Safety story

Anupam, Kate and Bill outlined an incident at Sherman where a physician provided an order for bicarbonate at a markedly elevated dose that was verified by nursing with read-back and administered to the patient. The patient had received a kidney transplant and the excessive bicarbonate threatened the kidney's viability and necessitated a higher level of care.

2015 KRA progress

The organization is on-track to reduce transcription costs by 20% from January 2015 rates. When compared to 2014 transcription costs, the spend has decreased by 33%. The reduction is a combination of negotiating a lower per-line transcription charge with our vendor and migrating users away from telephone transcription toward direct data entry, desktop Dragon and the mobile CareConnection application (PC Touch).

The system-wide CPOE rate for radiology, medication and laboratory orders has risen 1.4% since January 2015. Three sites were able to raise their CPOE rate by two percentage points, and one site was able to raise their rate by nearly five percentage points. The group agreed that targeting one or two sites to reach 90% would be inspire more action to move toward this goal than trying to move the group slowly toward the target.

Proposed 2016 KRAs

Anupam outlined four KRAs that could be included in 2016:

• Operative report timeliness: Our coding colleagues are looking for ways to encourage our surgeons and other proceduralists to complete their operative notes sooner. This faster turn-around time would improve the odds of having a coding specialist review the note content and suggest changes that might lead to higher reimbursement.

• VTE prophylaxis: Many inpatient sites struggled to meet the higher benchmarks for providing VTE prophylaxis. Since most of this work is driven through the EMR, encouraging adoption of the admission PowerPlans and the VTE Advisor when appropriate would help justify the importance of clinical informatics to the organization.

• 90% CPOE at two sites: The group encouraged modifying the target to focus on medication orders as that would target those orders most likely to provide the benefits of CPOE from a patient safety perspective.

• Additional 15% reduction in transcription costs across inpatient sites: Having seen the financial savings from 2015, the organization is looking for clinical informatics to move physicians off of telephone transcription toward voice-to-text technology. The physicians in the group believe their peers migrate to the technology that most closely fits their workflow. We will probably not be able to retire any individual application, but we should be able to move the majority of users off of telephone transcription.

Other work in 2016 related to physicians but not linked to a KRA

In addition to the work outlined above, physician informatics will also be working on:

• Standardizing education for new physicians: To standardize the educational experience of our physicians across our inpatient facilities, the clinical informatics teams will be developing training videos that highlight best practices that incorporate the latest enhancements within the EMR.

• Moving from order sets to PowerPlans: By the end of 2016, we expect to retire all site-specific order sets and have enough PowerPlans to allow most users to customize an existing PowerPlan to be saved as a favorite.

• Routing test results to multiple physicians after hospital discharge: Anupam will be proposing a three-year project to the Advocate Project Governance group to reliably attribute physicians to patients and then route test results to those physicians after a patient leaves an inpatient setting. The work has implications for Registration, Safety and Risk Management.

• Identifying copy & paste behavior: Advocate has contracted with a firm to help identify copy & paste behavior without manually reviewing notes in an electronic system. The technology would enable hospital and physician leadership to target remediation efforts to improve physician documentation quality.

• Meaningful Use - ePrescribing at least 10% of all discharge prescriptions: Many physicians have objected to ePrescribing until controlled substances could also be transmitted. Advocate's IT team requested funds to enable CareConnection transmit these prescriptions, but the request was denied. Now that the most recent Meaningful Use ruling has come out, we will push to fund this work as the penalties for not complying with ePrescribing are much larger than the cost of purchasing and deploying the software.

Clinical Informatics restructuring

As part of our centralization process, Clinical Informatics will be restructuring to operate with five regional directors across Advocate and no site managers. The department will have an optimization team to prioritize and design change requests. The structure will be re-examined over the year to determine if adjustments will need to be made in 2017.

Enabling Emergency Room Physicians access to PC Touch

One member mentioned the concern about some sites using an older version of Dragon in the emergency rooms that is not as accurate as PC Touch. Currently, the Dragon contracts are managed at the site level. Three sites have made the investment in a site-wide Dragon license. The remaining sites are committed to purchasing individual licenses that are locked into an older version of the voice-recognition software. Anupam believes it will be more likely to migrate emergency room physicians to PC Touch than to convince the site chief financial officers to move to a new Dragon licensing agreement.

Viewing information across Advocate's inpatient sites

In response to another safety event involving a transfer of a patient from Good Shepherd to Lutheran General, the CareConnection team is exploring what options might make the most sense to share records internally. Laurie Gift will be sharing what options might be possible with Jeff and Kate. The group discussed the possibility of opening access to a patient's records from other sites at the time of transfer. Some were concerned about the need for consultants to view the "outside" records days after the transfer.

Year-end review

The group was comfortable maintaining a one-hour meeting cadence of every other month. Anupam will send out meeting invites for 2016.