Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek MHQP Education Ch

1. Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month March 24th Healthcare Reform Quality & Informatics Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek MHQP Education Chair skipvalusek@comcast.net Slides are posted at: http://www.healthforceminnesota.org/pages/Programs/courses.html

2. Hopefully you provided your name & organization when you signed in. If so: Just say Hi in the Chat Pod and we’ll capture your name and organization in the log. If not: identify yourself and organization in the Chat Pod to the left of your screen. Register your Attendance

3. Rural / Outstate ? Metropolitan area ? Organization that has (or serves) both ? Poll: Who is Attending this Session ?

4. Healthcare system Hospital Clinic or Clinic System Long term care Healthplan Homecare / Hospice A Quality Support Organization Other ? (e.g. MCM ) Poll: Who is attending: Organization Type ?

5. 1 2 3 4 5 6 7 >7 Poll: How many total participating in your room ?

6. I am a healthcare quality professional and am interested in additional education. I am a healthcare professional interested in developing quality skills as a core competency. I am a healthcare professional interested in learning more about healthcare quality. Poll: What do you hope to gain by participating?

7. Informatics and QualityOn the Radar ScreenIn the Crosshairs of Healthcare Reform ASQ Minnesota Section 1203 March 8, 2011 John R. (Skip) Valusek PhD CPHQ Director Clinical Analytics HealthEast Informatics Department srvalusek@healtheast.org Minnesota Healthcare Quality Professionals Education Chair Minnesota Council for Quality Evaluator

8. Agenda • A few thoughts from ASQ’s “Future of Quality” Study • Healthcare: A Decision Intense Industry • Healthcare Reform : A Catalyst for Quality • Healthcare Quality & Informatics • Change Management

9. ASQ’s 7 key forces • Globalization • Social Responsibility • New Dimensions of Quality • Innovation • Managing change • Aging Population • Healthcare • Environmental Concerns • 21st Century Technology: Driver of Change

10. ASQ’s Implications That Resonated • Culture of CQI: • The knowledge and ability to apply the tools of quality continue to be drawn out of the profession and into the hands of everyone in the organization. • As quality moves into areas less tangible than manufactured goods, it will increasingly become an issue of culture; a “quality mind-set” is needed. • Measuring waste and managing its reduction will continue to focus quality on the cost side of the equation. • Change and innovation are as much attributes of quality and how we manage as they are of products, processes, and services that are produced and delivered. • …… This plethora of data will serve only to pollute clear thinking and rational decision making if it is poorly designed, managed, and analyzed.

11. Supreme Court Federal Circuit Courts Departmental Congress Appeals CMS Formerly Health Care Financing Admin OIG MIPS State Survey & PRRB Survey Certification Regional Offices Intermediaries Carriers PRO's State & Local Governments JCAHO DMERC State Health State Medical Boards Boards Regional Home Health Intermediaries HIPAA State Medicaid EMTALA HHS/NIOSH Leapfrog HHS/OMH HHS/HRSA HOSPITALS 27 Nevers HHS/OCR State CLAS Licensure FDA DOT OSHA Labor/Justice ADA DOL/ Employment OPO'S DOJ NRC SEC IRS EPA FTC FCC FBI CDC CARF NCQA Who Accredits / Regulates a Hospital ?

12. Allegiance Health, Jackson MichiganSlide from 2010 McKesson Users Group

13. Some of the Reform drivers • Care Across the Continuum replaces fragmentation of care • Homecare / Hospice • Clinics • Acute Care (hospital) • Long term care; Skilled Nursing Facilities • Emphasis on Prevention , then treatment • Pay for outcomes rather than pay for procedure • Telemedicine

14. Machine • Military Operation Predominant Metaphors Used in Organizations: The new, emerging metaphor of the decision paradigm: Biological or Living Systems

15. Healthcare: A Decision Intense Industry Input Process Output Clinical Outcomes Patient Satisfaction • Physicians • Nurses • Pharmacists • Respiratory therapists • Dieticians • Social workers • Rehab therapists • Etc • Judgments • Choices

16. ? • Can we model this process? Decision Making : What is a Decision ? • Decisions commit resources through • judgment and choice processes • There is process in decision-making: • Opportunity/Problem Detection & Explanation • Alternative Generation • Analysis (Cost/Benefit judgments) • Selection among alternatives • Implementation • (Monitoring/measurement repeats the cycle)

17. Demographic C U R R E N T H I S T O R Y “Source” Systems “ “ “ Data Warehouse Decision Categories RETROSPECTIVE / ANALYTICAL TACTICAL & STRATEGIC DECISIONS CONCURRENT CLINICAL & OPERATIONAL DECISIONS • RESEARCH & PI ANALYSIS • ‘across’ • patients • continuum of care • channels, • markets, • periods • Unstructured (little or no process) • Find key variables • Collaboration & sharing. • Refine protocols/pathways • ‘Quick Look’ JUDGMENTS • ‘within’ • a PATIENT: Solve problem; • Exploit Opportunity • a PROVIDER: activity levels • a DEPARTMENT: staff scheduling • a REGION: assess event impacts • Empower employees (within limits) • Semi-structured process • Apply protocols/pathways

18. Objective of Decision Support in a single sitting. to achieve closure Unobstructed exploration

19. Clinical/Business Decision-Making IT ARCHITECTURE STRUCTURE KNOWLEDGE MANAGEMENT TRADITIONAL DECISION SUPPORT Retrieval Math Models Data Storage Cross Referencing Dialogue Decision Process Modeling: The Requirements GAP FLEXIBILITY

20. Decision Paradigm: Additional Bridges Required STAR (MUMPS) ORYX 6-digit coding Pharmacy Radiology Lab Med Staff Inpatient Pharmacy (STAR) SYSTEMS/DATA USERS ADAC Lab database (Fortran) Quality Indicators Outpatient Pharmacy Pxyis STAR Lab Radiology (STAR) HDM (B-trieve) Sungard (Oracle) OB database External/Regulatory Relations Eclipsys (Sybase ?) Neuro database? Oncology EXTERNAL SOURCE SYSTEMS OR Navicare Ortho Medline MN Hospital Assoc OB/ Womencare SurgiServer b-trieve Care-effective Cost Payor Relations CV Lab Abaton (Oracle) Micromedex (drug info) OLAP Analytical Decision Processes Neuro MICC database CV IT MODELS Provider Relations Allina KnowledgeQuest USER’S DECISION WORLD CV MicroMedical Behavioral Health Transaction Process (ERD; DFD) OLTP Logician (MedicaLogic) (Oracle) Patient Relations Ortho Database Demographic C U R R E N T H I T O R Y S ED OR Outpatient/ Ambulatory Cactus (credentialing) Warehouse (Oracle) Quality Patient Safety Picker (local) DISC Operational/Clinical Decision Process Storyboards Complaints RisKey (AREV) MediPac Medica Claims

21. Healthcare IT & Informatics • IT • Hardware and infrastructure • Backup and recovery • Transaction applications • Registration/scheduling • Coding • Billing • Informatics • Electronic Health Records: The Clinical applications • Clinical Decision Support & Documentation • “The most significant change a clinician will ever encounter” Valusek

22. Healthcare Informatics • Clinical Applications Build • Orders • Nursing Documentation • Clinician Notes • Medication Reconciliation • Lab & Imaging integration • Trainers • Super Users • Pharmacy Informaticists • Reporting & Analytics

23. Performance Improvement Accreditation Readiness Infection Control Patient Safety Patient Representatives Care Management Case Mgrs; Social Workers; Utilization Review Organizational Development Healthcare Quality • Is everybody’s job • Is supported by the following departments (and many others) Quality “Departments” Clinical Care Measurement & Reporting Medical Staff Office Quality IT Informatics Simulation Center HIPAA Corporate Compliance Medical Records Ethics

24. view as of 12/31/10 (HBI) Retrospective Analysis & Operational Decision Support ? ? REDCap research data Web Registries Horizon Expert Documentation RL Solutions Implants Registry Benchmarks (e.g. DataVision?) Island databases MIDAS Access Islands Excel Islands Horizon Patient Folder Data Warehouse (HPM) Horizon Care Record (HCR) Flowcast/Allscripts Ambulatory PMS/EHR Clinics Other “Source” Systems Hospital real-time decision support Informatics Analytics Clinic real-time decision support HealthEast Informatics Conceptual Model Operational Reports (e.g. patient lists) “Integration” (Transform & Load) Extract EMPI Enterprise Master Patient Index (Illuminate) HealthQuest (aka Medipac) (aka Clinipac) ADT & demographics Ambulatory operational reports and analytics Homecare/Hospice

25. Healthcare Reform : A Catalyst for Quality • Meaningful Use • Value-Based Purchasing • Accountable Care Organizations

26. + Meaningful Use = Necessary Conditions • Meaningful Use • EHR’s (hospital and clinic) over next 5 years • Health Information Exchanges (HIE) • Continuity of Care Document (CCD) • Continuity of Care Record (CCR) + ICD-10 + Master Patient Index

27. Value Based Purchasing VBP = Quality / $ Quality = .7 ( clinical outcomes) + .3 (satisfaction) “First do no harm” Quality = (Patient Safety) * (clinical outcomes + satisfaction)

28. ACO Structure and Financial Models Key Elements of ACO • Defined legal entity • Financial Model • Payment Distribution • Payment predicated on • Quality • Care coordination • Standardized clinical reporting • Clinical re-engineering Financial Models • Full Capitation • Partial Capitation • Symmetric Model • Asymmetric Shared Savings Risk Slide from Steve Heilman MD CMIO , Norton Healthcare Louisville KYScottsdale Institute presentation 03/17/11

29. Information Technology ChallengesSupporting ACO Development • EMR – clinical integration/ CDS/ Standards • Data Warehouse/ Data Aggregation • Disease Registry Development • Health Plan Data/ Actuarial Analysis • Patient Health Data Across Health Plans/ HIEs • Home monitoring/ Web Presence • Clinical Analysis for Re-Engineering Processes • Remote Presence – MDs/ Case management • Business Intelligence/ Physician Feedback • Timeliness of Data is crucial to success Slide from Steve Heilman MD CMIO , Norton Healthcare Louisville KYScottsdale Institute presentation 03/17/11

30. Clinical Re-engineering • Improved care coordination and communication • Improved access – physician extenders – email – phone call etc. • Prevention and early diagnosis • ED and Immediate Care Center visits • Increase generic medication utilization • Hospital re-admissions and multiple ED visits • Improved management of complex patients Slide from Steve Heilman MD CMIO , Norton Healthcare Louisville KYScottsdale Institute presentation 03/17/11

31. Accountable Care Organizations Measures

32. Change • The only constant is change • (except from a vending machine) • Life is change . . . . • Growth is optional • It is not necessary to change. • Survival is not mandatory. • Deming

33. Change Management Identify the change occurring on your unit this week: • Professional partnership model; • medication reconciliation; • new staff starting/orienting/precepting; • new nursing students; • new hospital planning; • new equipment (SCD pumps, ceiling lifts); • focus on decreasing overtime; • focus on increasing team playing; • focus on patient Picker scores "would you recommend?"; • telemetry training; • new protocol for insulin pens w/discharged patients; • added edunet modules (diabetes, moderate sedation, influenza); • management changes; • construction/detours outside and inside building; • EHR monthly updates; • relocation of our supply room; • focus on email as primary source of information/no paper postings; • daily medicare discharge notices; • patient room changes/ loss of private rooms.”

34. What are the implications of this much simultaneous change in a decision-intense environment ? Input Process Output Clinical Outcomes Patient Satisfaction • Physicians • Nurses • Pharmacists • Respiratory therapists • Dieticians • Social workers • Rehab therapists • Etc • Judgments • Choices

35. Re-Cap • Healthcare: A Decision Intense Industry • Healthcare Reform : A Catalyst for Quality • Healthcare Quality & Informatics in the crosshairs • Change Management and Innovation • A few thoughts from ASQ’s “Future of Quality” Study

36. Review/Summary: ASQ’s 7 key forces • Globalization HIE; CCD; CCR • Social Responsibility (STEEEP) (Safe,Timely,Equitable,Effective,Efficient,Patient-centered) 3. New Dimensions of Quality • Innovation • Managing change 4. Aging Population 5. Healthcare 6. Environmental Concerns (e.g. medication disposal) • 21st Century Technology: Driver of Change (EHR/EMR;diagnostics; telemedicine; predictive decision support)

37. Questions ?

38. Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month April 28 Analyzing Study Results Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek MHQP Education Chair skipvalusek@comcast.net Slides are posted at: http://www.healthforceminnesota.org/pages/Programs/courses.html