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14th AnnualMIDAS+ User Symposium

Bridgit Strachan, RN, MHRODVice-President, Professional/Support Services

Diane E. Irby, RN, MSN, CPHQDirector, Performance Improvement and Patient Safety

NorthBay Healthcare SystemFairfield, California

DataVision in Everyday Use

NorthBay Healthcare

Northern California not-for-profit healthcare system

• Two community hospitals

• Multiple outpatient clinics

• Combined 188 licensed beds

Mission

Compassionate Care

Advanced MedicineClose to Home

Vision

“To achieve a position of recognized superior quality…”

NorthBay’s Culture Before DataVision

• Slow to change• Slow to adopt technology• Lack of effective execution• Lack of integration among systems• Lack of sustained improvement• Entrenched medical staff

NorthBay’s Culture Before DataVision

• “My patients are sicker”

• “My units are doing fine”

• “My LOS is below everyone else’s”

NorthBay’s Culture Before DataVision

Data, data, data but no information

– Not risk adjusted

– Not benchmarked

– Spattered paint

NorthBay’s Strategic Goal

Recognized Superior Quality

• Performance in Top 25th percentile

• Clinical Best Practices

• Comprehensive Performance Monitoring

Moving the System Forward

DataVision SmartReport provides:

• Clinical decision making support

• Comparative benchmarked data

• Risk-adjusted data

SmartReport

Launching into action!

PerformanceOpportunities

for Improvement

DataVisionSmart Report

Coding Compliance

SafetyRare EventOccurrence

SafetyComplications

of Care

DataVision Smart Report

Smart Report 3rd Qtr 2003PerformanceOpportunities for Improvement

– LVF Assessment– Diet Instructions at Discharge– Follow-Up Instructions at Discharge– Medication Instructions at Discharge– Symptoms Worsening Instructions at

Discharge – CHF % Readmits < 31 Days

Congestive Heart Failure 3rdQtr03Compliance Snapshot (Before)

All or none.

Congestive Heart Failure 3rdQtr03 LVF Assessment (Before)Comparative Trend Analysis

27/47 50/81

41/5139/54

NA

Congestive Heart Failure 3rdQtr03 All Discharge Instructions (Before)

Comparative Trend Analysis

DataVision in Action

• Presented quarterly Smart Report

• Initiated Congestive Heart Failure Performance Improvement Team

CHF Admission Order Sheet

CHF Discharge Orders

CHF Discharge Instructions

Pocket Guidelines

DataVision Measuring for Improvement

Congestive Heart Failure 4thQtr04Compliance Snapshot (After)

Congestive Heart Failure 4thQtr04All Discharge Instructions

Comparative Trend Analysis (After)

Congestive Heart Failure 4thQtr04 LVF Assessment(After)

Control Chart

Congestive Heart Failure 4thQtr04 LVF Assessment(After)

Comparative Trend Analysis

Congestive Heart Failure 4thQtr04 Performance Barriers

• Documentation - electronic and paper

• Availability of:–Forms–Teaching packet

• Unit Activity - “Don’t have time”

• Communication

What’s Next• DataVision SmartReport - an integrated

approach to care management

• CHF PI Team now addressing quality and utilization indicators and issues

• Drilling down into physician patterns

• CHF pathway under development

ZYNX

DataVision Tools Support Integrated UM Approach

DataVision SmartReport

Care Management 4thQtr04Heart Failure and Shock

% CHF Readmits < 31 Days (ICD-9)Comparative Trend Analysis

Quarterly CHF Readmissions

CHF Physician Drill Down

Utilization Management

Utilization Management

PerformanceOpportunities

for Improvement

DataVisionSmart Report

Coding Compliance

SafetyRare EventOccurrence

SafetyComplications

of Care

DataVision SmartReport

Patient SafetyRare Event Occurrence

Appendectomy Mortality• Rate represented one case

• Findings: No acute appendicitis, right sided diverticulitis

• Met IHI measurement tool for severe sepsis on admission

• Sent to Medicine Peer Review

DataVision SmartReport

Obstetric Trauma/Vaginal Delivery w/o Instrument per 1000

Complications of Care

Obstetric Trauma/Vaginal Delivery w/o Instrument per 1000

Control Chart (Internal)

Obstetric Trauma/Vaginal Delivery w/o Instrument per 1000

Comparative Trend Analysis

Obstetric Trauma/Vaginal Delivery w/o Instrument per 1000

• Based on data:– Initiated data analysis and drill down

with OB-GYN Department–Medical staff challenged the inclusion of

other vacuum extraction code 72.79–Consulted with MIDAS–MIDAS consulted with AHRQ–AHRQ guidelines to exclude code 72.79

DataVision SmartReport

Potential DRG Over-CodingDRG 174/(174+182)

DRG 174 GI Hemorrhage w/cc Volume toDRG 182 Esophagitis, Gastro & Misc >17 w/cc Volume

Potential DRG Over-CodingDRG 174/(174+182)

DRG 174 GI Hemorrhage w/cc Volume toDRG 182 Esophagitis, Gastro & Misc. >17 w/cc Volume

DRG 174 Freq/1000 ACA DRG 182 Freq/1000 ACASite-2003 26.0 8.9CDB-20030 15.2 18.8

DRG Over Coding• Review by Health Information

Management Department

• Audit by external consulting group

– small physician group – excellent documentation– coding appropriate

NorthBay Healthcare After DataVision

At the “tipping point”• Changing vocabulary• Prioritization of initiatives:

– Performance Improvement– Utilization Management– Patient Safety

NorthBay Healthcare After DataVision

• Data Based Decision Making

• Rapid Cycle PDSA

• Medical Staff Functions

– Refining Peer Review Processes

– Physician Profiling

• System Dashboard

NorthBay Healthcare After DataVision

NorthBay Healthcare After DataVision

NorthBay Healthcare - NOW

MIDAS+DataVision

Clinical Decision Support

Reduces Barriers

Promotes Timely Action

Increases Participation

Provides Reliable

Information

DataVision A New Perspective