanTotal $ 2.3M*SystemHealthcareTotal $35.5M**
*
62%
of
health
plan
benefits
will
be
passed
on
to
employers
**Excludes$2.7Minphysicianpracticebenefitswhichwillaccruetophysicians
10
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eCare
Costs and
Benefits by Year$50,000.0
$60,000.0
$(30,000.0)
$(20,000.0)
$(10,000.0)
$-
$10,000.0
$20,000.0
$30,000.0
, .
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
, .
Ex pected Benef its Achieved Benef its Expenses
Net Impact (vs. Achieved) Net Impact(vs. Expected)Note:2010dataannualized
11
Clinical Staff Became eCare
ExpertsProjectTeamComposition:
100ClinicalStaff(RN,LPN,RT,PT,XRayTechs,Pharmacists)
TookFullTimePositionsontheeCare
ProjectTeam
BecameEpicTrained&Certified ApplicationDesign ContentValidation Workflowdevelopmentandredesign
Design,Build,Validate(DBV)&ImplementationLeadswereTrainedinLeanPrinciples
12
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Clinical Staff Became eCare
Experts
,
andLTAC,etc)
AtcompletionofprojectClinicalTeamtoreturntoclinicalcaresitesascaregivers
ProjectTeamSupplementedandWorkValidatedbyover300SubjectMatterExperts(directcaregivers)fromacrossthe
ea sys em
13
Physician Advisory Group (PAG)
50+PrimaryandSpecialtyMDs
SubstantialTimeCommitment(4+hrsperweekatpeak)
Developed/DesignedMDspecificpartsofEMR
Content(OrderSets&ClinicalDocumentation)
ScreenFormats&CustomReports
Workflows
Workedcollaborativelywithotherclinicalstafftoachieve
standardizationonsharedworkflows MDsAreCompensated
14
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eCareGo Live Dashboards
15
Go Live: Daily Dashboard
16
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GoLive:DailyCPOETracking
%CPOE Trend HOSPITAL #5
Sept 13, 2009 Go Live
20%
40%
60%
80%
%CPOEGoalshouldNOTbe100%
SometimesVerbal/Telephoneisbetter:
Emergencysituations(CodeBlue)
Duringprocedures
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13Days Post Go Live
17
GoLive:MonthlyDashboard
Monthly Dashboard Metrics
18
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Go Live: Monthly Dashboard
19
eCareROI Dashboards
20
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ROIDashboard:HospitalROI
21
ROI
Dashboard:
System
Rollup2010 eCare Benefits Achieved (annualized)
Unfavorable to 2006 Baseline Red
Favorable to 2006 Baseline Yellow
Favorable to 2010 Expected Benefits Green
# eCare Hospital Benefit Process Owner SLH SVBGH SBH SNGH SCH SWRMC Total
1-3 S tr eam li ne Rec ord Com plet ion M S $255,306 $315,147 $173,672 $595,031 $307,592 $179,003 $1,825,750
4 Reduc e Trans cri pt ion Cos ts MS $493,387 $663,564 $247,402 $722,253 $400,131 $198,476 $2,725,212
5 Streamline Coding Process MS $73,041 $54,229 $94,336 $129,930 $61,619 $25,978 $439,135
6 St ream line HIS M anagement MS $28, 014 $26 ,847 $22, 206 $54, 133 $0 $47, 423 $178, 623
7 Reduce Risk Mgmt Claims & Uninsured Losses FS $41,667 $41,667 $41,667 $41,667 $41,667 $41,667 $250,000
8,21 Reduce Length of Stay and/ or Reduce ADEs GY/ TJ $1,325,550 $1,798,126 -$28,066 $3,287,675 $1,497,548 $824,219 $8,705,052
9 Reduce Paper Related Supply Costs MS $248,712 $395,018 $56,907 $615,842 $373,586 $120,913 $1,810,979
10,11 Increase Unit Efficiency/Retention of RN's LK $294,334 $378,240 $355,087 $3,172,134 $4,371,045 $452,079 $9,022,918
13 Improve Charge Capture AW $342,344 $395,652 $180,862 $649,031 $272,262 $133,947 $1,974,097
20 Increase Outpa tien t P rocedures AW/ KH $928,189 $1,147,886 $572,633 $1,857,276 $841,067 $438,371 $5,785,423
22 Reduce Pharmac is t Order Entry TJ $58,752 $71,353 $24,354 $106,417 $37,012 $16,996 $314,884
Benefit Achieved 2010 (annualized)
, , , , , , , , , , , , , ,
# Other eCare Benefits Process Owner Q1 Q2 Q3 Q4 YTD
* SHP realized benefits AP $500, 205 $500,205 $500, 205 $500, 205 $2,000, 819
* SE realized benefits RD $191, 958 $243,956 $420, 841 $285, 584 $1,142, 338
* Redu ce IT m aintenanc e ex pens e RD $464, 553 $464,553 $464, 553 $464, 553 $1,858, 212
Total Additional eCare Benefits $2,872,110
Total 2010 eCare Benefits Achieved $40,905,552
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Cumulative ROI Business CaseBenefits
$29.3MBudgetedfor2010; $40.9MAchieved(annualized)
BenefiteCare Benefit Category (Millions)*
- Reduce Length of Stay/ Reduced ADEs $8.7
- Increase Outpatient Procedures $5.7
- Increase Unit Efficiency/Retention of RNs $9.0
- Reduce Transcription Expense $2.7
- Reduce Med Records Supply Costs $1.8
- Reduce Medical Records Positions $1.8
23
- Reduced Optima (health plan) costs $2.0
- Improve Charge Capture $1.9
- Reduced 63 Administrative Positions $2.0- Reduced other costs $5.3
Total $40.9
*2010for6Hospitals,HomeHealthandHealthplan
eCareProcess Redesign Measures
24
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eCare
Process Innovations
Redesigned18majorprocessescoveringentirecontinuumofcare
LeanSixSigmaMethodology1. ArrivalManagement
2. BedManagement
3. CaseManagement
4. ChargeCapture
5. ClaimsProcessing
6. ClinicalCommunications
7. DiseaseManagement
8. EmergencyDepartment
9. HomeHealth
10. MDProcesses
11. MedicalRecords
12. MedsManagement
13. Monitoring/Recording
14. OrderSets
15. PatientCareTransformation
16. Patient/MemberSatisfaction
17. PhysicianPractice
18. Scheduling
DDesignesign
MMeasureeasureDDefineefine
VValidatealidate AAnalyzenalyze
25
ComplementaryTechnology:Barcoding;Document
Management;
Device
Integration Eachprocessredesigndefinedmeasuresofsuccess
Process Redesign Measures:
Patient Throughput Improvements
26
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rocess e es gn easures:Pre and Post eCareMedications
Management Improvements
Avoided117,400potentialmedicationerrorsduetomedicationsbarcoding
Baseline Post-eCare
Average time from order written
to order available to act on
59.0 minutes 4.5 minutes
Reducedmedsadministrationtime
Average time from order written
to med administration (NOWorders)
132.0 minutes 38.4 minutes
27
2009 Clinical Scanning On-Time-Performance% Indexed in
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Process Redesign Metrics:ED Admits LEAN Dashboard
IP Bed Ready to IP Unit
%
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Welcome to the Starting Line
Patient
Centered
Care
31
SITechnicalArchitectureSourcesofData
DivisionalSystems
Divisional
ReportingSystems
EPIC
HBOCCasemix
Clarity
ReportingWorkbench
BusObjects
DataStorage
Framework
DataIntegration
Framework
DataDistribution
Framework
SelfService UserAccess
ExcelServices&PowerPivot
SurgicalServices
SubjectDatamarts
Processes:
Extraction
Profitability
Durations
Hospital Dashboard
PrerequisiteInfrastructure
Other To ic
MMIS
IDX
PICIS
SHP
CareDiscovery
Extelligence
HorizonsBA
ProductModeling
Anodyne
Clinical
Warehouse
(Clarity)
Nonclinical
Warehouse
(akaDW)
Staging
Error
Handling
Quality
Checks
Data
Translation
DataLoad
E
T
L
E
T
L
AllPatients
HeartFailure
Sepsis
KPI
Pharmacy
ServiceLine/CEC
DiseaseMgmt
DiseaseMgmt
DiseaseMgmt
Dashboard
32
Diabetes
Mgmt
SHPCCS
Population Mgmt
External
Benchmark
Partners MEDai
ETG
ETLofsourcedatatoBenchmarkPartners
PredictiveModeling
DiscoveryAnalystics
StatisticalAnalysis
CDSSRealTimeviaWebServiceOrientedArchitecture(SOA)
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Continuous Improvement LoopContinuous Improvement Loop
Pricing & Customer
Smart
Alerts
OrderSets
InfrastructureContinuestoEvolve
EDW
Phase1
Surgery
Health
Plan
Data
Medical
Group
Data
Enriched
EDW
Medicine
Rx
EPIC
Clinical
Data
Choice
EnterpriseInformaticsArchitectureEnterpriseInformaticsArchitecture
33
BestPractices&OutcomeAnalysisPatternrecognitionand
PredictiveModeling
ProcessImprovement
EpisodeTreatmentGrouper
Data
Warehouse
34
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KPIBasedQuality/SafetyReport
35
36
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H1N1Results MDsUSEDordersets&ClinDocTools MDsTHANKEDUS theyGotIt
Feltreassuredthattheywerepracticingbasedonlatestinfo Efficientdocumentationhelpedcopewithlargevolumes
KPIReportingofVolumes MaterialsManagement(N95Masks) Guidedmanagementdecisionsaboutmoreextrememeasures(visit
restrictions,tentsonthelawn)
3737
Clinical Quality Goals andDashboards
38
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Sentara Strategic Plan2010 2012 Strategic Goals
Top10% ClinicalQualityandSafety
PatientSatisfaction
EmployeeEngagement
FinancialStewardship
TransformationofCare PrimaryCareRedesign
ChronicDiseaseCoordination
AdvanceCarePlanning
Alignment&Accountability
39
KnowledgeManagement
Growth
HamptonRoads Virginia/NorthCarolina
Patient SafetySentarapartneredwithnuclearpowersafetyexpertstoformHPI
asconsultantstohealthcareindustryinhighreliability
Methodsbasedonscienceandfacts
Scienceofhumanerrorandeventprevention
Practicalexperienceinhighreliabilityindustriesincludingnuclearpowerandaviation
Experiencedbasedmentoring
n ere
ea care
n
229hospitalsacross75organizations
ConsultingteamwithHROexperienceandhealthcareexperience(clinicians,nonclinicians,andphysicians)
40
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Sentara Healthcare
CY2010 Clinical Initiatives
Performance Summary Report
Executive Summary
Reporting Month: October 2010
Core Measures Reporting Period: August 2010
Anthem CMS CMS Gap SH SH Goal SNGH SLH SBH SCH SVBGH SWRMC SOH SPH
Goal Mean Top 10%Variance from
top 10%CY2009 CYTD 10 CY2010 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10
AMI
*** Early aspirin use 95% 100% 1% 99% 99% 98% 100% 99% 98% 100% 100% 10 0% 96% 100%
*** Aspirin at discharge 94% 100% 0.5 % 9 9% 1 00 % 98% 100% 100% 100% 100% 99% 100% 96% 97%
*** Beta-blocker at discharge 94% 100% 1% 99% 99% 98% 99% 100% 100% 100% 99% 99% 98% 100%
FINAL
Clinical Goals: System Dashboard
1*** ACEI or ARB for LVEF 100% 93% 100% 2% 96% 98% 98% 99% 100% 80% 100% 100% 100% 90% 100%
*** Angioplasty within 90 minutes of arrival 84% 100% 5% 90% 95% 90% 86% 90% 100% 97% 100% 100% 94% SNP
*** Smoking Cessation Counseling 9 7% 1 00 % 0% 99% 100% 99% 100% 100% 100% 100% 100% 100% 100% 100%
2 AMI %Green (includes ***) = Appropriate Care Measure 9 4. 4% 9 8. 8% 1 % 95% 97% 95% 98% 96% 94% 99% 98% 99% 92% 99%
Inpatient Mortality Rate 2% 1% Trend 0% 2% 3% 0% 2% 1% 2% 2%
AMI Outpatient Measures
Aspirin at arrival - ED AMI Patients 93% 100% 2% 9 9% 9 8. 0% 98% SNP 100% 100% 100% 100% 100% 94% 100%
Aspirin at arrival - ED Chest Pain Patients 93% 100% 3% 92% 97% 98% SNP 100% 97% 95% 100% 50% 100% 100%
Median Time to ECG - ED AMI Patients (Minutes) 7.0 6.0 10.0 SNP 8.5 6.0 5.5 16.0 8.5 4.0 7.0
Median Time to ECG - ED Chest Pain Patients (Minutes) 10.0 7 .0 10.0 SNP 12.0 7.0 6.0 17.0 8.0 5.0 9.0
Overall Median Time to ECG (Minutes) 43 4 -3. 00 10.0 7 .0 10.0 SNP 10.0 7.0 6.0 16.5 8.0 5.0 8.0
Median Time to Transfer for Acute Coronary Intervention (Minutes) 6 7.0 5 4. 0 T re nd SNP No Cases 53 .0 56.0 No Cas es No Cas es 71.0 55.0
ACC-NCDR Metrics for PCI NCDR MeanNCDR Top
10%
3 Overall PCI within 90 minutes of arrival 8 6% 87.3% 1 00 .0% 9% 86% 91% 86% 76% 83% 91% 95% 100% 100% 94% SNP
PCI Local Vascular Complications 1% 1.40% 0.0% 0.9% 0 .34% 0 .88% 0.4% 0. 92% 7. 46 % 0. 00% 0.00 % 0.0 0% 0. 00% 0 .00% SNP
PCI Serious Complications 3 .00% 2 .0% - 1% 2 .1 2% 0 .6 3% 2% 0. 72% 0. 00 % 0. 00% 2.30 % 0.0 0% 1. 43% 0 .00% SNP
4 PCI Statins or Non-statins on DC (h/o dyslipidemia) 95% 92.20% 98.4% 95% 98% 95% 98% 98% 100% 99% 99% 100% 100% SNP
PCI Risk Adjusted Mortality (1Q 2010) 1% 1.46% 0.8 0% 2 .19% 2 .21% 1.00% 2. 93% 0. 00 % 0. 00% 0.00% 1.65% 0.0 0% 0 .00% SNP
RAM O/E Ratio (1Q 2010) 1 .0 0 1 .1 9 1.00 1.99 0.00 0.00 0.00 1.12 0.00 0.00 SNP
Pneumonia
*** Antibiotic selection consistent w/ recommendations ICU 68% 100% 5% 84% 95% 90% 100% 100% 100% 100% 86% 86% 50% 86%
*** Antibiotic selection consistent w/ recommendations Non ICU 95% 100% 3% 96% 97% 97% 97% 96% 98% 100% 97% 100% 93% 95%
5*** 1st dose antibiotic given w/in 6 hours 99% 94% 100% 3% 97% 97% 98% 98% 95% 99% 98% 95% 100% 97% 95%
*** Blood cultures performed in ED prior to 1st dose antibiotic 93% 100% 2% 96% 98% 97% 98% 98% 99% 97% 97% 98% 98% 95%
*** Blood cultures performed on ICU Admissions 96% 100% 2% 97% 98% 98% 96% 100% 97% 100% 98% 100% 93% 92%
6*** Administration of Influenza Vaccine 97% 86% 100% 3% 95% 96.6% 97% 96% 91% 99% 100% 98% 98% 95% 80%
7*** Administration of Pneumococcal Vaccine 98% 88% 100% 4% 95% 96% 98% 90% 95% 99% 100% 98% 93% 93% 88%
*** Smoking cessation counseling 91% 100% 0.4% 99% 100% 99% 99% 100% 100% 100% 100% 100% 98% 93%VTE Prophylaxis CYTD 99% 99% 98% 98% 100% 100% 100% 100% 99% 95% 97%
8 Pneumonia %Green (includes***) = Appropriate Care Measure 86.3% 98.6% 6% 89% 93% 95% 92% 90% 97% 97% 93% 93% 88% 80%
Heart Failure
9*** ACEI OR ARB at Discharge with EF
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Clinical Goals:Serious Safety Event Rate
All Sentara Hospitals YTD November 2010
0.50
0.75
1.00
EventRate
81%ReductionSince2003
43
0.00
0.25
J-03
M-03
S-03
J-04
M-04
S-04
J-05
M-05
S-05
J-06
M-06
S-06
J-07
M-07
S-07
J-08
M-08
S-08
J-09
M-09
S-09
J-10
M-10
S-10
SeriousSafetyEventsper10,000AdjustedPatientDay
Clinical Goals: Mortality Ratio
44
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Clinical Goals: Avoided Deaths
600
100
200
300
400
(100)
-
SNGH SLH SBH SCH SVBGH SWRMC SOH
20 02 20 03 2 004 2 005 200 6 200 7 20 08 20 09
45
Clinical Goals:eHospital Resulting Interventions
4%
1%
MRT
RTContacted
TypeofInterventionsResultingfromAlerts
4%
%ofAlertsthatledtoanintervention
96%ofallalertsresultinsomesortofintervention
Interventions haveledto350+additionalcoaching opportunitiesw/staff
24%
13%
7%
5%
0% 5% 10% 15% 20% 25%
Coaching
MDContacted
Meds
EKG
96%
Intervention
NonIntervention
46
42%
58%
Interventions
requiring
MD
Contact1stQuarter2009:SamplePopulation
MDContacted
MDNot
Contacted
13%
87%
n erven onsrequ r ng on ac
Nov2009 Jun2010
MDContacted
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Clinical Goals:
ED Clinical Effectiveness CouncilDashboard
DailyMedianVolume
DailyAverageVolume
LWBS%
AMA%
QuickRegtoProvider
% =9 0% > =5 0% > =5 0% < =1 0% > =9 7% > =9 7% > =9 7% < =1 0 < =1 0 =9 0% > =9 6% > =9 6% > =9 6% > =9 0%
SBH 100 97 0.5 0.6 63 96 55 79 37 70 50 663 60 4 100 1 00 1 00 8.5 10.0 10.0 NC 0 100 1 00 1 00 90.6
SCPH 175 1 72 1.4 1.0 44 79 57 46 25 39 21 1 862 6 8 5 100 NC 100 NC 8.5 8.5 NC 100 1 00 1 00 95 86.4
VOLUME
PATIENT FLOW 1 CLINICAL INITIATIVES 2,4,5
AMI PNEUMONIABOARDERACCESS 2 LOS 2
SLH 131 131 1.9 0.8 46 99 52 60 21 44 40 1448 68 9 100 NC NC NC NC NC NC NC 1 00 93 100 85.3
SNGH 142 1 45 0.7 1.5 50 94 42 75 45 49 29 2444 69 8 100 NC NC NC NC NC NC NC 100 1 00 100 85.6
SOH 100 99 1.2 0 .7 48 96 42 42 63 40 916 6 7 5 100 NC NC NC NC N C NC 100 9 1 93 92 83.5
SVBGH 133 133 0 .5 0.8 51 97 63 55 55 44 43 1829 69 6 100 NC NC NC NC NC NC 1 00 93 91 94 8 1.4
SWRMC 97 98 0.3 0.5 73 98 89 63 58 60 51 833 78 4 100 NC 100 NC 3.0 3.0 NC 10 0 1 00 10 0 9 3 87 .8
SBLH 57 58 0.2 0.5 70 96 96 85 57 0 0 0
SPA 127 130 0.8 0.6 59 94 68 62 78 40 249 67 2 92.7
SPW 110 109 0.9 0.8 56 88 70 55 81 41 56 86 0 95.3
47
Guiding Principles
48
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Lessons Learned
WhatgetmeasuresgetsimprovedSelectappropriatedata:Retrospective,Dynamic,Predictive
FrequencydependsontheexpectedinterventionsDaily,Monthly,Quarterly
EmbedgoalsintobudgetsandbonusesPhysicians,Executives
Involveprocessownersinimpactedareas
Buildanindustrializedorganization
49
DiscoveryAnalytics&CorporateDecision
QualityResearchInstitute
Industrialized Organization
SentaraInformatics
50
Clinical&BusinessInformaticsSupport
Services Design&Development
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Guiding Principles of DataManagement
DataManagementisaProcess
Data>Information>Knowledge>Action
StrongDataGovernance:
SingleSourceofTruth DataDrivenAccountability
CreateaClearandSimpleMessage
BuildCompetitiveAdvantagewithAnalytics
51