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VCUHS

CLIMBING A STEEEP CURVE : VCU: Using the EHR to Improve Patient Safety and the Provider and Patient Experience VA HIMSS November 8, 2012 Sue Wolver, MD, FACP Physician Informaticist. VCUHS. Tertiary care, academic medical center, Richmond, VA Single hospital, satellite clinics

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VCUHS

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  1. CLIMBING A STEEEP CURVE:VCU: Using the EHR to Improve Patient Safety and the Provider and Patient ExperienceVA HIMSSNovember 8, 2012Sue Wolver, MD, FACPPhysician Informaticist

  2. VCUHS Tertiary care, academic medical center, Richmond, VA Single hospital, satellite clinics 800 beds, 32,000 admissions/yr 550,000 outpatient, 80,000 ED visits/yr

  3. Objectives Overview of IOM report, Crossing the Quality Chasm and the STEEEP goals Discuss initiatives to use our EHR meaningfully Improve patient safety Improve patient satisfaction Improve provider satisfaction Demonstrate how the initiatives have improved STEEEP goals

  4. IOM report, To Err is Human (1999) Between 44,000 and 98,000 Americans die from medical errors annually. Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents. More than 50 percent of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately.

  5. Crossing the Quality Chasm (2001) All healthcare should be STEEEP: Safe, Timely, Effective, Efficient, Equitable, Patient Centered

  6. IT is a bridge to STEEEP care IT

  7. How do we get there?

  8. Dashboards: Safe, Timely, Effective, Efficient • You’ve spent years laying the foundation, but how do I see the patient’s story? • 70 clicks to look around to get data

  9. How do we aggregate the information? For each patient Across a population of patients

  10. Inpatient Dashboard: Efficient

  11. Outpatient Dashboard: Efficient

  12. OB Dashboard: Efficient Custom

  13. BloodBank Dashboard: Efficient Custom

  14. Blood Bank Dashboard: Efficient Let’s say the Blood Bank dashboard prevents an unnecessary phone call to the lab 10% of the time (CONSERVATIVE). Each phone call takes 2 employees 1½ minutes to conduct (CONSERVATIVE)The BloodBank Quickview is used 600 times per day on average       600 x 10% prevent rate          = 60 phone calls saved per day        60 x 1.5 min x 2 employees/cal = 180 employee minutes saved per day      180 minutes x 365 days        = 65,700 minutes saved per year 67,500 minutes/60min/hr = 1,095 man hours saved per year At a minimum this is 1,095 clinician hours/year we can give back to our patients because we made a process more efficient by reducing waste

  15. Still better, but not there yet… Can we assimilate the information across a population?

  16. Effective Care: Safety Dashboard • Pop Quiz • What’s that patient’s code status? • Have they had Med Reconciliation performed? • Do they have any lines? How long have those been in? • Do they have appropriate prophylaxis? • Do they have any precautions? • Any overdue tasks?

  17. Safety Dashboard: Across populations Safe, Effective, EfficientVisual Indicators for Evidence Based Medicine Custom

  18. Safety Dashboard Used ~100 times per day, needs to be more Active tool for nursing huddle and to spur interventions

  19. Better, but can the assimilated information improve decision making and become actionable?

  20. A Burning Platform – The Jazmin Story 14 year old, with pyelonephritis and ileus Failure by multiple specialties to truly appreciate her decline and sepsis Code blue 5AM on HD#7 Deceased by 10AM

  21. Jazmin’s story. Bottom line…we didn’t notice soon enough, we didn’t intervene soon enough, we didn’t realize how sick she really was

  22. MEWS: Safe, Timely, Effective • Medical Early Warning System • A real-time and constantly refreshing clinical dashboard of the acuity of patients based on evidence based scoring algorithm • Uses temperature, respiratory rate, pulse, blood pressure, oxygenation, and mental status, i.e. some of the data that we’ve spent years getting into digital form

  23. Medical Early Warning System What is the resuscitation status? What is the trend? What is the EWS Score? Where is the patient? Who is the patient? Who is caring for this patient?

  24. MEWS: Results Live March 2012: used ~ 50 times a day Serves as the “compass” for the Rapid Response Team (RRT) Have instances of the RRT beating the care team and the floor nurses to the patient Goals Continued reduction of codes outside of the ICU Continued reduction of unexpected transfers to ICU 33

  25. Quicklinks: Timely, Efficient • Frequently used sites • Smart Quicklinks • Passes user information to avoid second login • Passes patient information to avoid patient search • Provider efficiency = satisfaction = more face-to-face time with patients

  26. Quicklinks: Timely, Efficient

  27. Radiology Quicklink

  28. Radiology Quicklink • Let's say the iSite QuickLink saves the provider CONSERVATIVELY one minute per lookup. The iSite Quicklink is used 1430 times per day.         1430 x 1 minute           = 1430 minutes saved per day          1430 x 365 (days)       = 521,950 minutes saved per year         521,950 / 60 (minutes)    = 8,699 man hours saved per year At a minimum this is 8,700 clinician hours/year we can give back to our patients because we made a process more efficient

  29. Automated Notification of Admissions, Discharges, ED visits: Safe, Timely, Efficient, Effective

  30. Referring Provider Portal: Equitable Referring Provider Portal – VCUHSConnect.Org

  31. Referring Provider Portal: Equitable Equal access to the electronic record

  32. VCUHSConnect • Live for only 2 months • Already ~300 external requests for accounts • Already ~100 active users • Top user accesses the record more than 60 times per week

  33. Alert: Safe, Timely, Effective A 66 year-old female with multiple medical problems including a need to be on lifetime blood thinning with Warfarin presented to clinic with cellulitis. Resident chose to give patient an antibiotic – Bactrim due to a penicillin allergy. Over the course of 5 days patient noticed increasing nose bleeds and belly swelling. She presented to the ED with a blood thinning level of 8.9 (normal for her would be 2-3). Admitted and within hours was having low blood pressures, seizures, and loss of consciousness. Was diagnosed with head bleed, despite emergent surgery she never awoke.

  34. Patient Portal: Timely, Equitable, Patient Centered

  35. Summary IT can improve the delivery of STEEEP care Alerts, Dashboards, Tools, Processes Improve patient and provider outcomes and experience

  36. Questions? • Sue Wolver swolver@vcu.edu • Follow VCUHS Success on Twitter @VCUHS_ONE_CMIO

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