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Quality and Rural Health- One Hospital’s Experience

Ky Sanders, RN, BSN. Quality and Rural Health- One Hospital’s Experience. Disclaimers . Mt. Graham Regional Medical Center is not a Critical Access Hospital, so differences may be present. All information should be verified by experts as they relate to your facility.

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Quality and Rural Health- One Hospital’s Experience

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  1. Ky Sanders, RN, BSN Quality andRural Health-One Hospital’sExperience

  2. Disclaimers • Mt. Graham Regional Medical Center is not a Critical Access Hospital, so differences may be present. • All information should be verified by experts as they relate to your facility. • Any mention of a vendor is for informational purposes only, not as an endorsement of any product or service.

  3. “It is not necessary to change. Survival is not mandatory.” -W. Edwards Deming

  4. Where we were… • MGRMC had adopted computerized records in 1999. • Incremental changes performed over the next 10 years. • Adoption rate was low, with only half of the units using computerized records • Physicians only viewed records—orders and documentation was still on paper.

  5. Surviving Because of Change • MGRMC decided to change hospital information systems in 2010. • We spent 10 months analyzing our current workflows and vetting different systems. • Contracts were signed in the spring of 2011 and implementation began in the fall of 2011. • Go live was Nov 1, 2012. Additional functions became live in June 2013.

  6. Hurdle #1:Determining system architecture

  7. Selecting our framework Best of Breed Modular System All-in-One Allows the greatest flexibility Also the most complex for upkeep Modules group similar areas together Requires reports to be pieced together Contains all necessary modules May be limited in how those modules function

  8. Framework choice and impact on reporting • Inpatient method versus all ED method • Specialized areas such as OB • How is data stored in the system?

  9. Proprietary Tables

  10. Standardized data store

  11. Hurdle #2:Getting all areas to adopt an EMR system

  12. Adopting an EMR • We had to remove perceived barriers for some departments, such as OR and the ED • Specialized modules obtained for these areas • Expectation was that there are no “special cases”

  13. Hurdle #3:Optimizing Workflows

  14. Optimizing Workflows • Get rid of “Because that’s the way we’ve always done it.” • Build in safety checks and clinical support • Ask around/network • Use workarounds as a last resort

  15. Hurdle #4:Educating Staff

  16. Educating Staff • Formal versus informal training • Explain the “Why’s” behind the changes • Don’t forget per diem staff!

  17. Hurdle #5:Physician Adoption

  18. Physician Adoption • Have a dedicated team for addressing physician needs • Use a physician champion • Modify training as needed

  19. Hurdle #6:Capturing Accurate Data

  20. Capturing Accurate Data • Use the “Single Query Theory” • Match queries to workflows—make them intuitive • Shift in thinking from “If it isn’t documented, it isn’t done” to “If it isn’t documented in the correct spot, it isn’t done.”

  21. Using single queries

  22. Hurdle #7:Optimization

  23. Optimization • After working with the system for a few months, some things were just not working • Optimization helps tweak workflows and the system for continued use • Without optimization there is a risk of stagnation and regression

  24. Hurdle #8:Reporting the Data

  25. Reporting the Data • For 2013 we had to use a variety of methods • EMR Vendor support was crucial • Specialized training needed • Report writer • SQL reporting • 3rd Party Report Writing service contracted to get them all done

  26. Hurdle #9:Making Sense of All Our Data

  27. What do I do with all this data? • Data is worthless unless it is used • Educate, educate, educate! • Administration • Staff • Physicians • Present high quality data in an easy to use format

  28. Clinical Quality Measures • Differences between abstracted measures and electronically calculated measures • Attestation versus electronic submission

  29. ED Throughput Measures-2013 • ED-1 and ED-2 • Easiest to capture data • Used internal system times for all calculations

  30. Stroke Measures-2013 • Stroke-2 through Stroke-10 • Difficult for us to measure, as most stroke patients are transported to another facility • Required specialized reports from vendor to capture medications accurately

  31. VTE Measures-2013 • VTE-1 through VTE-6 • Required extensive queries to be set up • These measures caused the most concern for our hospital • Also required specialized reports from vendor similar to the Stroke reports

  32. Clinical Quality Measures-2014 and beyond • Eligible hospitals must report on 16 of 29 approved CQMs (15 required in 2013) • Selected CQMs must cover at least 3 domains • CQMs are much more flexible for rural hospitals

  33. ED Throughput-2014 • ED-1 and ED-2 are essentially the same as 2013 • Make sure the data is stratified between inpatients, inpatients with psychiatric/mental health diagnoses, and observation patients • ED-3 is new measure for stratified discharge times

  34. Stroke Measures-2014 • Essentially the same as 2013 • Not sure if MGRMC will report on this in the future

  35. VTE Measures-2014 • Essentially the same as 2013

  36. AMI Measures-2014 • New: Available for 2014 eCQMs • AMI-2: Aspirin prescribed at discharge • AMI-7A: Fibrinolytic Therapy within 30 min of arrival • AMI-8A: Primary PCI within 90 min of arrival • AMI-10: Statin prescribed at discharge • MGRMC most likely not to use

  37. Pneumonia Measures-2014 • New: Available for 2014 eCQMs • PN-6: Initial antibiotic selection for community acquired pneumonia • MGRMC determining how to capture data needed

  38. Perinatal Care-2014 • New: Available for 2014 eCQMs • PC-1: Elective Delivery prior to 39 weeks • Exclusive Breast Milk feeding of Newborns • Healthy Term Newborns • EHDI-1a: Hearing screening before hospital discharge • Some data captured at MGRMC, but working on processes for all data

  39. Surgical Care Measures-2014 • New: Available for 2014 eCQMs • SCIP-INF-1: Prophylactic Antibiotic received within 1 hour prior to surgical incision • SCIP-INF-2: Prophylactic Antibiotic selection • SCIP-INF-9: Urinary catheter removed on post-op day 1 or 2 • MGRMC trying to determine process for discrete data capture

  40. Pediatric Asthma-2014 • New: Available for 2014 eCQMs • Home Management Plan of Care document given to patient/caregiver • MGRMC will most likely not use this CQM

  41. Smart Practice #1:Get everyone on the same page

  42. Get everyone on the same page • We had separate teams for HEN, Hospital Inpatient Quality reporting, Core Measures, and Meaningful Use reporting. • Beginning in 2014, the separate lines of demarcation become blurred • Select data that is meaningful to your hospital

  43. Smart Practice #2:Leverage your EMR vendor

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