presentation
TRANSCRIPT
William W. Stead, M.D.
Professor of Medicine and Biomedical InformaticsAssociate Vice Chancellor for Health Affairs
Vanderbilt University
September 28, 2006
Picking an Enterprise TargetPicking an Enterprise Target
Disclosures: McKesson distributes WizOrder as Horizon Expert Orders. I am a Director of Healthstream & Netsilica.
Road Map to the TalkRoad Map to the Talk
Framework to guide thinking about alignment of enterprise and IT strategies
Picking the purpose of IT in your business
Key trends in IT and Informatics that will bear on the art of the possible
One vision of how ready access to information might change health care in the near term
Status check
Enterprise AlignmentEnterprise Alignment
What technical barriers stand in our way? When will technical progress
solve the problem? Is there a work around?
Will technology enable a new entrant to disrupt our business plan?
Will technology enable us to develop a new business model?
What is the purpose of technology in our business?
Framework to guide thinking about alignment of enterprise and IT strategies
Picking the purpose of IT in your business
Key trends in IT and Informatics that will bear on the art of the possible
One vision of how ready access to information might change health care in the near term
Status check
Road Map to the TalkRoad Map to the Talk
Supply Chain & Revenue Cycle Efficiency
– FTEs, – TimeAutomation
Management Decision Support Strategy, Execution
IT Strategy/Benefit Framework IT Strategy/Benefit Framework
Remote Operation Access
Patient Centered Care Quality, – Errors
Context Sensitive Closed Loop – Errors
Communication & Documentation – Errors, – Cost, – FTEs
Clinical Decision Support Quality, – Errors, – Utilization
EfficiencyUtilization of Scarce Resources
Time
High
Low
INF
O U
TIL
ITY
Info. Value Shift
Source
Global
AV
AIL
AB
ILIT
Y
I/T Value
Problems – Solutions – Results
• Correct Testing 1– ICD9– Imaging Advisor
Problems – Solutions – Results
• Correct Testing 2– ICD9– Imaging Advisor
Problems – Solutions – Results
• Correct Testing 3– ICD9– Imaging Advisor
pre-CPOE post-CPOE
Err
ors
pe
r 1
00 O
rde
rs
2.2 1.3
30.1
0.2
6.8
0.10
5
10
15
20
25
30
35
Potential ADE's Medication Prescribing Errors Rule Violations
Potts, A. et al. PEDIATRICS 2004;:113:59-63
Potential ADEsDuplicate therapyInappropriate doseInappropriate intervalInappropriate routeWrong drugAllergyDrug interactionWrong units
MPEsWeight not availableMissing InformationIllegible
RVsTrailing zerosAbbreviation
<0.001<.001
.69
.39
.01
.07
.49
.49<.001<.001<.001<.001<.001<.001<.001<.001
Pre-CPOE (n = 6803) Post-CPOE (n = 7025) P Value
1474
5324
6611
522049
221979
4846655
411
TotalNumber
2.20.060.780.350.090.090.010.010.76
30.10.32
29.090.716.80.816.04
Number Per 100 Orders
880
591901009
120
120
10100
TotalNumber
1.30
0.84
0.270
0.0100
0.130.20
0.1700.1
0.140
Number Per 100 Orders
Medication Drug Errors
Impact of Advanced Dosing on Impact of Advanced Dosing on Potential ADE’sPotential ADE’s
7.3
13.9
2.2* 2.5*
0
2
4
6
8
10
12
14
16
pre- post-
Err
ors
per
100
Ord
ers All orders
Patients < 7 days
*p value < 0.001Wright L, Gregory DF, Barr FE, Patel NR, Waitman LR. Impact of patient-specific decision support on medication errors in critically ill children. Critical Care Medicine. Society of Critical Care Medicine 35th Critical Care Congress San Francisco, CA, January 7-11, 2006. 33(12) Abstract Suppl:A12, December 2005
Clinical Decision SupportClinical Decision Support Costs
Hardware, software, implementation 24 hr receptionist coverage SWAT team during training & go-live Pharmacist to reconcile multiple systems Iterative development of content and process
Benefits Appropriate utilization increases quality while
reducing marginal cost Quality improvement decreases downstream cost Reduced error decreases LOS utilization, and risk
management Quality, safety and cost effectiveness increase
market share
Framework to guide thinking about alignment of enterprise and IT strategies
Picking the purpose of IT in your business
Key trends in IT and Informatics that will bear on the art of the possible
One vision of how ready access to information might change health care in the near term
Status check
Road Map to the TalkRoad Map to the Talk
Technology TrendsTechnology Trends
Convergence of media, computing and communication technologies
More natural user interfaces (voice & 3DVR)
Embedded sensors aware to person, place, time
Just-in-time data mining and simulation
Disruption of publication channels that limit access
Global/Best of Class content creation, organization to meet a purpose, mentoring during use
Faster, smaller, less expensive hardware
Avoiding HypeAvoiding Hype
0
2
4
6
8
10
12
14
16
18
Yr 1 Yr 2 Yr 3
Information Technology
Software Development
PE
RF
OR
MA
NC
ETechnical RealityTechnical Reality
Implications for Technical Approach
User Driven
Communication Data Mining Visualization
Programmed Workflow
Purpose Mechanism
Balance between Human & Technology
Efforts Impact on Process
Reproducibility Adaptability
Information Technology Tool KitInformation Technology Tool Kit
Information Access
Work Flow
Automation
AggregationData MiningVisualization
Communication Work Lists
Context Sensitive Decision Aids
Data Processing & Knowledge Mgmt.
Open Process Control
Robotics
TT/TT/T/T
H/T
H/H/T
H/H/H
H/T
T/T/T
Framework to guide thinking about alignment of enterprise and IT strategies
Picking the purpose of IT in your business
Key trends in IT and Informatics that will bear on the art of the possible
One vision of how ready access to information might change health care in the near term
Status check
Road Map to the TalkRoad Map to the Talk
Work-aroundsSystem
Development
The Healthcare Non-systemThe Healthcare Non-system
System
DesignPractice
System
DesignPractice
Evidence Based System of CareEvidence Based System of Care
Pick Population•Risk•Cost•Variability
Pick Population•Risk•Cost•Variability
Evidence•Research•Guidelines•Practice database
Evidence•Research•Guidelines•Practice database
Workflow• People – Crew Training• Process – Plans, Goals, Actions• Technology Tools – Advisors,
Order Sets, Alerts
Workflow• People – Crew Training• Process – Plans, Goals, Actions• Technology Tools – Advisors,
Order Sets, Alerts
Individualize & Act•Assess•Order•ResultsIndividualize & Act• Assess• Order• Results
Feedback• Trigger/Sentinel Events• Process Outcome• Clinical Outcomes
System
DesignPractice
Individualize & Act• Assess• Order• Results
Workflow• People – Crew Training• Process – Plans, Goals, Actions• Technology Tools – Advisors,
Order Sets, Alerts
Evidence•Research•Guidelines•Practice database
Feedback• Trigger/Sentinel Events• Process Outcome• Clinical Outcomes
Pick Population•Risk•Cost•Variability
Evidence Based System of CareEvidence Based System of Care
Vignette from a System of CareVignette from a System of Care
The clinician and patient are “on the same page,” the approach is standardized yet individualized
Complementary and alternative approaches to health improvement work in combination with scientific medicine
The patient is a full partner in tracking their progress and adapting course
The patient’s plan is updated proactively as standard of practice evolves
Roles & Process ChangeRoles & Process Change
Evidence
Patient Record
Synthesis & Decision
Clinician
Clinician and Patient are PartnersClinician and Patient are Partners
Evidence
Patient Record
Provider
Personalized Knowledge
Base
Patient
New Skills are NeededNew Skills are Needed
Teamwork, problem solving and coaching
Guiding a data-driven system of care
Privacy, confidentiality, security
Learning at “teachable moments”
Finding, assessing and applying ‘just in time’ information
Managing change
Infrastructure Requirements ChangeInfrastructure Requirements Change
Information Islands
Discipline specific information and records
Task specific systems, each with its own record
Each note stands on its own
Common Information
Aggregate information from all sources
Provide views specific to experience and roles
Link into role specific workflow tools
Framework to guide thinking about alignment of enterprise and IT strategies
Picking the purpose of IT in your business
Key trends in IT and Informatics that will bear on the art of the possible
One vision of how ready access to information might change health care in the near term
Status check
Road Map to the TalkRoad Map to the Talk
State of the Art 2006State of the Art 2006
Life-Time Patient Record Remote Operation Continuous/Personalized Medicine Industrial Engineering Models for Scheduling
Re
sea
rch
Sta
nd
ard
of
Ca
re Access to Medical Literature, Test Results,
Transcription Data Driven Practice Modification & Contracting Supply Chain/JIT Inventory Revenue Cycle Management
Se
lec
tive
U
se
Point of Care Systems Patient Portals Electronic Data Interchange (Direct) Telemedicine Consultation Clinical Trial Management
Execution ChallengesExecution Challenges
Aligning strategy and infrastructureAligning strategy and infrastructure Managing discontinuous changeManaging discontinuous change Building trustBuilding trust Focusing organizational energyFocusing organizational energy Leveraging intersectionsLeveraging intersections Maximizing returnMaximizing return
ResearchMission
2010
InformaticsCenter
Process & Infrastructure
ManagementDecisionSupport
EducationMission
ClinicalMission
Direct Care Layer
Support of Direct Care Layer
Unit/Service/
Clinic Support Layer
>
>
>
>
Informatics Center 5-Year Plan
Major Project Groups Supporting Milestones
>
Curriculum Appropriate to a System
of Care
20072005 2006
Breakthrough from Focused
Interdisciplinary Research Team
MedicationSafety
Best-of-ClassAcross
Continuumof Care
20092008
Culture that Values Evidence
Based, Individualized,
Systematic Care
Overview of RoadmapOverview of Roadmap
Pt. IDLab
Specimen Plan
Patient to Provider
MessagingWidely
Available
Decision Symbols
Go-Live Date Symbols
Roadmap SymbolsRoadmap Symbols
High Level GoalsCulture that
Values Evidence Based,
individualized, Systematic Care
Skills for All TimesSkills for All Times
Comfort the patient
Recognize patterns
Know what you do not know
Reflect the patient’s values
Observe the patient