Keeping an IT eye on quality

Dr. Brian Patty, an emergency medicine specialist, has served as chief medical informatics officer at the three-hospital HealthEast Care System in the Twin Cities of Minnesota.

Since his arrival in 2005, Patty has led a process of “hardwiring” the organization's quality goals into clinical decision-support tools that make it as easy as possible for clinicians to adhere to best practice.

Consistently positive changes in CMS core measures scores across its three acute-care hospitals give some sense of the progress HealthEast has made between 2005 and 2010 in basic blocking and tackling—heart failure, scores from 83% to 95%; acute myocardial infarction, 96% to 99%; pneumonia, 87% to 97%; surgical care infection prevention from 87% (for calendar 2006) to 98%.

But a technology-enhanced monitoring tool that Patty co-developed with the hospital's electronic health-record vendor, McKesson Corp., is the whiz-bang gizmo of the system right now.

Called the “quality monitor,” the tool was rolled out at a single intensive-care unit in the fall of 2009, then quickly taken up in ICUs at the other two system hospitals. Initially, the monitor was tasked with tracking compliance with a complex bundle of time-sensitive guidelines to prevent ventilator-assisted pneumonia.

The tool uses embedded logic to analyze charting and orders already produced in the normal course of practice and then displays adherence to the best practice standards of care in a simple and familiar “red-yellow-green” stoplight format.

“There were about eight or nine things that we put on this score card for each patient,” Patty says. “Here are all of your patients and here's how you're doing with all of your patients for this bundle.”

The quality monitor can be called up on a desktop computer, but it also runs on a monitor in the nurse's break room, where care rounds are held twice a day. Nursing managers also check in every two hours or so, Patty says.

“It helps the charge nurse decide if there is someone that needs some help,” he says.