Best Practices:
Adventist Creates Quality Dashboard Using Cerner EMR System
Volume 1, Issue #9
June 5, 2008
After struggling with challenges at some of its pilot sites, Adventist Health System, headquartered in Winter Park, FL, is implementing a quality measures dashboard tool in all 36 of its hospitals.
The dashboard gathers information from Adventist’s Cerner Millennium EMR, measures outcomes based on national quality measures, and alerts clinicians in real time, explains Phil Smith, MD, Adventist Health’s chief medical information officer.
“For instance, if a physician orders a particular antibiotic for a patient with pneumonia, the quality data may say a different antibiotic is more appropriate, based on the patient’s risk factors,” Smith says. “The system will alert the pharmacist and he can then call the clinician to confirm or change the medication. Then the measure is met and the best care is provided.”
Adventist Wanted Immediate Notification of Quality Measures Compliance
In August 2006, Smith and other Adventist officers were trying to decide how to create a reporting system that would catch quality measures and assist in patient care. Unfortunately, Smith says, terminology was not clearly defined and those measures could not be captured in the health system’s EMR.
Adventist was abstracting quality data, says Smith, but two to six weeks after discharge – a system that offered little benefit to the patient or clinician. The organization decided to use Cerner’s EMR outcomes tools combined with newly created modules that provide immediate notification of compliance.
The health system’s scorecard was in a rudimentary form in the beginning, but it has become more integrated into daily workflow, Smith says. For instance, Adventist recently added smart templates that bring in associated documentation recorded elsewhere in the chart.
“The system serves a lot of purposes,” Smith says. “It provides a structure for the data, it gives immediate feedback to clinicians, and as clinicians see the structure again and again, they become educated as to what the actual quality measures are.”
Quality Dashboard Gives Green Check or Red X
One emergency quality measure, for example, requires patients with chest pain or other cardiac symptoms to have an EKG administered within ten minutes of arrival and then read by a physician. The quality dashboard indicates when the test was performed and when it was read, flagging it with either a green check mark or a red X. That mark stays on the patient’s chart as a reminder of success or failure to meet the standards, says Smith.
The system also allows Smith to provide Adventist’s quality team with a daily list of patients who qualify for measurement, along with a report of how each hospital is doing. It also produces an end-of-the-month report with aggregated data about measured populations and success rates.
Implementing the dashboard tool at Adventist’s pilot sites was not without hurdles, says Smith. The measures had been the responsibility of abstractors and not clinicians providing bedside care. Convincing nurses and physicians to accept actionable data in their workflow proved to be a major challenge, he says. He advocates active, top-to-bottom leadership for success.
“A provider who is doing this has to understand that success begins with the leadership at the top of the organization understanding the goal and empowering everyone to achieve that,” Smith explains. “Without this leadership, it can become one more thing clinicians feel like they have to do.”
At its first pilot site, the performance improvement office ran the project. That was a big mistake, says Smith, who stressed the need for a larger, team-oriented approach.
Cerner Helped Develop System, Will Sell It
Cerner played a pivotal part in providing technical support and rule development, says Smith. After Adventist developed the scorecard, the health system partnered with Cerner to further develop it for upcoming versions of its EMR. The system is now in its second generation, with scorecards in place for nursing, emergency, surgery, and outpatient care. The next step, he says, will be CPOE.
“Cerner has already taken this to other hospitals, including North Kansas City Hospital, and it is now available for all clients,” Smith says.
Cerner and Adventist also created style guides and are developing a package that will allow other Cerner customers to have their dashboard scorecards up and running in less than six weeks, says Smith. “They can start at zero and get the benefit of our 18 months of learning.”
Hospital’s Clinicians Appreciate Notifications
At Adventist’s Florida Hospital Fish Memorial in Orange City, FL, clinicians have successfully adapted to the scorecard and have come to appreciate the documentation notifications, say Sue Fowler, RN, BSN, MBA, the hospital’s chief nursing officer.
It took some time, she adds, because there is so much detail built into the system and there were many rules to learn.
“The system links to the medical record and then links to the core measures from CMS so we can see if our documentation requirements have been met,” Fowler says. “What we’ve tried to do with the scorecard is take the multitude of quality information from CMS and make it quick and easy to understand.”
While Fowler predicts that the system will help the hospital in future pay-for-performance initiatives, she says the bigger goal is establishing a standard of care for patients.
“We hope that we can change an industry to a paradigm of making sure we can capture data and give the best care, not spend our resources chasing after data,” Smith says. “The data is just a confirmation that the actual care is at a certain level and we need to look at it that way.”
— Correspondent Maureen McKinney