STAGE 7 SPOTLIGHT Tucson Medical Center: Tracking Infection Rates in Real-Time
The HIMSS Analytics Electronic Medical Record Adoption Model is an eight-stage model (0-7) that measures an electronic medical record's (EMR) impact on a health system and the providers and patients within that health system. Using this assessment, healthcare leaders can strategically plan out a roadmap for technology implementation and adoption within the organization, to advance and maintain industry best practices.
Having become a standard for evaluating health IT advancement around the globe, the EMRAM acts as a testament to an organization's commitment to better patient outcomes, higher quality care and lower overall costs. A HIMSS Analytics EMRAM Stage 7 validation is the highest level an organization can reach, indicating maturity across all facets of the model.
Let's dive into the Stage 7 Achievement process of Tucson Medical Center (TMC).
About Tucson Medical Center (TMC)
Located in Southern Arizona, TMC is a locally-governed nonprofit regional hospital, licensed at more than 600 beds. Its mission is to educate and promote health, wellness and safety throughout Southern Arizona.
As the leading provider for emergency and pediatric care, the TMC health system includes top-notch intensive care units for adults, children and newborns. Other specialty areas include women’s, maternity, cardiac, orthopedic, neuroscience, hospice, surgical, vascular and geropsychiatric care.
As the region’s largest acute-care hospital, TMC contends with a variety of infections. Addressing these infections involved four staff members spending a combined 144 hours per month working on the previous month's infection data to share with clinical owners and hospital leadership. The work included:
- Pulling data and maintaining five layers of Excel spreadsheets
- Creating and updating 29 standard reports
- Pulling together any special requests needed in the environment
In the end, it was a static, time-lagged data set that lacked real-time occurrences.
“It was difficult to get timely infection information,” said Nina Mazzola, director of Infection Prevention at TMC. “It was hard to get a total view of how we were doing and difficult to visually communicate trending over time.”
The EMRAM Implementation
TMC’s Business Intelligence (BI) and Infection Prevention teams worked together to improve this process through automation and improved accuracy. The BI Team was familiar with the work of Infection Prevention and the enormous effort that went into Hospital-Acquired Infection (HAI) reporting, so they decided to tackle the challenge and map out the processes with the help of an EMR dashboard.
“We took time to define the problem and to get a handle on the current state. We kept peeling back the onion to get to root causes,” said Michael Griffis, director of Information Services.
Once the BI Team had a handle on the current state, they used a rapid development approach to create a dashboard that would provide actionable, real-time infection information. “We would focus our resources on a key set of functions we needed to develop, and work on these sets in two-week increments," explained Griffis. "It was an effective way of tackling a problem this large and complex.”
The team spent three weeks defining and scoping the issue and two months to develop, validate and implement the new EMR dashboard. The team based the dashboard on Qlik Sense, a BI toolset, to reach into various components of the electronic health record and other systems to track and document infections.
With the EMR dashboard, staff members can simply open up their laptops to view and discuss HAI activity throughout the hospital in real time. This insight allows the team to "swarm" hot spots with overwhelming resources to get to the root cause of a spike in infection and eliminate the source. Additionally, the dashboard provides trending information based on two years of historical data.
While Mazzola is the tool’s super admin, the dashboard is available to unit managers and other clinicians, so they can monitor their areas of responsibility. With an average of 200 sessions a month, the EMR dashboard is the organization’s most utilized analytical tool — second only to the Human Resources Department's turnover tool. This utilization is expected to grow over time as users become more comfortable with it and understand its value.
The dashboard users can only identify trends since May 2017 (the time it has been operational), so long-term benefit have yet to be realized. Anecdotal evidence suggests improvement in infection rates so far.
Using the EMRAM as a guide, TMC was able to drive decision-making and develop actionable, real-time infection information through the rapid improvement process.
“In the end, we were able to deliver a way for clinical operations to see with surprising clarity what was happening on their units," said Frank Marini, Sr. Vice President & CIO. "This project is a wonderful example of committed and talented professionals – clinical and IT – working together to address our most important objective: keeping our patients safe.”
Like TMC, healthcare organizations around the world can use the EMRAM to help them discover new operational efficiencies, implement improved processes and deliver better, more successful care to all of their patients.