Trinity Health Advancing Clinical Quality and Patient Safety with Health IT Paul Conlon, PharmD, JD

Trinity HealthAdvancing Clinical Quality and Patient Safety with Health IT

Trinity HealthAdvancing Clinical Quality and Patient Safety with Health IT

Paul Conlon, PharmD, JDPaul Conlon, PharmD, JD

2

• Fourth Largest Catholic Health System in the U.S.

• 45 Hospitals (33 Owned and 12 Managed) Across the Nation

• 8,074 Active Staff Physicians

• 45,000 Full-Time Equivalent Employees

• Revenue of $7.0 Billion

• $400 Million in Community Benefit Ministry

Trinity Health

Trinity Health

Mission

Core

Values

Vision

Guiding

Behaviors

We serve together in Trinity Health in the spirit of the Gospel, to heal body, mind and spirit, to improve the health of our communities and to steward the resources entrusted to us.

RespectSocial JusticeCompassionCare of the Poor and UnderservedExcellence

Inspired by our Catholic faith tradition, Trinity Health will be distinguished by an unrelenting focus on clinical and service outcomes as we seek to create excellence in the care experience. Trinity Health will become the most trusted health partner for life.

We support each other in serving our patients and communitiesWe communicate openly, honestly, respectfully and directlyWe are fully presentWe are all accountableWe trust and assume goodness in intentionsWe are continuous learners

Copyright 2007 Trinity Health – Novi, Michigan

Copyright 2007 Trinity Health – Novi, Michigan 4

• Trinity Health’s clinical and operations transformation initiative

• Best-in-class clinical and administrative processes that are enabled by information systems on a common platform

• Large-scale people, process, and technology advancement:

– Enhanced Care/Clinical Experience

– Implemented Electronic Medical Record (EMR)

– Computerized Physician Order Entry (CPOE)

– Unified Revenue management

– Clinically-driven Supply Chain management

– Improved productivity

Decisive and Focused System-Wide IT Investment

• The vision to unite state-of-the-art information management systems in three areas: clinical, revenue and supply chain, was launched in 2000

• Goal is to transform care delivery, increase patient safety and improve financial performance

• Strategic investment in excess of $400 million capital over 10 years

• Unified people, process, culture, and technology

• Leveraged skill and scale to achieve efficiencies

• Standardized evidenced based processes to improve quality of care, patient safety and financial performance

• Provided critical transparency to data and processes

• Reduced variability in processes and costs


Trinity Health is using Genesis to standardize operational processes and information systems.

Trinity Health’s bold vision and skillful execution of Genesis:


Trinity Health: Circa 2001…

Eastern Division Western Division

Operating UnitsSilver Spring, MD

Columbus, OH

Port Huron, MI

Mt. Clemens, MI Pontiac, MI Livonia, MI

Ann Arbor, MI

Battle Creek, MI

Grand Rapids, MI

Muskegon, MI

South Bend, IN Clinton, IA

Dubuque, IA

Mason City, IA

Sioux City, IA Boise, ID Fresno, CA

Patient Administration

Registration

Patient Accounting

Medical Records

DRG Grouper 3M 3M Quadramed 3MQuadraMed

3M

APC/APG Grouper HSS HSS

Enterprise Resource Planning (ERP)

General Ledger People Soft Global People Soft People SoftPayroll/Human Resources GEAC Ceridian GEAC

A/PMaterials Management

Cost Accounting

Self Developed (Analysis & DSS)

TSI Mainframe TSI Mainframe TSI AS400


TSI AS400


Contract Management SARMC

McKesson HBOC

Clinical SystemsPhysician Order Management Eclipsys

Order EntryHBOC STAR

SMS MedSeries 4

HBOC Plus 2000

HBOC Series

SMS MedSeries4 HBOC STAR HBOC STAR

Results Reporting In-house/3M CWS CWS Cerner In-House

ADEsClinical Documentation Eclipsys

HBOC Care Manager TDS

HBOC Care Manager TDS Eclipsys

LifeServ Petronics

LaboratoryHBOC STAR

Cerner Pathnet

Cerner Pathnet

Sunquest ClassicHBOC ALG

Classic Cerner Millenium

Classic ClassicCerner Pathnet

Cerner Millenium

United Clinical Labs Sunquest

Cerner Millenium Sunquest

HBOC STAR

Pharmacy HospitalCerner

MsMedsCerner

MsMedsCerner

MsMedsHBOC Series

Cerner MsMeds

Cerner MsMeds

Cerner MsMeds

Cerner MsMeds

HBOC STARCerner

MsMedsCerner

MsMedsCerner

MsMedsCerner

MsMedsMediware WORX

Surgery Management

RES-Q Healthcare Omni-server

Omni-server

Patient Scheduling HBOC Pathways HBOC Pathways HBOC Pathways

Radiology HBOC STAR IDXADAC MARS II

HBOC Series

ADAC MARS II HBOC STAR

ADAC MARS IIPer-Se'Consort

HBOC STAR

Transcription Softmed Dolbey Softmed Dolbey Softmed Medrite Softmed Dictaphone Softmed SARMC Softmed

HBOC STAR

SMS Med Series4

HBOC

SMS Med Series4

Medline Systems

Global

SMS Med Series4

HBOC Plus 2000 HBOC

Series

TDS TDS

SMS Med Series4

SMS MedSeries

4

HBOC STAR

HBOC

SMS Med Series4

Per-Se'ORSOS

HBOC STAR

HBOC

HBOC Health-Quest

SMS Med Series4

HBOC Health-Quest


Trinity Health IT Unification 2012…

Consistent Tools + Best Practice Processes = Operational Excellence


Genesis Clinical Timeline 23 of 41 facilities are now live3 ministries in readiness

–Ann Arbor–Muskegon-Hackley–Boise

Genesis Standard Delivery Model (GSDM) in processMuskegon-Hackley will come live with current Muskegon footprint with additional functionality to facilitate barcode

medication administration and PowerPlans.Chelsea will implement the Ann Arbor Genesis footprintFresno & Columbus will implement GSDMCadillac & Grayling TBD

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

GenesisBoard

Approval Port HuronGo-Live

MuskegonGo-Live

Grand RapidsGo-Live

Battle CreekGo-Live

MacombGo-Live

Mason CityGo-Live

Sioux CityGo-Live

DubuqueGo-Live

LivoniaGo-Live

OaklandGo-Live

ClintonGo-Live

South BendMishawakaPlymouth

Silver SpringGo-Live

Mason CityNetworks

FresnoGo-Live

BoiseGo-Live

Ann Arbor

Go-LiveColumbusGo-Live

2010 2011

HackleyGo-Live

ChelseaGo-Live

2012

Cadillac & GraylingGo-Live


Project Genesis

• Single design deployed across 23 hospitals since May 2003.– Identified deficiencies prioritized for correction and enhancements

deployed across full system.– 3 more hospitals in October 2009.

• Standardized readiness assessment• Standardized deployment• Standardization of care delivery

– Design heavily influenced by front-line care givers– Constant enhancement/refinement

• Heavy focus on implementing evidenced based practices• Full deployment of order entry, results reporting, rules,

alerts and advisories.– Over 75% CPOE rate

Accomplishments to Date on the Clinical Platform

• Over 7 million patients within the EMR making it the 3rd largest repository in the nation.

• Data is contained in a single location including clinical, financial, and administrative information across all facilities.

• 2 facilities have clinics managing inpatient & outpatient care in the same system

• In 23 of the 41 hospitals scheduled for full implementation…– They are live on Computerized Prescriber Order Entry (CPOE) with physician

entry rates average 74% and as high as 84% of all orders– 100%% of the previous paper medical record is now electronic– More than 1,200 caregivers will use the system simultaneously during peak

hours with over 300,000 chart openings per day. – Inpatient nursing care, pharmacy, and medication administration is

documented directly by providers in the same electronic system. Lab and Radiology data also feeds from regional and hospital based systems.

– Over 600,000 orders are placed, processed, and completed per day electronically from order to administration in the same system.

– Over 700 physicians place orders each day.



Current Performance and Recognition

• Severity adjusted mortality rate at 71% of expected• HCAHPS “Would Recommend” score at the 76th percentile• 100% of core measure performance is greater than the

national average– 47% of hospital level core measures above the national top 10%

• Trinity Health is one of the Thomson Reuters 100 Top Hospitals®: Health System Quality/Efficiency Benchmarks award winners

• 5 of our hospitals are recognized as Thomson Reuters 100 Top Hospitals

• Trinity Health is the recipient of the 2004 National Health Care Quality Award


Genesis: Process Impact

• Clinicians access records and place orders at any place and time

• Nurses spend 8% more time at bedside rather than with paper records

• Emergent medications administered 40% faster

• Comparative effectiveness eliminates clinical variation with 172 adopted standard order sets and over 2,500 standard drugs in our formulary

• Computer-generated alerts prompt physicians to change medication orders, avoiding approximately 14,000 potential Adverse Drug Events per year

• Automatic system alert on diabetes medication (Avandia) within 10 days of FDA warning

• Clinical Process Re-design has resulted in benefits in Pressure Ulcers (45% reduction) and Patient Falls (31% reduction) and improvements in DVT and Pain management.

Genesis has required fundamental changes to core patient care processes.


Key Implementations/Process Changes in FY09

• Admit, transfer, and discharge Medication Reconciliation• System-wide formulary• Integrated electronic surgical record pilot• Urinary catheter rules/alerts• Universal protocol revision• Change patient satisfaction vendor• Phased in implementation of credentialing and privileging soft ware• Standardized concentrations of key IV solutions• Expansion of nurse witness functionality (double checks)• Standardized heparin administration and availability• OB program reviews• Implementation of Genesis at large teaching hospital and 8 rural access

hospitals.• Surgical ‘tiger team’s’• Review of case management programs

Patient Medication List from EDPatient Medication List from ED


Patient Medication List from ED

New Rx’s

Home Meds


Patient Medication List from ED

Meds received in ED

Meds to hold


Drivers

• A Unified Enterprise Ministry approach• Relentless pursuit of improvement• Extensive readiness preparation• Frontline staff involvement• Transparency• Reliance on evidenced based care• Collaboration across disciplines

– Strong technical and clinical expertise

• Many, many, many groups….

Documents

Trinity Health Advancing Clinical Quality and Patient Safety with Health IT Paul Conlon, PharmD, JD