EMR tools to Improve Quality Improvement

Paul St. Jacques, M.D.Quality and Patient Safety Director

Department of AnesthesiologyVanderbilt University Medical Center

COI/Disclosure

• I am a registered inventor of the VPIMS software per Vanderbilt University policies.

• I am a minority equity holder in Acuitec, LLC which markets a commercial version of the VPIMS Perioperative Software Suite.

For those who came primarily for the lunch:

• Take a deep breath• It will all be over before

you know it

Quality Improvement

• “Proactive”– Reducing the variability in the process– Shifting the process’ outcome in the

desired direction.

• “Reactive” – Non-routine events• Analysis and improvement

Prevention…

• VPIMS Applications:– Whiteboard– GasChart / Decision Support– Vigilance / Situational Awareness

• Tools for event detection• Tools for tracking/closing events

Preop Nurse Charting

Case Board GasChart

VPIMS Database-MS SQL Server

CQI

Hospital

EMR

BillingElectronic Charge Capture

VigilanceVPIMS Web

First things first:Prior to surgery, ensuring we have the right patient, procedure, side, other items present in the OR.

Intraoperative Whiteboard(during time out)

Decision Support• Delivering timely

information to providers

• To help providers ‘do the right thing’

Time Triggered antibiotic prompt…

Situational Awareness

VPIMS-Vigilance• Delivering OR Suite and

patient status information to providers regardless of provider location.

• Providing automated messages regarding changes in patient status/critical events.

“Paying attention to all that is going on around you…”

That was…’suboptimal’

Intraop – ProvidersPostop – ProvidersPost Discharge – PatientsPostop - Automated EMR scans

Detection, Reporting Structure and Event Analysis

Intraoperative Self reporting of events

Review of Self reported events (links to documentation)

Electronic Web based reporting

Weekly Reports / Monthly Summaries via email

Postop Satisfaction(Complaint Tracking)

Email Delivery of Notifications

MCE3: Patient stated that she was having difficulty understanding the anesthesiologist due to his accent. And because of the communication problem, she felt he was not listening to her concerns regarding her allergies. She stated that he kept questioning her regarding whether it was a true allergy or just a side effect.

MCE3: Patient stated that she had a difficult time awakening and felt very groggy and felt that she was not able to get a breath. She stated that this was the worst time she has had in the last 5 surgeries.

We don’t know what we don’t know

Postop Biochemical Markers• Postop lab value analysis– Acute Kidney Injury (incr. Cr > 0.3)– Troponin

• Screening Chart review

• 14,000 inpatient surgeries (FY12)

• 10,500 with pre/post Cr lab values

• 1,257 with increases >0.3

• 1 Case reported to QI during same time period

Acute Kidney Injury Screening

Quality and Patient Safety Director

Morbidity, Mortality Improvement

Committee

Peer Review Committee

VeritasVPIMS/Admin

DataPhone Reports to

Quality Office

Direct Verbal/ Email Reports

VC Clinical, Dept. Chair

Division Chief

Close CaseJoint QMMI Conference

Departmental MMI

Conference

Project Development-Assignment to

individual/group

Automated:• Biochemical Markers• Chart Scanning

QI Database of all reported events (Excel)

Future DevelopmentEvents Dashboard

Future DevelopmentEvents Control Charts

Professional practice Evaluation via Optimal care score

Group improvement over time

July Aug Sept Oct Nov90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

Conclusion

• QI Processes are complex but important• Informatics resources can be brought to bear

on both preventing and detecting events, event reporting and analysis.

• Thank You