Maintaining a QAPI Program through OTTR 7 utilization

1. Maintaining a QAPI Program through OTTR 7 utilization By: Robyn Dye RN, MSN, MBA, CCTC

2. Objectives • Learn Nebraska is a FUN State!! • Understand how OTTR can be used to facilitate a Quality Program • Understand how OTTR can be used to for organization and communication • Comprehend OTTR Best Practices to Ensure Data is Accurate and Useable • Upgrade to OTTR 7 Experience

3. Wake up there’s lots of Things to Do in Nebraska!!

7. My Experience With OTTR • Florida Hospital Liver Program--- Cerner • Texas Health Harris Methodist Hospital Kidney Program--- Epic

8. OTTR and Quality

9. What is Quality Assessment • Process for ensuring Compliance with specifications, requirements, or standards and identifying indicators for performance monitoring and compliance with standards • Determine Standards of Care/Benchmarks for the population • Determine how to measure that standard • Ensure your program is meeting the standard, or understands what needs to be done to meet the standard

10. Why Do we do it? • CMS Mandates that Transplant programs have a Comprehensive Quality Assessment Program that at a minimum: • Has Objective measures for transplant Processes/Activities and outcomes for each phase of Transplantation for recipients and donors • Phases include Pre-Transplant, transplant, post transplant • Therefore…. Every Transplant program should be tracking at least 12 Objective measures!! • It leads to better patient care and better outcomes

11. Definitions • Transplant Activity/Process • A series of actions or functions during the delivery of patient care within the program’s system that results in an organ transplant • Patient outcome • A measurement or event that is the result of the transplant process and directly affects the length or quality of a person’s life. • Potentially modifiable by a defined intervention

12. Examples of Quality Measures for Transplant Programs

13. Chronological Summary Pre Transplant (Activity/Process)

14. Phase Report • Shows all patients that have been referred Since the reopening of our program • Useful in determining what has happened and what is currently happening with all of our patients • Useful to determine Time in Each Phase

15. Drill Down Pre Transplant (Activity/Process)

16. Waiting Time List • This list is used to drill down and view the time between different steps in the evaluation process • Helps us see where we need to focus on improving our process

17. Annual Appointments

18. Listed Patients with Annual Evaluations • All listed patient and INFO about their annual evaluations schedule • Runs off of a specific encounter

19. Inpatient and Post Transplant Process/Activity and outcome

20. Chronological Transplant with Donor Data • Potential to correlate with outcomes in the future

21. Complications and Outcomes

22. Complication List • Used to Track different types of complications and report for quality purposes

23. OTTR and Organization/Communication

24. ORGANIZATION • First Outline your process and then look for ways to Automate/Organize • Linking is Key!! • Our Process • Referral is entered (Insurance is entered as Awaiting Review), Plan with all Actions needed to take place during the referral is attached to the referral • Once insurance is marked as accepted and referral is associated with the insurance, Phone Intake action appears on the phone intake Que • Once phone intake action is marked done, Orientation Action appears on scheduling list • After class is completed, tx coordinator Ends Referral and Adds Eval making sure to LINK Referral to the Evaluation!! • Evaluation Plan is attached TO the Evaluation including All scheduling Actions

25. Organization • Once Eval is added and Orientation action has been marked done, schedule phase 1 action appears • Once Phase 1 action is marked done, schedule phase 2 action appears • Once Phase 2 action is completed patient remains on coordinator que until presented at Acceptance committee • Once patient is listed and Listing is Linked with Evaluation coordinators add an action for when the annual evaluation should be scheduled, this action appears on scheduling list one month before it is due to que the coordinators to put in orders and the scheduler to schedule appointment/send referral • Annual appointment process continues until patient is Transplanted

26. Pre Transplant Scheduling List • Utilized to see how many pending appointments are outstanding for the clinic

27. TAC Report • Used to streamline presentation for Transplant Acceptance Committee

28. Selection Committee List • Used to summarize outcome of selection committee meeting

29. OTTR 7 Upgrade • Time Line– Entered Request in THR request system September 2015 • OTTR 7 was in Test March 2016 • OTTR 7 Production APRIL 2016 • Suggestions • TEST ALL Processes, Lists, Linking, and Reports • Make sure to include your interface team in Testing • Copy your test environment frequently as new updates are coming along quickly • Follow internal process for additional updates

30. Questions • ???

31. Conclusion • I hope you enjoyed this presentation and now you can tell your friends back home that you learned a lot and you Got to Meet MISS Nebraska

32. References • https://www.cms.gov/outreach-and-education/outreach/opendoorforums/downloads/qapiresourceguide090810.pdf