using meditech data to drive clinical decision support meditech data to drive... · after this...

Co-presenters:

Stephania Fregeau

Jamie Gerardo

Using MEDITECH Data to

Drive Clinical Decision Support

2015 International MUSE Conference

Technologies used

Objectives

Surgical Scorecard reports

Application functionality and how it applies to the report data

Tips on setup

Demo of Scorecard and related reports

Overview of the MEDITECH data repository

Briefly cover how we are gathering data for our reports

Tables used

Surgical Care Improvement Project

Going from paper to an electronic dashboard

Measure requirements

Demo

AGENDA

MEDITECH Data Repository

(or other technologies such as Open Gate from Blue

Elm)

Microsoft SQL Server

SQL Server Management Studio

Stored Procedures

Reporting Services (SSRS)

Report Manager

Visual Studio (Business Intelligence Development

Studio)

TECHNOLOGIES USED

After this presentation, you will be able:

To outline the elements on the Surgical Services

Scorecard

To apply a few tips on using the Meditech Operating

Room Management module

To describe how NMC is using the electronic SCIP

Dashboard to drive clinical decision support

To know the various reporting options available

To state Meditech tables which can be used to create

reports

OBJECTIVES

NORTHWESTERN MEDICAL CENTERSt. Albans, Vermont

70 bed hospital

NMC staff have won 5 consecutive national Avatar

awards for “Overall Patient Satisfaction” &

“Exceeding Patient Expectations.”

HIMSS Stage 6 achieved in 2014

MEDITECH 6.07 PP5d

Per Year, NMC has:

1,900 inpatients

28,000 emergency room patients

400 babies born

Performs 6,000 surgical and outpatient procedures

NORTHWESTERN MEDICAL CENTERST. ALBANS, VERMONT

NMC’s MISSION IS TO PROVIDE EXCEPTIONAL

HEALTHCARE FOR OUR COMMUNITY

5 Star Caring Model

55 member staff

6 member Anesthesia

team

20+ Surgeons w/ many

Community providers

NORTHWESTERN MEDICAL CENTER

Surgical Services

16 Ambulatory rooms

2 Endoscopy rooms

4 Outpatient Treatment rooms

5 Operating Rooms

5 bay PACU

Central Sterile

Purchasing Specialist

OR Scheduler

Registration Office

Surgical Council &

Shared Governance Councils

• Quality

• Research & Education

• Clinical Practice

First Case On Time Starts

Turnover Time

Scheduling Accuracy

Block Utilization

SURGICAL SERVICES SCORECARD

PAPER/MANUAL SCORECARD

ELECTRONIC VERSION

ELECTRONIC VERSION

SURGEON COMPARISON

Define the measure and target

Why is the measure important?

Where does the documentation occur?

How do I query the data in the DR and which

tables do I use?

FIRST THINGS FIRST

Definition

A first case on time start occurs when the first patient of

the day arrives in OR room within 5 minutes of scheduled

start time

Why?

First case on time starts will improve patient

satisfaction, productivity and staff satisfaction

FIRST CASE ON TIME STARTS

OR Scheduler Desktop:

report looks to first

scheduled case

of the day


Documentation

OR Customer Defined Time Headers

ORM>System Mgmt>View OR Customer Defined Time Headers


Documentation


Staff & Physician Involvement

ORM>Dictionaries>Surgical>Delays

FIRST CASE ON TIME STARTSDELAY REASONS

FIRST CASE ON TIME STARTSNURSE DESKTOP - DELAY REASONS

JANUARY – MAY 2015 PIE CHART

Recommend using AppointmentDateTime

SchAppointments table

Use determine the first case

Example

Use for the calculation to determine if the case started on

time

(Example: DATEDIFF(minute, AppointmentDateTime, IntoOR) )

Define the timeframe

You’ll want to be specific on what counts as ‘on time’

What if the surgery starts early? Within 5 minutes?

FIRST CASE ON TIME STARTSNotes/Tips

../../../../../../../Documents/Northwestern/MUSE2015/FirstCase_code.rtf

Definition

Time from prior patient out of room to succeeding

patient in room time

Why?

Good turnover time helps maintain surgeon, anesthesia,

staff and patient satisfaction

Documentation

Statistic driven by patient into & out of room times

documented by the Circulator in the Operative Record.

TURNOVER TIME

To be efficient at

operating room turnover,

every player needs

TO KNOW THEIR JOB & DO IT!

TURNOVER TIME

Staff & Physician Involvement

SET UP/CLEAN UP TIMES FROM

PROCEDURE LEVEL

ORM>Dictionaries>Schedule>Procedures>Proc/Resources

PROCEDURE DICTIONARY PURGE &

PREFERENCE CARDS

Turnover time can be calculated based on the

surgeon only (as we do here) or on the surgeon and

the room.Example

You’ll want to filter out cases before or after a

certain time of day – as in example.

From a reporting stand point this is fairly straight

forward.

TURNOVER TIMENotes/Tips

../../../../../../../Documents/Northwestern/MUSE2015/TurnoverTime.rtf

Definition

The percentage of all cases with an accurate estimate of

case duration. A case is considered accurate when the

estimated case duration is within 15 minutes of the

actual case duration (time patient in room to out of

room).

Why?

Accuracy of estimated case duration is essential in

managing block time, productivity and staffing needs

within Surgical Services.

SCHEDULING ACCURACY

1) Determined at the Procedure Level

ORM>Dictionaries>Schedule>Procedures>Proc/Resources

SCHEDULING ACCURACY

Documentation

2) Restricted Routine: average case duration (surgeon

specific) once the defined number of cases has been

reached

ORM>Dictionaries>Customer Defined Parameters>Parameters

SCHEDULING ACCURACYRestricted Routines

Determined in OR Customer Defined Time Headers

Procedure Length (Surgeon)

Scheduling Length (Schedule): defaults into duration while

booking the case when the defined number of cases has been

reached

ORM>System Mgmt>View OR Customer Defined Time Headers> Bil l ing/Reports

SCHEDULING ACCURACYProcedure vs Scheduling Restricted Routine

3) Run Restricted Routines directly from OR Scheduler

Desktop while booking the case or thru Restricted

Routines

ORM>Restricted Routines>Default Scheduling Length

SCHEDULING ACCURACYRestricted Routines

RESTRICTED ROUTINES FROM

OR SCHEDULER DESKTOP

Estimated Time - There are many places where you

can find the estimated time for surgical cases.

SchAppointmentOrOperations is the correct table if you want only

time ‘In’ and ‘Out’ of OR. - SUM(Duration)

Actual Time – You’ll calculate this time.

SchPatTimesOp contains custom defined dates in ORM.

Op1DateTime AS IntoOR

Op2DateTime AS SurgeryStart

Op3DateTime AS Incision

Op4DateTime AS Closed

Op5DateTime AS SurgeryStop

Op6DateTime AS OutofRoom

SCHEDULING ACCURACYNotes/Tips

Definition

Percentage of block time assigned to a surgeon (not

released) that is used by the surgeon; includes turnover

time

Why?

Helps determine staffing needs and patterns for nursing,

Central Sterile and Anesthesia

Reported to Surgical Council quarterly who make

recommendations to Surgeons

BLOCK UTILIZATION

ORM>Dictionaries>Schedules>Operating Rooms

*Do not delete entries as this will af fect the Scorecards past

data. Use the from date & thru date fields.

BLOCK UTILIZATION

Documentation

BLOCK UTILIZATION

DAILY BLOCK UTILIZATION

BLOCK UTILIZATIONNotes / Tips

Reporting on Block Utilization is challenging!!!

Most important pieces to get right

Surgeon Profile

Process for releasing a block

Let’s add patience and perseverance

A good process for keeping profiles up to date

A potential “gotcha” in MEDITECH on released

blocks

SCHEDULER DESKTOP AND DR TABLES

SchCalendarLogs

SchCalendarTable

SchCalendarOrProfileProviders

DEMO SCORECARD

MEDITECH DATA REPOSITORY

Report

DatamartSSRS Report

Generation

IIS

Web-ServerReport

DatamartSSRS Report

Generation

IIS

Web-Server

Production EnvironmentORM data mart is not

real time

Admitt ingData

AdmVisits

DMisGroupResponseElements

DMisProvider

DSchAppointmentGroups

DSchApptTypes

DSchOrDelays

DSchResourceDates

DSchResourceOrProfi leDoctor

DSchResourceOrProfi leDrGroups

DSchResources

MisQry_Main *

OmOrd_HomeMedAccounts

OmOrd_Main

OmOrd_Main2 *

OmOrd_Main3 *

OmOrdDict_AmbulatoryMeds *

OmOrdDict_Main *

PcsAcct Inst_Instances *

PhaRx

TABLES USED IN ORM ANALYSIS

PhaRxAdministrations

PhaRxAdminReasons

PhaRxIvAdditives

PhaRxIvCarriers

PhaRxMedications

PhaRxSplitMedications

RegAcctQuery_Result *

RegAcctQuery_Result_Value_Mult *

SchAppointmentOrOperations

SchAppointments

SchCalendarLogs

SchCalendarOrProfileProviders

SchCalendarTable

SchOrPatCaseActualOps

SchPatDelaysOp

SchPatOrCaseMain

SchPatOrCaseStaff

SchPatTimesHold

SchPatTimesOp

SchPatTimesPacu

SchPatTimesPhase2 * Indicates 6.0 tables

SSRS REPORT DEPLOYMENT OPTIONS

• Reports can be ad-hoc (with or without parameters)

• Reports can be pushed to a file-share on a schedule

• Reports can be e-mailed on a schedule

• Snapshots of report data at a specific time can be taken

• Reports can be rendered in web-format (html or xml), text,

image format, Adobe, Excel, and more

Surgical

Care

Improvement

Project

SURGICAL CASE DASHBOARD

Case Types

Total Knee & Hip Arthroplasty

Hysterectomies

Colon Resections

Hip Fractures

Data Elements

Antibiotic Selection, Timing of administration and

Discontinuation within 24hrs of anesthesia end time

Beta-blocker documentation in Home Medication

Screen and administration on post -op day #1 or #2

Urinary Catheter Removal on post-op day #1 or #2

Pharmacologic or Mechanical Venous

Thromboembolism (VTE) prophylaxis timing

DATA ELEMENTS ON

SCIP CORE MEASURE CHECKLIST/DASHBOARD

SURGICAL CARE IMPROVEMENT PROJECT (SCIP)

CORE MEASURE CHECKLIST

SURGICAL CASE DASHBOARD

DRILL DOWN TO DOCUMENTATION

1) Group facility procedure mnemonics to type of case

2) Determine facility formulary antibiotics mnemonic & group into class of drug

Ancillary>Pharmacy>Dictionaries>Drug

3) Determine facility allergen (beta-lactam) mnemonic

Ancillary>Pharmacy>Dictionaries>Shared MIS>Allergen

4) Map each type of case to correct antibiotic selection and all variations

ANTIBIOTIC SELECTION

1) Home Medications Beta-Blockers

Clinical>Dictionaries>Ordering>Ambulatory Drug>Drug

2) Formulary Beta-Blockers


3) Documentation on Medication Administration

Record

BETA-BLOCKERS

1) Did the patient have a foley catheter placed in the

operating room? If documented using Assessment in the

ORM Nurse Desktop, look up query mnemonics.

ORM>Dictionaries>Surgical>Assessments to find doc section

Clinical>Dictionaries>Documents>Doc section to determine

query mnemonic

2) Collaborate with PCS Informaticist to determine

where documentation occurs on the inpatient unit for

discontinuation of foley.

URINARY CATHETER REMOVAL

1) Determine facility formulary pharmacologic VTE

prophylaxis mnemonics


2) Collaborate with PCS Informaticist to determine

query mnemonics for mechanical VTE prophylaxis used

by inpatient units

PHARMACOLOGIC OR MECHANICAL VENOUS

THROMBOEMBOLISM (VTE) PROPHYLAXIS

EXTERNAL LINK IN MEDITECH

1) Add the link to the External Link Dictionary

Info Systems>MIS>Dictionaries>Person/Profile>External Link

2) Add the link to the user in the person dictionary

Person/Profile Dictionary>Person>External>External Link

EXTERNAL LINKHow To

GATHERING DATA FOR SCIP

Patient list, home meds, medications ordered, and

allergies are populated three times a day

6am, Noon, 6pm

Medication administrations and catheter

documentation is gathered at report run time

Dashboard indicators - logic based on operation date

and time, report execution date and time, and

measure specific rules.

DEMO SCIP DASHBOARD