EMR tools to Improve Quality Improvement

1. EMR tools to Improve Quality Improvement Paul St. Jacques, M.D. Quality and Patient Safety Director Department of Anesthesiology Vanderbilt University Medical Center

2. COI/Disclosure • I am a registered inventor of the VPIMS software per Vanderbilt University policies. • I am a minority equity holder in Acuitec, LLC which markets a commercial version of the VPIMS Perioperative Software Suite.

3. For those who came primarily for the lunch: • Take a deep breath • It will all be over before you know it

4. Quality Improvement • “Proactive” • Reducing the variability in the process • Shifting the process’ outcome in the desired direction. • “Reactive” • Non-routine events • Analysis and improvement

5. Prevention… • VPIMS Applications: • Whiteboard • GasChart / Decision Support • Vigilance / Situational Awareness • Tools for event detection • Tools for tracking/closing events

6. Preop Case Board CQI Nurse Charting GasChart Vigilance VPIMS Database-MS SQL Server Hospital EMR VPIMS Web Electronic Charge Capture Billing

7. First things first: Prior to surgery, ensuring we have the right patient, procedure, side, other items present in the OR.

8. Intraoperative Whiteboard(during time out)

10. Decision Support • Delivering timely information to providers • To help providers ‘do the right thing’

11. Time Triggered antibiotic prompt…

15. Situational Awareness “Paying attention to all that is going on around you…” • VPIMS-Vigilance • Delivering OR Suite and patient status information to providers regardless of provider location. • Providing automated messages regarding changes in patient status/critical events.

17. That was…’suboptimal’ Detection, Reporting Structure and Event Analysis Intraop – Providers Postop – Providers Post Discharge – Patients Postop - Automated EMR scans

18. Intraoperative Self reporting of events

19. Review of Self reported events (links to documentation)

20. Electronic Web based reporting

22. Weekly Reports / Monthly Summaries via email

23. Postop Satisfaction(Complaint Tracking)

24. Email Delivery of Notifications

27. We don’t know what we don’t know

28. Postop Biochemical Markers • Postop lab value analysis • Acute Kidney Injury (incr. Cr > 0.3) • Troponin • Screening  Chart review

29. Acute Kidney Injury Screening • 14,000 inpatient surgeries (FY12) • 10,500 with pre/post Cr lab values • 1,257 with increases >0.3 • 1 Case reported to QI during same time period

30. VPIMS/Admin Data Veritas Direct Verbal/ Email Reports Phone Reports to Quality Office • Automated: • Biochemical Markers • Chart Scanning Morbidity, Mortality Improvement Committee Quality and Patient Safety Director Peer Review Committee Project Development- Assignment to individual/group Departmental MMI Conference Division Chief VC Clinical, Dept. Chair Joint QMMI Conference Close Case

31. QI Database of all reported events(Excel)

32. Future DevelopmentEvents Dashboard

33. Future DevelopmentEvents Control Charts

34. Professional practice Evaluation via Optimal care score

35. Group improvement over time

36. Conclusion • QI Processes are complex but important • Informatics resources can be brought to bear on both preventing and detecting events, event reporting and analysis. • Thank You