May / June 2012
Stories of Success!
Case Studies Show Health IT Improves Safety and Quality
The Stories of Success! Project is focused on two goals: the first, to solicit case studies demonstrating how healthcare information technology (IT) is leveraged in support of the National Quality Strategy, the development of which was required by the Accountable Care Act (ACA), the Partnership for Patients Goals (PfP), the National Priorities Partnership (NPP) recommendations for national focus and The Joint Commission National Patient Safety Goals (NPSG) and the second, the use of the Standards for Quality Improvement Reporting Excellence (SQUIRE) to submit case study reports. The project is sponsored by HIMSS under the aegis of the Quality, Cost, and Safety Committee. The American Society for Quality (ASQ), National Committee for Quality Assurance (NCQA), and National Patient Safety Foundation (NPSF) are co-sponsors. This article describes the project; background of the NPP recommendations, the NPSGs, and Partnership for Patients goals; marketing of the call for case studies; how the case studies are reviewed and selected; and overview of a winning Texas Health Resources Case Study.
National Priorities Partnership
The National Quality Forum (NQF) convened a group of 28 stakeholders—the National Priorities Partnership (NPP)—to develop criteria, which include: focus on high leverage areas, align and harmonize efforts; and accelerate the need to emphasize speed of change. The six NPP national priorities are: improve population health, engage patients and families, improve safety and reduce harm, ensure well-coordinated care, grant appropriate and compassionate care for patients with life-limiting conditions and reduce overuse and waste. Recently, NPP has been tasked by the Centers for Medicare & Medicaid Services (CMS) to facilitate collaboration in support of the NQF and the PfP. Full explanation of the NPP Priorities is available at http://www.qualityforum.org.
Partnership for Patients
Using as much as $1 billion in new funding provided by the Accountable Care Act (ACA) and leveraging a number of ongoing programs, the Department of Health and Human Services (HHS) launched the Partnership for Patients in 2011. Partnership for Patients is a national effort of public and private partners to achieve the two core goals: 1) keeping patients from getting injured (i.e., reducing harm) and 2) improving transitions to and from acute-care hospitals to other care settings, like home or a skilled nursing facility, with an explicit focus on reducing re-admissions. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable, and less costly. To read the nine areas of focus of the Partnership for Patients go to: http://www.healthcare.gov/compare/partnership-for-patients/safety/index.html
National Patient Safety Goals (NPSG)
The Joint Commission established the National Patient Safety Goals (NPSG) in 2003 to help accredited organizations address specific areas of concern in regards to patient safety. The NPSGs are updated annually. The purpose of the NPSG is to promote specific improvements in patient safety. They highlight problematic areas in healthcare by providing evidence and expert-based solutions to the safety issues presented. Recognizing that sound system design is intrinsic to the delivery of safe, high quality healthcare, the NPSGs focus on system-wide solutions, wherever possible.
To read the 2012 Hospital NPSG’s go to: http://www.jointcommission.org/assets/1/6/2012_NPSG_HAP.pdf
To read the 2012 Ambulatory National Patient Safety Goals go to: http://www.jointcommission.org/assets/1/6/2012_NPSG_AHC.pdf
Louis Diamond, MBChB, FACP, FCP(SA), FHIMSS, who is the project lead for HIMSS’ Stories of Success! Program explains,
A focus on the National Quality Strategy, the Triple Aims, the Partnership for Patients and the recommendations and convening role of the National Priorities Partnership has the potential of galvanizing collective action. Such collective action is needed if we are to make a dent in the known quality gaps and our attempts to bend the cost curve. Stories of Success! is designed to solicit case studies focused on these national initiatives and to explicitly describe how health information technology has been deployed to support these initiative—QHS, PfP, The Triple Aims, and NPP. Use of the Standards for Quality Improvement Reporting Excellence (SQUIRE) Tool is required to organize and standardize the reports of the case studies.
Standards for Quality Improvement Reporting Excellence: SQUIRE
SQUIRE has been developed to advance the scholarship of improvement, facilitate dissemination of experience in conducting quality improvement projects (QIP). SQUIRE provides a structured tool to capture the fundamental dimensions of a QIP. The tool was modified for use in the Stories of Success! project. Some dimensions were eliminated, and one important one was added, i.e., a dimension to capture the specific components of the health IT used to support the NPP priorities, TJC goals and Partnership for Patients goals. The HIT dimensions outlined three sections: the elements of an EHR utilized, the HIT standards incorporated, and the data elements captured. The ten sections of the Stories of Success! Case Study Form SQUIRE tool are: Title, Background Knowledge, Local Problem Being Addressed, Intended Improvement, Planning and Implementing the Intervention, HIT Utilized, Value Derived/Outcomes, Barriers/Challenges Faced, Financial Considerations, and Summary/Conclusions. For additional information see the Stories of Success! PPT Presentation and On Demand webinar at www.himss.org/storiesofsuccess/whyapply.
Marketing and Call for Case Studies
The value proposition to promote interest in the program is to provide applicants the framework that they will be helping to increase awareness that the adoption and use of health IT improves patient safety, quality, effectiveness, and efficiency; and their success stories will be recognized in a variety of educational venues including poster presentation at HIMSS Annual Conference.
As an effective marketing strategy, a variety of methods were used to create awareness for the call for case studies: leveraging HIMSS e-newsletters (HIMSS, ASQ, NCQA, The Joint Commission, NPSF); social media, website promotion, dedicated web page; press release announcing call for case studies and winners; flyers emailed as links and hard copies to key constituencies serving on the peer review body; and word of mouth.
A peer review body with representation from HIMSS Quality, Cost and Safety Committee, ASQ, The Joint Commission, NCQA, NPSF and subject matter experts was formed. All case studies are independently scored by each member of the Peer Review Body, with a “champion” for each submission to report out a gap analysis of the submission during a voting call of the peer review body. Submissions are selected to be winners based on how comprehensively they aligned with SQUIRE application criteria, that is, narrative backed by rich data metrics substantiating the described processes, improvement, and outcomes, especially the key elements of a national patient safety goal, national priority, and/or Partnership for Patients goal through leveraging of health IT.
Jonathan French is director, Healthcare Information Systems, HIMSS.
Patricia Johnson is manager, Healthcare Information Systems, HIMSS.
Reducing Venous Thromboembolism Using Clinical Decision Support (Synopsis)
I. Project Focus/Topic
Blood clots, called venous thromboembolism (VTE), are among the most common preventable causes of hospital death. Texas Health Resources’ clinical quality project was focused on the prevention of hospital-acquired blood clots throughout Texas Health facilities by early identification of patients at-risk and appropriate and timely intervention strategies conforming to national guidelines and evidence-based practices.
II. HIT Utilized
The project used Texas Health’s electronic health record (EHR), computerized physician order entry (CPOE), and clinical decision support system (CDSS).
All 13 Texas Health wholly owned hospitals are securely linked through the EHR. Texas Health has invested more than $200 million in its EHR, which contains more than 4.7 million patient records. All 13 hospitals have achieved HIMSS Stage 6 designation.
In 2008, Texas Health hospitals began a performance improvement project designed to prevent patients from developing potentially deadly clots. The project uses the EHR to help assess each patient’s risk of developing a clot and to remind clinicians to deliver preventive therapies where necessary. These reminders come in the form of Best Practice alerts that pop up on the computer screen in a bright yellow banner while physicians are interacting with a patient’s medical record. The physician may then order a medication therapy or mechanical compression devices, which wrap around the feet and legs and contract to promote blood flow.
This innovative use of technology has helped contribute to a reduction in post-operative blood clots of greater than 20% system wide since the initiative began. Preventive treatment for blood clots has become standardized, with clinicians either using the recommended therapy or documenting the reason it is not being used. The blood clot risk assessment process has also become more efficient because risk calculations are performed electronically.
V. Benefits of Stories of Success! Recognition
Texas Health believes strongly in collaboration to improve health. We have appreciated the opportunity to share best practices and innovation with other patient-centered organizations nationwide. The Stories of Success! recognition has encouraged us to develop and submit other projects such as our current work to reduce catheter-associated urinary tract infections.