Provincial Digital QBP Order Sets Program. Champlain Lung Health Network Meeting June 20, 2017

Transcription

1 Provincial Digital QBP Order Sets Program Champlain Lung Health Network Meeting June 20, 2017

2 Provincial Program Background The Ministry of Health and Long-Term Care (Ministry) is funding a provincial clinical quality-focused project to develop and implement digital QBP order sets in Ontario. hospitals through St. Joseph s Health System (SJHS) as the Project Management Office. SJHS has procured Think Research Corporation through a competitive process to be the delivery partner for the provincial program. The current project term is from March 4, 2016 to March 31, 2018, inclusive. Provincial Steering Committee Funder Project Management Office Delivery Partner 2

3 Provincial Steering Committee Membership Mandate is to monitor and oversee implementation over the project term Co-Chairs Dr. Kevin Smith, Chief Executive Officer, SJHS Paul Huras, Chief Executive Officer, SE Members Susanne Bjerno, Senior Advisory Hospitals and Health System Funding, Health Policy, Ontario Medical Association Dr. Adalsteinn Brown, Director, Institute of Health Policy, Management & Evaluation, U of T Anthony Dale, President & CEO, Ontario Hospital Association Dr. Irfan Dhalla, Vice President, Evidence Development & Standards, Health Quality Ontario Dr. Jennifer Everson, Physician Lead, Clinical Planning & Integration, HNHB Lee Fairclough, Vice President, Quality Improvement, Health Quality Ontario Greg Hein, Director, ehealth Strategy & Investment Branch, MOHLTC Dr. Robin McLeod, VP Clinical Programs & Quality Initiatives, Cancer Care Ontario Derek McNally, Executive Vice President, Clinical Services & Chief Nursing Executive, Niagara Health System Paul Santaguida, Vice President, Client Success, Think Research Corporation Fredrika Scarth, Director, Health Quality Ontario Liaison and Program Development, MOHLTC Ex-Officio Donna Kline, Executive Lead, SJHS, PMO Sophie Zikmanis, Operations Lead, SJHS, PMO 3

4 Standardized Clinical Content Enabling Technology Adoption & Utilization Data Overall Goal: Evidence-Based Standardized Care 202 digital order sets: QBP Clinical Handbooks (including post-acute (rehab) for 4 QBPs) Mental Health Quality Standards In-development: Additional post-acute (2 QBPs) Stroke QBP refresh Hip Fracture QS Hysterectomy QBP/Menstrual Bleeding QS Hospitals customize to local formulary and clinical workflow Evidence-based that is regularly and systematically updated Technology allows clinicians to access clinical content in check list format 90% of participating hospitals will submit orders in the cloud-based platform, EntryPoint Less than 10% of participating hospitals will input clinical content into their existing CPOE systems Real-time data, owned by the hospital, is generated to capture local adoption and utilization Focus on quality improvement Regional and provincial reporting will allow for measurement of utilization against standard 4

5 Four Phase Road Map Recruitment 100 hospitals voluntarily signed onto the provincial program Goal was 75 hospitals over two years 100+ face-to-face site-visits to hospitals Implementation Hospitals identify scope of digital QBP order sets to implement Dedicated Think Research project team Follow 36-week implementation plan Adoption 47 hospitals are live with digital QBP order sets Implement strategies to support local adoption and utilization Generate local, regional and provincial data reports Sustainability Continue expansion of scope Drive to improved patient outcomes 5

6 Implementation Approach, Scope & Timing Demonstrate progress & refine approach Build momentum & scale up Drive adoption across the province Wave I Jun Aug 2016 Wave II Nov 2016 Feb 2017 Wave III April June hospitals 39 hospitals 23 hospitals 6

7 Wave I Wave II Wave III 100 Participating Hospitals across 14 s Central (1) Central East (6) Hamilton Niagara Haldimand Brant (7) North East (19) Waterloo Wellington (4) Central (3) Central West (1) Champlain (6) Erie St. Clair (1) Hamilton Niagara Haldimand Brant (1) Mississauga Halton (1) North Simcoe Muskoka (3) North West (11) South East (6) South West (5) Toronto Central (1) Champlain Champlain (6) (5) Erie Erie St. St. Clair Clair (2) (2) South South West West (2) (14) Waterloo Waterloo Wellington Wellington (1) (1) Central East (1) 7

8 QBP Clinical Handbooks & Quality Standards There are 300+ digital QBP order sets and associated clinical documents available as provincial standardized reference order sets translated from QBP Clinical Handbooks and Health Quality Ontario s Mental Health Quality Standards. Each hospital has the flexibility to choose the number and type to implement, and will customize the reference order sets based on local formulary and clinical workflow. Up to April 2016 Existing Clinical Handbooks Cancer Surgery Cardiac Aortic Valve Disease Chronic Kidney Disease Chronic Obstructive Pulmonary Disease Community Acquired Pneumonia Coronary Artery Disease Elective Aortic Aneurysm Repair Knee Arthroscopy Neonatal Jaundice LEOD Pediatric Tonsillectomy Primary Hip and Knee Replacement QBP Cataract Surgery QBP Hip Fracture* QBP Congestive Heart Failure Retinal Care Stroke* January 2016 September 2014 January 2016 February 2015 February 2014 September 2014 January 2014 December 2014 September 2013 January 2014 December 2013 November 2013 September 2015 May 2013 February 2015 November 2015 December 2015 August 2016 New & Updated Clinical Handbooks Aortic Valve Disease Coronary Artery Disease Degenerative Disorders of the Shoulder Integrated Corneal Transplant Care Integrated Retinal Care Low Risk Birth Non-Emergent Integrated Spine Care Paediatric Asthma Sickle Cell Disease Vaso-Occlusive Crisis March 2016 March 2016 July 2015 September 2015 November 2015 December 2015 September 2015 March 2016 January 2016 October 2016 Mental Health Quality Standards Major Depression Schizophrenia Behavioural Symptoms of Dementia *Order sets currently being updated to reflect most recently published QBP Clinical Handbooks and / or Quality Standards 8

9 Digital Post-Acute (Rehab) QBP Order Sets In-patient rehabilitation represents an important phase of care. This library is based on the post-acute (rehab) best practice recommendations released in the following QBP Clinical Handbooks: Hip Fracture, Hip / Knee Replacement and Stroke. Expertise from key provincial agencies, including the Rehabilitation Care Alliance (RCA) and the Cardiac Care Network (and former Ontario Stroke Network), was sought to review the translated orthopedic and stroke clinical content. These partnership efforts are continuing to develop subsequent iterations of clinical content to best reflect the rehabilitation sector. *The development of digital post-acute QBP order sets is underway for COPD and CHF QBPs. Hip Fracture QBP Hip Replacement QBP Knee Replacement QBP Stroke QBP Digital QBP Post-Acute (Rehab) Order Sets QBP Hip Fracture Transition to Rehabilitation Phase of Care Order Set QBP Rehabilitation Hip Fracture Ongoing Management Order Set QBP Rehabilitation Hip Fracture Discharge and Follow-up Order Set QBP Primary Hip Replacement Transition to Rehabilitation Phase of Care Order Set QBP Rehabilitation Primary Hip Replacement Ongoing Management Order Set QBP Rehabilitation Primary Hip Replacement Discharge and Follow-up Order Set QBP Primary Knee Replacement Transition to Rehabilitation Phase of Care Order Set QBP Rehabilitation Primary Knee Replacement Ongoing Management Order Set QBP Rehabilitation Primary Knee Replacement Discharge and Follow-up Order Set QBP Stroke Rehabilitation Phase of Care Order Set QBP Rehabilitation Stroke Discharge and Transition Planning Order Set 9

10 Content Validation A content validation is conducted by clinical experts to ensure best practice recommendations from QBP Clinical Handbooks and QS have been accurately translated into digital order sets. Each reviewer is provided with the digital order sets, associated documents, and an Excel Checklist. Layout of content: Order sets are laid out in modules under the DAVID format The Checklist is used as a guide to review the order sets and to ensure that the recommendations have been accurately translated/captured The Checklist (to use as a content map) contains all of the recommendations from the QBP Clinical Handbooks and Quality Standards QS recommendation are identified with this icon: QBP recommendations are identified with this icon: The digital post-acute QBP order sets for COPD and CHF QBPs will require content validation prior to deployment to participating hospitals. 10

11 Implementation ~ 36 Weeks Setup the team, logistics, governance, and supports Confirm the QBP scope (type and number of digital order sets) Clinical teams tailor reference digital QBP order sets Wind down the project and transition to sustainable operations Initiation Assessment Development Implementation Sustain Implement content deployment system Launch digital QBP clinical tools Use data to drive performance improvements Install the cloud-based content deployment and analytics system Train physicians & staff and launch new system across hospital Employ regular rhythm of cascading reviews to sustain improvement 11

12 Thank You & Questions Sophie Zikmanis Operations Lead, Project Management Office St Joseph s Health System sophie.zikmanis@qbpordersets.ca Kirsten Lewis Vice-President, Research & Development Think Research kirsten.lewis@thinkresearch.com Tommaso D Ovidio Project Manager Think Research tommaso.dovidio@thinkresearch.com