Stories of Success! · 2014. 3. 4. · 2. Social media (Twitter). Web site promotion. HIMSS built a stand-alone dedicated Web page, ASQ Web site and TJC Web site. A press release

KEywORDS

Health IT, national patient safety, national priorities, quality.

ABSTRACT

The Stories of Success! project is focused on two goals:

to solicit case studies demonstrating the use of health

IT in support of the National Priorities Partnership (NPP)

recommendations for national focus and The Joint

Commission National Patient Safety Goals (NPSG); and the

use of the Standards for Quality Improvement Reporting Excellence

(SQUIRE). The project is sponsored by HIMSS, under the

aegis of the Patient Safety & Quality Outcomes Steering

Committee. The Joint Commission and American Society of

Quality are co-sponsors. This article will describe the project;

the background of the NPP recommendations and the

NPSGs; the background and basis for using SQUIRE; how

the case studies were solicited and reviewed; how they are

being showcased; lessons learned; and plans for the future.

FoCus Quality outComes and Patient saFety

national PrioritieS PartnerShiP recommendationS for national action

we are faced with a triple threat cover-

ing the uninsured, bridging the quality

gap and bending the cost curve. How

to cover the uninsured is arguably knowable and

essentially to be determined through the federal

and state political process. Bridging the quality

gap and bending the cost curve are to some extent

doable by the delivery system, with process being

slow on the former and even slower on the latter

fronts. There is a call for a national focus.

To that end, the National Quality Forum (NQF) convened a group, initially of 28 stakeholders covering all segments—consumers, pro-viders, accreditors, purchasers, insurers—from both the public and private sectors. The group is chaired by Donald Berwick, MD, President of IHI and CMS Administrator, and Margaret O’Kane, CEO, National Committee for Quality Assurance (NCQA). Criteria include: a focus on high leverage areas; align and harmonize efforts; and accelerate the need to emphasize speed of change.

Some of the criteria for selecting the priorities are to reduce waste, reduce disease burden, eliminate harm and eradicate dis-parities. These criteria were used to identify high areas for focus.

The six 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.Reduce overuse and waste.

1.2.3.4.5.

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Stories of Success!Case Studies of Health IT in Support of the National Priorities Partnership Recommendations and The Joint Commission National Patient Safety Goals

By Louis H. Diamond, MB ChB, FACP, FCP (SA), FHIMSS; Kathleen A. Catalano, RN, JD, FHIMSS; David A. Collins, MHA, CPHQ, CPHIMS, FHIMSS; and Patricia Johnson, MAT

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The NPP also identified a number of drivers to achieve the best results, includ-ing payment reform; infrastructure issues, such as supportive health information tech-nology and workforce capacity; accredita-tion and certification; performance mea-surement; research and information dis-semination, as well as public reporting.

The Patient Protection and Healthcare Accountability Act of 2010, requires the US Department of Health & Human Ser-vices Secretary to report back to Congress in January 2011, and intermittently there-after, on national priorities. It is widely believed that the HHS Secretary will turn to the NPP to develop such a report.

the joint commiSSion’S national Patient Safety goalS

Established by The Joint Commission in 2003, the National Patient Safety Goals (NPSG) program was designed to help accredited organizations address specific areas of concern in regards to patient safety.

The NPSGs were first recommended by the Sentinel Event Advisory Group (renamed the Patient Safety Advisory Group in 2009) in 2002. The initial six recommended NPSGs were reviewed and approved by The Joint Commission’s Board of Commissioners in July 2002. These six NPSGs were surveyed in Janu-ary 2003. The eighth set of NPSGs went into effect on Jan. 1, 2010.

The Joint Commission has long been a proponent of patient safety as evidenced through their “patient safety trilogy.” The trilogy began with The Joint Commis-sion’s concern and dedication to the iden-tification and “elimination” of sentinel events. This resulted in the development of the sentinel event definition, publish-ing of reviewable sentinel events, senti-nel event standards and Sentinel Event Alerts. The patient safety standards were the second part of the trilogy and the NPSGs the third.

The purpose of The Joint Commission’s National Patient Safety Goals is to pro-mote specific improvements in patient safety. The NPSGs highlight problem-atic areas in healthcare by providing evi-dence 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.

The Joint Commission will accept any process the organization has in place—electronic or paper—as long as the purpose of the standard is accomplished. Health IT can be leveraged as a tool to meet requirements. For instance, regarding acronyms, symbols,

Table 1a: The Modified SQUIRE Tool/Application Submission Form Used in the Stories of Success! Project.

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dose designations and abbreviations not to use, doctors and staff could no longer use the abbreviation and had to choose the cor-rect statement fully written out. This has become an Information Management Standard IM.02.02.01-EP 2, and no longer a NPSG.

Another example of leveraging health IT to meet TJC standards includes the Universal Protocol, which has been significantly

changed for 2010, with much of the rigidity and prescriptiveness removed. The organiza-tion must document that a time out has taken place, otherwise, they must document accord-ing to their processes.

Therefore, most perioperative depart-ments have a computer-based documen-tation system and this is handled via that system. Lastly, of interest is the ability to leverage health IT to serve as a second veri-fication; specifically, NPSG 01.03.01, Trans-fusion Errors, which allows the ability to use barcoding, RFID, etc, in place of an indi-vidual if two individuals are not available

The 2010 Hospital and Ambulatory National Patient Safety Goals are as follows:

2010 Hospital National Patient Safety Goals:

Improve accuracy of patient identification.Improve the effectiveness of communica-

tion among caregivers.Improve the safety of using medications.Reduce the risk of healthcare associated

infections.Identify safety risks inherent in the patient

population.Prevent wrong site, wrong patient, wrong

person surgery – The Universal Protocol.2010 Ambulatory National Patient Safe-

ty Goals:Improve accuracy of patient identification.Improve the safety of using medications.Reduce the risk of healthcare associated

infections.Prevent wrong site, wrong patient, wrong

person surgery – The Universal Protocol.It is important to note that for each spe-

cific NPSG listed above, there are corre-sponding Elements of Performance (EP) that explain how to comply with the NPSG. In other words, the EPs highlight what must be done by an organization to be in compliance with the NPSG and thus fur-ther patient safety.

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).1 More recently, Armistead and Diamond have indicated the tool is of assistance in planning a QI project and used in the process of documenting “attribution.”2

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. (See Table 1a and 1b)

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•

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Table 1b: The Modified SQUIRE Tool/Application Submission Form Used in the Stories of Success! Project.



Some dimensions were eliminated, and one important one was added, i.e. a dimen-sion to capture the specific components of the health IT used to support the NPP priori-ties and the TJC goals. The HIT dimensions outlined three sections: the elements of an EHR utilized, the HIT standards incorpo-rated, and the data elements captured.

marKeting and the call for caSe StudieS

The value proposition to promote interest in the program was to provide applicants the framework that they would be helping to increase awareness that the adoption and use of health IT improves patient safety, quality, effectiveness and efficiency; and their efforts would be recognized in a variety of educa-tional venues.

As with any effective marketing strategy, a variety of methods were used to create awareness for the all call for case studies:

Leveraging HIMSS e-newsletters (HIMSS, ASQ and The Joint Commission).

2. Social media (Twitter).Web site promotion. HIMSS built a stand-

alone dedicated Web page, ASQ Web site and TJC Web site.

A press release announcing the all call, and a second announcing those who had been selected.

Flyers sent as links and hard-copies to key constituencies serving on the peer review body.

Word of mouth. Promoting the oppor-tunity to submit a case study at a variety of conferences and industry relevant meet-ings, followed-up by e-mails with PDF fly-ers and the case study submission form.

revieW ProceSS

A peer review body was established including members of the HIMSS Patient Safety & Qual-ity Outcomes Steering Committee, and addi-tional diverse subject matter experts, including ASQ, The Joint Commission and The National Committee for Quality Assurance.

All applications were independently scored by each member of the Peer Review Body, with a “champion” of each submission to report out a gap analysis of the submission during a voting call of the peer review body. Submissions were selected to be showcased based on how comprehensively they aligned with the SQUIRE application criteria, that is, narrative backed by rich data metrics substantiating the described processes, improve-ments, and outcomes, especially the key elements of fulfilling a national patient goal and/or national priority based through

1.

2.3.

4.

5.

6.

leveraging of health IT. Submissions were divided into Tier 1 and Tier 2 recognition.

reSultS of the call for caSe StudieS

Six Tier 1 applicants (the most informative submissions aligned with the Stories of Success! purpose) were selected, and 10 Tier 2 applicants, additional impressive successes to highlight and share with the industry.

Table 2a and 2b highlight the case studies that were selected,

Table 2a: Fact Sheet Summary of Tier 1 and Tier 2 Selected Case Studies.

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an example of one of their successful outcomes, the health IT that was used, and the related NPP recommendations and the TJC Patient Safety Goals.

recognition

Each applicant received a certificate of recognition for their par-ticipation. A press release was sent to the media and posted to the HIMSS Stories of Success! Web site, with messages sent on Twitter announcing the selected submissions.

A summary flyer (see Table 2) including an embedded hyper-link to each respective case study was posted to the website, and as well distributed at the 2010 HIMSS Annual Conference & Exhi-bition in Atlanta.

The Greater Rochester Independent Practice Association (GRIPA) case study “Electronic prescribing significantly and

measurably improves the quality and effi-ciency of patient care in a teaching-hospi-tal’s outpatient medical clinic” presented their case study as part of a HIMSS qual-ity Webinar series. All case studies were featured as part of a Stories of Success! exhibit at the June 2010 HIMSS Virtual Conference & Exhibition.

leSSonS learned and commentS

We are in the early stages of explicitly uti-lizing health IT to improve patient out-comes, bend the cost curve, facilitate elec-tronic data exchange and engage patients and their families in their care. The mean-ingful use of health IT requirement, artic-ulated by CMS in the NPRM, under the aegis of ARRA.

We are seeing the merging of essen-tially two parallel worlds, one previously dedicated to adopting health IT, often without documenting the value in terms of improved patient outcomes, and the other demonstrating improvement, but without integrating with the use of health IT in the various aspects of these efforts, like one-time electronic data collection, followed by electronic data transmission, aggregation and reporting. SQUIRE has the very potential of facilitating this pro-cess of the merging of two cultures and two previously somewhat separate activ-ities and processes.

Based on the experience of the first cycle of a call for case studies, some next steps seem evident:

The deployment of professional devel-opment opportunities for the quality mea-surement and improvement teams and the health IT professionals.

Conduct efforts to facilitate joint learning between these two groups of professionals.

Specific additional guidance to all on how to utilize SQUIRE.Modification to SQUIRE for the purposes of use in this type of

project.Examples of these modifications include: Item 3: Local problems. Emphasize the need to document the

details of the local problem in regards the gaps in care that have been demented.

Item 4: Intended improvement. Inclusion of specific measur-able metrics, processes of care, patient outcomes, cost reduction—that are the focus of the intervention.

Item 6: Health IT dimension. Needs more details and the sem-blance of a classification system.

Items 8a and b: Outcomes. Needs details of process and patient outcomes.

1.

2.

3.4.

Table 2b: Fact Sheet Summary of Tier 1 and Tier 2 Selected Case Studies.



Item 13: Financial considerations. Need a framework and additional guidance for the submitters.

A second call for submissions is planned for 2010, with some modification of instructions to the submitters.

note

Special recognition is given to the Stories of Success! peer review body: Louis H. Diamond, MB ChB, FACP, FCP (SA), FHIMSS, of Thomson Reuters; Pat Adamski, RN, MS, MBA, of The Joint Com-mission; Kathleen A. Catalano RN, JD, FHIMSS, of Catalano and Finch Compliance Advisors; Floyd Eisenberg, MD, of the National Quality Forum; Joseph Fortuna, MD, of the American Society for Quality; Trish Gallagher, RN, MSHS, CPHQ, of Credence Health; Pamela Graves RN, CNP, FHIMSS, of Children’s Hospital of Min-nesota; Pat Hale, MD, PhD, FACP, of the New York State Depart-ment of Health; Paul M. Schyve, MD, of The Joint Commission; Megan Siears of Precision Dynamics Corp.–TimeMed; Jonathan Teich, MD, PhD, FACMI, FHIMSS, of Elsevier; and Ray Zielke of the American Society for Quality. Additionally, thank you to the support of HIMSS staff, including David A. Collins, MHA, CPHQ, CPHIMS, FHIMSS; Patricia Johnson, MAT; and Patricia B. Wise, MA, MS, RN, FHIMSS. JHIM

LouisH.Diamond,MBChB,FACP,FCP(SA),FHIMSS, is Vice President and

Medical Director, Thomson Reuters Healthcare (part-time) and President of

Performance Excellence Associates. He currently serves as Chair, Planning

Advisory Committee, PCPI; Chair,QMRI Council, NQF; and Chair, HIMSS PS&QO

Committee.

KathleenA.Catalano,RN,JD,FHIMSS, is a partner of Catalano and Finch

Compliance Advisors and an accomplished national speaker/author on The Joint

Commission/NPSGs, regulatory compliance, core measures, CMS compliance,

medical staff issues, sentinel events, risk management, quality improvement and

patient safety.

DavidA.Collins,MHA,CPHQ,CPHIMS,FHIMSS, is Director of Healthcare

Information Systems for HIMSS, overseeing the Davies Awards of Excellence and

the Patient Safety & Quality Outcomes Steering Committee.

PatriciaJohnson,MAT, is Manager of Healthcare Information Systems for

HIMSS, managing the Davies Awards of Excellence and the Patient Safety &

Quality Outcomes Steering Committee.

REFERENCES1. Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S. Publication guidelines for quality improvement in health care: evolution of the SQUIRE project. Qual Saf Health Care. 2008;17[Supplement 1]:i3-i9.

2. Armistead and Diamond; AJMQ. Accepted for publication, 2010.

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Documents

Stories of Success! · 2014. 3. 4. · 2. Social media (Twitter). Web site promotion. HIMSS built a stand-alone dedicated Web page, ASQ Web site and TJC Web site. A press release