Distribution Notice:

1. Distribution Notice: The author of this presentation requests that you share this presentation only within your organization. Do not reproduce, post, or make any portion of this file available for use outside of your organization without first receiving the permission of the author.

2. Quality, Facing the Challenge Electronically! Epic User Group Meeting Session #63

3. Objectives • List the CMS Core measures were focused on by the Organization • List activities by the organization to track their indicators • Describe 3 Workflows created to assist concurrent auditing • Describe how concepts are being used • State the measured successes for the 4 indicators involved

4. The Challenge! Current National Campaign To Save 5 Million From Harm (IHI, 2006) “Challenges to health care providers to create ever-safer patient care environments” • Clinical Burden is immense • Technical Burden is immense • Regulatory Burden is immense We Need to Make The Systems Work for Us!

6. Where We Began

7. Strategic Goals To be at or above benchmark by 9/30/07 for: AMI CHF Pneumonia Surgical Care Improvement Project core measures.

8. Pathways Epic Patient lists Order sets Flowsheet rows Length of Stay Report Manual Chart review CART Tool Best Practice alerts Current Activities

9. Problems with Current Activities • Select few involved • Core Measures…what……..! • No ownership……something that is reported at PI • Information does not match perception • Cannot impact the results

10. Information does not match Perception • Excellent Outcomes of Care • Reduced incidence of Stage II pressure Ulcers from 4.3 to 1.5% (Benchmark 3.8%) • Reduced Falls to • Reduced MRSA related infection by 60% • At 0.2 above GMLOS • Medication Safety Award • Anecdotal belief of clinical excellence • Excellent Press-Ganey scores

11. Issue #1 Lack of documentation in the patient record! Need to create the USB port from “cerebration to documentation”

12. Cannot Impact Results • CMS results form CART were for the previous quarter • Patients were discharged before they were identified as being included in the cohort • Lack of discreet documentation • Lack of knowledge as to what actions affected the core measures

13. Issue #2 Poor concurrent reporting tools! Need to identify the patient as they walk through the door and have tools that will track every move!

14. Opening the “War Chest” • Tracking patients using an excel file • Build the data warehouse reports • Enhance Epic tools to reduce clinical burden • Education of the Clinicians

15. Excel File for CHF

16. Excel File for SCIP

17. Manual Tracking • Began with pneumonia & CHF • Daily review of all patients in the hospital • Eligible patients entered onto spread sheet • Unit Managers contacted • Completeness of documentation monitored • Status of patient eligibility on discharge recorded

18. Example of Data Warehouse Report

19. Automating the Tracking • Identification of discrete and non discrete data points • Build the reports so that non discrete columns have a place holder • Run the reports on a daily basis from the Data Warehouse • Access the report via the Intranet • Charts of identified patients reviewed for non discrete information • Non-discrete information keyed into the Excel spreadsheet

20. Epic Changes • SCIP Changes • SCIP Row • Procedure End Time • Home Page additions • CMS Row • Pneumovax changes • Beta Blockers • Discharge Instructions

21. Surgery Type © 2007 Epic Systems Corporation Confidential

22. Procedure End Time • Row was Text • 14 different “End Time” rows • Analyses which was used most frequently and in correct format • FYI re change • Swapped out Row • Add to Home Page

23. © 2007 Epic Systems Corporation Confidential

24. Core Measures Row Select AMI or CHF and Cascades in additional row PAF allows Managers and Staff to track patients concurrently © 2007 Epic Systems Corporation Confidential

25. Beta Blockers © 2007 Epic Systems Corporation Confidential

26. Beta Blockers © 2007 Epic Systems Corporation Confidential

27. Workflow – Text and CUIs

28. D/C Instructions • Workflow Streamlined • CUIs • Visual Cue • Improved Compliance? © 2007 Epic Systems Corporation Confidential

29. Quality Behind the Scenes • CUIs behind smart Lists • Reporting from notes

30. Workflow – Identifying Eligibility

31. System identifies patients and presents support tools for the RN to adhere to protocol. Workflow documentation switches off alert. © 2007 Epic Systems Corporation Confidential

32. Track Patients: Easy tools for managers to concurrently track patients © 2007 Epic Systems Corporation Confidential

33. Where We Are Now

34. Next Steps • Continuing to drive towards the goal of integrating discrete data capture into clinical workflows • Getting the system to provide more information that is not only patient specific but also drives the clinician towards Best Practice

36. Questions?

37. Contact Information Dan Exley Director Systems Integration & Development Medical Informatics Evanston Northwestern Healthcare 4901 Searle Parkway Suite 220, PO Box 1006 Skokie, IL 60076-8006 Tel: (847) 982-5490 Fax: (847) 982-6986 email: dexley@enh.org Katherine Reynolds, RN Senior Director Medical Informatics - Inpatient Evanston Northwestern Healthcare 4901 Searle Parkway Suite 220, PO Box 1006 Skokie, IL 60076-8006 Tel: (847) 982-3999 Fax: (847) 982-6986 Pager: (847) 479-0878 email: KReynolds@enh.org