|St. Joseph Health System
Mission Hospital is the largest medical center in south Orange County with the area's only designated trauma center with Centers for Excellence for Heart, Maternity, Vascular, Spine, Cancer and Brain Injury. Our Patient Care Tower houses CHOC at Mission, the only pediatric hospital in the area and a cooperative effort with Children's Hospital of Orange County. It is a very busy place and rapidly expanding with the recently expanded and modernized emergency department, a new conference center and construction under way on a new four-story, critical care tower and a 140,000 sq. ft. medical office facility and other projects. Winner of the 2000 Ernest A. Codman award for excellence in quality healthcare presented by The Joint Commission and other awards, Mission Hospital has been recognized for its quality of care.
Upon my arrival at Mission, June 9, 2003, there was a paper Incident Reporting System (QREs or Quality/Risk Events) that was in the process of being converted to a document-scanning program that would be mapped to an existing Access Database. We were using Palm Pilots to collect quality indicator data and running reports from the main clinical system and credentialing software as well as shuffling a lot of paper to complete the information required for physician reappointment. There was no automated method of managing peer review. It was a jungle of systems, vendors and paper.
One of my first responsibilities was to analyze all the systems, or lack thereof, that were either in place or about to be put into place and come up with some new ideas. The Director of Medical Staff Services had a brochure from Insight Health Solutions. I then began researching web-based programs that would meet the needs of several internal customers. A number of vendors were identified and presentations were arranged. The Quality Management staff from the Medical Staff Services participated in Web presentations as well as onsite presentations. By August 29,2003 we had the first draft proposal from Insight.
The field was narrowed quickly. Our requirements were for a more complete product and not one just for QREs (Quality/Risk Events). We were also looking for product(s) that could be completely customized by Mission and the end users. While price was an issue it would not be a deal breaker. Deal breakers for Mission Hospital were lack of flexibility, compatibility, interrelationship of the modules and the ability to interface with Meditech and Quality Edge (credentialing software used by the medical staff office) as well as customer service.
I worked closely with Mission’s Director of Information Technology and formal proposals were drawn up and presented for approval. Due to the fact that the multiple modules that were available were all inter-relational, the decision was made to purchase the entire solution from Insight Health Solutions.
Once the software became operational we were able to immediately identify trends and because of the systems we put in place, also identified serious issues within minutes of reporting. We have been able to configure the software for immediate identification of events requiring further investigation. We identified a need to change the critical values for lab reporting specific to the Emergency Department. Values for bandemia for the Emergency Department are critical for implementing the sepsis bundle in a timely manner. Because of this change we can call a code sepsis and initiate the sepsis bundle while the patient is still in the Emergency Room. We also identified an at risk process of patient transportation. Polices and Procedures were changed within days of the identified need thus improving patient safety. When we installed RiskInsight, one of our goals was to increase the reporting of quality risk events and near misses. In fact, we increased our reporting by 80% and yet we are handling that increase with less labor than before.
We have put in place a complete Medical Record review process utilizing RiskInsight that allows online, real-time reporting of medical record completeness as well as deficiencies. We can track by individual physicians and/or care units. When requested we are able to produce individual physician reports for feedback, trending and analysis. These reports include the results of all peer review, special studies, Medical Record completeness and appropriateness.
As another example, the Surgical Intensive Care Unit wanted a way to monitor themselves and their adherence to the ventilator bundle. Now, at any moment in time, the Manager can see if the data has been entered and verify that the data is valid. The result is improved patient care and outcomes.
With the Insight software, we are able to produce individual physician reports for trending and analysis. These reports include the results of all peer review, special studies, Medical Record completeness and appropriateness, safety and quality risk events involving the physician, numbers & types of diagnoses and procedures, credentialing information and other data that allow us to build a complete reappointment profile in minutes versus days. This has enabled us to greatly streamline our reappointment and privileging processes and has removed large amounts of labor.
With the interfaces to our main hospital information systems, patient demographic information is available within the Insight software so users can easily and accurately identify the correct patient and episode of care. ICD-9s are captured from our main clinical information system to provide all diagnoses and procedures. Future interfaces will provide even greater opportunities to consolidate all of our quality, performance improvement and risk data in a single consolidated system.
I can honestly say, in many years of experience with many software vendors, that Insight Health Solutions is the most responsive and service oriented software vendor that I have ever experienced. We are now completing the upgrade of our system to the new 2.0 version. We are excited by all the new functionality as Insight Health Solutions continues its own process of continuous improvement.
Just a few minutes ago the Director of QI needed a report for transfers to higher level of care. This was an ASAP request. I immediately went into the program, pulled up the indicator and ran the report. It is the interrelationship of the modules that makes our work so much easier. We often get these “I need a report right now” requests. If we did not have all the modules, we would not be able to meet the needs of our internal customers quickly and efficiently.