Minimally Invasive Surgery Center

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Leveraging Data for Success    - Coring the
Core Measures  - Chasing
Discrepancies            

• Richard S. MacKenzie, MD, FACEP
• Chair Department of Emergency Medicine
• Lehigh Valley Hospital Health Network
• L. Albert Villarin MD FACEP
• CMIO Albert Einstein Healthcare Network
• Chris DeFlitch, MD, FACEP
• Director Vice-Chair - Department of Emergency
  Medicine
• Physician Director, Connected, CIS

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Overcoming the Hurdles Improving DTB in the
LVHHN MI-Alert Program
Richard S. MacKenzie, MD, FACEPChairDepartment
of Emergency MedicineLehigh Valley Hospital
Health Network
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Problem at the Millenium

• Inconsistency
• Mortality 5-7 PCI
• Mortality lytic 6-16

EUR HEART J. 2002 23 550
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PSIMT

• Plan
• Problem identification clarification
• Solution identification clarification
• Presentation for input
• Do
• Implement - education precedes date
• Presentation for understanding

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PSIMT (2)

• Study - Monitor for
• protocol violations
• anecdotes
• Trends
• Act Tweak the process

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D2B Specifics Road Show

• Remove decisions
• streamline by consistency no artists
• Reduce transitions or hand-offs
• Challenge tradition
• Dance the same dance
• Order Sheets

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Regional MI AlertThe Core

• STEMI only
• Definitive State-of-the-Art care
• One call does it all
• Parallel vs. sequential processing
• Tight reporting of data for performance
  improvement

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Faster is better
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Reduction in Mortality!

• Overall Mortality
• STEMI local and regional 2.4

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Data Utilities Application

• Chris DeFlitch, MD, FACEP
• Penn State Hershey Medical CenterConnected (CIS)
  Physician ChampionFounder, Penn State Partners
  for Healthcare Engineering
• Director Vice-Chair, Dept of Emergency Medicine

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Using EDIS for Meds Rec

• ONE system
• Integrated Provider Information
• Master Medication List
• Drug-Drug Interaction
• Documentation of Proces

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Arrival

• E-med list collected on Triage Powerform by RN
• List autopopulated from prior encounters
• Viewable in all Venues

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Ordering

• Meds Ordered
• Individual
• Order Sets
• Interaction Checking
• Auto-populates
• E-Mar
• Master Medication List

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Physician Documentation

• Person and Time Stamped at each step
• Info and modification to all providers
• All physicians
• Nursing (e-mar med list)
• Pharmacy (if admitted)
• Soon to pre-populate MD Note

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Admitted Patient

• Med List Carries to the Inpatient World
• Same Interaction Checking
• Automated Review at Key Stages
• Admit orders
• Transfer of service
• Transfer of Location

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Discharge

• RULE generates required Review
• Integrated in discharge Processing
• Recon prior to printed discharge
• Med List Printed on Discharge for patient
• ALL updates Master List for future visits

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Core Measures and EDIS

• Community Acquired Pneumonia

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Identification on Arrival

• Advanced Nursing Protocol or PDQTM
• Tracking Board Identification
• Order Set for Initial Orders
• O2 Sat
• CXR with pre-populated indications
• IV labs if criteria
• Blood Culture ..

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Tracking Board
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Order Set
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Evaluation Treatment

• Communication to Physician
• Review RN doc discrete data online
• View Image On-Line
• CAP Order Set
• IV Lab (dup check)
• Blood Culture (dup check)
• ABX recommendations
• Allergy Checking

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Decision Support

• On-line Viewable Risk Stratification
• Disposition by Criteria
• Complete documentation of Process
• SOON to integrate MD documentation

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Core Measures

• Albert Einstein Medical Center
• Pneumonia time to antibiotics
• Acute MI time to CATH Balloon Up / TPA
• Penn State Hershey Medical Center
• Pneumonia time to antibiotics ( CPOE Order
  Sets)
• Lehigh Valley Hospital
• Acute MI time to CATH Balloon Up

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Chasing Discrepancies by Medical Center

• Radiology Re-Reads
• Laboratory Re-Dos
• Cardiology Alternative Interpretations

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Core Measures / Discrepancies

• OPEN DISCUSSION