DATAVISION IN THE REAL

WORLD Betsy Stauffer

Lancaster General Hospital Lancaster, PA

LANCASTER GENERAL HOSPITAL

Presenter Name Presenter Title

Presenter Name Presenter Title

AWARDS

• Midas+ implemented in 1999

• DataVision implemented in 2003

• EMR – Epic – Implemented in 2011 – HAR-based

• J A Thomas for Clinical Documentation Improvement

• Advisory Board products – Crimson Clinical Advantage and Continuum of Care

– Crimson Realtime Readmissions

– Quality Compass

History of Midas+, DataVision, and

Other Applications Used with DataVision

Midas+ & DataVision Access

• Electronic Intranet form

• Midas+ Care Management Training

– Department-specific training

– Midas+ COW self-paced learning

• System Access and Conventions

• DataVision Server and Web applications

– Midas+ sponsored training WebEx participation

• Midas+ and DataVision access monitored

USER ACCESS REQUEST

Departments with DataVision Access

• Business Intelligence–Analytics

• Performance Improvement

• Quality and Patient Safety

• Case Management

• Health Information Management

• Heart and Vascular Institute

• Disease Management

• Financial Decision Support

• Medical Data Analysis

• Administration

• Nursing

• Stroke Coordinator

• Social Work

• Risk Management

4/2014

Primary Care &

HospitalistCEC

ED/Urgent Care CEC

Critical Care CEC

Surgical CEC

Trauma CEC

Heart & Vascular

CEC

Behavioral Health CEC

Women & Pediatrics

CEC

Oncology

CEC

Gen. Surgery CM team

Colorectal/GI CM team

Thoracic CM team

Orthopedics CM team

Neurosurgical CM team

Bariatric CM team

OB/GYN CM team

Pediatric CM team

NICU/Newborn CM team

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•

•

•

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Vascular CM team

Cardiac Surgery CM team

System-wide Clinical PI Teams

PERFORMANCE IMPROVEMENT COMMITTEE (PIC)

PIC Membership to also include: • VP of Medical staff (chair)

• President, Medical staff

• Quality Medical Directors

• Chief Physician Executive

• Sr. VP, Hospital Operations

Journey – Quality Department to IT

• New Division of IT Department – Business Intelligence – Reporting

– Analytics – Clinical Reporting

– Database Services

– Several employees transitioned from Quality Department to IT – Business Intelligence

– Midas+ and DataVision transitioned from Quality to IT – Business Intelligence

• Business Intelligence Healthcare Data Analysts to the rescue!

• They receive a project and/or request – Validate request – Analyze request

• Determine which systems to use

• Explore DataVision Indicators

• Validate Indicators by using the DV Measure Definition

• Access DataVision, Toolpacks, Report Data Transfer

• Use Excel tools – pivot tables, filters, V-lookup, and so on

• Determine optimal method of display – delivery

• Request profiles of specific Indicators for trending

• Healthcare Data Analyst updates Quality

Indicator slide deck for senior leadership

trending (monthly) displaying historical

graphics

– 85 slides from various systems

– 57 of the 85 slides originate

from DataVision

INDICATOR METRIC INVENTORY

DataVision Functions Used at LGH

• DataVision 3M PPR Toolpack

• DataVision Navigator

• DataVision Provider profiles

• DataVision Readmission Toolpack

• DataVision SmartReport

• DataVision Value-Based Purchasing

• DataVision User-selectable Indicator Functions

Easy Access to Standard Reports

Report Toolpack based on

user-created Indicators

DataVision Reporting – Ongoing

• Pay-for-performance Metrics

• Senior Leadership Slide Deck – updated monthly

• Disease-specific profiles

• Hospitalist provider group volumes and metrics

• Scorecard data elements

• Bundled payment metrics

Reports Generated

by Healthcare Data Analyst

• DV Web Application

– Provide Stroke Program Coordinator with GMLOS data, as well as Comparative Database information for stroke population

• DataVision Toolpacks

– Update Quality Metrics for Senior Leadership

· 30-day All-cause Readmissions

· 30-day Unscheduled Readmissions

• Readmission Report for Transition of Care Committee

Reports Generated

by Healthcare Data Analyst

DV Server application (1) Update Quality Metrics for Senior Leadership including:

· Hospital-acquired pulmonary embolism

· Hospital-acquired pressure ulcer

· Major birth trauma

· Elective deliveries

· All-or-None Bundles for Acute MI, Heart Failure, Pneumonia, SCIP, Children's Asthma, Stroke, and VTE

· Clinical Processes of Care for AMI, Heart Failure, Pneumonia, SCIP

· AHRQ Patient Safety Indicators

· Median ED Times

· IQR Measures for Stroke, VTE, and Immunization

(2) Hospitalist Scorecard – VTE and Stroke Bundle (group specific)

(3) Highmark Quality Blue data for VTE

(4) ED Scorecard components – Core measures for AMI, Stroke, Pneumonia

DataVision Reports Used to Report

Pay-for-Performance Metrics

• READMISSION PERFORMANCE MEASURES

– Defined by payer – DataVision populations and

Toolpacks used for monthly reporting of

• Readmission rates for 3, 7, and 30 day readmissions

• Readmissions with present on admission infections

• Readmissions due to complications of care

• Principal DX of Heart Failure readmitted within 30 days to

inpatient or observation

DataVision Readmission Toolpack

DataVision Readmission Metrics

Adjusted for Specific Payer Report

• Standard Report – DataVision Readmission Toolpack

• CDB:009 – All Acute Care Inpatients – Denominator

• Separate numerator (readmissions) and denominator (All Acute Care Inpts)

• Delete cases under age 18

• Create a month column for the start date for readmission encounter

• Filter on MAPPED DISCHARGE DISPOSTION for first encounter – Exclude discharge disposition for first encounter per metric instructions

Use the column in the Toolpack entitled Days Between Encounters to determine the

3-day readmissions

7-day readmissions

30-day readmissions

AHRQ Indicators in DataVision

• MEASURE AND DEFINITION

• AHRQ Pt. Safety Indicator - Composite - ADULT (Rate per 100 Adult Discharges)

– Risk-adjusted ratio of observed-to-expected encounters that qualify for selected AHRQ PSI measures for potentially preventable adverse events

SOURCE

Midas+ > Function> DataVision >DV Navigator > Safety > Patient Safety > AHRQ Patient Safety Indicators - Adult ACA > PSI 90 Patient Safety Indicators Composite, Adult (CDRB:1408)

INDICATORS CHANGE

• AHRQ DEFINITIONS CHANGED – May 2013

– Historical values in DataVision change

• AHRQ PSI-90 – definition changed

– NOTE: PSI- 90 Indicators changed in May 2013 when AHRQ made modifications to adjust the risk-adjusted coefficients for these two PSIs. When Midas+ applied the values, a historical update was made (noted in DataVision Release Notes) modifying the historical trending.

Healthcare Infection Prevention

• DataVision Indicators utilized

– OP6 – Timing of preoperative antibiotics

– OP7 – Antibiotic selection

• Surgical Safety Indicators utilized • SCIP-Inf-9 – Urinary catheter removal

• SCIP-Inf -10 – Normothermia

• SCIP-Card 2 – Perioperative beta-blocker usage

Worklist Based on DV Indicators

Examples of Worklists Based on

DV Indicators

• Pulmonary Embolus NPOA – worklist created to

monitor DV Indicator

• DVT-NPOA worklist created to monitor DV

Indicator

In conclusion…

Contact information

Betsy Stauffer

bfstauff@lghealth.org