Advancements in Analytics
MU Health Care and the Tiger Institute are committed to ensuring value-driven outcomes for our patients through the collaborative delivery of intuitive and prescriptive information, which enables agile, data-driven decisions by clinical and operational leaders.
Over the last year, analytics leaders from various business and clinical domains have come together to create a strong, inclusive governance structure; develop the roadmap for the future; and provide advanced analytics to support the university’s strategic goals.
Using a centralized strategy with decentralized teams, we have a single point of intake for the organization’s analytics requests. By working together in this way, we can reduce confusion for end-users, eliminate redundancy and inefficiency, and create transparency across the organization. This methodology also will help us better understand and meet our broad analytics needs.
Key components of our prioritized roadmap to support value-based outcomes include:
- Enhancement of existing enterprise data warehouse (EDW) capabilities
- Development of an analytics hub
- Establishment of strategic communication points
Taken together, these steps will help us ensure our analytics strategy aligns with the needs of various business and operational leaders.
Our EDW roadmap builds on existing Tiger Institute-developed EDW/Business Intelligence (BI) capabilities, which have historically focused on the Revenue Cycle space.
We have made remarkable progress since launching our Value Driven Outcomes and Analytics structure in January,” said Kristin Hahn-Cover, MD, chief quality officer. “This leadership team rapidly articulated our desired future state, with deep insights into the information, collaboration, and support needed to get us there.
In particular, the HealtheIntent population health platform has enabled us to develop clinical and claims-based EDW capabilities for the first time. Our plan is to create a true EDW by moving all data into a single repository.
We are also planning for one centralized analytics hub for finding and serving analytics deliverables. This hub will allow us to improve efficiencies and transfer knowledge throughout the organization.
Building on this work, we designed and built a new series of cardiovascular service line insights. Through our collaboration and our scalable EDW and BI capabilities, we can expand these insights to all clinical service lines to create cohesive, directional information for decision making support throughout MU Health Care.
2/21/19 | Delivering Results
Managing Emergency Department Overcrowding With NEDOCS
In collaboration with Cerner’s Emergency Medicine group, Tiger Institute developed the National Emergency Department Overcrowding Score (NEDOCS) component for display on the ED Real Time Dashboard. The NEDOCS algorithm provides an overcrowding score based on factors in the ED, including number of waiting patients, free beds, and ED patients on ventilators — among others.
By sending alerts to providers and hospital administration, staff can mitigate the factor(s) contributing to department overcrowding, and to get patients seen and moved to the appropriate level of care more quickly.
Our development work is available to the broader Cerner ED Dashboard client base, and as such, the NEDOCS component and alerting system now provide value to more than 15 health systems.
Making Surgery Easier for Patients and Families
Team InteGrated Enhanced Recovery (TIGER) is a new protocol, which helps MU Health Care better prepare patients, shorten hospital stays, make pain more manageable, and reduce direct costs associated with radical cystectomy (a procedure where surgeons remove all or part of the bladder.) Because of the protocol’s success, the team is adapting it to impact other kinds of surgical procedures.
Tiger Institute associates and MU Health Care staff members built new tools in the EHR to track patients’ progress and lay out a daily care plan. A nurse navigator helps guide each patient along all steps of his or her surgery — from preparation to post-operation.
Improved pain management
The TIGER protocol encourages preemptive pain medications and informs patients about alternatives to narcotics for pain management.
Three days after the operation, patients in traditional care used a total median of 413 morphine milligram equivalents (MME), while those using the TIGER protocol had a median of 275 MME.
Improved care plans, fewer drugs and other improvements helped patients spend less time in the hospital. Those who experienced the normal procedure had an average length of stay (ALOS) of 10.5 days. However, those who used the TIGER program had an ALOS of only six days.
Patients didn’t realize they were going home four days sooner,” said Mark Wakefield, MD, associate chief medical officer. “They were better prepared for surgery, more engaged in their own recovery, had less post-operative pain, and returned to a better condition sooner after surgery.
A reduced length of stay, along with fewer drugs and other items related to surgeries, helped reduce the median cost of a cystectomy surgery by 25%.
Similar work continues to improve other major surgical cases, such as liver or pancreas resections, colon surgeries and lung surgeries. These teams have already started developing protocols and are in various stages of implementation.
1/24/19 | Empowering Wellness
MU Health Care Surpasses Readmissions Goals for Congestive Heart Failure
To improve patient outcomes, MU Health Care staff set a goal to lower congestive heart failure (CHF) readmissions by 5%. The EHR intervention project proved so successful, MU Health Care cut CHF readmission numbers by nearly a third. The project received the MU Health Care CEO Award, which recognizes innovative solutions to complex problems.
The improvement team worked with cardiologists and other key stakeholders to build tools and develop an algorithm within the EHR to lower CHF readmissions. The algorithm digs through EHR data, comparing information from the current admission and the patient’s medical history to determine if the patient may have CHF. If the algorithm identifies the patient, it prompts several possible actions. For example, in some cases, a physician receives an alert informing him or her the patient potentially suffers from heart failure. In most instances, however, when a patient is identified with heart failure, the provider does not receive an alert.
To remove ordering burden and alert fatigue, the algorithm automatically fires certain tasks to appropriate care team members. For example, it prompts nurses to take daily weight and inputs and outputs, patients to view CHF-related videos and the pharmacy and nutrition teams to perform specific tasks. The cardiac rehabilitation team also receives tasks for education and outpatient cardiac rehabilitation.
Communication between teams is vital,” said S. Hasan Naqvi, MD, associate chief medical officer. “Using technology allows us to increase communication, better assess patients, and ultimately, make significant improvements in patient outcomes.
Projects like this, where IT staff join clinical performance improvement teams, bring success with the combination of the robust IT solutions and the diligent work of MU Health Care clinicians.
This algorithm is now available as a standard for all Cerner Millennium implementations.
Blood transfusions have the power to save lives. But when used inappropriately, they can harm patients, generate excessive costs and waste an important, limited resource.
Armed with studies showing up to 40 percent of transfusions in the U.S. are unnecessary(1), University of Missouri Health Care leaders saw an opportunity to improve patient safety and reduce costs by implementing a red blood cell (RBC) transfusion clinical decision support alert.
The Big Bang Theory at MU Health Care and Capital Region Medical Center
MU Health Care is replacing its legacy revenue cycle system (GE/IDX), which has been in place for nearly 40 years, with Cerner’s Revenue Cycle.
Cerner was the clear choice to help us achieve clinical and financial integration throughout our health system and optimize the revenue cycle,” said Jonathan Curtright, CEO, MU Health Care. “MU Health Care and Cerner have a long-standing relationship. We share a similar vision of health care for the next five, 10, 20 years and beyond.
MU Health Care will integrate Cerner’s registration, scheduling, patient accounting and practice management solutions, and transaction services with the existing Cerner Millennium EHR.
Integrating this data will help MU Health Care streamline the financial experience for staff and patients while controlling the organization’s cost to collect.
Concurrently, Capital Region Medical Center is implementing Tiger Institute’s instance of our EHR and other Cerner applications at MU Health Care, replacing CRMC’s current EHRs (Meditech and eClinicalWorks).
Separately, these are both major projects. But to make things more interesting, we decided to combine them into one big bang go-live scheduled for March 2020. Hundreds of associates from Cerner, CRMC, MU Health Care, and the Tiger Institute will help us ensure we have a smooth transition to the new platforms.
MU Health Care’s and CRMC’s transitions to one integrated system will give doctors and nurses access to one complete digital record of their patients’ health history, including clinical and financial data, which will help them improve outcomes.
Precision Medicine Collaborative Forum
In 2018 Tiger Institute partnered with the newly formed MU School of Medicine Center for Bio-Medical Informatics (CBMI) to launch the Precision Medicine Collaborative Forum. Together, we plan to facilitate the formulation, launch, and support of multidisciplinary collaborative research projects. Our primary focus will be on research programs that improve human health care and outcomes.
For investigators who want to participate in the collaboration, we assess project requests in line with the forum’s charge to create, participate in and support collaborative multidisciplinary health care and patient outcome improvement research projects.
The forum meets bi-weekly with an open invitation to all clinical investigators with relevant research interests.
We plan to increase investigator productivity (e.g., more publications and external funding) by supporting them with:
- EHR data
- Data science/informatics
- Innovating within the clinical workflow
Solution Partner Testing
Tiger Institute is a valued tier one member of Cerner’s Solution Validation Partner Program. We have consistently ranked in the top one or two clients every quarter in volume for the last four quarters.
We partner for more pre-general availability projects than any other client, sharing what we learn and identifying defects to improve the software.
For the 2017 calendar year, we partnered on 91% of all pre-general availability projects when we had the corresponding workflow and solution already in use.
Some additional highlights over the last four quarters include:
- Identified 100% of defects prior to go live
- Averaged less than 100 days for project duration
- Improved cross-organization collaboration
Some examples of the projects we tested that are now live in the production environment include PowerChart Touch ONE Doc App Advancement, Know Me View, SMART Zone, Waveform, ED Real Time Dashboard with NEDOCS details, and Video Visits—Cloud App Development.
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