Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment" Luis Saldana, MD, MBA, FACEP CMIO Texas Health Resources iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.

1. Optimizing the EHR for Value in Today’s Health Care Environment
Luis Saldana, MD, MBA, FACEP
CMIO
December 10, 2014

2. Learning Objectives
1.Provide an overview of THR’s strategy for improving patient outcomes and physician satisfaction through use of the EHR.
2.Share case studies from THR’s submission for HIMSS Stage 7 and 2013 Enterprise Davies Award.
3.Discuss strategies for aligning Governance with Organizational Strategy, and moving from Implementation to Optimization.
4.Share principles for adapting to a rapidly changing Healthcare environment.
5.Discuss future plans for ongoing use of the EHR in improving patient outcomes.
.

3. Link to Value
As indicated below, benefits of a fully deployed and adopted EHR contribute to each category of the value chain
.
http://www.himss.org/ValueSuite
Patient Safety
Decreased med errors
Clinical decision support
Longitudinal data
ADE cost avoidance

5. Texas Health Mission To improve the health of the people in the communities we serve Texas Health Vision Texas Health Resources, a faith-based organization joining with physicians, will be the health care system of choice Innovative Technology Solutions Innovate, transform, and serve

6. THR Value Proposition
•2005 – 2006
–Implementation of the electronic health record across 14 THR entities was one of our largest investments.
–Created Value Model Program
•Performance Measurement
•(Value Model Realization) Project Objective:
To assure organizational focus on achieving the desired outcomes of improved quality, safety, efficiency, and satisfaction.

8. Value Proposition Evolution
Past Approach
•Benefits Realization
•Direct Cost Savings
•HIM Efficiencies
•Forms Cost
•Cost Avoidance
•Falls
•ADE
•VTE
•Utilization
•CPOE
•Data-Defined Reporting
Current Approach
•Outcomes focused
•CAUTI
•Evidenced-based
•Order Set Management
•Predictive
•MEWS
•Increased use of CDS tools
•CBI for Outcomes Monitoring
•MU Dashboard
Future Approach
•Population Based
•Sepsis
•Diabetes
•CHF
•Transitions of Care
•PIECES
•Patient Engaged
•Portals, Interactive
•Care Continuum instead of episodic
•User-defined reporting/dashboards
•CBI for answering clinical questions

9. Implementation
“The Primary Objective of the EHR Value Model Realization Project and Steering Committee was to oversee the development, implementation and monitoring of a framework for realizing and measuring the value of the EHR at THR”. – August, 2005
9
Baseline
PHP
Baseline
PHD
Baseline
HMSW
Baseline
HMFW
Baseline
Little
H’s
…..
Post Measures
HMSW
Post Measures
PHD
Post Measures
PHP
…..
2006 2007 2008 2009 2010

10. Identified Benefit Categories
Reduce paper forms usage and cost
Increase Efficiencies: HIM, Unit Clerk, and Nursing
Increase documentation compliance screening for Pressure Ulcers and Falls for improved patient outcomes
Increase Medication Safety – Adverse Drug Events (ADE) and Medication Errors
Decrease Postoperative Venous Thrombolytic Embolism (VTE) Incidence
$ Demonstrate Meaningful Use
6

11. CLINICAL VALUE

12. Medication Safety
•Demonstrated Reduction in ADEs:
–53% reduction in medication errors through closed-loop medication administration process.
–36% decrease in adverse drug events through universal use of CPOE by physicians, resulting in $1.8 million in cost avoidance.
–Current project to deploy smart pumps with “guardrail” software to alert the nurse when dosage parameters are exceeded.

13. THR Approach to Medication Safety
CPOE
Smart Pump Integration- Ongoing
BMV
Optimized CDS(FDB/Leapfrog)
© 2013 Epic Systems Corporation. Used with permission

14. Overall Medication Error Reduction
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
% Change
% Change
Represents an overall medication error rate decrease of
42% between 2010-2013

15. Modified Early Warning System- MEWS
•Evidenced-based predictive tool that indicates patients at risk of clinical deterioration.
•Proactive management of patients before they experience significant clinical events that negatively impact their recovery.
•EHR facilitates clinician’s ability to aggregate patient information to make care decisions sooner.
•MEWS project designed to bring relevant information to the registered nurse with which to make immediate care decisions in critical situations.

16. MEWS
•Cardiac arrest decreased by 38% in the first six months of use.
•Cardiac arrest decreased 65% within 1 year(represents 22 at-risk patients)
•Represents cost avoidance $640,000* per year from increased MEWS surveillance
So how does it work?
*based on the Centers for Medicare and Medicaid Services average of ICU bed cost of $4,850, and an average ICU stay of three days).

17. MEWS Vital Sign Early Warning System
•Optimizes view of patient specific data
•Helps staff prioritize care
•Provides prompts to escalate concerns dependent on clinical judgment
© 2014 Epic Systems Corporation.

18. Venous Thromboembolism
•In 2008, Texas Health Resources launched a program to prevent venous thromboembolism (VTE).
–We saw immediate change in practices, and by 2011, post-operative VTE rates were less than half of pre- program rates.
–Lowering post-op VTE rates has helped Texas Health to satisfy Surgical Care Improvement Project requirements, and to meet measures set forth by the Centers for Medicare and Medicaid Services.
–The VTE prophylaxis program was awarded a 2011 HIMSS Story of Success, which also was used as a case study to show the effectiveness of the Texas Health electronic medical record for EMRAM Stage 7 award designation.

19. Decreased Incidence of Deep Vein Thrombosis and Pulmonary Embolus
•CareConnect provides standardized CPOE Order Sets and Clinical Decision support tools for appropriate VTE Prophylaxis.
•THR System VTE incidence steadily decreasing since implementation of CareConnect.*
•The Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Projects' estimates of inpatient cost are $10,000 per DVT and $20,000 per PE.**
* Data from CI DAM and VTE reporting **Data from AHRQ website 4/2011
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20. THR VTE Incidence Per Year

21. ITS key accomplishments - 2013
12/10/2014
21
Clinical EMR deployment
Meaningful use
Systems advancement
National and state recognitions
•Continued to extend significant EMR advantage
-Deployed integration of device monitoring with CareConnect systemwide
-2 of 4 THPR JV’s began the migration to CareConnect (complete in 2014)
-Achieved Ambulatory EMR Adoption Model (AEMRAM) Stage 6 for THPG Clinics on CareConnect
-82% THPG providers on an EMR and 32% on CareConnect
-9 hospitals at HIMSS Analytics EMRAM Stage 7 (top 2.2% of U.S. hospitals)
•EMR deployment allowed THR to receive all of its allocated meaningful use funds
-3 of 4 THPR JV’s successfully attested for MU year 2
-Third consecutive year of MU attestation for eligible hospitals (est: $13mm for 2013; $52mm to date)
-THPG will receive approximately $2.8M MU funds and 72 % eligible providers are on track to attest for 2013
•Continued to expand quality of care through technology enablement
-Deployment of population health dashboard
-96%ile physician satisfaction with IT in 2013 Press Ganey survey
-Partnered with Healthways for deployment of population health technology
-Rolled out significant technology in support of H&V service line (CVIS)
-Went live with first deployment of THR’s Health Information Exchange
•Received national recognitions and accolades,
-John E. Gall Jr. CIO of the Year Award – Edward Marx
-2013 Enterprise HIMSS Davies Award of Excellence
-HIMSS EMRAM Stage 7 Award – THA, THAL, THAZ, THC, THDN, THFW, THSH, THS, THSW, THK
-Information Week 500 – (Ranking – 168)
-Health Care’s Most Wired Winner
-Computerworld 100 Best Places to Work in IT – (Ranking – 31)
-CSO40 Honoree

22. Current Focus –Transition from
Hospital System to System of Care
Home
health
LTACH
SNF
Rehab
Urgent
care/ED
Diagnostics
JV
ASC
JV
Population
health
Independent physician
engagement
Ambulatory Plan Post-acute Services
Acute Care
MD expansion
IHC
Hospice /
Palliative

25. Supporting System Strategy

26. Guiding Principles
•Focus on the tactical to be strategic
•Be Protean, break down silos
•Stay focused on the Important
•Build teams you can trust to lead and execute
•Communicate the Why
•Remain sensitive to Clinical Operations-Workflows
•Emphasize Measurement and Accountability
•Celebrate victories and build on successes
•Know Effective communication is elusive
•Create Clarity

27. CHIO Leaders
CIO
CNO
CMO

28. Governance
•Restructured in 2013 to shift to better support optimization
and Summit goals
•Identify problem areas early
and act
•Decommissioned all COPICs
•Create New User Groups to better serve the organization’s Strategy and stakeholders
•Allows for input by clinicians to recommend, approve, and manage optimization requests, and new functionality.

30. Optimization Process
•Requests entered by user, entity, user group or system initiative team (via a Service Ticket)
•Nursing Informatics reviews all requests initially and decides to deny or move forward.
•Request that move forward, then go to a User Group to be approved and defined.
•Then resource approval by Optimization Review Board.
•Then work completed, training, communication and implementation

31. Physician Satisfaction with IT Services
THR Data; Illustrative Only – 2014

32. Key Takeaways
•CMIOs and CNIOs can bring the nursing and physician communities together. Break down communication barriers between nurses and physicians.
•Be flexible and adaptable. It’s all about relationships and building relationships between disciplines. The process is important, not just the result.
•Break down silos- be protean, not territorial.
•Find a balance between strategic and tactical
•Align reporting structures and governance to facilitate collaboration.

33. Summarizing
•Collaborating with clinicians is hard work, but pays dividends; Keep showing up, be visible
•Nursing can play a pivotal facilitating role in optimizing clinical workflows; empower your nurses and build strong teams
•Clinical Informaticists have to be bridge builders for their organizations; Play a unique role
•Critical to build a culture of focus on measurement
•CMIO-CNIO collaboration can be key success factor for successful Healthcare organizations

34. In Summary
Implementing an EHR
•Big investment
•Gets you in the game
Value begins
•Closing care loops, gaps
•Informing, monitoring
Organizational Focus
•Evolves
•Leverage EHR to support
Its a continuing Journey we are privileged to be on
•To improve the health of the communities we serve

35. Questions? Thank You! Luis Saldana, MD LuisSaldana@Texashealth.org @lsaldanamd

36. Edward Marx
THAM, THD, THFW THP, & THSW
HIMSS EMRAM Stage 6 designation at all hospitals
THA, THAL, THAZ, THC THD, THDN, THFW, THSH, THS, THSW, THK
Top Technological Innovators across America for the 13th consecutive year
2008 Healthcare SIG Project of the Year
2013 Enterprise Award
Innovator State Advocacy Award
John E. Gall Jr. CIO of the Year Award Edward Marx
Edward Marx
Ranked 8 Large Company
Ranked 18
14 of the past 15 years
Finalist