2/16/2011

Creating A S
Successful
ccessf l
Dashboard

Bert Reese, CIO and Senior Vice President,

Sentara Health System

DISCLAIMER:  The views and opinions expressed in this presentation are those of the author and do not  necessarily represent official policy or position of HIMSS.

Conflict of Interest Disclosure

Bert Reese, 
The University of Utah, MBA 
Operations Research/Systems Engineering
Norwich University, Northfield, Vermont, B.S., 
Business Administration

Has no real or apparent 
conflicts of interest to report.

DISCLAIMER:  The views and opinions expressed in this presentation are those of the author and do not  necessarily represent official policy or position of HIMSS.

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Outline
• Sentara Background
• eCare Project
– Go Live Dashboards
– ROI Dashboards 
– Process Redesign Measures
• Welcome to the Starting Line
Q y
• Clinical Quality Goals and Dashboards
• Guiding Principles

Sentara Healthcare
Mission
We improve health every day.
Values
People, Quality, Patient Safety,
Service, Integrity
Vision
Be the healthcare choice of the
Be the healthcare choice of the 
communities we serve.

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Sentara Healthcare
• 123‐year not‐for‐profit mission
• 8 hospitals; 1,935 beds 3,000 physicians on staff
• 10 long term care/assisted living centers
• Extended stay hospital
• 520‐provider Sentara Medical Group
• 432,600‐member health plan Virginia
• Sentara College of Health Sciences
• $3 3B
$3.3B total operating revenues
l i North Carolina
• $3.7B total assets
• 19,225 employees

Sentara Healthcare
System Development
• Series of community hospital  MILESTONES
1888  Retreat for the Sick – 25 Beds Norfolk
mergers 1892 S h l f N i
1892  School of Nursing 
1972  State’s first merger of two non‐profit hospitals –
• Belief that integration would  Norfolk General & Leigh Memorial
lead to better comprehensive  1982  Home Care formed
1983  Life Care division developed
care for patients 1984  Optima Health Plan started
1988  Hampton General Hospital 
• Medical Group  1991  Bayside Hospital acquired
• Hospitals 1995  Sentara Medical Group formed
1998 Vi i i B h G
1998  Virginia Beach General Hospital 
l H it l
• Nursing Home 2002  Williamsburg Community Hospital
2006  Obici Hospital
• Medical Transportation 2009  Potomac Hospital
2011  RMH Healthcare & Martha Jefferson Hospital  
• Home Health (pending)

• Optima Health
6

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Sentara and Epic

®
• Sentara’s Care Transformation: eCare
®
• eCare
C … What is it?
Wh t i it?
– Epic Implementation
• A shared medical record for patients across the 
continuum of care
– Opportunity for Process Redesign
• Re‐evaluate and optimize 18 major 
R l d i i 18 j
processes
®
• “eCare is bigger than Epic”

Project Overview
Timelines:
– Sep 2005: Epic contract signed
– Nov 2005 – April 2006: Process redesigns
Nov 2005  April 2006: Process redesigns
– May 2006 – June 2007: Design, Build, Validate
– August 2007: First MD office implemented (150 MDs/Year)
– February 2008: First hospital implemented all but CPOM
– May 2008: First hospital implemented CPOM 
– Sep 2008 – Oct 2008: 2nd & 3rd hospital go lives
– Mar 2009– Nov 2009: Three more hospitals  implemented
– 2010: Epic 2009 release upgrade; 7th hospital go live
– 2011: 8th hospital go live; community focus

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Total Cost of Ownership

10 Year Overview
Capital  $   67 M
Operating Expenses $ 170 M
Hardware Maintenance $   15 M
Software Maintenance $   50 M
Disaster Recovery $     3 M
Work Redesign $   36 M
Training $   16 M
Implementation $   22 M
Ongoing Support $   22 M
Other Non‐Salary Support $     6 M
Total Cost of Ownership over 10 years $  237 M

Annual Expected
Business Case Benefits
Hospitals Total $30.0 M 
Improved Nursing Efficiency $ 4.9 M
Reduced IT Maintenance $ 3.6 M
R d d M di l R
Reduced Medical Records/Transcription 
d /T i ti $36M
$ 3.6 M
Increased Outpatient Services $ 4.8 M
Reduced Length of Stay  $ 3.8 M
Improved Pharmacy Process/ADEs $ 3.0 M
Reduced Paper/Storage $ 2.7 M
Other Improvements $ 3.6 M
Home Health Total $   1.8 M  
System Health Plan Total $   2.3 M*
System Healthcare Total $ 35.5 M **
* 62% of health plan benefits will be passed on to employers    
** Excludes $2.7 M in physician practice benefits which will accrue to physicians

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®
eCare Costs and
Benefits by Year
$60,000.0
$50,000.0
$40 000 0
$40,000.0
$30,000.0
$20,000.0
$10,000.0
$-
$(10,000.0) 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
$(20,000.0)
$(30,000.0)
$(40 000 0)
$(40,000.0)

Expected Benefits Achieved Benefits Expenses

Note: 2010 data annualized
Net Impact (vs. Achieved) Net Impact(vs. Expected)

11

®
Clinical Staff Became eCare Experts
Project Team Composition:

• 90
90 Information Technology Professionals
Information Technology Professionals
• 100 Clinical Staff (RN, LPN, RT, PT, X‐Ray Techs, Pharmacists) 
®
Took Full Time Positions on the eCare Project Team
– Became Epic Trained & Certified
• Application Design
• Content Validation
• Workflow development and redesign
– Design, Build, Validate (DBV) & Implementation Leads 
were Trained in Lean Principles

12

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®
Clinical Staff Became eCare Experts

• All
All Venues of Care Represented (office, acute care hospitals 
Venues of Care Represented (office acute care hospitals
and LTAC, etc) 
• At completion of project Clinical Team to return to clinical care 
sites as care givers
• Project Team Supplemented and Work Validated by over 300 
“Subject Matter Experts” (direct care givers) from across the 
h lth t
health system  

13

Physician Advisory Group (PAG)

• 50+ Primary and Specialty MD’s
• Substantial Time Commitment (4+ hrs per week at peak)
• Developed/Designed MD specific parts of EMR
– Content (Order Sets & Clinical Documentation)
– Screen Formats & Custom Reports 
– Workflows
• Worked collaboratively with other clinical staff to achieve 
y
standardization on shared workflows
• MD’s Are Compensated

14

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eCare
Go Live Dashboards

15

Go Live: Daily Dashboard

16

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Go Live: Daily CPOE Tracking

% CPOE Trend HOSPITAL #5

Sept 13, 2009 Go Live
100%

80%

60%
%CPOE Goal should NOT be 100%
Sometimes Verbal/Telephone is better:
40%
Emergency situations (Code Blue)
20% During procedures
Small number of orders at 2 AM from home
Small number of orders at 2 AM from home
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Days Post Go Live

17

Go Live: Monthly Dashboard 

Monthly Dashboard Metrics

18

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Go Live: Monthly Dashboard

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eCare
ROI Dashboards

20

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ROI Dashboard: Hospital ROI

21

ROI Dashboard: System Rollup
2010 eCare Benefits Achieved (annualized)

Unfavorable to 2006 Baseline Red

Favorable to 2006 Baseline Yellow
Favorable to 2010 Expected Benefits Green

Benefit Achieved 2010 (annualized)

# eCare Hospital Benefit Process Owner SLH SVBGH SBH SNGH SCH SWRMC Total
1-3 Streamline Record Completion MS $255,306 $315,147 $173,672 $595,031 $307,592 $179,003 $1,825,750
4 Reduce Transcription Costs MS $493,387 $663,564 $247,402 $722,253 $400,131 $198,476 $2,725,212
5 Streamline Coding Process MS $73,041 $54,229 $94,336 $129,930 $61,619 $25,978 $439,135
6 Streamline HIS Management MS $28,014 $26,847 $22,206 $54,133 $0 $47,423 $178,623
7 Reduce Risk Mgmt Claims & Uninsured Losses FS $41,667 $41,667 $41,667 $41,667 $41,667 $41,667 $250,000
8,21 Reduce Length of Stay and/ or Reduce ADEs GY/ TJ $1,325,550 $1,798,126 -$28,066 $3,287,675 $1,497,548 $824,219 $8,705,052
9 Reduce Paper Related Supply Costs MS $248,712 $395,018 $56,907 $615,842 $373,586 $120,913 $1,810,979
10,11 Increase Unit Efficiency/Retention of RN's LK $294,334 $378,240 $355,087 $3,172,134 $4,371,045 $452,079 $9,022,918
13 Improve Charge Capture AW $342,344 $395,652 $180,862 $649,031 $272,262 $133,947 $1,974,097
20 Increase Outpatient Procedures AW/ KH $928,189 $1,147,886 $572,633 $1,857,276 $841,067 $438,371 $5,785,423
22 Reduce Pharmacist Order Entry TJ $58,752 $71,353 $24,354 $106,417 $37,012 $16,996 $314,884
Cumulative Hospital Benefits $4 089 296 $5,287,729
$4,089,296 $5 287 729 $1
$1,741,060
741 060 $11,231,389
$11 231 389 $8,203,528
$8 203 528 $2
$2,479,072
479 072 $33 032 073
$33,032,073

# Other eCare Benefits Process Owner Q1 Q2 Q3 Q4 YTD

* SHP realized benefits AP $500,205 $500,205 $500,205 $500,205 $2,000,819
* SE realized benefits RD $191,958 $243,956 $420,841 $285,584 $1,142,338
* Reduce IT maintenance expense RD $464,553 $464,553 $464,553 $464,553 $1,858,212
Total Additional eCare Benefits $2,872,110
Total 2010 eCare Benefits Achieved $40,905,552

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Cumulative ROI Business Case

Benefits
$29.3 M Budgeted for 2010;  $40.9 M Achieved (annualized) 
Benefit
eCare® Benefit Category (Millions)*
- Reduce Length of Stay/ Reduced ADEs $8.7
- Increase Outpatient Procedures $5.7
- Increase Unit Efficiency/Retention of RNs $9.0
- Reduce Transcription Expense $2.7
- Reduce Med Records Supply Costs $1.8
- Reduce Medical Records Positions $1.8
- Reduced Optima (health plan) costs $
$2.0
- Improve Charge Capture $1.9
- Reduced 63 Administrative Positions $2.0
- Reduced other costs $5.3
Total $40.9
*2010 for 6 Hospitals, Home Health and Healthplan
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eCare
Process Redesign Measures

24

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®
eCare Process Innovations
• Redesigned18 major processes covering entire continuum of 
care
• Lean Six Sigma Methodology
1.
2.
Arrival Management
Bed Management
10.
11.
MD Processes
Medical Records 
D efine M easure
3. Case Management 12. Meds Management
4. Charge Capture 13. Monitoring/ Recording
5. Claims Processing  14. Order Sets V alidate A nalyze
6. Clinical Communications 15. Patient Care Transformation
7. Disease Management 16. Patient/ Member Satisfaction D esign
8. Emergency Department 17. Physician Practice
9. Home Health 18. Scheduling

• Complementary Technology: Bar‐coding; Document
Management; Device Integration
• Each process redesign defined measures of success

25

Process Redesign Measures:

Patient Throughput Improvements

26

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Process Redesign Measures:

Pre and Post eCare® Medications
Management Improvements

• Avoided 117,400 potential medication errors due to medications 
barcodingg
• Reduced meds administration time

Baseline Post-eCare

Average time from order written 59.0 minutes 4.5 minutes

to order available to act on

Average time from order written 132.0 minutes 38.4 minutes

to med administration (NOW
orders)

27

Process Redesign Measures:

Clinical Scanning
2009 Clinical Scanning On-Time-Performance
% Indexed in <=30 minutes

100

99

98

97
%

96

95 Goal

94

93
SBH SLH SNG SPA SVB SWR

28

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Process Redesign Metrics:

ED Admits LEAN Dashboard
E D M D A dm it O rde r ( B e d R e que s t ) to IP Unit IP B e d R e a dy to IP Unit
M E D IA N T A T in M inut e s % <= 6 0 m inute s

100
400
90
350
80

300
70
250
60

200 50

150 40

100 30

50 20

0 10

We e k E nding We e k Endi ng

IP B e d R e a dy t o ED D e part E D D e pa rt t o IP Unit
% <= 4 5 m inut e s % <= 15 m inute s

100 100
90 90
80 80
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0

We e k Ending We e k Ending

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Sentara eCare®
• eCare® Today
EMR at 7 Sentara hospitals
 87% CPOE (Computerized Physician Order Entry)
87% CPOE (C i d Ph i i O d E )
 Realized benefits ($40.9M) exceed plan ($35.5M)
 115 SMG locations
 45,000 MyChart patients (patient portal)
 SVBGH piloting EMS eCare connection

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Welcome to the Starting Line

Patient 
Centered
Care

31

31

Prerequisite Infrastructure
Divisional  SI Technical Architecture
Reporting Sources of Data‐ Data Integration  Data Storage  Data Distribution  Self Service ‐ User Access
Systems Divisional Systems Framework Framework Framework Excel Services & Power Pivot
Subject Data‐marts
Clarity Profitability
Reporting Workbench EPIC
Bus Objects
Durations

Casemix HBOC Processes: Surgical Services

Hospital Dashboard
Extraction Other Topic
Other Topic
Extelligence PICIS Dashboard
Staging Clinical 
KPI
Warehouse  Service Line/CEC
Horizons BA MMIS Error 
Handling (Clarity) E E Pharmacy 

Anodyne IDX Quality  T All Patients

T
Checks Disease Mgmt
L L
Product Modeling SHP Data 
Translation Non‐clinical  Heart Failure

Warehouse  Disease Mgmt
Data Load 
(aka DW) Disease Mgmt
Care Discovery Sepsis
External 
Diabetes Mgmt
Benchmark 
Partners MEDai Population Mgmt

SHP CCS
ETG

Predictive Modeling
ETL of source data to Benchmark Partners Discovery 
CDSS Analystics
Real‐Time via Web Service Oriented Architecture (SOA) Statistical 
32 Analysis

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Infrastructure Continues to Evolve
Continuous Improvement Loop
Order Sets

Smart 
Alerts Pricing & Customer
Choice

Enriched 
EDW  EPIC Medical  Health 
EDW
Phase 1 Clinical  Group Plan 
Medicine
Surgery Data Data Data
Rx

Enterprise Informatics Architecture
Episode Treatment Grouper
Pattern recognition and
Best Practices & Outcome Analysis Predictive Modeling

Process Improvement

33

Data
Warehouse

34

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KPI‐Based Quality/Safety Report

35

36

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H1N1 Results
• MD’s USED order sets & Clin Doc Tools
• MD’s THANKED US – they “Got It”
– Felt reassured that they were practicing based on latest info
– Efficient documentation helped cope with large volumes
• KPI Reporting of Volumes 
– Managed staffing 
Managed staffing
– Materials Management (N95 Masks)
– Guided management decisions about more extreme measures (visit 
restrictions, “tents on the lawn”)

37 37

Clinical Quality Goals and

Dashboards

38

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Sentara Strategic Plan

2010 – 2012 Strategic Goals
•Top 10%
 Clinical Quality and Safety
 Patient Satisfaction
 Employee Engagement
 Financial Stewardship
•Transformation of Care
 Primary Care Redesign
 Chronic Disease Coordination
 Advance Care Planning 
 Alignment & Accountability 
 Knowledge Management
•Growth
 Hampton Roads
 Virginia/North Carolina 

39

Patient Safety
Sentara partnered with nuclear power safety experts to form HPI 
as consultants to healthcare industry in high reliability 
performance and patient safety
performance and patient safety

Methods based on science and facts
 Science of human error and event prevention
 Practical experience in high‐reliability industries including nuclear power 
and aviation

Experienced‐based mentoring
 Entered healthcare in 2002
E t d h lth i 2002
 229 hospitals across 75 organizations
 Consulting team with HRO experience and healthcare experience 
(clinicians, non‐clinicians, and physicians)

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Clinical Goals: System Dashboard

Sentara Healthcare
CY2010 Clinical Initiatives
Performance Summary Report FINAL
Executive Summary
Reporting Month: October 2010
Core Measures Reporting Period: August 2010

Anthem CMS CMS Gap SH SH Goal SNGH SLH SBH SCH SVBGH SWRMC SOH SPH
Variance from
Goal Mean Top 10% top 10%
CY2009 CYTD 10 CY2010 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10 CYTD 10

AMI
*** Early aspirin use 95% 100% 1% 99% 99% 98% 100% 99% 98% 100% 100% 100% 96% 100%
*** Aspirin at discharge 94% 100% 0.5% 99% 100% 98% 100% 100% 100% 100% 99% 100% 96% 97%
*** Beta-blocker at discharge 94% 100% 1% 99% 99% 98% 99% 100% 100% 100% 99% 99% 98% 100%
1*** ACEI or ARB for LVEF 100% 93% 100% 2% 96% 98% 98% 99% 100% 80% 100% 100% 100% 90% 100%
*** Angioplasty within 90 minutes of arrival 84% 100% 5% 90% 95% 90% 86% 90% 100% 97% 100% 100% 94% SNP
*** Smoking Cessation Counseling 97% 100% 0% 99% 100% 99% 100% 100% 100% 100% 100% 100% 100% 100%
2 AMI %Green (includes ***) = Appropriate Care Measure 94.4% 98.8% 1% 95% 97% 95% 98% 96% 94% 99% 98% 99% 92% 99%
Inpatient Mortality Rate 2% 1% Trend 0% 2% 3% 0% 2% 1% 2% 2%

AMI Outpatient Measures

Aspirin at arrival - ED AMI Patients 93% 100% 2% 99% 98.0% 98% SNP 100% 100% 100% 100% 100% 94% 100%
Aspirin at arrival - ED Chest Pain Patients 93% 100% 3% 92% 97% 98% SNP 100% 97% 95% 100% 50% 100% 100%
Median Time to ECG - ED AMI Patients (Minutes) 7.0 6.0 10.0 SNP 8.5 6.0 5.5 16.0 8.5 4.0 7.0
Median Time to ECG - ED Chest Pain Patients (Minutes) 10.0 7.0 10.0 SNP 12.0 7.0 6.0 17.0 8.0 5.0 9.0
Overall Median Time to ECG (Minutes) 43 4 -3.00 10.0 7.0 10.0 SNP 10.0 7.0 6.0 16.5 8.0 5.0 8.0
Median Time to Transfer for Acute Coronary Intervention (Minutes) 67.0 54.0 Trend SNP No Cases 53.0 56.0 No Cases No Cases 71.0 55.0

NCDR Top
ACC-NCDR Metrics for PCI NCDR Mean 10%
3 Overall PCI within 90 minutes of arrival 86% 87.3% 100.0% 9% 86% 91% 86% 76% 83% 91% 95% 100% 100% 94% SNP
PCI Local Vascular Complications 1% 1.40% 0.0% 0.9% 0.34% 0.88% 0.4% 0.92% 7.46% 0.00% 0.00% 0.00% 0.00% 0.00% SNP
PCI Serious Complications 3.00% 2.0% -1% 2.12% 0.63% 2% 0.72% 0.00% 0.00% 2.30% 0.00% 1.43% 0.00% SNP
4 PCI Statins or Non-statins on DC (h/o dyslipidemia) 95% 92.20% 98.4% 95% 98% 95% 98% 98% 100% 99% 99% 100% 100% SNP
PCI Risk Adjusted Mortality (1Q 2010) 1% 1.46% 0.80% 2.19% 2.21% 1.00% 2.93% 0.00% 0.00% 0.00% 1.65% 0.00% 0.00% SNP
RAM O/E Ratio (1Q 2010) 1.00 1.19 1.00 1.99 0.00 0.00 0.00 1.12 0.00 0.00 SNP

Pneumonia
*** Antibiotic selection consistent w/ recommendations ICU 68% 100% 5% 84% 95% 90% 100% 100% 100% 100% 86% 86% 50% 86%
*** Antibiotic selection consistent w/ recommendations Non ICU 95% 100% 3% 96% 97% 97% 97% 96% 98% 100% 97% 100% 93% 95%
5*** 1st dose antibiotic given w/in 6 hours 99% 94% 100% 3% 97% 97% 98% 98% 95% 99% 98% 95% 100% 97% 95%
*** Blood cultures performed in ED prior to 1st dose antibiotic 93% 100% 2% 96% 98% 97% 98% 98% 99% 97% 97% 98% 98% 95%
*** Blood cultures performed on ICU Admissions 96% 100% 2% 97% 98% 98% 96% 100% 97% 100% 98% 100% 93% 92%
6*** Administration of Influenza Vaccine 97% 86% 100% 3% 95% 96.6% 97% 96% 91% 99% 100% 98% 98% 95% 80%
7*** Administration of Pneumococcal Vaccine 98% 88% 100% 4% 95% 96% 98% 90% 95% 99% 100% 98% 93% 93% 88%
*** Smoking cessation counseling 91% 100% 0.4% 99% 100% 99% 99% 100% 100% 100% 100% 100% 98% 93%
VTE Prophylaxis CYTD 99% 99% 98% 98% 100% 100% 100% 100% 99% 95% 97%
8 Pneumonia %Green (includes***) = Appropriate Care Measure 86.3% 98.6% 6% 89% 93% 95% 92% 90% 97% 97% 93% 93% 88% 80%

Heart Failure
9*** ACEI OR ARB at Discharge with EF <40% 100% 90% 100% 1% 100% 99% 98% 100% 100% 100% 100% 97% 98% 95% 100%
*** Documentation of Ejection Fraction 100% 91% 100% 0.05% 100% 100% 99% 100% 100% 100% 100% 100% 100% 100% 99%
*** Smoking Cessation Counseling 93% 100% 1% 100% 99% 99% 100% 100% 100% 100% 100% 100% 95% 97%
10*** Documentation of all discharge instructions 97% 80% 100% 4% 79% 96% 94% 96% 99% 100% 100% 93% 97% 86% 90%
VTE Prophylaxis CYTD 99% 100% 98% 100% 100% 100% 100% 100% 100% 97% 99%
11 CHF %Green (includes ***) = Appropriate Care Measure 86.4% 99.5% 4% 78% 96% 90% 97% 100% 100% 100% 94% 98% 86% 90%

41

Clinical Goals: Red Light Green Light
Percent Green vs. Percent Red

CMS Quality Measures: Cardiac; Pneumonia; Surgical Care; Infections, Patient Safety
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2004 2005 2006 2007 2008 2009 2010

Percent Green Metrics Percent Red Metrics

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Clinical Goals:
Serious Safety Event Rate
All Sentara Hospitals YTD November 2010

1.00

81% Reduction Since 2003
0.75
Event Rate

0.50
E

0.25

0.00
J-03
M-03

J-04
M-04

J-05
M-05

J-06
M-06

J-07
M-07

J-08
M-08

J-09
M-09

J-10
M-10
S-03

S-04

S-05

S-06

S-07

S-08

S-09

S-10
Serious Safety Events per 10,000 Adjusted Patient Day
43

Clinical Goals: Mortality Ratio

44

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Clinical Goals: Avoided Deaths

600

500

400

300

200

100

-
SNGH SLH SBH SCH SVBGH SWRMC SOH

(100)
2002 2003 2004 2005 2006 2007 2008 2009

45

Clinical Goals:
eHospital Resulting Interventions
% of Alerts that led to an intervention Type of Interventions Resulting from Alerts
4%
RT Contacted 1%

MRT 4%
Intervention EKG 5%
Non Intervention
Meds 7%

MD Contacted 13%

Coaching 24%
96%
0% 5% 10% 15% 20% 25%

• 96% of all alerts result in some sort of intervention
• Interventions have led to 350+ additional coaching  opportunities w/ staff

Interventions requiring MD Contact IInterventions requiring MD Contact
t ti i i MD C t t
1st Quarter 2009: Sample Population Nov 2009 ‐ Jun 2010

13%
MD Contacted MD Contacted
42%
58% MD Not 
Contacted 87%

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 2/16/2011

Clinical Goals:
ED Clinical Effectiveness Council
Dashboard
1 2,4,5
PATIENT FLOW CLINICAL INITIATIVES
2 2
VOLUME ACCESS LOS BOARDER AMI PNEUMONIA

(4) Blood cultures, if ordered in

(3) Antibiotics started <= 6 hrs
(2) Abx meet standard - Non-
%Boarder Hour of Total Bed

(3) ASA given in the ED - ED

(4) Median time to ECG - ED

(5) Median time to ECG - ED

% Boarder Hours 1000-2259

(2) ASA given at arrival - ED

(1) Abx meet standard - ICU

(ED Admit Order to IP Unit)

(7) Median transfer time for

(6) Overall Median time to

2,6
Release % <= 180 mins

ED, drawn prior to Abx

Daily Average Volume

Quick Reg to Provider

Patient Satisfaction %
3

Pre-Emptive Order %
Admit % <= 270 mins
Daily Median Volume

Total Boarder Hours

Quick Reg to Triage

(1) Early aspirin use

MEC % <= 75 mins

Chest Pain (mins)

Quick Reg to Bed

of patient arrival
Bed to Provider
% <= 30 mins

% <= 15 mins

% <= 15 mins

% <= 15 mins

ECG (mins)
Chest Pain

AMI (mins)

ACI (mins)
LWBS%

AMA %

Hours

AMI

ICU
BEST PRACTICE <=1% <=1% >=90% >=90% >=90% >=90% >=95% >=95% >=95% <=10% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94.3%

GOAL <=2% <=1% >=50% >=90% >=50% >=50% <=10% >=97% >=97% >=97% <=10 <=10 <=10 >=90% >=96% >=96% >=96% >=90%

SBH 100 97 0.5 0.6 63 96 55 79 37 70 50 663 60 4 100 100 100 8.5 10.0 10.0 NC 0 100 100 100 90.6
SCPH 175 172 1.4 1.0 44 79 57 46 25 39 21 1862 68 5 100 NC 100 NC 8.5 8.5 NC 100 100 100 95 86.4
SLH 131 131 1.9 0.8 46 99 52 60 21 44 40 1448 68 9 100 NC NC NC NC NC NC NC 100 93 100 85.3
SNGH 142 145 0.7 1.5 50 94 42 75 45 49 29 2444 69 8 100 NC NC NC NC NC NC NC 100 100 100 85.6
SOH 100 99 1.2 0.7 48 96 42 42 63 40 916 67 5 100 NC NC NC NC NC NC 100 91 93 92 83.5
SVBGH 133 133 0.5 0.8 51 97 63 55 55 44 43 1829 69 6 100 NC NC NC NC NC NC 100 93 91 94 81.4
SWRMC 97 98 0.3 0.5 73 98 89 63 58 60 51 833 78 4 100 NC 100 NC 3.0 3.0 NC 100 100 100 93 87.8
SBLH 57 58 0.2 0.5 70 96 96 85 57 0 0 0
SPA 127 130 0.8 0.6 59 94 68 62 78 40 249 67 2 92.7
SPW 110 109 0.9 0.8 56 88 70 55 81 41 56 86 0 95.3

47

Guiding Principles

48

24
 2/16/2011

Lessons Learned
• What get measures gets improved
– Select appropriate data: Retrospective, Dynamic, Predictive

• Frequency depends on the expected interventions 
– Daily, Monthly, Quarterly

• Embed goals into budgets and bonuses
– Physicians, Executives

• Involve process owners in impacted areas

• Build an industrialized organization

49

Industrialized Organization
Discovery Analytics & 
Quality Research 
Corporate Decision 
Institute
Support

Sentara 
Informatics

Sector Analytics 
Sector Analytics – Informatics Technical 
Informatics Technical
Clinical & Business  Services – Design & 
Informatics Support Development

50

25
 2/16/2011

Guiding Principles of Data

Management
• Data Management is a Process
– Data > Information > Knowledge > Action
• Strong Data Governance:
– “Single Source of Truth”
• Data Driven Accountability
• Create a Clear and Simple Message
• Build Competitive Advantage with Analytics

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