Sue Barnes , RN, CIC, National sue.barnes@kp

1. Automating Infection Surveillance in KP APIC SFBA July 2009 Sue Barnes, RN, CIC, National sue.barnes@kp.org Nolana Daoust, MPH, CIC Vallejo nolana.daoust@kp.org Jackie Escalante, RN, CIC SSF jacqueline.escalante@kp.org An IP mining infection data

2. Why Data Mining (i.e. Automating Infection Surveillance) • Regulatory/Legislative mandates for infection related process/outcome data • Priority for IPs is preventing infection vs. case finding and report creation. Automation can help to reduce this diversion of expert resources • Technology permits this automation • QUESTION: Can we make the leap as a profession from doing surveillance for public reporting and performance improvement differently than for publication by accepting less than the perfect CDC case finding methodology = perhaps NIM/other?

3. Data Mining in KP: Current systems to help automate infection surveillance currently being “evaluated” in KP: • MedMined http://www.cardinal.com/us/en/brands/medmined/ • Medici nolana.daoust@kp.org • AICE http://www.icpa.net/ • EPIC/HealthConnect (EMR) reports

4. What is MedMined? Daily (Virtual Surveillance Interface) Makes Infection Prevention less clerical and more clinical Important data is immediately accessible Weekly (Nosocomial Infection Marker Scorecards) Able to track unit specific Nosocomial Infection Rates IPs able to use Medmined as a goal setting tool Monthly Patterns (Data Mining Surveillance Service) Automatically identifies important quality issues Focuses interventions Documents the impact of process improvements Annual Executive & Outcomes Reporting Financial proof that MedMined with active Infection Preventionist(s) makes good business sense

5. Streamline surveillance to meet compliance with SB1058 – State reporting requirements – Healthcare associated infections (HAI) HAI MRSA BSI – Medmined MRSA scorecard (denominator patient days) HAI VRE BSI – Medmined blood scorecard (denominator patient days); report on Blood with VRE with LOS >2 days HAI Central line bloodstream infections in all Nursing Units – blood scorecard (denominator central line days) HAI Clostridium difficile – Medmined stool scorecard (denominator patient days) Surgical Site Infections – Deep/organ space in clean and clean/contaminated in all Orthopedic, Cardiac and Gastrointestinal surgeries: Medmined report of readmissions within 30 days from surgical floors (denominator is total number of procedures) & wound scorecards looking for acquisition location MedMined – how does it help?

6. Web-based application Create/Run reports (e.g.; + MRSA > 2 LOS for all inpatient locations) Create/Run alerting (e.g.; surgical readmission)

7. Nosocomial Infection Marker Scorecard Kaiser NIM Scorecard 7/1/2006 – 3/31/2007

8. Nosocomial Infection Marker (NIM) • A highly sensitive surrogate marker of hospital-acquired infections • An epidemiologic tool, not a diagnostic tool • NIMs are objective, consistent - NIM algorithm is applied to every patient • High correlation with cost, LOS & chart review • Rapidly computable from electronic clinical data • Peer reviewed and clinically validated¹ • Sensitivity (CI95): 0.86 (0.76-0.96) • Specificity (CI95): 0.984 (0.976-0.992) • ¹Brossette SE et al. American Journal of Clinical Pathology. 2006;125:34-39.

9. Data Mining Pattern

10. MedMined – what can it do in your hands? It is clear that Infection Preventionists supported by timely/objective data, actively engaged with stakeholders, guide optimal care for the Member and enhance the culture toward infection prevention best practices. • 22.53% reduction in Catheter Associated Urine NIMs • 72 patients prevented from acquiring a UTI • 1,669 days LOS avoided • $1.87 million in estimated LOS cost avoidance

11. MedMined – Benefits Benefits: Expedite daily surveillance – faster response Trends/cluster pattern reviews – provides actions Algorithm – streamlines case finding and cultures that require review Monthly scorecards – Can see NIMs for each medical unit at a glance Patient days available for rates Alerts for reportable infections to local public health as sentinel events Alert for patients requiring isolation Antibiograms – by medical units or medical center wide in 24 hours Web-Based Data Management Tools Graphs, SPC, Export to Excel, Word Data Mining Reports

12. MedMined - how is it supported? CLINICAL SERVICE SUPPORT: Epidemiologist available by phone any time to review data, patterns. MedMined University (3 day offsite course) Excellent customer service. Training provided and continued work with each facility to review improvements, changes in NIMs, new ideas. MedMined comes to your medical center annually to present financial reports to Hospital Administration and IP team. Cost analysis includes impact of length of stay for major DRGs by HAI using Nosocomial Infection Markers (NIM). Electronic document Library available. Reports, surveillance tools, other resources. REGULATORY/LEGISLATIVE COMPLIANCE Facilitates reporting all aspects of SB1058. Download to NHSN in development. Sentinel alerts used to identify reportable conditions to PHD, new cases of MRSA, VRE, C. diff, + MRSA surveillance cultures. Alert flags readmissions with MRSA and VRE. COST Based on bed size – for 400 beds approx $100,000 per year plus $50,000 for antibiotic monitoring component – vendor is CareFusion (used to be Cardinal Health) Inclusive of all travel and training costs

13. More info on MedMined Click on Cardinal (will soon be CareFusion) at: http://www.cardinal.com/us/en/brands/medmined/ Or contact: MedMined: Jason Hopper at: Jason.Hopper@carefusion.com IPs using MedMined: Teresa Canola at Kaiser Fontana (SCal) at maria.t.canola@kp.org, Connie Izzo IP at Baylor Health: connieI@baylorhealth.edu

14. What is Medici? • Clinical Decision Support Tool for Regulatory Compliance • Clinical Pharmacy Workflow for Productivity Management • Near real-time data for operational reports • Relational database capability

15. How Does Medici Work? • Automatically extracts data from EMR (HealthConnect and CIPS) into Medici database • User-entered data linked with clinical data to correlate effect and outcome and help track early detection of illnesses • Medici system available through Web, desktop, laptop and Tablet PCs

16. Current Data Flow

17. Point and Click

18. Infection Prevention Surveillance

19. Orsini Search Interface

20. Orsini Search Interface

21. More info on Medici Click on the Asolva website at: http://www.asolva.com/subpage.php?page=products_01 Or contact Dr Steve Parodi or Nolana Daoust at: stephen.m.parodi@kp.org nolana.daoust@kp.org

22. What are EPIC/HealthConnect Reports? • Crystal Enterprise • Crystal Enterprise is an online report viewing system for EPIC (KP HealthConnect) • Users are able to access standard reports for their region via a browser • The reports on Crystal Enterprise access the Clarity database and do not contain real-time data; data is only up to midnight of last night • Crystal Reports - Uses • Line, Drain and Urine Catheter Days • Central line insertion practices (CLIP) • Determine central line days • NHSN reporting of CLIP data for ICU • MDRO Surveillance (C.diff and MRSA) • Prior MDRO • HAI • Chart flagged to alert staff to implement Isolation and Contact precautions

23. Clarity Reports

24. Clarity Reports

25. Clarity Reports

26. Moving Forward – Questions for the Group: Would you agree that surveillance for different purposes can be collected in different ways? i.e. public reporting/ performance improvement vs. publication For public reporting and performance improvement, could we move from infection surveillance based on CDC definitions to infection surveillance based on agreed upon “trigger equations”? Such as: • SSI = surgical procedure + antibiotic administered within 30 days post op • CAUTI = positive urine culture + foley catheter

27. From Google Search