A catheter-associated urinary tract infection (CAUTI) occurs when germs enter the urinary tract through the urinary catheter and cause infection. CAUTIs have been associated with increased morbidity, mortality, health care costs, and length of stay. The risk of CAUTI can be reduced by ensuring that catheters are used only when needed and removed as soon as possible. The HOUDINI Protocol gives criteria to help ensure nurses use catheters only when appropriate, with each letter in the acronym representing a different reason.
Nurses at MU Health Care began a process improvement project to reduce the CAUTI rate in the adult intensive care units (ICU) at University Hospital by implementing evidence-based practices, including a modified HOUDINI indication protocol, education, and aligning data reporting for urinary catheters.
Our team adjusted the EMR nursing documentation to add indications when a patient was using a urinary catheter. If patients do not meet HOUDINI criteria, the EMR generates a task to recommend catheter discontinuation. Additionally, the physicians receive the same indications in their orders list as a mandatory field.
Along with EMR adjustments, the nurse leaders used surveys, frequent communication, education on the modified HOUDINI criteria, skin care for incontinent patients, regular updates on CAUTI rates and catheter utilization, and a reward system.
University Hospital has seen a 5% drop in catheter utilization rates in the last fiscal year in the ICUs and a 2% drop in catheter utilization rates on the floors (non-ICU beds.) The team is working to roll out the proven protocols across the hospital.
Join Eileen Phillips RN MSN, CIC, Infection Control Professional, at the Cerner Health Conference for her presentation entitled CAUTIon! A Process Improvement for Catheter-Associated Urinary Tract Infection on November 4, 2014 at 1:30 PM.
The University of Missouri Hospital’s Pathology Department partnered with Mayo Medical Laboratories as the hospital’s sole Reference Lab in 2014. The Tiger Institute partnered with the MU Pathology Department, the Cerner Reference Lab Network, and the Mayo Medical Laboratories teams to electronically interface the orders and results from MUHC bi-directionally to Mayo Medical Laboratories ensuring accurate and on time results for patient care.
Our health information exchange (HIE) gives care teams access to patients health care information from disparate sources – this allows care teams to know our patients and provide better care. Over the past year, we have enhance the value of health information exchange for the Tiger Institute Health Alliance (TIHA).
In addition to sharing information among the Health Alliance membership, which consists of 16 hospitals, 140+ clinics, 2 skilled nursing facilities, and 750+ employed providers, TIHA has begun collaboration with other HIEs throughout the Midwest.
In early 2014, TIHA began sharing information with the Lewis and Clark Information Exchange (LACIE), an HIE that serves the greater Kansas City metropolitan region. This connection was one of the first HIE to HIE connections in the country. Since February, we’ve had 2,800 searches run between the two HIEs.
Join Michael Seda, Director of Business Development – Tiger Institute, at the Cerner Health Conference for his presentation entitled Community, State-Wide and Regional Approaches to HIE and Data Interoperability, on November 4, 2013 at 2:45 PM
COLUMBIA, Mo. — University of Missouri Health Care has been ranked among the 12 top performing academic medical centers in the 2014 Quality and Accountability Study for delivering high-quality, safe, efficient, patient-centered and equitable care.
UHC, a Chicago-based alliance of the nation’s leading nonprofit academic medical centers, announced Oct. 23 that MU Health Care has been awarded a 2014 UHC Quality Leadership Award.
“One of MU’s core values is excellence,” said R. Bowen Loftin, chancellor of the University of Missouri. “This is one more confirmation that we continue to strive for — and achieve — excellence in all we do, including health care.”
“MU Health Care received this national quality award for demonstrated excellence in patient care,” said Mitch Wasden, MU Health Care chief executive officer and chief operating officer. “We’re proud to be recognized for the superior care we provide to our patients.”
The UHC Quality Leadership Award uses a unique and in-depth methodology and ranking system based on data analysis from the annual Quality and Accountability Study, which was designed to help academic medical centers identify structures and processes associated with high performance in quality and safety across a broad spectrum of patient care activity.
“UHC commends these academic medical centers for their strong commitment to providing high-quality patient care throughout their clinical enterprises,” said Irene M. Thompson, UHC’s president and chief executive officer.
The Institute of Medicine’s six domains of care — mortality, effectiveness, safety, equity, patient centeredness and efficiency — were used as a guide in structuring the study. The composite scoring system uses a comprehensive approach to analyzing patient-level data from the UHC Clinical Data Base/Resource Manager™ as well as data from the UHC Core Measures Data Base and the publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems.
“As evidenced by their performance on the measures in the Quality and Accountability Study, these organizations exhibit the fundamental characteristics — shared sense of purpose, successful leadership style, accountability mechanisms, focus on results and collaboration — of top-performing academic medical centers,” Thompson said.
This year, UHC’s award methodology was refined with enhanced measures related to safety, including data on hospital-acquired infections from the Centers for Disease Control and Prevention’s National Healthcare Safety Network and new metrics on venous thromboembolism based on the Joint Commission’s National Quality Core Measures. For more information, visit www.uhc.edu.
The 2014 UHC Quality Leadership Award winners are:
- NYU Langone Medical Center
- Mayo Clinic Hospital – Rochester
- The Ohio State University Wexner Medical Center
- Beaumont Hospital, Royal Oak
- Rush University Medical Center
- University of Utah Health Care
- The University of Kansas Hospital
- Emory University Hospital
- University of Missouri Health Care
- Cleveland Clinic
- Houston Methodist Hospital
- Memorial Hermann-Texas Medical Center
Identifying alternative care and payment models that align incentives for individuals, providers, and payors (including employers) will accelerate delivery system transformation. These changes give us our greatest opportunity to positively impact population health, costs, and outcomes both in Missouri and across the country.
In partnership with the Tiger Institute, MU Health Care is positioning itself for success in a value-based system where payment is increasingly linked to outcomes and cost. We are focused on transforming the care delivery system, where most of the value is created and where most of the costs are incurred. We have five strategic initiatives that serve as foundations to executing our strategy. Together, these initiatives support quality programs and produce improved outcomes at a lower cost.
To effectively manage a defined population, it is necessary to have a way to systematically identify and track the care and health outcomes of those individuals and of the populations as a whole.
A registry provides clinicians insights into patient panels, allowing them to optimize care and identify and close gaps in care. A registry is also essential to population-based quality measurement and improvement efforts.
Using Cerner’s HealtheIntent platform and HealtheRegistries solution, our initial focus is on six chronic conditions and a number of adult and pediatric care measures.
A comprehensive care management model enables more effective management of patients within and across care settings based on patient complexity and co-morbidities.
The Care Coordination Taskforce is building on our longstanding experience with primary-care embedded nurse care managers (e.g., CMS LIGHT2 grant, MO Health Home initiative). We are also pursuing innovative partnerships to expand care coordination efforts, including payment reform models with the UM System and commercial payors.
The Tiger Institute partnership is invaluable to implementing innovative care delivery and payment reform models that position UMHS and our partners to achieve the best outcomes, experience, and value at the patient and population level, thus advancing our thought leadership position at the national level.
— Keith Mandel MD, Chief Clinical Integration Officer
Managing the health of populations requires effective and efficient communication of information as patients transition within and across settings.
When providers are armed with timely and comprehensive information during transitions, better decisions can be made and care is delivered more efficiently (e.g., less likelihood of duplicating expensive tests).
We are defining a standard information set and communication process that is simple and reliable to access by referring providers. We are exploring different health information exchange technologies to automate this process and enhance knowledge of past care provided to patients.
Measurement and Analytics
The Measurement and Analytics Taskforce is building a population health analytics infrastructure that supports clinical and financial improvement efforts within MU Health Care and among clinical integration partners. This includes identifying and prioritizing measures to facilitate quality improvement initiatives and new payment reform models. These measures encompass those needed for registries, population health scorecards, and local, regional and statewide clinical integration partnerships.
To support these efforts, we are expanding our internal data infrastructure through the Health Analytics Library (HAL), HealtheIntent, and HealtheRegistries. These tools provide the foundation for quality improvement analytics for MUHC initiatives and those involving our external clinical integration partners.
We recognize that the individual is at the center of any population health effort. When provided with information, consumer-friendly tools, and aligned incentives, individuals will help drive better care delivery, utilization, and spending.
We are piloting benefit redesign, wellness incentives, and using our existing patient portal to support University of Missouri employees’ efforts to proactively manage their health. This initiative also includes a new “narrow network” health plan option.
Join Keith Mandel MD, Chief Clinical Integration Officer – MU Health Care, at the Cerner Health Conference for his presentation entitled Leveraging Strategic Partnerships to Accelerate Value Based Transformation on November 3, 2014 at 2:15 PM.
Innovation is a key focus of the Tiger Institute
We are developing new ways to transform the delivery of care. Our engineers and designers collaborate directly with physicians, nurses, researchers, and students.
Projects range from enhancing our EMR to developing unique innovations that can be marketed globally.
In 2014, we focused our innovations on creating e-visit technology, integrating calculators into the EMR, and developing a mental health consumer facing app, which were direct contributions to providing better care, better health and better value. We have summarized additional innovation accomplishments that we achieved this year.
Blood Pressure Percentiles Summary MPage Component
Physicians identified a need to see the patient’s blood pressure percentiles in an easy to understand format. This is important because it allows the physician to identify patterns and make clinical decisions in minimal time, thereby optimizing physician time and improving the patient experience. The component was designed in direct collaboration with physicians in the pediatric, family medicine, and internal medicine departments at the University of Missouri.
CareView Tracking Board
Nurses working the floors at MUHC hospitals often face many challenging time pressures: patients’ needs, physician questions, day to day duties, and heavy case loads, to name a few.
The CareView Tracking Boards help nurses prioritize their time and improve patient care by providing a convenient, always-on window into patient status at-a-glance. Displayed on wall-mounted 42” touch screen monitors, nurses can quickly see which of their patients have STAT orders, new labs results, or special needs, all in a HIPAA complaint manner. The touchscreen provides the interaction necessary for a nurse to quickly filter down the patient list, display patients by status, service, or location, all without logging in to a computer.
InnovATE and Cerner’s DeviceWorks team developed the solution with input from the Department of Nursing. Medical ICU, Oncology, and Surgical Specialties units piloted the tracking boards for over a year. This pilot period has allowed the collaborating teams to fine tune and perfect the solution. It is now being rolled out broadly to every inpatient unit at University Hospital, Women’s and Children’s Hospital, and Missouri Orthopaedic Institute,and is generally available for all of Cerner’s clients.
Framingham Risk Summary Mpage Component
The Framingham Risk Score is a sex-specific algorithm used to estimate the 10-year cardiovascular risk of an individual. Our calculator runs the model with data from the chart. This is important because it allows the physician to identify patterns and provide recommendations to patients to improve their health, thereby optimizing the patient experience and providing a dialogue between the physician and patient. The component was designed in direct collaboration with physicians in the family and internal medicine departments.
The ACS (Acute Cardiac Syndrome) Calculator is a collection of 3 predictive models targeting the risk of heart attack. They are designed to alert a physician to the possibility of a patient dying due to heart attack while an inpatient, or within 6 months of discharge, so appropriate measures can be taken. Additionally, the calculators provide talking points for physicians with their patients about lifestyle choices and the impact they have on heart attack risk.
Care teams at MU Health Care are constantly on the move. Recognizing a need for users to easily transition between different security positions, the InnovATE team, Nursing Leadership, Physician Leadership, and the local Clinical Applications Team collaborated on a new PowerChart MPage. Leveraging existing role type functionality, the MyExperience MPage provides the ability for providers to quickly change their security position. MyExperience offers users the chance to define their starting Organizer and Chart level tabs and the number of charts that they can open concurrently.
Pain Management Summary MPage
The Pain Management Summary MPage was developed at MU as a support tool for clinicians to help manage patient’s pain more effectively. In collaboration with the Pain Management Committee and several pilot physicians, the InnovATE team developed this MPage to provide a scrolling 12 hour view of pain related nursing documentation, meds administration, pain score graph, and vital signs. With this pertinent clinical information in one place, care providers can more easily make informed decisions regarding administration of analgesics and non-pharmacological interventions, and improve patients overall satisfaction with the way their pain is managed.
Online Forms Pilot
Online Forms allow patients to complete required medical reconciliation documentation prior to their visits. The forms are automatically sent to the patient through the Patient Portal based on appointments scheduled. Completed forms are delivered to the provider’s inbox in Message Center for review and the information is automatically applied to the Medication History form in PowerChart.
Innovating Mental Health
According to the National Alliance on Mental Illness, one in four adults experiences mental illness in a given year and adults living with serious mental illness die an average of 25 years earlier than other Americans, largely due to preventable medical conditions.
Because of these facts, the journey to lower health care costs and to create a healthy Missouri cannot afford to ignore mental illness. While there is broad recognition of this problem, there remains an imbalance in supply and demand. While the demand for psychiatric-related services has grown tremendously over the past decades, the corresponding supply of providers — especially in the rural, low income areas, has not.
At the Tiger Institute, we believe we can improve the communication between patients and providers, while also expanding the impact of a single care provider. Through the development of MoodTrek, an innovative consumer smartphone app, the care team gains a depth of knowledge into their patients’ shifting moods, activity, sleep, and experiences at a glance. This level of insight can help providers regulate medications, make treatment changes, and focus on the right issues, rather than just the most apparent ones.
MoodTrek helps providers be confident that they are giving their patients the right medication at the right dose to reach therapeutic levels more quickly, while also allowing them to focus on patients who need the most assistance. This improved ability to triage care allows the rest of the care team to meet the needs of the patient for whom they are best suited.
For many patients, efforts to manage physical health may not be successful unless they can first achieve good mental health. Through new tools like MoodTrek, we seek to empower both our patients and our care teams in achieving better health.
The Tiger Institute has been invited to showcase MoodTrek during a presentation at the American Psychiatric Association’s leading educational conference for public, community, and clinical psychology. Hosted in San Francisco, the Institute on Psychiatric Services garners a crowd of over 1,500 mental health professionals from across the nation.
Join Clayton Hicklin, Sr. Manager – Tiger Institute Innovations, at the Cerner Health Conference for his presentation entitled Innovating at the Edge: How to Take an Idea to the Next Level on November 3, 2014 at 3:30PM
The EMR is an integral part of the physician’s workflow. The feedback from our providers clearly indicates that the initial “one size fits all” design of the user interface is no longer sufficient.
In 2012, Cerner introduced the first Physician Playbook to tailor the EMR to the needs of the provider based on his or her specialty and venue. Since then, the Tiger Institute’s Physician Localization and Optimization Workgroup (PhLOW) has teamed up with Cerner’s physician experience group to implement many of the available Physician Playbooks at MU Health Care.
To date, we have updated eight provider specialties with new security positions in Family and Community Medicine, Dermatology, Nephrology, and Orthopaedic Surgery. These new positions are optimized for efficient navigation and performance, and designed to allow both the user and specialty service the maximum in customizable options and specialty views.
The PhLOW team expects to have implemented additional Playbooks by January 2015 to give six more specialties their customized EMR view.
We were able to push the capabilities of PowerChart to enhance the user experience and efficiency for our providers. I hope our experiences can serve as a model for future roll outs.
— Blake Peterson, MD Orthopaedic Surgery Resident
Join Thomas Selva MD, Chief Medical Information Officer – MU Health Care, at the Cerner Health Conference for his presentation entitled Cerner Specialties: Let’s Get to the Results on November 3, 2014 at 2:15 PM.
University of Missouri was awarded a $13.3 million grant in July 2012 to fund the LIGHT2 research project. Work on the grant application and the subsequent award highlighted the close collaboration between MU Health Care, the Tiger Institute, and Cerner Corporation. More importantly however, it showcased the power of public/private collaboration to rapidly advance the body of knowledge within health care, a fact which played a prominent role in the Centers for Medicaid and Medicare Services’ (CMS) decision to award this grant.
We have helped MU reach industry recognized milestones such as HIMMS Level 7 and the Most Wired awards by bringing in innovative technical solutions and facilitating process change. We also recognize our unique position to support the core academic mission of the University of Missouri, and to help drive fundamental change to the industry through contributions in basic and applied research. Since the LIGHT2 grant award, the Tiger Institute and MU have steadily progressed towards creating an environment in which researchers at MU feel empowered in their academic pursuits as it relates to health and care.
Additionally, in October 2013, MU was awarded a five year grant with funding of $878,177 from the Agency of Healthcare Research and Quality (AHRQ) to develop a center for patient-centered outcomes research. The broad focus of the grant is on improving patient care transitions across health care settings, or from one phase of care to another, which aligns closely with MU’s transition strategy. Cerner’s role in the grant is to provide HealthFacts data and for Cerner Math resources to provide expertise in predictive modeling.
Health care research today is complicated and varied. University of Missouri is well positioned to take on the modern challenges of clinical effectiveness, population health, genomics and personalized medicine, cost and utilization, clinical decision support, and translational research. To help MU reach these goals, we have created a focused strategy around four pillars of research support:
Access to data
Research and funding opportunities
Join Tracy Greever-Rice, Interim Director – OSEDA, MU Health Care, at the Cerner Health Conference for her presentation entitled Leveraging Clinical and Claims Data for Research on November 3, 2014 at 2:15 PM.
The Tiger Institute and Cerner have provided i2b2 (informatics for integrating biology and the bedside), an industry standard informatics research tool that is used by nearly 100 medical centers, academic institutions, and companies. Researchers use the i2b2 query tool against de-identified MU patient data in order to determine the availability of a patient population (cohort) for their studies. Once established, the cohort could be extracted for further analysis under the direction of the Institutional Review Board (IRB) and Honest Broker. There are currently three major data domains available for querying and export:
Pharmacy data mapped to National Drug Code
Lab data mapped to LOINC terms
Diagnoses and procedures mapped to ICD-9
In addition, i2b2 can connect to other institutions through a data sharing mechanism. Tiger Institute and Cerner are also working with MU to pursue participation in the Great Plains Health Research Consortium.
Join Abu Mosa, Director of Research Informatics – MU Institute for Clinical and Translational Science, at the Cerner Health Conference for his presentation entitled Cohort Discovery and Management I2B2 on November 4, 2014 at 1:30 PM
Radiology, pathology, and sleep study results are now available for patients to review in their Healthe portal.
At MU Health Care, medical devices capture a large amount of critical patient data. Traditionally, clinicians have manually recorded the data and entered it into the medical record. This “swivel chair” interface results in:
Delayed entry of data into the EMR — Local studies indicated wide variances in data entry times, ranging from 2 minutes to as long as 8 hours.
Increased clinician workload — Many workflows involved a two-step process in which clinicians recorded data on paper, and then entered it into the EMR at a computer workstation.
Increased opportunities for data entry errors — Studies published in the Journal of Healthcare Information Management indicate that manual data entry yields error rates as high as 13.5%.
Given these findings, we implemented medical device integration with the EMR using three approaches. In the first approach, we deployed traditional HL7 interfaces where the device vendor had already provided its own system of servers for processing data. This approach permitted the vendor’s system to efficiently process the data, and then flow selected data to the EMR.
In the second approach, we worked extensively with Cerner, to use technology developed specifically to facilitate the flow of data to the EMR. Cerner’s CareAware solution employs specialized adapters and servers to process and flow the data from a variety of medical devices. Drivers obtained from each medical device vendor facilitate the connections. This was the most commonly used approach, driving the integration of more types of devices than any other.
In the third approach, we deployed medical devices that already contained the technology required to flow data directly to the EMR, without the need for additional adapters or data conversions. This effort focused on the deployment of vitals sign machines, which connected wirelessly to the hospital’s network, and then sent the data to the record through application servers in Cerner’s data center.
IT personnel and clinicians worked closely together to determine what parameters could be derived from each device, and what data needed to be moved to the EMR. MU Health Care and Cerner partnered to prepare the EMR to accept and chart the data.
We formed the device integration team to bring together critical skill sets from both IT and Clinical Engineering. With a single management structure to combine these two disciplines, we began efforts to use Cerner technology.
Our team integrated FetaLink, VitalsLink, respiratory ventilators, dialysis equipment, cardiac output, and anesthesia ventilators into the EMR, as well as a Real-Time Locating System and other technological innovations, resulting in the following benefits:
Removed risk of error by automating the manual process, achieving labor efficiencies
Removed the 2 minute to 8 hour lag for getting data into the EMR reducing it to as little as 60 seconds or less
Flowed data to algorithms that enable bedside intelligence for clinical decision-making
With a dedicated expert team, and innovative and flexible connection options, we will continue to deliver integrated devices that improve efficiencies and patient safety.
Join Mike Bragg, Director of Tiger Institute Technologies, and Bridgett Robbins RN, Clinical Manager – University of Missouri Health Care, at the Cerner Health Conference for their presentation entitled Improve Safety and Care and Enhance Efficiency Through Advanced Device Integration on November 3, 2014 at 10:30 AM.
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