Advancing Clinical Quality and Patient Safety with Health IT (Text Version)

On September 19, 2009, Paul F. Conlon made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (979 KB).

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Slide 1

Trinity Health
Advancing Clinical Quality and Patient Safety with Health IT

Paul F. Conlon, PharmD, JD

Slide 2

Trinity Health

• Fourth Largest Catholic Health System in the U.S.
• 45 Hospitals (33 Owned .and 12 Managed) Across .the Nation
• 8,074 Active Staff .Physicians
• 45,000 Full-Time .Equivalent Employees
• Revenue of $7.0 Billion
• $400 Million in Community Benefit Ministry

 

Slide 3

Trinity Health

Mission

We serve together in Trinity Health in the spirit of the Gospel, to heal body, mind and spirit, to improve the health of our communities and to steward the resources entrusted to us.

Core Values

• Respect
• Social Justice
• Compassion
• Care of the Poor and Underserved
• Excellence

Vision

Inspired by our Catholic faith tradition, Trinity Health will be distinguished by an unrelenting focus on clinical and service outcomes as we seek to create excellence in the care experience. Trinity Health will become the most trusted health partner for life.

Guiding Behaviors

• We support each other in serving our patients and communities
• We communicate openly, honestly, respectfully and directly
• We are fully present
• We are all accountable
• We trust and assume goodness in intentions
• We are continuous learners

 

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• Trinity Health's clinical and operations transformation initiative
• Best-in-class clinical and administrative processes that
  are enabled by information systems on a common platform
• Large-scale people, process, and technology advancement:
  • Enhanced Care/Clinical Experience
  • Implemented Electronic Medical Record (EMR)
  • Computerized Physician Order Entry (CPOE)
  • Unified Revenue management
  • Clinically-driven Supply Chain management
  • Improved productivity

 

Slide 5

Decisive and Focused System-Wide IT Investment

Trinity Health is using Genesis to standardize operational processes and information systems.

• The vision to unite state-of-the-art information management systems in three areas: clinical, revenue and supply chain, was launched in 2000
• Goal is to transform care delivery, increase patient safety and improve financial performance
• Strategic investment in excess of $400 million capital over 10 years

Trinity Health's bold vision and skillful execution of Genesis:

• Unified people, process, culture, and technology
• Leveraged skill and scale to achieve efficiencies
• Standardized evidenced based processes to improve quality of care, patient safety and financial performance
• Provided critical transparency to data and processes
• Reduced variability in processes and costs

 

Slide 6

Trinity Health: Circa 2001.

 

Slide 7

Trinity Health IT Unification 2012.

Consistent Tools + Best Practice Processes = Operational Excellence

 

Slide 8

Genesis Clinical Timeline

• 23 of 41 facilities are now live
• 3 ministries in readiness
  • Ann Arbor
  • Muskegon-Hackley
  • Boise
• Genesis Standard Delivery Model (GSDM) in process
• Muskegon-Hackley will come live with current Muskegon footprint with additional functionality to facilitate barcode medication administration and PowerPlans.
• Chelsea will implement the Ann Arbor Genesis footprint
• Fresno & Columbus will implement GSDM
• Cadillac & Grayling TBD

2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012
Genesis Board Approval			Port Huron Go-Live	Muskegon Go-Live Grand Rapids Go-Live	Battle Creek Go-Live Macomb Go-Live Mason City Go-Live Sioux City Go-Live	Dubuque Go-Live Livonia Go-Live	Oakland Go-Live Clinton Go-Live	South Bend Mishawaka Plymouth Silver Spring Go-Live Mason City Networks	Ann. Arbor Go-Live	Boise Go-Live Hackley Go-Live	Chelsea Go-Live Cadillac & Grayling Go-Live Fresno Go-Live	Columbus Go-Live

 

Slide 9

Project Genesis

• Single design deployed across 23 hospitals since May 2003.
  • Identified deficiencies prioritized for correction and enhancements deployed across full system.
  • 3 more hospitals in October 2009.
• Standardized readiness assessment
• Standardized deployment
• Standardization of care delivery
  • Design heavily influenced by front-line care givers
  • Constant enhancement/refinement
• Heavy focus on implementing evidenced based practices
• Full deployment of order entry, results reporting, rules, alerts and advisories.
  • Over 75% CPOE rate

 

Slide 10

Accomplishments to Date on the Clinical Platform

• Over 7 million patients within the EMR making it the 3rd largest repository in the nation.
• Data is contained in a single location including clinical, financial, and administrative information across all facilities.
• 2 facilities have clinics managing inpatient & outpatient care in the same system
• In 23 of the 41 hospitals scheduled for full implementation.
  • They are live on Computerized Prescriber Order Entry (CPOE) with physician entry rates average 74% and as high as 84% of all orders
  • 100%% of the previous paper medical record is now electronic
  • More than 1,200 caregivers will use the system simultaneously during peak hours with over 300,000 chart openings per day.
  • Inpatient nursing care, pharmacy, and medication administration is documented directly by providers in the same electronic system. Lab and Radiology data also feeds from regional and hospital based systems.
  • Over 600,000 orders are placed, processed, and completed per day electronically from order to administration in the same system.
  • Over 700 physicians place orders each day.

 

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Current Performance and Recognition

• Severity adjusted mortality rate at 71% of expected
• HCAHPS "Would Recommend" score at the 76th percentile
• 100% of core measure performance is greater than the national average
  • 47% of hospital level core measures above the national top 10%
• Trinity Health is one of the Thomson Reuters 100 Top Hospitals®: Health System Quality/Efficiency Benchmarks award winners
• 5 of our hospitals are recognized as Thomson Reuters 100 Top Hospitals
• Trinity Health is the recipient of the 2004 National Health Care Quality Award

 

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Genesis: Process Impact

Genesis has required fundamental changes to core patient care processes.
 

• Clinicians access records and place orders at any place and time
• Nurses spend 8% more time at bedside rather than with paper records
• Emergent medications administered 40% faster
• Comparative effectiveness eliminates clinical variation with 172 adopted standard order sets and over 2,500 standard drugs in our formulary
• Computer-generated alerts prompt physicians to change medication orders, avoiding approximately 14,000 potential Adverse Drug Events per year
• Automatic system alert on diabetes medication (Avandia) within 10 days of FDA warning
• Clinical Process Re-design has resulted in benefits in Pressure Ulcers (45% reduction) and Patient Falls (31% reduction) and improvements in DVT and Pain management.

 

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Key Implementations/Process Changes in FY09

• Admit, transfer, and discharge Medication Reconciliation
• System-wide formulary
• Integrated electronic surgical record pilot
• Urinary catheter rules/alerts
• Universal protocol revision
• Change patient satisfaction vendor
• Phased in implementation of credentialing and privileging soft ware
• Standardized concentrations of key IV solutions
• Expansion of nurse witness functionality (double checks)
• Standardized heparin administration and availability
• OB program reviews
• Implementation of Genesis at large teaching hospital and 8 rural access hospitals.
• Surgical 'tiger team's'
• Review of case management programs

 

Slide 14

Patient Medication List from ED

 

Slide 15

Patient Medication List from ED

New Rxs
Home Meds

 

Slide 16

Patient Medication List from ED

Meds received in ED
Meds to hold

 

Slide 17

Drivers

• A Unified Enterprise Ministry approach
• Relentless pursuit of improvement
• Extensive readiness preparation
• Frontline staff involvement
• Transparency
• Reliance on evidenced based care
• Collaboration across disciplines
  • Strong technical and clinical expertise
• Many, many, many groups..