Introduction to the Surgery Quality & Workflow Manager (SQWM)

1. Introduction to the Surgery Quality & Workflow Manager(SQWM) April 23 2013

2. SQWM Business Drivers • Address the key issues of patient safety and wait times • - Patient wait time for surgery may be lengthy • - Patient surgeries are being canceled at the last minute for missing tests / results or lack of ICU beds • Improve the efficiency and cost effectiveness of the surgery scheduling process, including alerting bed management and ancillary services of daily needs • - Expensive staffed OR rooms may be unused • - Regional and National view of resources and utilization • Allow for day of surgery patient tracking, provide local management reports • - Manual OR reporting processes result in lower information quality • - OR documentation/reporting is not consistent • Improve data availability for the national surgery quality programs • - Allow relevant clinical data collection on all cases • - Automate data collection to improve data quality and timeliness

3. SQWM Objectives • Standardization of VA surgery • Support business process change • Streamline surgery workflow • Improve efficiency • Monitor wait times • Track compliance with VA surgery complexity • Provide interface capabilities to other VA systems • Improve quality and patient satisfaction

4. SQWM Overview The Surgery Quality & Workflow Manager (SQWM) software solution will allow the tracking of surgery patients through the pre-surgical process, scheduling of surgery, peri-operative period and post-operative assessment and disposition, including quality outcomes reporting. This solution includes GE Centricity, a Commercial-Off-The-Shelf (COTS) product, and development of system integration to the existing VA patient support applications.

5. SQWM Product Description • End-to-End patient tracking and clinical documentation from consult to discharge • Centralized management of all resources needed for surgery • Configurable clinical manager component to allow standardization and updating of business processes across the VA in the shortest amount of time • Maximize re-use of existing components to interface with VA information assets, such as standardized terminology services, Standard Data Services, Identity Management, etc. without the need for further development • Industry best practices of quality monitoring and reporting built in the highly configurable product to meet the VA’s local, VISN, and national level quality assurance goals • Optimized peri-operative workflow and surgical block time utilization to improve patient safety and Veteran access, increase overall patient and employee satisfaction, and reduce wait times, first-time late starters, and cancellations, improved efficiency = increase in capacity

6. SQWM Project Activities • PMAS Approval Granted 3/28/2011 • Contract awarded for SQWM Solution on 9/13/2011 • GE Centricity team completed walk through of Alpha Site, Portland VAMC, week of 9/26/2011 • Training Recommendation completed in January 2012 • SQWM Demonstration Presentation April 2012 • Software Delivery, testing initiation August 2012 • Begin use in Production (first site) April 2013 • IOC roll-out in May 2013 • National roll-out complete August 2014

7. SQWM Interfaces

8. Integration – Phase 1 Training • ADT • SQWM will receive patient demographics, VA specific fields (e.g. service connected, radiation exposure, etc.) and admitting data for patients • Scheduling • SQWM will receive patient demographics, VA specific fields, and surgery Clinic Appointment data at the point of scheduling and checking in the patient • TIU • SQWM will send notes to CPRS at the end of documentation by the clinical provider (e.g. progress notes, procedure notes, operation reports, operative note, etc.). These will show on the appropriate tabs with signer, location, and date/time in CPRS as text. • MVI • SQWM will receive veteran demographic updates from MVI and utilize MVI during the ADT and scheduling process to confirm correct patient demographics prior to processing the ADT and Scheduling interfaces. • VASQIP • SQWM will send VASQIP data to the national report center • VistASurgery • SQWM will send select data elements to VistA Surgery to allow for other downstream reports and systems to access data from the existing VistA Surgery data elements • PCE • SQWM will send PCE forms to PCE for workload accounting.

9. Integration – Common Questions Training • Will Medications integration be available in SQWM during phase 1? • SQWM will not be integrating medications during phase 1 but is on the roadmap for future phases • How are allergies integrated during Phase 1 in SQWM? • Yes, allergies are received into SQWM via the ADT interface in Phase 1. • Will Labs be sent to SQWM during Phase 1? • SQWM will integrate labs during a future phase. • What documentation is available to review about these interfaces? • Each interface has an ICD that is available • SQWM will have new note types. • New note names and types are being rolled out with SQWM. This will allow for standardization across the VISN and Nation • Will notes and documentation elements from SQWM be in CPRS? And on the correct tabs (e.g. surgery) • Yes, notes and forms completed in SQWM will be in CPRS via the TIU interfaces. Surgery documentation (e.g. Operation Report & Operate Note) will be on the surgery tab. Notes will have signer, date/time, and location.

10. SQWM Project Team Members VA Team Members: • VA Initiative Lead – Craig Powell • VA Deputy Initiative Lead/Budget Manager – Craig Powell VA Project Manager / IPT Chair – Daniel Reed Business Sponsor – Dr. William Gunnar Director of Surgery, Portland – Dr. James Edwards VA Requirements Representative – Dr. Jack Varga VA Health Systems Representative – Avaretta Davis National Training Manager – Scott Ridings ~75 other members of SQWM IPT Harris (Prime Contractor) Team Members: Harris Program Manager – Mark Merz Harris Chief Systems Engineer – Keith Bourke GE Centricity Program Mgr – Joe Smith LSI Training Lead – Charlie Houghton Integration Documentation – Amanda Peckham SQWM PMO Contract Team Members: SQWM Lead – Sarah Abdow Project Coordinator – Ashley Crews Risk Manager – Jeff Morris Lead Planner – Stephen Jones Functional/Business Analyst – Rosie Perez

11. SQWM - Where to get Information • SQWM Project Notebook – • http://tspr.vista.med.va.gov/warboard/anotebk.asp?proj=1387&Type=Active • SQWM VA OIT SharePoint: • http://vaww.oed.portal.va.gov/projects/sqwm/Public%20Library/Forms/AllItems.aspx • SQWM Project Management Team • Dr. William Gunnar, Business Sponsor – William.Gunnar@va.gov • Dr. James Edwards, SQWM Medical Director – James.Edwards2@va.gov • Daniel Reed, SQWM Project Manager – Daniel.Reed2@va.gov

12. SQWM Technology • COTS: GE Centricity Perioperative • Servers Hosted at AITC • Access via Citrix All VA facilities are associated with one of the eleven SQWM Install Groups hosted within the AITC where Citrix XenApp and VMware technologies are used.

13. SQWM Access – Citrix Login • SQWM users will select an icon on their desktop that will route them to the SQWM Citrix farm • VA credentials are used to access SQWM capabilities

14. SQWM Access – Select Environment • After valid entry of VA credentials, SQWM users will have selections to choose the appropriate SQWM environment PROD Training Pre-Prod DEV SQA SQWM users will normally be working in the Production environment.

15. SQWM Access – Install Group Selection • SQWM Users will select the SQWM install instance associated with their hospital PROD Notional approach depicted that would enable users to identify their hospital location on a map. The user is then routed to the correct install instance associated with their selection. Alternatively, icons/list may be presented.

16. SQWM Access – Centricity Functions • Once a user has navigated to the instance of SQWM they want to use, they are presented with a number of icons

17. SQWM Access – Centricity Login • Once a SQWM user selects a SQWM function, they log into the SQWM COTS Product • Centricity Perioperative • Role-based credentialsadministered by the SQWM business owners

18. Centricity Perioperative VistA Scheduling

19. SQWM Modules / Components • Census – List of Patients • vForm – Notes (H&P, Anesthesia, Nursing) • Scheduler – Schedule Cases • Nursing Documentation - Perioperative • Tracker – Patient Tracking

20. Censuses • Surgery Clinic Census • Miscellaneous Census • Pre-op Clinic Census • OR Census • Pending Work Census

21. Surgery Clinic Census

22. Miscellaneous Census

23. Pre Op Clinic Census

24. OR Census

25. Pending Work Census

26. vForm – Overview

27. Pending Work Census

28. vForm – WNL = Default Values (1 of 2)

29. vForm – WNL = Default Values (2 of 2)

30. vForm – No Change (1 of 2)

31. vForm – No Change (2 of 2)

32. vForm – Field Choices

33. vForm – Field Choices

34. vForm – Field Choices

35. Anesthesia “Worksheet”

36. Anesthesia “Worksheet”

37. Anesthesia “Worksheet”

38. Anesthesia “Worksheet”

39. Anesthesia “Worksheet”

40. Tracker Board

41. Users (multiple - with role specific access) • Surgical Resident • Attending Surgeon • Facilitator • Scheduler • Pre-op Clinic Nurse • Tracker User • Anesthesia Resident • Attending Anesthesiologist • Pre-op Holding Nurse • Circulating Nurse • Administrator • Biological Implant Tracking Coordinator

42. Reporting • Crystal – Wait List* • Crystal – Bed / Resources Report • Crystal – Staff Privileges Report • Crystal – Implant Reports • Crystal – Multisite Report: Executive Summary • Crystal – First Case Late Starts • Crystal – Turn Over Times • Crystal – Utilization Report Block & Room • Crystal – Pathology Report • Business Objects – Adhoc Reporting • Etc.

43. Questions Questions can be forwarded to the SQWM Implementation support team at: SQWMImplementationCommunications@va.gov