reducing patient harm and improving quality through...
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Proprietary and Confidential. Please do not share.
Reducing patient harm
and improving quality
through technological
innovation
Laurie Anne Buckenberger MSN, ANP
Vice President, Information Technology
Mount Sinai Health System
Robbie Freeman, MSN, RN, NE-BC
Assistant Director, Nursing Quality Initiatives
Mount Sinai Beth Israel
About Mount Sinai Health System
▶ Founded in 1852
▶ 3,535 beds across 7 hospital campuses
▶ 135 operating rooms
▶ 6,200 physicians
▶ 2,000 residents and fellow
▶ 36,000 employees
▶ 170,000 inpatient admissions
▶ 2,600,000 non-ED outpatient visits
▶ 500,000 ED visits
▶ 18,000 babies delivered per year
▶ 542 medical students and 600 graduate
students (PhD, MPH, MD/PhD,
Masters)
▶ 5,100 faculty
▶ School receives $214M in NIH funding
▶ MSH and MS Queens are HIMSS
EMRAM Stage 6 Hospitals
3
MSHS IT At a Glance
4
Our Team
▶ The IT Leadership Team is comprised of the CIO
and 14 senior leaders
▶ Total authorized staff for IT is ~750FTEs
▶ IT staff are concentrated at our Corporate Services
Center in Midtown and data centers at MSH and in
Secaucus, NJ
Our Finances 1
▶ 2015 IT Operating Budget: $175M
▶ 2015 IT Capital Budget: $54.0M
1 Includes School of Medicine, but not Scientific Computing
Our Customers
The IT Team supports:
▶ 144 Remote Clinical and Administrative Sites
▶ >40,000 End-Users, including:
▶ >20,000 Epic users
▶ (Inpatient & Ambulatory EMR at MSH,
MSQ, and some BI and SLR practices)
▶ >17,400 PRISM users
▶ (Inpatient EMR at BI and SLR)
▶ >3,400 eClinicalWorks users
▶ (Ambulatory EMR at many BI and SLR
practices)
▶ >800 Meditech users
▶ (Inpatient & Ambulatory EMR at NYEE)
Our Environment
The IT Team operates and supports:
▶ 6 Data Centers
▶ Mount Sinai Icahn Building (11,000 sq ft)
▶ BI-SLR Secaucus (4,360 sq ft)
▶ Mount Sinai Hess Center (2,350 sq ft)
▶ Beth Israel-Fierman (2,200 sq ft)
▶ Roosevelt-Winston (1,150 sq ft)
▶ NYEE (400 sq ft)
▶ > 54,000 Phone Lines
▶ > 750 Applications
▶ > 27,000 Workstations
▶ > 5,800 Printers and Scanners
▶ > 6,200 MSHS-owned Smartphone Devices
Struggling to meet the need
“To succeed in a tough environment,
we need micro optimized solutions to fill the obvious gaps in our
systems” Chief Nursing officer’s, Chief Medical Information Officer’s, Chief Quality Officer’s, Chief Information Officer’s and Chief Patient
Safety Officer’s
Difficult Economic Headwinds
• Declining reimbursements
• Increasing shared risks
• Fierce competition
• Razor thin margins
Resource Constraints
• Budget constraints
• Staffing
• Fierce competition
In today’s healthcare environment organizations face…
…but must continue to deliver on Quality, Safety, Risk
Management and Patient Satisfaction
EMR Gaps
• Do not quite meet the need
• Too hard to get information
• Technology fatigue after often
arduous implementation
Targeted Innovation Needs
Improve quality and
safety scores
Lower hospital costs
Early identification of high cost
hospital events
Reduce LOS Improve patient
satisfaction
Micro Optimization…Filling in the gaps
Micro-Optimization
Innovation Partners
“Mt. Sinai was seeking ways to use mobile technologies to energize our clinical community
and provide new innovative cutting edge technology at the point of care”
Proprietary and Confidential. Please do not
share.
From Use Case to Go Live
Used Lean and Agile methodologies to deliver highly
successful applications
Immediate measureable benefits
• Reduction in Key Clinical Goals
• Migration from paper to automated systems -
Near Real Time data
2 products - 6 months
Rapid Innovation
Tied to System Quality Goals
4 Hospitals – 100 users
“I use the Konnarock system on a daily basis. In my job, it helps me to avoid incidences of
CLABSI’s by unit as well as provides the ability to assign patients for follow up to specific nurse
managers. The system is intuitive and easy to learn.”
Laurie Anne Buckenberger ANP, MSN
VP IT , Mount Sinai Health System
Robbie Freeman, MSN, RN-BC
Assistant Director, Nursing Quality Initiatives
I. Using a Framework for Partner Engagement
II. Pre-Discovery Process
III. Capability Curve Mapping – Where do we want to be
IV. Deep dive user engagement workflow mapping
V. Build and Deploy
Framework for Partner Engagement
Pre-Discovery Example
Capability Curve Mapping
Post-Discovery Example
Deep Dive Session with Proven Tools
High Value Workflow Driven Apps
▶ QCRM – Key Users – Infection Prevention, Quality/Safety, Nurse Managers
– Identify at risk patient population for potential intervention with high risk devices and MDRO’s
– Standard of care observation/audits
▶ NQM – Key Users – WOCN’s, Quality/Safety, Nurse Mangers, Staff Nurses
– Identify at risk patient population for potential skin integrity intervention
– Survey at risk patient population
– Submit data to Press Ganey
▶ KRM – Key Users – CNO/CMO/CSO, Physician/Nurse Dyads, Quality/Safety, Nurse Managers, Staff Nurses
– Identify at risk patient population for potential intervention
– Early sepsis recognition
– Provide visibility into care process measures and gaps in care
NQM Nursing Quality Manager
QCRM Quality Care Risk Manager
RM Risk Manager
KRM Risk Manager
Shine a spotlight on skin
integrity to improve patient safety
Mobile bedside risk and care assessments
Automated Press Ganey submission
Map risk and safety data into existing workflows and display interventional data real time
Identifies At Risk and high risk patient populations and provides easy to use application to identify, monitor, intervene
Give providers a quick, consolidated , easy view of key real-time risk and safety data to improve patient care
Give CXO's, Quality and Safety a risk associated profile of unit and facility census based upon predefined clinical criteria
Why did we go after it?
Cloud Mobile Easy
Highly Intuitive
Pluggable Rapid Time to
Value
Demo
IT - Rapid Time to Value
Low Effort
• Up and running within a
matter of days
• Quick cloud based
implementation
• Configurable data element list
to choose from
• Simple intuitive User
Interface minimizes training
• Integrates with EMR -Accepts
all types of data
Key Decisions
• Data sources
• Data elements
• Apps in suite
• On-premise vs. Cloud
• Number of users
Integration
• Mapping based on data
elements selected
• Connections based on data
sources
Vendor Resources
• Dedicated concierge
implementation
• Bundled program
management and integration
resources
Health System Resource
Requirements
• Part time project manager – 5
hours per week for 4 weeks
• Clinical champion (CNO,
CMO, CQO) – 5 hours per
week for 4 weeks
• Nursing resource – 5 hours per
week for 4 weeks
• IT Resource – 5 hours per
week for 4 weeks
Key Takeaways
▶ Move Seamlessly from the office to the bedside
▶ Workflow design and process improvement supported by technology
▶ The carrot's just as important as the stick - using incentives for positive
reinforcement
▶ Success Metrics
Q&A
APPENDIX