Data is Power: Making Your EDIS Work for You

Data is Power: Making Your EDIS Work for You A Multi-Site Experience

Discussion Panel • L. Albert Villarin MD FACEP • CMIO : Albert Einstein Healthcare Network • Director. Medical Informatics – Dept Emergency Medicine • Albert Einstein Medical Center – Philadelphia, PA • Richard S. MacKenzie, MD, FACEP • Chair : Department of Emergency Medicine • Lehigh Valley Hospital & Health Network • Chris DeFlitch, MD, FACEP • Director & Vice-Chair • Department of Emergency Medicine • Physician Director, Connected, CIS

Albert Einstein Medical Center - Background • 600 bed teaching hospital in north Philadelphia • Level 1 Trauma Center • Approximately 75K annual emergency department visits • Well established emergency medicine residency program • PGY 1-4 • 48 residents • Ten million dollar renovation completed in FY 04

Emergency Department Renovation • Renovation goals and challenges • Maximize clinical space • Reduce the perception of “chaos” and decrease noise levels • Improve efficiency • Improve patient flow • Improve patient, staff, and referring physician satisfaction

Emergency Department Renovation • Renovation solutions • Three contiguous “Pods” and an adjacent Urgent Care • 3 nursing stations • 48 Beds • New equipment • Advanced procedure capability • Ultrasound • Dialysis • Respiratory isolation and decontamination • Dedicated CT scanner and two plain film suites • PACS system • Portable telephones for physicians and other designated staff • Staff lounge and locker rooms

Emergency Department Renovation

Renovation Challenges • Renovation plans created questions and new challenges • How to track “real time” patient status in the new environment • How to improve efficiencies in triage, patient flow, lab, x-ray, and dispositions • How to improve communication among the ED staff and between ED staff and other departments • How to track important milestones for review and analysis • How to do all of the above without increasing the work load of an ED staff already at or near its limits The answer… Passive Tracking

Passive Tracking • Amelior EDTracker™ • Tracks “real time” status of patients, staff, and equipment • Provides the ED staff with minute-to-minute knowledge of the entire department • Allows staff to effectively communicate with each other and with other hospital departments (e.g., admissions) • Provides multiple layers of patient safety (e.g., “road blocks”, physician call-ins, return visit warnings, delays in care warnings) • Provides a vast amount of visit information • Allows department administration to “see” where issues and problems lie • Provides “hard” data to effect change • Does all of the above “passively”

Excellent training materials and support Four hour training sessions Go-live went extremely well Exceptional support and real time problem solving Within about 1 month staff were not only comfortable using the system, but were relying on it for day-to-day patient care Quickly and easily accepted by the ED staff We do not track staff location outside of patient rooms Quickly accepted by the hospital staff and administration Resulted in the purchase of hospital wide bed tracking soft ware Extensively used during twice daily admission rounds Provided the impetus for additional funds/staff for the ED Resulted in a number of hospital wide initiatives to improve patient flow and the admissions process Implementation Training and go-live Staff and hospital acceptance

Amelior EDTracker™ – The Results

Amelior EDTracker™ – The Results • Amelior ED™ advantages • Integrated system with Amelior EDTracker • Interfaces with all hospital systems • Customized for use in a teaching environment • Allows for individualization and/or group defaults • Allows any data element to be optional, prompted, or mandatory • Allows self maintenance • Built in patient safety software • Discharge instructions and prescription writing • Audit log (HIPPA compliant)

Amelior EDTracker™ – The Results • Amelior ED™ in the teaching environment • Allows prompts and mandatory information to assist junior residents, yet simultaneous provides autonomy for senior residents • Types of orders can be “adjusted” based on level of training • Allows residents to “assign” patients to their attending physician • Allows diagnosis and procedure tracking for resident logs • All of the above does not require repeated PCTS action or input

Data is Power: Making your EDIS work for You LVH Experience

Problems • Intubation • Time out verify & Procedural Sedation • “QC Passed”

Opportunities • Best of Breed Hospital • How… not can • EDIS • T-System EV • IDX/LastWord HIS • McKesson • Horizon Performance Manager (HPM) • Horizon Business Insight (HBI) • Pervasive Data Parsing Tool with MS Access • http://pervasivedatatools.com

Hemoccult Quality Control Passed Documentation • ESC: PC.16.60 (Quality control documentation) • All quality control test results are documented, including internal, external, liquid, and electronic. • LVH- M (#6017): 10/17 – 10/20/06 JCAHO accreditation survey

Document that the Quality Control dot turned blue on the Hemoccult Card when testing stool for occult blood by typing “QC Passed” In the T-Record QC pooh Document QC Passed

T-System Documentation

Hemoccult Quality Control Passed Documentation • Pervasive Program Used to Divide Text Document produced by T-system into “sections” • MS Access used to find specific words or phrases-queries • Query results sent to HBI to be presented in graphical and tabular formats. • Providers notified via E-mail if there is documentation of hemoccult testing but no documentation of “QC Passed”

50,000 Visits 22% pediatrics 20% Admits 40% of HMC Front Door of Penn State HMC Department of Emergency Medicine

Key Concepts • What Data & Why • Where is Data ? • Data collection should Improve Process • Data Results to Drive Process Outcomes

Financial Defense ROI (if buying) Revenue Communication Universal Access Providers Patients Efficiencies Quality Measures Deficiency/complaint Clinical Outcomes Med Rec J…C.. National Patient Safety Goals Data Points of WHY

Where is the DATA ? • System Generated Reports • Viewable? • Exportable? • Usable ? • Self-Generated Reports • Mining a parallel system • Data Warehousing • Multi-contributor Reports • Interoperable • Contextualized

Connected* EDIS FirstNet (cerner) RIS/PACS (GE) CPOE (cerner) Lab (mysis) MUSE (cards) Others ADT (eclypsys) Facility Bill (eclypsys) Prof Bill (signature,SMS) ID tracking (MedMine) Filemaker PRO (s) Penn StateInformation Technology And DATABASES we have NO IDEA exist

ED Lab order Future State Redesigned Process

Future State Redesigned Process ED Lab order ED Lab order Future State Redesigned Process

Time Goals Door-MD –20 min Door-D/C – 70 min Door-admit – 210 m Triage – 3 minutes Door-EKG- 10min Door-lytics- 30 min Door-Abx – 4hrs Metric for Management • Personal productivity • Pts per hour (2/provider) • Visits/day/year • Work-up variability • wRVU production • Systems Measures • Bed availability • Cost/case • Diversion times • Satisfaction

Metric for Management • Time UHC 2004 bench • Door-D/C (ED LOS) • 50%ile – 230min • Top 25% - 180 min • Top Decile – 134 min • Door-admit • 50%ile – 354 min • Top 25% - 289 min • Top Decile – 240 min

OPEN - Discussion Panel • L. Albert Villarin MD FACEP • CMIO : Albert Einstein Healthcare Network • Director. Medical Informatics – Dept Emergency Medicine • Albert Einstein Medical Center – Philadelphia, PA • Richard S. MacKenzie, MD, FACEP • Chair : Department of Emergency Medicine • Lehigh Valley Hospital & Health Network • Chris DeFlitch, MD, FACEP • Director & Vice-Chair • Department of Emergency Medicine • Physician Director, Connected, CIS

Data is Power: Making Your EDIS Work for You