Signature Initiative Teams Update
SI Team 1
Investing in Quality and Utilization Infrastructure
Key information systems-related goals here involve implementation of computerized provider order entry (CPOE) and electronic medical records (EMR). By the end of 2006, all the PHS acute care hospitals will have completed CPOE implementation. EMR adoption is proceeding, with 80-90 percent of academic medical center physicians using the EMR, and 36 percent of PCHI community primary care physicians on board and 24 percent with signed commitments, though adoption by community specialists has been low.
For FY06, the focus will be on encouraging comprehensive use of the EMR by physicians to include prescribing by computer, using the alerts and reminders effectively and keeping problem lists and medication lists current.
SI Team 2
Enhancing Patient Safety by Reducing Medication Errors System-Wide
This team has ongoing projects in three areas: medication administration, electronic error-reporting and transfer of critical patient information from acute to non-acute settings. All acute care hospitals have budgeted for or have partially implemented electronic medication administration record (eMAR) systems and “smart pump” purchases. For error-reporting, Team 2 is working on two fronts: electronic error-reporting (the team believes that converting from paper reports will encourage reporting and improve data-gathering capabilities so clinicians can learn more about types of errors and “near misses”), and electronic surveillance systems, which allow the convergence of real-time lab data with pharmacy data to flag potential errors. In terms of patient data transfer, Team 2 developed an innovative way to track and measure seven critical data elements needed by the receiving non-acute settings when a patient is transferred from acute care.
Most Partners entities (except McLean) will adopt 4NEXT, an electronic patient referral and discharge data transmission tool, which Team 2 believes will help raise the rate of complete “good data” transfers to 55 percent.
SI Team 3
Enhancing Uniform High Quality by Measuring Performance to Benchmark for Select Inpatient and Outpatient Conditions
Goals for this team center on evidence-based measures for inpatient and outpatient cardiac, diabetes and, this year, pneumonia care. Across all HEDIS measures for diabetes care, PHS performed above the 90th percentile. PHS hospitals achieved inpatient cardiac guideline goals 92 percent of the time, and exceeded the 90th percentile on over half of the measures. Ultimately, Partners’ self-imposed goal for all these measures is to exceed the national 90th percentile for publicly reported measures wherever those benchmarks are available. Team 3 also added a PHS-wide inpatient smoking cessation initiative this year.
For FY06, Team 3’s goal is to reach or surpass the 90th percentile on at least three-quarters of the benchmark opportunities for inpatient cardiology, pneumonia and smoking cessation measures, as well as for outpatient diabetes care. Among the enhancements to their efforts this year will be implementation and evaluation of electronic decision support and comprehensive registries to support diabetes improvement.
SI Team 4
Expanding Disease Management Programs
Patients at high risk for hospitalization have been the focus of Team 4’s work. Goals have centered on identifying the high-risk population and connecting those patients to systems that can improve their health and lessen the likelihood of hospitalization. For heart failure patients, a screening-and-triage system is being implemented at the PHS acute care hospitals so that patients are connected with an outpatient heart failure program once they are discharged. Twelve percent of the low-income or uninsured patients seen by PHS PCPs have been identified as being at high risk, and more than half of these patients have agreed to work with a nurse health coach through the Health Dialog program.
In FY06, Team 4 expects to complete the screening and triage system for heart failure patients and to further integrate the health coach program by providing nurses with access to the PHS Clinical Data Repository. And the team will continue to pursue the implementation of a predictive modeling system that could provide alerts to patients requiring intervention before an actual admission.
SI Team 5
Improving Cost-Effectiveness through Managing Utilization
Team 5 developed and implemented radiology management systems that offered an alternative to the prior-authorization programs introduced by the Commonwealth’s three major payers, and offered a series of educational efforts targeting nuclear cardiac testing and use of CT/MRI for head, neck and back. In the pharmacy area, guidelines for the use of high-cost drugs at PHS acute care hospitals have been developed and are being implemented, and a committee has been formed to work on creation of decision support to enhance the cost-effectiveness of prescribing patterns.
For FY06, Team 5 will continue these efforts, which may involve increasing the use of decision-support software for radiology management and other initiatives aimed at curbing the use of inappropriate imaging.