healthcare it adoption, function, value & beyond february ... · healthcare it adoption, function,...

Healthcare IT Adoption, Function, Value & Beyond

February 29, 2016 John H. Daniels, CNM, FACHE, FHIMSS, CPHIMS

Global Vice President, HIMSS Analytics

Agenda • Challenge • Approach • Progress • Benefits realization • Q&A

Learning Objectives • Recognize the clinical and business value that can be achieved from

the use of information technology in care delivery processes • Recognize stages of electronic medical record functionalities towards

improving care delivery processes • Identify the next great challenge to multi-stakeholder continuity of

care and the recommended strategic approach to address the challenge

98K+ patients die annually in the United States

due to medical errors!!

Why?

Lack of Relevant Information

Kohn, Linda T. To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academy Press, 2000.

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Medical Knowledge

Automate to optimize clinical decision making

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Information technology is a MUST Using information technology, we can

help make healthcare …

Crossing the quality chasm: A new health system for the 21st century. (2001). Washington, D.C.: National Academy Press.

Ultimate Goal

Ensure the most relevant

information is available to the

decision maker at the right place

and at the right time

How can we do this?

Shared Vision

Better health through Information Technology

Global HIMSS Analytics EMR Adoption ModelSM

N = 5439 N = 5449

Complete EMR, Data Analytics to Improve Care

Physician documentation (templates), full CDSS, Closed loop medication administration

Full R-PACS

CPOE, Clinical Decision Support (clinical protocols)

Clinical documentation, CDSS (error checking)

CDR, Controlled Medical Vocabulary, CDS, HIE capable

Ancillaries - Lab, Rad, Pharmacy - All Installed

All Three Ancillaries Not Installed

1.1%

4.0%

6.1%

12.3%

46.3%

13.7%

6.6%

10.0%

3.4%

16.5%

29.5%

14.5%

23.9%

5.3%

2.5%

4.4%

2011 Q2 2014 Q3

Data from HIMSS ® Database ©2015 HIMSS

… 7 Stages that lead to the

Highest Quality in Patient Care

Progressively sophisticated model …

HIMSS’ contribution to the vision • Thought leadership

– Quality, Safety, Efficiency improvements • To reflect the market

– Where are the current trends • To inform government policy

– Contribute to national eHealth strategies – Used by governments for policy formulation

• To “drive the market” – Useful roadmap for C-suite, governance boards,

& policy makers

It takes time to make “significant” national progress

20.4% 17.4%

40.0%

18.7%

3.1% 0.5% 0.1% 0.0%

0 1 2 3 4 5 6 7EMRAM Stage

2006

19.3%

14.0%

37.2%

25.1%

2.2% 1.4% 0.8% 0.0%

0 1 2 3 4 5 6 7EMRAM Stage

2007

15.6% 11.5%

31.4% 35.7%

2.5% 2.5% 0.5% 0.3%

0 1 2 3 4 5 6 7EMRAM Stage

2008

11.5% 7.2%

16.9%

7.4% 3.8%

1.6% 0.7%

0 1 2 3 4 5 6 7EMRAM Stage

50.9%

2009

10.1% 7.1%

14.6% 10.5%

4.5% 3.2% 1.0%

0 1 2 3 4 5 6 7EMRAM Stage

2010

49.0%

9.0% 5.7%

12.4%

44.9%

13.2% 8.4%

5.2% 1.2%

0 1 2 3 4 5 6 7EMRAM Stage

2011

8.4% 4.3%

10.7%

38.3%

14.2% 14.0%

8.2%

1.9%

0 1 2 3 4 5 6 7EMRAM Stage

2012

5.8% 3.3%

7.6%

30.3%

15.5%

22.0%

12.5%

2.9%

0 1 2 3 4 5 6 7EMRAM Stage

2013

3.8% 2.0% 5.1%

21.0%

14.0%

32.7%

17.9%

3.6%

0 1 2 3 4 5 6 7EMRAM Stage

2014

2.1% 1.7% 2.6%

16.4%

10.1%

35.9%

27.1%

4.2%

0 1 2 3 4 5 6 7EMRAM Stage

2015

EMR Adoption ModelSM (2006-2015) United States

Stage 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Stage 7 0.0% 0.0% 0.3% 0.7% 1.0% 1.2% 1.9% 2.9% 3.6% 4.2%

Stage 6 0.1% 0.8% 0.5% 1.6% 3.2% 5.2% 8.2% 12.5% 17.9% 27.1%

Stage 5 0.5% 1.4% 2.5% 3.8% 4.5% 8.4% 14.0% 22.0% 32.8% 35.9%

Stage 4 3.1% 2.2% 2.5% 7.4% 10.5% 13.2% 14.2% 15.5% 14.0% 10.1%

Stage 3 18.7% 25.1% 35.7% 50.9% 49.0% 44.9% 38.3% 30.3% 21.0% 16.4%

Stage 2 40.0% 37.2% 31.4% 16.9% 14.6% 12.4% 10.7% 7.6% 5.1% 2.6%

Stage 1 17.4% 14.0% 11.5% 7.2% 7.1% 5.7% 4.3% 3.3% 2.0% 1.7%

Stage 0 20.4% 19.3% 15.6% 11.5% 10.1% 9.0% 8.4% 5.8% 3.7% 2.1%

N = 4,237 N = 5,073 N = 5,166 N = 5,281 N = 5,337 N = 5,458 N = 5,458 N = 5,449 N = 5,467 N = 5,460

Data from HIMSS Analytics® Database ©

This is how long it takes to make “significant” national progress

Cross Regional EMRAM Score Distribution# (2015)

Stage Asia Pacific Middle East United States Canada Europe*

Stage 7 0.5% 0.0% 4.2% 0.2% 0.1%

Stage 6 3.9% 11.3% 27.1% 0.9% 4.6%

Stage 5 7.4% 21.1% 35.9% 3.4% 17.5%

Stage 4 1.7% 3.5% 10.1% 1.6% 5.5%

Stage 3 0.6% 19.0% 16.4% 31.2% 3.2%

Stage 2 32.7% 19.0% 2.6% 31.5% 30.2%

Stage 1 4.9% 9.9% 1.7% 13.9% 14.2%

Stage 0 48.2% 16.2% 2.1% 17.3% 24.1%

N = 770 N = 142 N = 5,460 N = 641 N = 2,395


Belgium, Brazil, Canada, Chile, China, Denmark, France , Germany, India, Italy, Malaysia, Netherlands, Norway, Saudi Arabia, Singapore, Switzerland, Taiwan, Turkey, UAE, UK, USA

China, Korea, Germany, Saudi Arabia, Spain, USA

Benefits realization from IT

HIMSS Analytics Database® correlation studies with other comprehensive data sources.

Profile of a Stage 7 Organization • Use data to drive improved outcomes related to …

– Process, Financial, Clinical, Quality & Safety

• Are paperless, or near paperless (create no paper) – All clinically relevant data is in the EMR

• Are fully committed to continuous process improvement

through collaboration – Strong IT leadership and executive champions – Clinician / end-user champions

Representation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage

1.9% 4.8%

10.1% 8.1% 4.2% 6.5%

7.9% 9.7% 0.4% 1.7%

6.2% 10.0%

6.4% 6.4%

12.8%

30.1%

0%

10%

20%

30%

40%

50%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7

All h

ospi

tals

with

in ea

ch E

MRAM

Sta

ge

3 or less 4 or more Source: HIMSS Analytics

2.3% 6.5%

16.3% 18.1%

10.6% 12.9%

20.7%

39.8%

Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage

0.0% 5.9%

12.8% 14.3% 20.1% 21.8%

30.8%

62.6%

0%

10%

20%

30%

40%

50%

60%

70%


All h

ospi

tals

with

in ea

ch E

MRAM

Sta

ge

Source: HIMSS Analytics

38.9

45.5 44.6 45.9 45.9 42.7

49.0

64.3

30

40

50

60

70


AVG

Pro

ject

ed V

BP

Clin

ical

Sco

re

Tipping Point

Tipping Point

Clinical Performance


Mortality Rates

0%

10%

20%

30%

Heart Atack Respiratory Therapy

Actual MortalityLow EMRAM

Actual MortalityHigh EMRAM


-1.52%

4.91%

-0.43%

6.19%

2.77%

7.95%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%


Aver

age

Ope

ratin

g M

argi

n

In 2011 In 2013 In 2015

Financial Performance (Profitability)



Stage 7 Case Studies

Actual case studies from validated Stage 7 hospitals

Medication Administration Errors per 1000 CMI-Adjusted Pt Days

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

Jan 2011 Jan 2013 Jun 2013

7 10

Pt Scan: 96% Med Scan 93%

Pt Scan: 79% Med Scan: 76%

44% 62%

19

Annual Incident Reports 2009 – 2013* per 1000 CMI-Adjusted Pt Days

0

0.5

1

1.5

2

2.5

0

5

10

15

20

25

2009 2010 2011 2012 2013*

Med

icat

ion

Even

ts

Oth

er In

cide

nt R

epor

ts

Other Incident Reports Medication Events

Annual Incident Reports 2009 – 2013* per 1000 CMI-Adjusted Pt Days

0

0.02

0.04

0.06

0.08

0.1

0

0.5

1

1.5

2

2.5

2009 2010 2011 2012 2013*

Sign

ifica

nt A

DE

Med

icat

ion

Even

ts

Medication Events Significant ADE

30

20

4 0

5.34

4.47

1.08

0.00 0

10

20

30

40

50

60

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Jul 10 to Jun 11 Jul 11 to Jun 12 Jul 12 to Jun 13 Jul 13 to Sep 13 (3months)

# C

AU

TI

Rat

e pe

r 100

0 ca

thet

er-d

ays

Catheter-Associated Urinary Tract Infection (CAUTI) rate per 1000 catheter-days

# CAUTI CAUTI rate per 1000 catheter-days

Central Line-associated bloodstream infection (CLABSI)

Human (breast) milk administration through CLMA process

% Antibiotics given within one hour

Attention to detail Some changes in the

pharmacy Reduction in the number

of unnecessary STAT orders

Great communication by the team

• Grid/Order Set Form Approach for Chemotherapy • Reduced CPOE from 90 Minutes to 15 Minutes per Patient

Order Sets Process Improvement

Questions

THANK YOU John H. Daniels, CNM, FHIMSS, FACHE, CPHIMS Global Vice President, Healthcare Advisory Services Group [email protected]

@JohnHDaniels

mailto:[email protected]:[email protected]:[email protected]

Healthcare IT Adoption, Function, Value & Beyond�February 29, 2016AgendaLearning ObjectivesSlide Number 4Slide Number 5Information technology is a MUSTUltimate GoalHow can we do this?Shared VisionSlide Number 10HIMSS’ contribution to the visionIt takes time to make “significant” national progressSlide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Benefits realization from ITProfile of a Stage 7 OrganizationRepresentation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage�Clinical Performance Mortality RatesFinancial Performance �(Profitability)Stage 7 Case StudiesMedication Administration Errors�per 1000 CMI-Adjusted Pt DaysAnnual Incident Reports 2009 – 2013* �per 1000 CMI-Adjusted Pt DaysAnnual Incident Reports 2009 – 2013*�per 1000 CMI-Adjusted Pt DaysSlide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46% Antibiotics given within one hourOrder Sets Process ImprovementQuestions

healthcare it adoption, function, value & beyond february ... · healthcare it adoption, function,...

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