CLINICAL HEALTH MANAGEMENT ISSUES

AND SEPSIS

Laura Mitchell and Keith EtenHCA 626 Healthcare Information

SystemsNational University

Professor Tyler Smith

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 year

Impact to the “Healthcare Organizations”Management needs to “ID” Challenges ofOperational, Strategic, Cultural and Political standpoints

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 PatientsNatural Language processing, real-time intelligent filtering~~~AVOIDS ALARM FATIGUE ~~~~DOCS LIKEVIP***Parkview Community Hospital Riverside Ca. ** Proven it really ~~WORKS~~~ (CEO) Doug Drumwright

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 shift

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 alert

Operational and Strategic ChallengesWho will be responsible ?

Many different modalities Clinicians and Medical Professionals

Informatics and Engineering departments

Administrative and upper Management divisions

Software 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~~~

Cultural Challenges

Adaptation~~individuals involved in the implementation process of new software systems

Collaboration efforts~~ALL department levels

Clinical Vigilance assists in the TRANSFORMATION from a Single informational SILOS

Shared data information system~~~~BENEFITS~~~More Transparency among system users

Resistance to “NEW” additional software programs at their workstations, and training modules (TIME)*

Baby Boomers resist usage of current EHRs HMIS Systems personnel “CAUTION” tread lightly

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 system

Disruptions in provider patient communication

Diminished Guidance in application workflow

Optimization with software interface

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.

1. Select clinical goals that will guide selection of CDS interventions

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

3. Select CDS interventions to achieve clinical goals and objectives

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

5. Map out current workflows and clinical processes affected by CDS interventions

6. Have a system for keeping interventions and knowledge current

7. Take steps to ensure the usability of intervention(s)

8. Test intervention for effects on workflow and usability

Step 1: Select clinical goals that will guide selection of CDS interventions

Clinical 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 control

Clinical 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

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 organization

Certain 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

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

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 organization

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 implemented

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

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 interventions

Step 6: Have a system for keeping interventions and knowledge current

Knowledge management should be considered and planned for earlyManagement 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.

Step 7: Take steps to ensure the usability of intervention

End-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 assessed

Step 8: Test intervention for effects on workflow and usability

Interventions 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.

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 followed

Questions?