a successful dashboard- a davies award winner's story

8/7/2019 A Successful Dashboard- A Davies Award Winner's Story

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rea ng uccess uDashboard

Bert Reese, CIO and Senior Vice President,

DISCLAIMER: Theviewsandopinionsexpressedinthispresentation arethoseoftheauthoranddonot necessarily represent officialpolicyorposition ofHIMSS.

ConflictofInterestDisclosure

BertReese,TheUniversityofUtah,MBA

OperationsResearch/Systems Engineering

NorwichUniversity,Northfield,Vermont,B.S.,

BusinessAdministration

Hasnorealorapparent

conflictsofinteresttoreport.

DISCLAIMER: Theviewsandopinionsexpressedinthispresentation arethoseoftheauthoranddonot necessarily represent officialpolicyorposition ofHIMSS.


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Outline

SentaraBackground eCareProject

GoLiveDashboards

ROIDashboards

ProcessRedesignMeasures

WelcometotheStartingLine

ClinicalQualit GoalsandDashboards

GuidingPrinciples

3

Sentara Healthcare

MissionWeimprovehealtheveryday.

ValuesPeople,Quality,PatientSafety,

Service,Integrity

Vision

e e ea carec o ceo ecommunitiesweserve.

4


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Sentara Healthcare

123yearnotforprofitmission

8hospitals;1,935beds3,000physiciansonstaff

10longtermcare/assistedlivingcenters

Extendedstayhospital

520providerSentaraMedicalGroup

432,600memberhealthplan

SentaraCollegeofHealthSciencesVirginia

3.3Btota operatingrevenues

$3.7Btotalassets

19,225employees

5

North Carolina

Sentara Healthcare

System Development

MILESTONES

1888 RetreatfortheSick 25BedsNorfolk Seriesofcommunityhospital

1892 Sc oo o Nurs ng

1972 StatesfirstmergeroftwononprofithospitalsNorfolkGeneral&LeighMemorial

1982 HomeCareformed

1983 LifeCaredivisiondeveloped

1984 OptimaHealthPlanstarted

1988 HamptonGeneralHospital

1991 BaysideHospitalacquired

1995 SentaraMedicalGroupformed

Beliefthatintegrationwouldleadtobettercomprehensive

careforpatients

MedicalGroup

Hospitals rg n a eac enera osp a

2002 WilliamsburgCommunityHospital

2006 Obici Hospital

2009 PotomacHospital

2011 RMHHealthcare&MarthaJeffersonHospital(pending)

6

NursingHome

MedicalTransportation

HomeHealth

OptimaHealth


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Sentara and Epic

SentarasCareTransformation:eCare

e are a s

EpicImplementation

Asharedmedicalrecordforpatientsacrossthecontinuumofcare

OpportunityforProcessRedesign Reeva uatean optimize18major

processes

eCare isbiggerthanEpic7

Project OverviewTimelines:

Sep2005:Epiccontractsigned

Nov 2005 A ril 2006: Process redesi ns

May2006 June2007:Design,Build,Validate

August2007:FirstMDofficeimplemented(150MDs/Year)

February2008:FirsthospitalimplementedallbutCPOM

May2008:FirsthospitalimplementedCPOM

Sep2008 Oct2008:2nd& 3rd hospitalgolives

Mar2009 Nov2009:Threemorehospitals implemented

2010:Epic2009releaseupgrade;7th hospitalgolive

2011:8th hospitalgolive;communityfocus

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Total Cost of Ownership

10 Year Overview

Capital $ 67M

OperatingExpenses $170M

HardwareMaintenance $ 15M

SoftwareMaintenance $ 50M

DisasterRecovery $ 3M

WorkRedesign $ 36M

Training $ 16M

Implementation $ 22M

OngoingSupport $ 22M

OtherNonSalarySupport $ 6M

TotalCostofOwnershipover10years $ 237M

9

Annual Expected

Business Case BenefitsHospitalsTotal $30.0M

ImprovedNursingEfficiency $4.9MReducedITMaintenance $3.6M

e uce e ca ecor s ranscr p on . IncreasedOutpatientServices $4.8MReducedLengthofStay $3.8MImprovedPharmacyProcess/ADEs $3.0MReducedPaper/Storage $2.7MOtherImprovements $3.6M

HomeHealthTotal $ 1.8MSystemHealthPlanTotal $ 2.3M*SystemHealthcareTotal $35.5M**

*

62%

of

health

plan

benefits

will

be

passed

on

to

employers

**Excludes$2.7Minphysicianpracticebenefitswhichwillaccruetophysicians

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eCare

Costs and

Benefits by Year$50,000.0

$60,000.0

$(30,000.0)

$(20,000.0)

$(10,000.0)

$-

$10,000.0

$20,000.0

$30,000.0

, .

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

, .

Ex pected Benef its Achieved Benef its Expenses

Net Impact (vs. Achieved) Net Impact(vs. Expected)Note:2010dataannualized

11

Clinical Staff Became eCare

ExpertsProjectTeamComposition:

100ClinicalStaff(RN,LPN,RT,PT,XRayTechs,Pharmacists)

TookFullTimePositionsontheeCare

ProjectTeam

BecameEpicTrained&Certified ApplicationDesign ContentValidation Workflowdevelopmentandredesign

Design,Build,Validate(DBV)&ImplementationLeadswereTrainedinLeanPrinciples

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Clinical Staff Became eCare

Experts

,

andLTAC,etc)

AtcompletionofprojectClinicalTeamtoreturntoclinicalcaresitesascaregivers

ProjectTeamSupplementedandWorkValidatedbyover300SubjectMatterExperts(directcaregivers)fromacrossthe

ea sys em

13

Physician Advisory Group (PAG)

50+PrimaryandSpecialtyMDs

SubstantialTimeCommitment(4+hrsperweekatpeak)

Developed/DesignedMDspecificpartsofEMR

Content(OrderSets&ClinicalDocumentation)

ScreenFormats&CustomReports

Workflows

Workedcollaborativelywithotherclinicalstafftoachieve

standardizationonsharedworkflows MDsAreCompensated

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eCareGo Live Dashboards

15

Go Live: Daily Dashboard

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GoLive:DailyCPOETracking

%CPOE Trend HOSPITAL #5

Sept 13, 2009 Go Live

20%

40%

60%

80%

%CPOEGoalshouldNOTbe100%

SometimesVerbal/Telephoneisbetter:

Emergencysituations(CodeBlue)

Duringprocedures

0%

0 1 2 3 4 5 6 7 8 9 10 11 12 13Days Post Go Live

17

GoLive:MonthlyDashboard

Monthly Dashboard Metrics

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Go Live: Monthly Dashboard

19

eCareROI Dashboards

20


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ROIDashboard:HospitalROI

21

ROI

Dashboard:

System

Rollup2010 eCare Benefits Achieved (annualized)

Unfavorable to 2006 Baseline Red

Favorable to 2006 Baseline Yellow

Favorable to 2010 Expected Benefits Green

# eCare Hospital Benefit Process Owner SLH SVBGH SBH SNGH SCH SWRMC Total

1-3 S tr eam li ne Rec ord Com plet ion M S $255,306 $315,147 $173,672 $595,031 $307,592 $179,003 $1,825,750

4 Reduc e Trans cri pt ion Cos ts MS $493,387 $663,564 $247,402 $722,253 $400,131 $198,476 $2,725,212

5 Streamline Coding Process MS $73,041 $54,229 $94,336 $129,930 $61,619 $25,978 $439,135

6 St ream line HIS M anagement MS $28, 014 $26 ,847 $22, 206 $54, 133 $0 $47, 423 $178, 623

7 Reduce Risk Mgmt Claims & Uninsured Losses FS $41,667 $41,667 $41,667 $41,667 $41,667 $41,667 $250,000

8,21 Reduce Length of Stay and/ or Reduce ADEs GY/ TJ $1,325,550 $1,798,126 -$28,066 $3,287,675 $1,497,548 $824,219 $8,705,052

9 Reduce Paper Related Supply Costs MS $248,712 $395,018 $56,907 $615,842 $373,586 $120,913 $1,810,979

10,11 Increase Unit Efficiency/Retention of RN's LK $294,334 $378,240 $355,087 $3,172,134 $4,371,045 $452,079 $9,022,918

13 Improve Charge Capture AW $342,344 $395,652 $180,862 $649,031 $272,262 $133,947 $1,974,097

20 Increase Outpa tien t P rocedures AW/ KH $928,189 $1,147,886 $572,633 $1,857,276 $841,067 $438,371 $5,785,423

22 Reduce Pharmac is t Order Entry TJ $58,752 $71,353 $24,354 $106,417 $37,012 $16,996 $314,884

Benefit Achieved 2010 (annualized)

, , , , , , , , , , , , , ,

# Other eCare Benefits Process Owner Q1 Q2 Q3 Q4 YTD

* SHP realized benefits AP $500, 205 $500,205 $500, 205 $500, 205 $2,000, 819

* SE realized benefits RD $191, 958 $243,956 $420, 841 $285, 584 $1,142, 338

* Redu ce IT m aintenanc e ex pens e RD $464, 553 $464,553 $464, 553 $464, 553 $1,858, 212

Total Additional eCare Benefits $2,872,110

Total 2010 eCare Benefits Achieved $40,905,552

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Cumulative ROI Business CaseBenefits

$29.3MBudgetedfor2010; $40.9MAchieved(annualized)

BenefiteCare Benefit Category (Millions)*

- Reduce Length of Stay/ Reduced ADEs $8.7

- Increase Outpatient Procedures $5.7

- Increase Unit Efficiency/Retention of RNs $9.0

- Reduce Transcription Expense $2.7

- Reduce Med Records Supply Costs $1.8

- Reduce Medical Records Positions $1.8

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- Reduced Optima (health plan) costs $2.0

- Improve Charge Capture $1.9

- Reduced 63 Administrative Positions $2.0- Reduced other costs $5.3

Total $40.9

*2010for6Hospitals,HomeHealthandHealthplan

eCareProcess Redesign Measures

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eCare

Process Innovations

Redesigned18majorprocessescoveringentirecontinuumofcare

LeanSixSigmaMethodology1. ArrivalManagement

2. BedManagement

3. CaseManagement

4. ChargeCapture

5. ClaimsProcessing

6. ClinicalCommunications

7. DiseaseManagement

8. EmergencyDepartment

9. HomeHealth

10. MDProcesses

11. MedicalRecords

12. MedsManagement

13. Monitoring/Recording

14. OrderSets

15. PatientCareTransformation

16. Patient/MemberSatisfaction

17. PhysicianPractice

18. Scheduling

DDesignesign

MMeasureeasureDDefineefine

VValidatealidate AAnalyzenalyze

25

ComplementaryTechnology:Barcoding;Document

Management;

Device

Integration Eachprocessredesigndefinedmeasuresofsuccess

Process Redesign Measures:

Patient Throughput Improvements

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rocess e es gn easures:Pre and Post eCareMedications

Management Improvements

Avoided117,400potentialmedicationerrorsduetomedicationsbarcoding

Baseline Post-eCare

Average time from order written

to order available to act on

59.0 minutes 4.5 minutes

Reducedmedsadministrationtime

Average time from order written

to med administration (NOWorders)

132.0 minutes 38.4 minutes

27

2009 Clinical Scanning On-Time-Performance% Indexed in


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Process Redesign Metrics:ED Admits LEAN Dashboard

IP Bed Ready to IP Unit

%


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Welcome to the Starting Line

Patient

Centered

Care

31

SITechnicalArchitectureSourcesofData

DivisionalSystems

Divisional

ReportingSystems

EPIC

HBOCCasemix

Clarity

ReportingWorkbench

BusObjects

DataStorage

Framework

DataIntegration

Framework

DataDistribution

Framework

SelfService UserAccess

ExcelServices&PowerPivot

SurgicalServices

SubjectDatamarts

Processes:

Extraction

Profitability

Durations

Hospital Dashboard

PrerequisiteInfrastructure

Other To ic

MMIS

IDX

PICIS

SHP

CareDiscovery

Extelligence

HorizonsBA

ProductModeling

Anodyne

Clinical

Warehouse

(Clarity)

Nonclinical

Warehouse

(akaDW)

Staging

Error

Handling

Quality

Checks

Data

Translation

DataLoad

E

T

L

E

T

L

AllPatients

HeartFailure

Sepsis

KPI

Pharmacy

ServiceLine/CEC

DiseaseMgmt

DiseaseMgmt

DiseaseMgmt

Dashboard

32

Diabetes

Mgmt

SHPCCS

Population Mgmt

External

Benchmark

Partners MEDai

ETG

ETLofsourcedatatoBenchmarkPartners

PredictiveModeling

DiscoveryAnalystics

StatisticalAnalysis

CDSSRealTimeviaWebServiceOrientedArchitecture(SOA)


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Continuous Improvement LoopContinuous Improvement Loop

Pricing & Customer

Smart

Alerts

OrderSets

InfrastructureContinuestoEvolve

EDW

Phase1

Surgery

Health

Plan

Data

Medical

Group

Data

Enriched

EDW

Medicine

Rx

EPIC

Clinical

Data

Choice

EnterpriseInformaticsArchitectureEnterpriseInformaticsArchitecture

33

BestPractices&OutcomeAnalysisPatternrecognitionand

PredictiveModeling

ProcessImprovement

EpisodeTreatmentGrouper

Data

Warehouse

34


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KPIBasedQuality/SafetyReport

35

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H1N1Results MDsUSEDordersets&ClinDocTools MDsTHANKEDUS theyGotIt

Feltreassuredthattheywerepracticingbasedonlatestinfo Efficientdocumentationhelpedcopewithlargevolumes

KPIReportingofVolumes MaterialsManagement(N95Masks) Guidedmanagementdecisionsaboutmoreextrememeasures(visit

restrictions,tentsonthelawn)

3737

Clinical Quality Goals andDashboards

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Sentara Strategic Plan2010 2012 Strategic Goals

Top10% ClinicalQualityandSafety

PatientSatisfaction

EmployeeEngagement

FinancialStewardship

TransformationofCare PrimaryCareRedesign

ChronicDiseaseCoordination

AdvanceCarePlanning

Alignment&Accountability

39

KnowledgeManagement

Growth

HamptonRoads Virginia/NorthCarolina

Patient SafetySentarapartneredwithnuclearpowersafetyexpertstoformHPI

asconsultantstohealthcareindustryinhighreliability

Methodsbasedonscienceandfacts

Scienceofhumanerrorandeventprevention

Practicalexperienceinhighreliabilityindustriesincludingnuclearpowerandaviation

Experiencedbasedmentoring

n ere

ea care

n

229hospitalsacross75organizations

ConsultingteamwithHROexperienceandhealthcareexperience(clinicians,nonclinicians,andphysicians)

40


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Sentara Healthcare

CY2010 Clinical Initiatives

Performance Summary Report

Executive Summary

Reporting Month: October 2010

Core Measures Reporting Period: August 2010

Anthem CMS CMS Gap SH SH Goal SNGH SLH SBH SCH SVBGH SWRMC SOH SPH

Goal Mean Top 10%Variance from

top 10%CY2009 CYTD 10 CY2010 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10

AMI

*** Early aspirin use 95% 100% 1% 99% 99% 98% 100% 99% 98% 100% 100% 10 0% 96% 100%

*** Aspirin at discharge 94% 100% 0.5 % 9 9% 1 00 % 98% 100% 100% 100% 100% 99% 100% 96% 97%

*** Beta-blocker at discharge 94% 100% 1% 99% 99% 98% 99% 100% 100% 100% 99% 99% 98% 100%

FINAL

Clinical Goals: System Dashboard

1*** ACEI or ARB for LVEF 100% 93% 100% 2% 96% 98% 98% 99% 100% 80% 100% 100% 100% 90% 100%

*** Angioplasty within 90 minutes of arrival 84% 100% 5% 90% 95% 90% 86% 90% 100% 97% 100% 100% 94% SNP

*** Smoking Cessation Counseling 9 7% 1 00 % 0% 99% 100% 99% 100% 100% 100% 100% 100% 100% 100% 100%

2 AMI %Green (includes ***) = Appropriate Care Measure 9 4. 4% 9 8. 8% 1 % 95% 97% 95% 98% 96% 94% 99% 98% 99% 92% 99%

Inpatient Mortality Rate 2% 1% Trend 0% 2% 3% 0% 2% 1% 2% 2%

AMI Outpatient Measures

Aspirin at arrival - ED AMI Patients 93% 100% 2% 9 9% 9 8. 0% 98% SNP 100% 100% 100% 100% 100% 94% 100%

Aspirin at arrival - ED Chest Pain Patients 93% 100% 3% 92% 97% 98% SNP 100% 97% 95% 100% 50% 100% 100%

Median Time to ECG - ED AMI Patients (Minutes) 7.0 6.0 10.0 SNP 8.5 6.0 5.5 16.0 8.5 4.0 7.0

Median Time to ECG - ED Chest Pain Patients (Minutes) 10.0 7 .0 10.0 SNP 12.0 7.0 6.0 17.0 8.0 5.0 9.0

Overall Median Time to ECG (Minutes) 43 4 -3. 00 10.0 7 .0 10.0 SNP 10.0 7.0 6.0 16.5 8.0 5.0 8.0

Median Time to Transfer for Acute Coronary Intervention (Minutes) 6 7.0 5 4. 0 T re nd SNP No Cases 53 .0 56.0 No Cas es No Cas es 71.0 55.0

ACC-NCDR Metrics for PCI NCDR MeanNCDR Top

10%

3 Overall PCI within 90 minutes of arrival 8 6% 87.3% 1 00 .0% 9% 86% 91% 86% 76% 83% 91% 95% 100% 100% 94% SNP

PCI Local Vascular Complications 1% 1.40% 0.0% 0.9% 0 .34% 0 .88% 0.4% 0. 92% 7. 46 % 0. 00% 0.00 % 0.0 0% 0. 00% 0 .00% SNP

PCI Serious Complications 3 .00% 2 .0% - 1% 2 .1 2% 0 .6 3% 2% 0. 72% 0. 00 % 0. 00% 2.30 % 0.0 0% 1. 43% 0 .00% SNP

4 PCI Statins or Non-statins on DC (h/o dyslipidemia) 95% 92.20% 98.4% 95% 98% 95% 98% 98% 100% 99% 99% 100% 100% SNP

PCI Risk Adjusted Mortality (1Q 2010) 1% 1.46% 0.8 0% 2 .19% 2 .21% 1.00% 2. 93% 0. 00 % 0. 00% 0.00% 1.65% 0.0 0% 0 .00% SNP

RAM O/E Ratio (1Q 2010) 1 .0 0 1 .1 9 1.00 1.99 0.00 0.00 0.00 1.12 0.00 0.00 SNP

Pneumonia

*** Antibiotic selection consistent w/ recommendations ICU 68% 100% 5% 84% 95% 90% 100% 100% 100% 100% 86% 86% 50% 86%

*** Antibiotic selection consistent w/ recommendations Non ICU 95% 100% 3% 96% 97% 97% 97% 96% 98% 100% 97% 100% 93% 95%

5*** 1st dose antibiotic given w/in 6 hours 99% 94% 100% 3% 97% 97% 98% 98% 95% 99% 98% 95% 100% 97% 95%

*** Blood cultures performed in ED prior to 1st dose antibiotic 93% 100% 2% 96% 98% 97% 98% 98% 99% 97% 97% 98% 98% 95%

*** Blood cultures performed on ICU Admissions 96% 100% 2% 97% 98% 98% 96% 100% 97% 100% 98% 100% 93% 92%

6*** Administration of Influenza Vaccine 97% 86% 100% 3% 95% 96.6% 97% 96% 91% 99% 100% 98% 98% 95% 80%

7*** Administration of Pneumococcal Vaccine 98% 88% 100% 4% 95% 96% 98% 90% 95% 99% 100% 98% 93% 93% 88%

*** Smoking cessation counseling 91% 100% 0.4% 99% 100% 99% 99% 100% 100% 100% 100% 100% 98% 93%VTE Prophylaxis CYTD 99% 99% 98% 98% 100% 100% 100% 100% 99% 95% 97%

8 Pneumonia %Green (includes***) = Appropriate Care Measure 86.3% 98.6% 6% 89% 93% 95% 92% 90% 97% 97% 93% 93% 88% 80%

Heart Failure

9*** ACEI OR ARB at Discharge with EF


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Clinical Goals:Serious Safety Event Rate

All Sentara Hospitals YTD November 2010

0.50

0.75

1.00

EventRate

81%ReductionSince2003

43

0.00

0.25

J-03

M-03

S-03

J-04

M-04

S-04

J-05

M-05

S-05

J-06

M-06

S-06

J-07

M-07

S-07

J-08

M-08

S-08

J-09

M-09

S-09

J-10

M-10

S-10

SeriousSafetyEventsper10,000AdjustedPatientDay

Clinical Goals: Mortality Ratio

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Clinical Goals: Avoided Deaths

600

100

200

300

400

(100)

-

SNGH SLH SBH SCH SVBGH SWRMC SOH

20 02 20 03 2 004 2 005 200 6 200 7 20 08 20 09

45

Clinical Goals:eHospital Resulting Interventions

4%

1%

MRT

RTContacted

TypeofInterventionsResultingfromAlerts

4%

%ofAlertsthatledtoanintervention

96%ofallalertsresultinsomesortofintervention

Interventions haveledto350+additionalcoaching opportunitiesw/staff

24%

13%

7%

5%

0% 5% 10% 15% 20% 25%

Coaching

MDContacted

Meds

EKG

96%

Intervention

NonIntervention

46

42%

58%

Interventions

requiring

MD

Contact1stQuarter2009:SamplePopulation

MDContacted

MDNot

Contacted

13%

87%

n erven onsrequ r ng on ac

Nov2009 Jun2010

MDContacted


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Clinical Goals:

ED Clinical Effectiveness CouncilDashboard

DailyMedianVolume

DailyAverageVolume

LWBS%

AMA%

QuickRegtoProvider

% =9 0% > =5 0% > =5 0% < =1 0% > =9 7% > =9 7% > =9 7% < =1 0 < =1 0 =9 0% > =9 6% > =9 6% > =9 6% > =9 0%

SBH 100 97 0.5 0.6 63 96 55 79 37 70 50 663 60 4 100 1 00 1 00 8.5 10.0 10.0 NC 0 100 1 00 1 00 90.6

SCPH 175 1 72 1.4 1.0 44 79 57 46 25 39 21 1 862 6 8 5 100 NC 100 NC 8.5 8.5 NC 100 1 00 1 00 95 86.4

VOLUME

PATIENT FLOW 1 CLINICAL INITIATIVES 2,4,5

AMI PNEUMONIABOARDERACCESS 2 LOS 2

SLH 131 131 1.9 0.8 46 99 52 60 21 44 40 1448 68 9 100 NC NC NC NC NC NC NC 1 00 93 100 85.3

SNGH 142 1 45 0.7 1.5 50 94 42 75 45 49 29 2444 69 8 100 NC NC NC NC NC NC NC 100 1 00 100 85.6

SOH 100 99 1.2 0 .7 48 96 42 42 63 40 916 6 7 5 100 NC NC NC NC N C NC 100 9 1 93 92 83.5

SVBGH 133 133 0 .5 0.8 51 97 63 55 55 44 43 1829 69 6 100 NC NC NC NC NC NC 1 00 93 91 94 8 1.4

SWRMC 97 98 0.3 0.5 73 98 89 63 58 60 51 833 78 4 100 NC 100 NC 3.0 3.0 NC 10 0 1 00 10 0 9 3 87 .8

SBLH 57 58 0.2 0.5 70 96 96 85 57 0 0 0

SPA 127 130 0.8 0.6 59 94 68 62 78 40 249 67 2 92.7

SPW 110 109 0.9 0.8 56 88 70 55 81 41 56 86 0 95.3

47

Guiding Principles

48


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Lessons Learned

WhatgetmeasuresgetsimprovedSelectappropriatedata:Retrospective,Dynamic,Predictive

FrequencydependsontheexpectedinterventionsDaily,Monthly,Quarterly

EmbedgoalsintobudgetsandbonusesPhysicians,Executives

Involveprocessownersinimpactedareas

Buildanindustrializedorganization

49

DiscoveryAnalytics&CorporateDecision

QualityResearchInstitute

Industrialized Organization

SentaraInformatics

50

Clinical&BusinessInformaticsSupport

Services Design&Development


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Guiding Principles of DataManagement

DataManagementisaProcess

Data>Information>Knowledge>Action

StrongDataGovernance:

SingleSourceofTruth DataDrivenAccountability

CreateaClearandSimpleMessage

BuildCompetitiveAdvantagewithAnalytics

51

a successful dashboard- a davies award winner's story

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