Clinical Health Management Issues - PowerPoint Presentation

Slide1

Clinical Health Management Issues

And Sepsis

Laura Mitchell and Keith EtenHCA 626 Healthcare Information SystemsNational UniversityProfessor Tyler SmithSlide2

Introduction

Sepsis was the top medical condition in 2010GLOBAL MEDICAL EMERGENCY Global Sepsis Alliance (GSA) 10K people “DIE” yearlyNIH~~Claims

INFECTIONS #1 Sever sepsis STRIKES 750k Americans per yearImpact to the “Healthcare Organizations”

Management

needs to “

ID” Challenges ofOperational, Strategic, Cultural and Political standpointsSlide3

Solutions

Clinical Vigilance Software Systems~~ Parity Computing IncAID providers in caring for patients at potential risk~~Early detection and treatment~~~

IMPROVEs Sepsis outcomes and costs $$$Software monitors ALL patients ALL the time ALERTS

attention to at-risk Patients

Natural Language processing, real-time intelligent filtering~~~

AVOIDS ALARM FATIGUE ~~~~

DOCS LIKEVIP***Parkview Community Hospital Riverside Ca. ** Proven it really ~~WORKS~~~ (CEO) Doug DrumwrightSlide4

Clinical Vigilance for Sepsis is a software system that continuously monitors all available data for hospitalized patients

Enables very early sepsis detection by caregiversAlerts annunciated to care team via channel of choice: e.g. smartphone, tablet, pager, computerExtremely low false positive rate: only a few alerts per clinical shiftSlide5

Length-of-stay reductions for sepsis patients lead to lower costs

The projected financial impact of Clinical Vigilance

™

for Sepsis at a 300-bed community hospital is over $2M in direct savings annually

In a

publication

authored by sepsis researchers at Cooper University Hospital reports that

Clinical Vigilance

for Sepsis

“

is able to identify the presence of sepsis and correlate with meaningful patient-centered outcomes

”

The publication associates shorter lengths of stays with timely initiation

of

treatment after

Clinical Vigilance for Sepsis

alertSlide6

Operational and Strategic Challenges

Who will be responsible ? Many different modalities Clinicians and Medical ProfessionalsInformatics and Engineering departments

Administrative and upper Management divisionsSoftware provides early alerting= decrease in false Positive levels

VIP

operational strategic support approach=

AID

Est. tech standards and Real-Time Clinical Decisions = RESULTSClinical Workflow systems need not adapt to changes QUALITY HEALTHCARE DELIVERY SYSTEMS to ~~~Patients~~~Slide7

Cultural Challenges

Adaptation~~individuals involved in the implementation process of new software systemsCollaboration efforts~~ALL department levelsClinical Vigilance assists in the TRANSFORMATION from a Single informational SILOS

Shared data information system~~~~BENEFITS~~~More Transparency among system usersResistance to “NEW” additional software programs at their workstations, and training modules (TIME)*

Baby Boomers resist usage of current EHRs

HMIS Systems personnel “

CAUTION

” tread lightlySlide8

Political Points of Change

Clinical Decision Support Systems like Clinical Vigilance may have great potential to improve performance and patient outcomes. However, poor user acceptance may block adoption and effective use.Negative themes have been indentified that cause problems with in a healthcare organization:

Reminders generated repeatedly

Struggles with data entry

System can be detrimental to clinic efficiency Solicitation of information should be

from one systemDisruptions in provider patient communicationDiminished Guidance in application workflow Optimization with software interfaceSlide9

Recommendations for Implementation

According to the Office of the National Coordinator for Health Information Technology (ONC) Eight steps should be taken to ensure successful implementation within an organization.Select clinical goals that will guide selection of CDS interventions

Consult with EMR system designers and vendors about ways CDS might help to improve clinical goals and related objectives.Select CDS interventions to achieve clinical goals and objectives

Specify baseline measures for the objectives to be addressed by selected CDS interventions

Map out current workflows and clinical processes affected by CDS interventions

Have a system for keeping interventions and knowledge current

Take steps to ensure the usability of intervention(s)

Test intervention for effects on workflow and usability

Slide10

Step 1:

Select clinical goals that will guide selection of CDS interventionsClinical Vigilance implementation should focus on improving outcomes in regards to Sepsis prevention within the healthcare organization

Begin with clear and non-controversial guidelines for the sepsis controlClinical Vigilance intervention should be ‘goal directed’ becoming a tool to achieve a specific task rather than a capability that must be implemented to meet external requirements (e.g. federal EHR adoption incentives)

Select clinical goals that are important for the organization and their patients Slide11

Step 2: Consult with EMR system designers and vendors about ways CDS might help to improve clinical goals and related objectives.

It is important that organizations at all levels of implementation communicate to their EHR vendors in order to gauge the feasibility of implementing Clinical Vigilance into their organizationCertain types of functionality or capabilities may have to be in place for new rules to gain the functionality required to meet clinical goals and objectives. System redesign or reprogramming should be avoided whenever possible Slide12

Step 3: Select interventions to achieve clinical goals and objectives

Healthcare organizations should think carefully about how many CDS interventions are to be implement and which intervention would be most effectiveOrganizations must consider the effect of implementing multiple interventions with the potential effect of overwhelming end-usersIt must be essential that end-users agree with and support the implementation of Clinical VigilanceEnd-users have to recognize the areas for clinical process improvement and not feel as though the system is forced upon them Slide13

Step 4: Specify baseline measures for the objectives to be addressed by selected CDS interventions

Specific clinical goals and corresponding objectives should be clearly defined before system implementationHigher-level consideration of baseline performance may be part of selecting a clinical goal in the case of Clinical Vigilance the goal is to control secondary Sepsis.Organizations should be specific and identify the clinical objectives and the CDS intervention that address it or themBefore implementing Clinical Vigilance the administrators should know the baseline rate of Sepsis within their organizationSlide14

Step 5: Map out current workflows and clinical processes affected by Clinical Vigilance implementation

Workflow is a series of tasks and actions performed by different individuals in the completion of clinical processesMapping current workflows are important to understand how clinical processes and tasks within are completed. This allows for better understanding on how processes may be affected by the addition of Clinical VigilanceInclude where system interventions will be accessed in various phases and tasks, and to relate clinical goals and corresponding CDS interventions to steps in the workflow.In essence support decisions as they are made and not after bad choices have already been implementedSlide15

Workflow Taxonomy (Step 5)

Clinical Workflow provides a common set of terms to Clinical Decision Support (CDS) designers and implementers to support communication about CDS and its use in clinical workflowsDesigners can use the taxonomy to identify points in the workflowDesigners can tag the CDS tools with terms from the taxonomy to inform practices about the intended use of the CDS Repositories can create tags based on the taxonomy to enable workflow-related organization and searches

Implementers can refer to the taxonomy when developing maps of the workflows and can use the terms to improve communication with their CDS vendor Slide16

Workflow Process Mapping Tool (Step 5)

Is a flowcharting template example that can be used for mapping workflows relevant to priority clinical decision support objectives you will be addressing with your interventionsSlide17

Step 6: Have a system for keeping interventions and knowledge currentKnowledge management should be considered and planned for early

Management can be automated by a vendor, it can be the responsibility of a particular clinician or institution, or it can be a collaborative effortMoreover there should be a systematic approach, staffing and other resources to keeping interventions and knowledge up-to-dateOngoing training ensure that interventions are aligned with practice needs and expectations. Slide18

Step 7: Take steps to ensure the usability of interventionEnd-user satisfaction will be related to how easy new interventions are to learn and to use and hoe they support workflow (e.g. completion of tasks)

Organizations need to understand how interventions operate in real work environmentsOrganizations must understand both usability and potential frustrations healthcare providers may with the new systemDiscussions with vendors or system developers is a start to understanding the level to which standard usability design features have been incorporated and usability assessedSlide19

Step 8: Test intervention for effects on workflow and usabilityInterventions should be tested in actual work processes prior to going live.

Testing highlights aspects of the workflow that were not consideredIf interventions disrupts workflow more than expected, alterations should be made to either to intervention or to the workflow may be necessaryIf users are engaged throughout the intervention configuration process, there will not be any major surprises.Slide20

Conclusion Sepsis is one of the top medical conditions affecting patients and has been declared a global medical emergency

Clinical Vigilance for Sepsis is a software system that continuously monitors all available data for hospitalized patients in an effort for prevention There are operational, strategic, cultural and political issues with implementation Following ONC guidelines will alleviate and mitigate implantation issues when followedSlide21

Questions?