Mitzi Cardenas - HIMSS Chapter

Mitzi CardenasSr. VP/Strategy, Business Development andTechnologyTruman Medical Centers

HIMSS Stage 7:What it MeansHeart of America HIMSS andthe Missouri Health Information Management AssociationCurrent Trends and Topics in Healthcare ITSeptember 14, 2016

Agenda TMC Overview Why did we do it? How did we get there? Why did it matter? How have we benefitted? The Future2

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Our vision “Leading the way to a healthy community”TMC Hospital Hill2 hospitals / 600 Beds (acute, LTC, psych)51 clinics (primary care and specialty)Academic medical center supportingUMKC School of Nursing, Medicine,Dentistry and PharmacyLevel one trauma centerTMC Lakewood19,908 acute care admissions2,722 behavioral health admissions3,708 births338,190 outpatient visits577 medical staff / 235 residents278,913 behavioral health outpatient visits4,000 employees97,729 ED visits*Fiscal Year June 20154

Mission and recognitionMissionTMC is an academic health center providing accessible, state-of-the-art quality health care to ourcommunity regardless of the ability to pay.Recognition2011-2016by Hospitals and HealthNetworks MagazineCHIME-AHATransformationalLeadership AwardAHIMA 2013 Grace Award2014 HIMSS Enterprise DaviesAward RecipientDual HIMSS Stage 7accreditation for both inpatientand outpatient settings acrossboth TMC facilitiesLevel III Patient-CenteredMedical HomeNational Committee forQuality Assurance (NCQA)5

WHY WE DID IT & HOW WEGOT THERE7

Value to the Organization:The EMRAM PromiseStage 7 creates a benchmarkfor ensuring measurement ofthe Value of technology to theorganization8

EHR before 2008Hybrid recordCitation in mock survey for inability forstaff to find documentation oncontinuum of careNot Planned/Under ConsiderationEnterpriseDecisionSupportPlanned/In ProcessIntegratedCarePlanningPartially Implemented/AdoptedImplementedRules mentImagingPACSHIM CodingAbstractingPharmacyMed BarCodingHIM ChartTracking &ROIRespiratoryDoc & ResultsHIM ChartCompletionMgmtDuplicate recordsFor patients seen at two hospitalse-MARMedicationED ogyResultsPatientRegistrationPPID / POCMeds AdminSurgeryDoc &SchedulingED NursingDocOrderManagementPartial electronic recordMeds, allergies, procedures,immunizations and problem list notconsistently documented in one placeDose RangeCheckingPhysicianOrdersICU/CCUDoc &WorkflowED entationClinicalDecisionSupportAmbulatoryDoc &WorkflowContinuityof Care DocAncillaryWorkflow& orkflow /ViewsEKG/EchoResultsPhys OfficeDocumentImagingPhysicianWorkspace /ViewsPatientLists8

Goals identified & achieved Single electronic patient record across theOrganization Identify, monitor and report defined benefits Structured documentationMeaningful Use Stage 1HIMSS Stage 6Quality reportingCPOE and e-prescribingBar-coded medication administration/closedloop meds processMedical device connectivityDocument imaging9

EHR JourneyAmb - Phase 1(Pilot & Grp 1),Doc imagingAcute rollout“Go-live with Q6”Amb - Phase1 (Grp 3&4)Women’s Healthgo-liveHIMSS Stage 7Dual HIMSS Stage 7HIMSS Enterprise Davies -AHATransformationalLeadership AwardMarMayOct‘10‘10‘10Amb - Phase 1 (Grp 2),Population HealthAmb – Phase 1(outlying clinics),Amb – Phase 2(all groups)HIMSS Stage 6May‘112013 Grace Award2011-201610

Adding Value by Avoiding cost withimproved outcomes75% reductionin VTE per 1000patient daysHIM anddocument imaging 89,141decrease 400,000Real estate made availablefor more productive useAug 2015—July 2016 supply costBaseline of Sept. 2009 – Feb.2010; performance period ofMar. 2010 – Aug. 20139% increaseCoder productivity improvingbilling TAT and enhancingrevenue remote coding –26 coders working from home11

Accumulated value to date1%Improved clinical outcomes10%Transcription cost savingsPharmacy42%28%FTE reductionReal estate optimizationSupplies14%5% 32.9M impactDec 2009 – July 201612

THE PROCESS FOR STAGE 7VISIT14

Preparation for Visit Assigned a Project Manager & created a Workgroup Used HIMSS Checklist as guideline Did our homework Engaged the Executive team Identified Champions Conducted audits and rounding Staged like a regulatory survey14

Review ProcessKey Resource Org Overview System Overview and Pervasiveness of Use Governance Clinical and Business Intelligence Health Information Exchange Disaster Recovery & Business Continuity Downtime processes15

Review ProcessUnits/ Department Visits Med/ Surg Chart Review––––Clinical DocumentationCPOEBar Code EnablementPhysician Documentation ICU– Alerts Emergency DepartmentBlood BankMedical ImagingPharmacyHIM16

Agenda for Acute Care Visit8:00 – 9:15 a.m.Intro/ OverviewWelcome and IntroductionsCIOTMC OverviewCEOIT Governance/ EMR OverviewCIOClinical Usage and BenefitsCMIO/ Dir. Nursing InformaticsClinical and Business IntelligenceAdmin. BI/ MD QualityHealth Information ExchangeCIO/ CTOTechnology Infrastructure/Disaster Recovery/ Business ContinuanceCTO9:20 – 2:05 p.m.Unit/ Department VisitsMed/ Surg, Rad, Pharmacy, CCU, ED, HIM2:15 – 2:55 p.m.Evaluation Team Meeting3:00 – 3:20 p.m.Decision Presentation3:30 p.m.Depart17

Agenda Ambulatory Visit9:30 – 11:00amIntro/ OverviewWelcome and IntroductionsCIOTMC OverviewCEOIT GovernanceCIOSystem Overview/Pervasiveness of UseCMIO/ Dir. Nursing Infor./ Clinic DirectorClinical and Business IntelligenceAdmin. BI/ MD QualityHealth Information ExchangeCTODisaster Recovery/ Business ContinuityCTO11:00am – 12:00pmClinic Visits(Family/Internal Med, Women’s Health,Surgery, Psych)12:00pm – 1:00pmTeam Lunch1:00pm – 2:00pmClinic Visits(Derm, Rheum, ID, Psych)2:00 – 2:30pmEvaluation Team Meeting2:30 – 2:50pmDecision Presentation3:00pmDepart18

Usage MetricsClinical Decision SupportCPOE (All orders)12 Month Average 97%Physician DocumentationOctober 2012-September 2013Weekly Bar-coding alHealthHHHHHH Primary HH SurgeryMedicine ealthLWLWLW PrimaryLWBehavioral Freetext Clinical Note27%28%35%14%15%7%26%20%17%9%17%Interfaced Template0%4%0%0%0%0%0%0%0%1%1%Back-end Dictation3%26%4%1%48%1%0%52%2%9%13%19

Lessons Learned Champions are key Be prepared for the unexpected Harness the power of creativity Educate and prepare Ensure coders are prepped for demonstration Don’t forget about downtime processes20

GOING FORWARD22

Continued optimizationPatient ‘12‘13OctJanJuly‘12‘13‘13Cerner ngInformationwithHIE22

WHY DOES IT MATTER23

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Panel Julie Hull, Vice President of Operations, KC oneHealth Innovation Alliance Amy Peters, Chief Nursing Officer Rob Jones, Chief Technology Officer, Sr. Director,Enterprise Applications Seth Katz, Assistant administrator, InformationManagement & Program Execution Lacey Alvarez, Practice Management26

Mgmt. Patient . Registration. Reference. Lab. Interfaces. Radiology. Reports. Physician . Workspace / Views. Patient. Lists. . 5%. 14%. 28%. 10%. 1%. 32.9M impact. Dec 2009 – July 2016. Improved clinical outcomes. . Assigned a Project Manager & created a Workgroup Used HIMSS Checklist as gu