Putting Quality in the EMR

1. Putting Quality in the EMR Peter A. Sanderson, MD Director of Medical Informatics Operations Ministry Health Care

3. Fundamental Law of Improvement “Every system is perfectly designed to achieve exactly the results it gets” Paul Batalden, MD (IHI)

4. Fundamental Law of Improvement Quality is the outcome of a process or a system

5. Fundamental Law of Improvement To improve a process (and quality) • Make it simpler • Remove unneeded steps • Reduce variation • Standardized work flow • Power to the people • Measure it

6. For Example: The Problem • We need to hire more staff to answer the phone

7. For Example: The Problem • The current average abandoned phone call rate has been 20 % and rose to 26.7% in June.

8. Huge variation, little standardization • No vectoring of calls • Many incoming phone numbers • Inaccurate phone numbers • Every staff member had a different priority and had tried uncoordinated solutions • Everyone thought someone else was answering the phone

9. WORK RULES • Developed by staff • Broken down into general rules and Phone room priorities • Answer call by third ring • Document and learn from the failures

10. Call Volume

11. Abandoned Phone Calls

12. Physicians don’t change • Many of the new demands on physicians are better done by others on their team, so: • Change the working environment • Make it automatic, easier than the alternative • Delegate where possible • Emphasize standing orders

13. Cooking with Magic video

14. EHR Guidelines(simplify and standardize) • we seek to determine what information our clinicians routinely collect and document and present the data to them. • Our staff will use common workflows and documentation tools to assemble standard patient queries prior to the clinician seeing the patient.