Update from The Pond

Update from The Pond

Greg Belden, Senior Program Associate [email protected]

June 18, 2004

Founded By The Business Roundtablewith Support From the Robert Wood Johnson Foundation

mailto:[email protected]

Populating the Pond

Leapfrog represents..

More than 155 large health care purchasers

More than 34 million Americans

More than $62 billion in health care expenditures

Leapfrog Members to DateFord Motor CompanyGateway Purchasers for Health General Electric CompanyGeneral Mills, Inc.General Motors CorporationGeorgia Health Care Leadership Council Georgia-Pacific CorporationGlaxoSmithKlineGreater Milwaukee Business Group on Health and the Health Care Network of WisconsinHampton Roads Health CoalitionHannaford Bros. Co.Healthcare21 Business CoalitionHealthPartnersHealthPlus of MichiganThe Health Action Council of Northeast OhioHealth Alliance Plan (HAP)Health Care Payers Coalition of New JerseyHealth LanguageHealth Net Inc.Horizon Blue Cross Blue Shield of New JerseyHoneywell Inc.HCA - Hospital Corporation of America HIP Health Plan of New YorkIndiana Employers Quality Health AllianceInternational Association of Machinists and Aerospace WorkersIBMIDX Systems CorporationInternational Paper CompanyJSA Healthcare Medical GroupJohnson Controls, Inc.Johnson CountyJostensKellogg CompanyThe KNW GroupLG&E Energy CorporationLTV Steel CompanyLand O’ LakesLockheed Martin CorporationLucent TechnologiesM-Care, Inc.MDanywhere Technologies Inc.MVP Health CareMaineHealthMaine Health Management CoalitionMaine Municipal Employees Health TrustMaine State Employee Health CommissionMarriott International, Inc.Massachusetts Healthcare Purchaser GroupMcKesson CorporationThe Mead CorporationMerck & Co., Inc.Meridian Automotive Systems, Inc.Microsoft CorporationMidwest Business Group on HealthMinnesota LifeMinnesota Mining & Manufacturing Company (3M)Misys Hospital SystemsMonsanto CompanyMotorola, Inc.National Education Association

AT&TAetna Inc.Allscripts Healthcare SolutionsAmerican Century Services Corporation American Federation of TeachersAmerican Medical SystemsAmerican Re-Insurance CompanyAmerisourceBergen CorporationArvinMeritor, Inc.AstraZenecaThe Auto Club GroupAventis Pharmaceuticals Inc.Barry-Wehmiller Group, Inc.Bath Iron Works CorporationBecton, Dickinson and Company (BD)Bemis Company, Inc.Bethlehem Steel CorporationBoard of Pensions of the Presbyterian Church (U.S.A.)The Boeing CompanyBrown ShoesBuyers Health Care Action GroupCargill, Inc.Carlson CompaniesCaterpillar Inc.Ceridian CorporationCerner CorporationCharter CommunicationsChicago Business Group on HealthCIGNA CorporationCITIGROUP INC.Cleveland State UniversityColorado Business Group on HealthComericaThe Commonwealth of Massachusetts Group Insurance CommissionCoors Brewing CompanyCummins Inc.DaimlerChrysler CorporationDallas-Fort Worth Business Group on HealthDelta Airlines, Inc.The Department of Employee Trust Funds and State of Wisconsin Group Insurance BoardThe Doe Run CompanyThe Dow Chemical CompanyEastman Kodak CompanyEclipsys Corporation Electronic Data SystemsEli Lilly and CompanyEmpire Blue Cross and Blue ShieldEmployer Health Care Alliance Cooperative (The Alliance)Employers’ Health CoalitionESCO Technologies, Inc.Excellus Inc.Exxon Mobil CorporationFedEx CorporationFidelity InvestmentsFisher Scientific InternationalFlint InkFleet Boston Financial

National Rural Electric Cooperative AssociationNevada Health Care CoalitionNew Jersey State Health Benefits ProgramNew York Business Group on HealthNorth Carolina Business Group o Health, Inc.North Carolina Teachers’ and State Employees’ Comprehensive Major Medical Plan Northwest Airlines, Inc.Olin Corporation, Brass & Winchester DivisionsOxford Health Plans, Inc. Pacific Business Group on HealthPediatrix Medical Group Inc.PepsiCo Pillsbury CompanyPitney Bowes Inc.The Procter & Gamble CompanyPromina Health System, Inc.Quality Systems Inc.Quest DiagnosticsQwest Communications International Inc. Ramsey CountyReliant Energy, IncorporatedRobert Wood Johnson University HospitalRobert Wood Johnson University Hospital at HamiltonRyder System, Inc.Savannah Business GroupSchering-Plough CorporationSiemens CorporationSolutia, Inc.South Central Michigan Health AllianceSouthern California Schools Voluntary Employees Benefits Association Sprint CorporationState of Kansas Division of Personnel ServicesSUPERVALU INC.TCF Financial CorporationTI AutomotiveTRW Inc.Target CorporationTennant CompanyTextron Inc.Trinity Health PlansTri-State Business Group on HealthTufts Health PlanUnion Pacific RailroadUnion Pacific Railroad Employees Health SystemsUnitedHealth Group United Parcel ServiceUniversity of Maine System Verizon CommunicationsWEA TrustWashington Mutual BankWashington State Health Care AuthorityWausau Benefits, Inc.Wells FargoWiseman and Associates Financial Services, LTDXcel EnergyXerox Corporation

The U.S. Office of Personnel Management (OPM); Centers for Medicare and Medicaid Services (CMS); the Department of Defense; and Minnesota Departments of Human Services and Employee Relations also participate as liaison members.

ProvidersNot Seeing Case for

Reengineering

InsurersNot Letting Provider Value Show Through

PurchasersNot Buying Right,

Toxic Payment System

ConsumersNot In the Quality

Game

Why Isn’t Quality Better?

Gridlock in the Health Care System: Everyone Responsible, No One Accountable

New Thinking Needed to “Leapfrog” Gridlock

The Silent Calamity

Needless mortality and morbidity

44,000-98,000 plus deaths each year from medical errors during hospitalizations (IOM, 1999)

7,000 deaths from medication errors alone

$17-29 million in added costs

Number of avoidable deaths in ambulatory care unknown

Preventable Deaths Personalized: The General Motors Example

US Population: 250,000,000

Preventable deaths per year: 98,000

Preventable deaths per 100,000 Americans per year: 39

GM’s covered lives: 1,250,000

GM’s preventable deaths–Per year: 488!–Per day: 1.3!

The Costs of Poor Quality Care

Patients, on average, receive recommended health care only 55 percent of the time (McGlynn et al. 2003)

30 percent of all direct health care outlays are the result of poor care (misuse, underuse, overuse, and waste) (Juran Institute/MBGH 2003)

Employers Fund U. S. Health Care System – The Buck Starts Here

Employers Fund U. S. Health Care System – The Buck Starts Here

How Are Employers Responding to Rising Costs?

8%

17%

20%

35%

51%

21%

36%

37%

47%

28%

35%

32%

30%

34%

12%

26%

15%

13%

5%

8%

Offer a high deductible plan

Implement new deliverysystems and purchasing

models

Move to differenthealthplans

Employ condition/diseasemanagement and healthimprovement programs

Increase employee costsharing

Primary Focus Moderate Interest Minimal Interest No InterestSource: Hewitt Associates, 2002Kaiser/HRET Survey, 2003

Less than 15% of employers think these changes will be “very effective”.

The Leapfrog Group’s Mission

Trigger giant leaps forward in the safety, quality and affordability of health care by:

– Supporting informed health care decisions by those who use and pay for health care

– Promoting high-value health care through incentives and rewards

Leapfrog’s Mission and Vision Aligned with IOM

Pursuit of Comparative Excellence

Measuring both hospital and physician performance across all 6 IOM Health Care Aims

– Timeliness

– Efficiency

– Safety

– Effectiveness

– Equity

– Patient-centeredness

Purchasing Principles

Educate and inform enrollees

Compare at the provider level

Reward superior provider value

– Patient volume (select/deselect/freeze,consumer incentives, consumer decision support)

– Unit price (pay for performance)

– Public recognition

Highlight tangible, evidence-based quality and safety practices (‘Leaps’)

Criteria for Safety Leaps

What’s the Difference? Leap will produce big improvement in safety

Value Self-Evident: Leap can be appreciated by consumers

Feasible Now: Implementation steps are doable

Easily Ascertainable: Purchaser or health plan can see if Leap is in place

Keep the List Short: Leaps can be remembered

Initial Quality and Safety ‘Leap’ Summary

An Rx for Rx

– Computer Physician Order Entry (CPOE)– Up to 8 in 10 serious drug errors prevented

Sick People Need Special Care

– ICU Daytime Staffing with CCM Trained M.D. live or via tele-

monitoring, or risk-adjusted outcomes comparison– 29% mortality reduction (JAMA, 11/02)

The Best of the Best

– Evidence-based Hospital Referral (EHR) or risk-adjusted

outcomes comparison– > 30% mortality reduction for 7 complex treatments

New! Overall Safety (See Appendix)

– Rolled-up score of the remaining 27 of the 30 NQF Safe Practices

(CPOE, IPS and EHR are the other 3 of the 30 NQF Safe Practices)

Annual Gain Projected by Dartmouth: 560,000-907,000 serious medication errors 61,700 deaths 61,700 X 5 disabilities Potential savings $9.7 billion / year

(if fully implemented in U.S. urban hospitals)

What We Stand to Gain from Initial 3 Leaps Alone?

Leap Refinement –Creating More Sophisticated Measures

CPOE: Online evaluation tool developed by First Consulting Group

ICU Staffing: Joint project with JCAHO to develop risk-adjustment methodologies and reporting program; e-ICU (telemedicine) now applicable

Evidence Based Hospital Referral: Seeking additional sources for outcomes reporting

Our Approach to Measure Development & Implementation

Collaborate with measure developers

– CMS, AHA, AHRQ, NCQA, JCAHO, others

Seek consensus on breadth and content of measurement set

Advance measures through NQF for consensus approval

Develop rapid implementation strategy with key partners

Leapfrog Leaps, Today and Tomorrow

Today: Hospitals

CPOE, IPS, EHR, NQF Safe Practices

Tomorrow: Hospitals and Physician Offices

Physician Office Clinical Decision Support (See Appendix)

– Initial development coordinated with HHS, awaiting outcome of HHS-led push toward nationwide EMR implementation

– Minimum standards: E-prescribing, E-lab results management, and E-care reminders

– Already in practice- CMS DOQ-IT, Bridges to Excellence Physician Office Link

Leapfrog’s Position on EMRs

Leapfrog supports the promotion and use of electronic data to protect patient safety and quality and recommends that hospitals implement CPOE systems.

An effective CPOE system rests on a broad array of patient information and an electronic medical record is one of the first steps to achieving this.

How Leapfrog Happens: Leaping in Unison

Health Plans (MD Leadership & Governance)

Purchasers

Consumers

Health Care Delivery System

(hospitals, physicians,

nurses pharmacy...)

Leapfrog’s Regional Roll-Outs

Leapfrog is a national movement using targeted regions (Regional Roll-Outs) to develop best practices, creating early successes and learning from all stakeholders.

*23 Regional Roll-Out areas reach 50% of Americans.

Regions must have: Effective leadership Competitive health

care market High concentration of

Leapfrog lives

*LF Regions in Green w/ exception of NV and NC

First Wave: First Wave: California

Seattle/Everett/ Tacoma

St. Louis

Michigan

East Tennessee

Minnesota

Atlanta

Dallas/Fort Worth

Colorado

Kansas City

Wisconsin

Savannah

Metro NY & Western CT

Rochester NY

Massachusetts

New Jersey

Central Florida

Memphis

Wichita

Second Wave:Second Wave: Maine

Illinois

Hampton Roads, VA

Third Wave:Third Wave:

23 Roll-Out Regions

Northern NV

*Raleigh/Durham/ Chapel Hill, NC

Fourth Wave:Fourth Wave:

*On Hold for 2004

Collecting Hospital Level Data

Hospital survey available via The MEDSTAT Group

Ongoing voluntary Web survey

Outreach to hospitals in 23 Roll-Out areas to date, but nationally available

Survey captures hospitals on the path

Data publicly reported, format based on feedback from consumers and hospitals (survey and results: www.leapfroggroup.org

http://www.leapfroggroup.org/

Leap Applicability to Urban/Rural Hospitals

2001-2003- Leaps Apply to Only Urban Hospitals

Areas where consumers have a choice of hospitals

Do not want to raise public expectation that rural hospitals should prioritize the leaps

2004 and Beyond- Leaps Apply to Urban and Rural

4th Leap (NQF Safe Practices) applies to Rural Hospitals

Rural task force working to apply initial 3 leaps to rural hospitals

Hospitals Are Reporting from All Over the Country

No ParticipationParticipation inRoll-Out RegionsParticipation inNon Roll-Out Regions

NM

WYSD

VT

RI

MT

Progress 2nd Quarter 2004 (cont’d)Hospital Survey Results - Regions

Final Results 1.0 Final Results 2.0

810 hospitals nationwide responded to Leapfrog’s survey

558 of 949 targeted in Regional Roll-Out areas (58.7%)

> 60% participation in 13 of 18 RROs

1,168 hospitals nationwide responded to Leapfrog’s survey

715 of 1,188 targeted in Regional Roll-Out areas (60.2%)

> 60% participation in 17 of 22 RROs

Hospital Survey Results – Regions

CPOEFinal Version 2.0– 5% (34) of the responding hospitals have fully

implemented CPOE - another 17% (118) will implement by 2005

Final Version 1.0– 5% of the responding hospitals had fully

implemented CPOE - another 22% said would implement by 2005

Hospital Survey Results – Regions

IPSFinal Version 2.0– 24% of responding hospitals have fully

implemented IPS

Final Version 1.0– 21% of responding hospitals had fully

implemented IPS - another 15% said would implement by 2004

Hospital Survey Results – Regions (cont.)

EHR % of responding hospitals meeting Leapfrog’s standard

Final Version 1.0

Final Version 2.0

CABG 12% 14%

Coronary angioplasty/PCI

30% 12%

AAA 21% 16%

Pancreatectomy N/A 15%

Esophagectomy 12% 8%

NICU 23% 39%

Consumers as Drivers

“Preventable mistakes” are frequent and serious

Provider differences can be significant

Enrollee Communications Toolkit by FACCT(NEW version available)

Engage Consumers

Heart NEJM 12-12-2002

– Leapfrog toolkit

– KFF survey results

Engage Consumers

Heart

– Leapfrog Toolkit

– NEJM survey results

Mind

– Web Hits

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Subimo

DQ

SQC

HealthGrades

Engage Consumers

Heart

– FACCT Toolkit

– NEJM survey results

Mind

– Web Hits

Wallet

– Co-pays, co-insurance

Number of Hospitals Responding to Leapfrog Survey

Atlanta, GA Dallas, TX CPOE ICU CPOE ICU

Fully Implemented

0 0 0 1

Good Progress

8 0 0 0

Tier 1 Criteria

Good early stage progress

2 3 1 2

Willing to report

14 16 14 10 Tier 2 Criteria

Did not submit information

7 12 0 2

DRAFT

The Leap Over the Gridlock Has Begun

Rapid growth in purchasers signing on to Leapfrog’s approach

Rapid growth in hospitals disclosing status to their communities

Active health plan support 80% of Americans have access to information for at

least one hospital in their community Massive education of consumers through purchasers Market reinforcement beginning through different

channels

Inform & Educate

Enrollees

Compare Providers

Rewarding & Creating

Incentives for Quality & Efficiency

Member Support & Activation

Improved Value (Quality &

Efficiency)

Multipliers: Health Plan Products

Federal & state purchasers

Other distribution channels &

partners

Market Reinforcement: “The Multiplier Effect”

Where We are Beginning to Make Progress

Transparency

Movement towards standardization of measures

– The National Quality Forum

– Medicare Modernization Act 2003: IOM to “evaluate

leading health care performance measures”

Education

Creation of consumer demand for good quality care

– 80% of Leapfrog members communicate to their

employees about medical errors and 70% about

Leapfrog

“Putting the Money Where Our Mouth Is- Working Markets Must Reward Quality”

Current reimbursement system does little to encourage quality improvement

– 80% of Leapfrog members publicly recognize providers but only 30% are working to reward providers

Optimal Incentive and Reward systems

– Pay-for-Performance/Direct Financial Reward (DFR) models

– Bonus payments/Financial awards

– Volume/Market-share Shift/Direct-to-Consumer (DTC) models

– Tiering, Payment differentials

Lily Pads: Opportunities to Shape the Movement

BOARD & MANAGEMENT

COMMITTEE

REGIONAL LEADERS

ENROLLEECOMMUNICATIONSLEAPS & MEASURES

BENEFITS CONSULTANTS

INCENTIVES & REWARDSCLINICIANHEALTH PLANS

Paying for Performance (DFR)

Blue Cross Blue Shield of Michigan

Blue Cross of California

Bridges to Excellence

Excellus

Pay for Performance - Integrated Healthcare Association (IHA)

Medi-Cal/Healthy Families - Integrated Healthcare Association (IHA)

Massachusetts Health Quality Partners


Bridges to Excellence

Physician Office Link

– Physicians can earn up to $50 per sponsored patient

– Must pass NCQA office practice performance assessment program

http://www.ncqa.org/pol/

IHA

Paying for Performance

– Common measures

– Clinical quality (40 percent)

– Patient experience (40 percent)

– Investment in information technology (20 percent)

– Each plan comes up with own reward methodology


Other Initiatives

Empire Blue Cross, IBM, PepsiCo, Verizon, and Xerox (NY)

– Hospitals: 4% bonus if meet Leapfrog’s CPOE and ICU standards

Group Insurance Commission (MA)

– Health plans: $25-50K bonus if plans increase admissions to Leapfrog-compliant hospitals

Anthem Blue Cross Blue Shield (NH)

– Physicians: $20 per enrollee for group practices that finish in top quartile for quality scores

Market-share/Volume Shift (DTC)

Minimum Maximum

Closed Networks

Provider Ratings

Co-pay/ins differentials

PBA fund

Tiered Networks

“COE”-type Benefits

(travel, etc.)

Provider Pressure

Consumer Resistance

Low

High


Provider Tiering

– Pacificare (CA), HealthNet (CA), Blue Shield (CA), Aetna (FL, TX, WA), Patient Choice Health Care (MN, CO, OR, MA)

Co-pay, co-insurance, premium differentials

– Hannaford Brothers

– $250 co-pay difference for employee going to hospital meeting the volume criteria for 5 of LF’s high risk procedures

– General Motors

– Adjusts employee premium contribution based on plan’s cost and quality performance

Health Plans Using or Planning to Use Leapfrog Criteria in Incentive Programs

Health Plan Brief Description of ProgramAnthem BCBS Midwest (KY, OH, IN) Agreement between Anthem and 38 hospitals (5 in KY and 33 in OH

and IN) which links reimbursements to quality measurements (CPOE included).

Anthem BCBS (VA) Awards for hospitals ICU staffing an d CPOE installation

Harvard Pilgrim Health Care/ Partners (MA) Rate increases based on patient safety measures identified by The Leapfrog Group as well as other performance measures

Empire BCBS (NY) Awards hospitals bonuses for meeting CPOE and IPS Leaps

BCBS (IL) Helps hospitals pay for electronic intensive care units

BCBS (MI) Rewards hospitals for including automated entry systems for prescriptions;

BS (CA) Tiers hospitals on cost effectiveness and good quality scores (uses LF)

HealthNet (CA) Incentive program modeled after Empire BCBS’s

Independence BC (PA) Rewards hospitals that meet LF standards and JCAHO’s performance criteria

Pacificare (CA) Tiers hospitals based on a number of variables including LF’s safety measures

Tufts/ Partners (MA) Contract with Partners' hospitals to provide financial bonuses for implementing "electronic systems" that improves the safety and efficiency

Tufts (MA) Tiers hospitals using quality and efficiency measures including CPOE and IPS

Regence BCBS (WA) Has plans to incent hospitals if fully-compliant with LF Leaps

Purchasers Using or Planning to Use Leapfrog Criteria in Incentive Programs

Purchaser Brief Description of Program

Pacific Business Group on Health (CA)

Places 2% of health plans’ premiums at risk- must meet targets to obtain full amount, one target being support of LF implementation

IBM, PepsiCo, Verizon, Xerox (NY)

Cooperate and pools funds with Empire BCBS to reward hospitals that meet the CPOE and IPS standards

Hannaford Brothers (ME) Applies an additional co-pay if an employee of theirs attends a hospital that does not meet the volume criteria for 5 out of the 7 LF high-risk procedures

Wisconsin Employee Trust Funds (WI)

Plans to evaluate health plans using HEDIS, The Leapfrog's recommended patient safety practices, and eventually the collecting and reporting of data around NQF's safe practices

Group Insurance Commission (MA)

The GIC has agreed to give their health plans financial bonuses if they meet standards for increasing admissions to Leapfrog-compliant hospitals

What’s in the Pipeline?

Pilot Type of Incentive

GE and Verizon; Albany, NY DFR and/or DTC

Boeing; Seattle, WA DTC- Payment Differential

Maine Health Management Coalition; Portland, ME

TBD

Healthcare 21; Eastern TN DTC- Tiering

AHRQ Incentive and Reward Pilots


Creating Differential Hospital Insurance for Employees – The Boeing Company

Part of collective bargaining agreement with two largest unions

Effective July 1, 2004, union employees and early retirees will

obtain 100% coverage after deductible for services provided by

a Leapfrog-compliant hospital

Hourly employees hospitalized in facilities that do not meet the

Leapfrog safety practices will obtain 95% coverage after

deductible

This benefit design will remain in place until July 1, 2006 when a new collective bargaining agreement becomes effective

What’s in the Pipeline?

Leapfrog’s E 2 (Effectiveness and Efficiency) Hospital Rewards Program- Piggy-backing on CMS-Premier “Pay-for-Performance” Demo

–Actuarial analysis shows win for members–Data collection method already in place–No new measures–Plans can implement quickly for self-insured

or fully-insured customers–Can implement nationally or at local level–Can expand to other GPOs/Hospital groups

Other Incentives and Rewards Initiatives/Leverage Points

*I&R Toolkit

*I&R Compendium

Health Plan User Groups

*Standard Health Plan Contract Language

*eValue8 Common RFI

*Update of Economic Implications of original three leaps

Malpractice Study

* Found on Leapfrog Web site: http://www.leapfroggroup.org

Beginning to Leap Over Gridlock but Gaps Still Exist

Transparent Market- nationally standardized measures of quality and efficiency

Market Reinforcement- reward quality and efficiency and better demonstrate business case

Engage Consumers- aware of variation, mechanisms for timely and effective delivery of information, financial incentives

Engage Purchasers- including government- sufficient tools and critical mass

New health plan products

APPENDIX

Appendix A: NQF Safe Practices

27 Safe Practices from the National Quality Forum Safe Practices Consensus Report (May 2003): The report is available at www.qualityforum.org

Applicable to urban and rural hospitals

Rolled up measure of patient safety for release to public in August 2004

27 Safe Practices

1. Create a healthcare culture of safety

2. Ensure an adequate level of nursing care

3. Pharmacists available for consultation with prescribers on medication ordering, interpretation, and overall medication use process

4. Read backs to the prescriber5. Standardized abbreviations and

dose designations6. Patient care summaries or other

similar records should not be prepared from memory

7. Care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form

8. Patient or legal surrogate can recount informed consent discussion

9. Patient's preference for life-sustaining treatments prominently displayed in record

10. Standardized protocol used to prevent the mislabeling of radiographs

11. Standardized protocols used to prevent wrong-site or wrong patient procedures

12. Evaluate and provide prophylactic treatment for patients at high-risk of acute ischemic cardiac event during surgery

27 Safe Practices, con’t

13. Evaluate each patient upon admission, and regularly thereafter, for the risk of developing pressure ulcers

14. Evaluate at admission (and treat), and regularly thereafter, for risk of deep vein thrombosis (DVT)/venous thromboembolism(VTE)

15. Utilize dedicated anti-thrombotic (anti-coagulation) services

16. Assess at admission, and regularly thereafter, patients for risk of aspiration.

17. Use effective methods of preventing central venous catheter-associated blood stream infections

18. Assess risk of surgical site infection; implement antibiotic prophylaxis and other measures

19. Reduce risk of renal injury based on the patient’s kidney function evaluation using standardized protocols

20. Evaluate risk of malnutrition, at admission and thereafter; employ clinically appropriate strategies to prevent malnutrition

21. When utilizing pneumatic tourniquet evaluate patient risk for an ischemic and/or thrombotic complication, and utilize appropriate prophylactic measures

22. Decontaminate hands with either a hygienic hand rub or by washing with a disinfectant soap after contact with patient or patient objects

23. Vaccinate healthcare workers against influenza

27 Safe Practices, con’t

24. Keep workspaces where medications are prepared clean, orderly, well lit

25. Standardize the methods for labeling, packaging, and storing medications

26. Identify all "high alert" drugs (e.g., intravenous adrenergic agonists and antagonists, chemotherapy agents, anticoagulants and anti-thrombotics, concentrated parenteral electrolytes, general anesthetics, neuromuscular blockers, insulin and oral hypoglycemics, narcotics and opiates)

27. Dispense medications in unit-dose or, when appropriate, unit-of-use form, whenever possible

Appendix B: Physician Office Clinical Decision Support

Rationale: E-PrescribingMedication errors affecting as many as 9% of prescriptions.

E-prescribing systems have the potential to improve quality and safety by:

– Eliminating legibility problems

– Reducing the occurrence of drug interactions, dosage errors, and other adverse effects by guiding prescribing based on computerized assessment of patient and medication information

Specifications: E-Prescribing

Physician office adopts and uses an electronic system which includes all of the following:

Decision support based on drug reference information

Patient-specific decision support database which includes age, weight, medications prescribed by that office, diagnoses, allergies, specified lab results, and electronically-available formulary information; inclusion of medications prescribed by other physicians is encouraged, but optional

Printing of a paper prescription or its NCPDP-compliant electronic transmission to the pharmacy

Rationale: E-Lab Results Management

Errors in managing lab results are common.

E-lab results management systems have the potential to improve quality and safety by:

Making a practitioner aware if lab test results which have been received have not been reviewed and/or shared with the patient

Reducing unnecessary test ordering by giving a practitioner easier access to previous lab test results

Specifications: E-Lab Results Management


Tracking whether results have been reviewed by the practice

Tracking whether results have been communicated to the patient, either electronically or via telephone or regular mail

Storage and retrieval of LOINC-compliant lab results reports (excepting microbiology) in database-structured format

Rationale: E-Care Reminders

Preventive services, or services recommended for chronic conditions, are underutilized. E-care reminder systems have the potential to improve quality and safety. Examples include:

Increase vaccination rates

Improved screening for breast cancer, colorectal cancer, cervical cancer, and other diseases

Improved cardiovascular risk factor reduction

Smoking assessment and counseling

E-Care Reminders, con’t.

Dietary assessment and counseling

Improved management of hypertension

Improved management of diabetes

Increased detection of medication errors and adverse drug events

Specifications: E-Care Reminders


Patient-specific database which includes age, gender, diagnoses, treatment codes, lab test results, and medications documented by a clinician, AND

Specified reminders for clinicians drawn from current US Preventive Services Task Force and other nationally recognized care guidelines (Appendix B)

Specifications: E-Care Reminders (2)

The electronic system enables all of the following clinician reminders:

Patients needing guidelines-based services at the time of patient contact

Patient lists for outreach communications to patients who require scheduling for guideline-based services

Generation of periodic reports of guideline-adherence rates for the physician office’s patient population as a whole

Documents

Update from The Pond