Davies Award of
Excellence
2016
Framework
What is the Davies Award?
The Davies Award Is:
• Since 1994, the Nicholas E. Davies Award of
Excellence is HIMSS highest recognition of
hospitals, ambulatory practices and clinics,
community health organizations, and public health
organizations that utilize electronic health records
and information technology to improve clinical and
financial outcomes and value.
The Davies Award is:
• Vendor Agnostic
• Peer Reviewed by volunteer members of the
Davies Committee
• Davies Committee members represent former
Davies winners or are nominated by current Davies
Committee members and HIMSS senior
management, and are approved by the HIMSS
Board.
Davies Award Categories
• Enterprise: Hospitals and Health Systems that
are Stage 7 and Stage 6 on the HIMSS
EMRAM Model
• Ambulatory: Fully Electronic at the Point of
Care
• Community Health Center: Fully Electronic at
the Point of Care
• Public Health
Key Dates
• Call for Submissions opens January 1st, 2016
• Call for Submissions ends June 30th, 2016
• Committee will evaluate the case studies as soon
as a quorum can be reached following a two week
period of review.
• Site visits will take place at minimum two weeks
following presentation of the questions of interest.
Is My Organization Ready for
Davies?
1. Do we meet the prerequisite requirements for
submission?
2. Can we demonstrate that we are using IT to improve
adherence to clinical best practice and improve
revenue/efficiency?
3. As result, can we show, through 12 months of trended
data, that we have improved adherence to clinical
best practice as indicated by improved quality
measures; and can we show that we have generated
hard sustainable return on investment through
increased revenue, decreased cost, and efficiencies
as direct result of our implementation?
Is My Organization Ready for
Davies?
4. Can our organization demonstrate improvement in
patient outcomes as result of improved adherence to
best practice demonstrated by 12 months of
outcomes data?
5. Has our organization created feedback loops, through
analyzing process improvement data, patient
generated data, payer data etc. to determine if a “best
practice” is resulting in improved patient outcomes?
(“Are our patients getting better?”) How are you using
data to adjust and improve those best practice
workflows to improve outcomes?
Steps to Apply for Davies
• Applicant participates in a “Pre-Submission Interview” to
discuss Davies Framework, Potential topics for case studies,
and logistics
• Applicant submits “intent to apply” letter and publication
authorization 60 days prior to submission date.
• Applicant submits case studies
• Committee reviews application and has conference call to
vote to move to a site visit or not.
– Yes vote results in a site visit
– No votes may be asked to reapply for submission the following
year
– If one outstanding case study is presented, it may be selected as a
HIMSS “Stories of Success” and be submitted to the HIMSS Value
Suite
Davies Site Visit
• A Davies site visit is a one day in-person or virtual
visit to demonstrate the workflows described in the
case study. The Davies Committee will ask
questions and review additional data that may not
have been included in the original submission.
Davies Evaluation Criteria
• Davies winners can demonstrate improved clinical outcomes and
hard return on investment as direct result of the implementation
of information technology and electronic health records.
• Winners must present a bare minimum of 12 months of data
demonstrating improved adherence to clinical best
practice/business practice and as result of improved adherence
demonstrate a bare minimum of 12 months of trended data
showing improved outcomes.
• The supporting narrative (describing the implementation,
workflow, and use of IT) must successfully demonstrate that the
improved outcomes described in the Value Derived was directly
the result of the use of IT/EHR
• Priority in Evaluation:
– Value
– Sustainability
– Innovation
What are Davies Committee
Members asking?
• Did the applicant provide a minimum of 12 months of trended
data that clearly demonstrates either clinical and patient
outcomes or business outcomes have improved?
• Is it clear that the improved sustainable clinical or business
outcome demonstrated via 12 months of trended data is the
byproduct of the Health IT solution/Health IT-enabled workflow
described in the case study?
• Did the case study reflect a replicable and actionable blueprint
for using health information technology to improve care quality
and/or business outcomes?
How to Develop a Case Study
Case Study Basics
• Enterprise applicants must complete four menu
case studies (8 pages per case study)
• Former Davies Winners reapplying must submit 3
new case studies.
• Ambulatory and Community Health Organizations
must complete three menu case studies.
Keys to a Successful Case Study
• All case studies must include:
– Background (Patient Population, Demographics)
– Local problem being addressed and intended
improvement
– Design and implementation.
• Governance, Selection Process, Testing and Field
Testing.
– How was HIT utilized?
– Value Derived
– Lessons Learned/Change Management
– Financial Considerations- Cost of Implementation and
ROI
Local Problem
• Provide the business case, utilizing pre-implementation
of IT and workflow data, to identify the clinical and/or
financial problem that your organization selected an IT
enabled solution to improve upon.
• Example:
– XXX began a process of looking at quality data in early 2011
shortly after our EMR implementation. We determined that
at baseline only 56% of our patient population had received
a pneumonia vaccination. This percentage did not seem to
significantly improve over the course of fiscal year 2012. To
address this, XXX set a goal during fiscal year 2013 to
increase the percentage of our patient population age 65
and older who had been vaccinated against pneumonia.
Design and Implementation Strategy
• Describe the selection process of the IT solution
highlighted. What was your governance structure?
• Describe the process for the development of the
workflow supported by IT.
• Identify how clinicians and end-users were
incorporated into the development of the workflow.
• Conclude with identifying the intended outcome of
the project.
Example: Design and Implementation
Strategy
Building Consensus with the SuperUser group
• Review of goals and
objectives of the network
• Duties of the SuperUser
• Define level of effort
• Solicit feedback
Meeting #1
• Establish communication
platform
• Fundamentals of Informatics
• Definition of a process
• Introduction to process
mapping
• Survey
Meeting #2
Build
foundation
for
consensus
Set
Expectatio
ns
Meeting #3
• Identify core
processes for each of
the practice areas
• Flow charting
Meeting #4
• Review of draft catalog
• Review of draft template
for diagramming
workflows
• Group decision points on
next steps
How Health IT Was Utilized (Part 1)
• Detail the workflow utilized for improving process:
• Example: UIHC Documentation Workflow
– RWB reports run by CDI staff
– CDI staff check to see if condition already documented
– Documentation questions sent via a separate Inbasket
called Doc Query
– Manual review of changed documentation
• Diagnosis and supporting documentation added
• Supporting documentation = how we evaluated, treated,
or monitored the condition
Example: Creating a BPA to Improve
Sepsis Mortality
• Early diagnosis reduces mortality 40%
• ED: Go Live 1/22/13, 1,271 patients triggered for LIP evaluation
• Pilot 6rc Go-live 3/3/14
• Bundles built in Order Sets and BPAs for initial, 3 hour and 6 hour guidelines
Timeline for Notification in EMR of Adult Inpatient Sepsis Bundle Adherence
Time ZERO
Patient qualifies for inpatient program by
meeting 2 or more of the following criteria:
A. Temperature < 35° c or > 38.9° c
B. Heart Rate > 120/min
C. WBC > 14k within last 24 hours
D. Respiratory Rate > 20/min
Patient must also meet 1 or more criteria:
A. Hypotension with SBP < 90 mmHg
B. Elevated serum lacate >= 4 mmol/L
+ 2 Hours
If patient has not had antibiotics
Physician prompted to order cultures and antibiotics.
Extra guidance given regarding choice of Rx with
regard to MRSA risk factors and Pseudomonas or
neutropenic shock.
+ 4 Hours
If initial lactate was elevated
Physician prompted to order
an additional serum lactate
If patient has qualified for the program already during
this admission, the following must also be true:
A. It must have been more than 24 hours ago
B. If patient has hypotension, he/she is not already on
an IV vasopressor
C. Patient has not had lactate measured
within last 24 hours
Automated Page
goes out to Nursing
Team on the Floor
If patient has not had lactate done
Physician prompted to order
serum lactate
If patient has not had crystalloid bolus
Physicians are notified in EMR of Time Zero occurrence
and are presented with options to:
-
Review rounding report for vitals, meds, labs
Print bundle worksheet or link to review program
Enter diagnosis for sepsis syndrome
Place sepsis initial orders via order set
Document an alternate reason for patient’s condition
Physician prompted to
order sodium chloride IV
If hypotension continues or
MAP >= 65mmHg
Physician prompted to initiate
vasopressors if they have not
already been started.
If hypotension continues or
Initial lactate elevated
Physicial will be prompted to measure
Central Venous Pressure if hemodynamic
monitoring is not already being done with
CVP readings.
How Health IT was Utilized
• Identify the workflow and IT tools utilized to
measure improvement and analyze how to continue
to improve process.
Change Management
Adjusting Clinical Workflow for Constant Improvement
eCW Request
Submitted
Ready for Release to
Facilities via training
and Communication
Plan
Design, Develop and
Test Phase
Reviewed and
Prioritized by
Informatics Team
Submitted to eCW
Change Control
Committee for
Approval
How Health IT Was Utilized:
Dashboard Example
Example: Inpatient
Sepsis BPAs
• Time Zero SIRS critieria # occurences: 41
• 6rc pilot Time Zero Physicians : 38 times displayed in
ROUNDING navigator – not required bpa. 10 times
action taken from bpa by LIPs
• 6rc pilot 3 hour bundle Lactate Missing = 12
• 3 hour bundle Crystalloid Bolus missing = 48 (will refire if action not taken after provider acknowledges
they will do this)
• 3 hour bundle Antibiotics Missing = 78 (note – will refire if action not taken after provider acknowledges
they will do this)
• 6 hour bundle CVP missing if needed = 7
• 6 hour bundle Vasopressors missing if needed = 5
• 6 hour bundle 2nd lactate missing if needed = 17
How Health IT was Utilized:
Analytics
• Demonstrate the workflow your organization and identify
analytics IT utilized to measure outcomes and identify
opportunities for improvement.
Value Derived
• Two Factors Need to Be Demonstrated
• Process Improvement
– Provided trended data for a minimum of 12 months to demonstrate
how IT was utilized to improve clinical/financial processes
• Outcomes Improvement
– Provided trended data for a minimum of 12 months to demonstrate
how IT-enabled improved adherence to clinical best
practice/financial best practice resulted in improved outcomes.
– An improved outcome:
• Did your patient get better as result of the workflow?
– Lowered Mortality, Length of Stay
– Lowered Readmissions
– Improved Health Outcomes (Lowered Morbidity)
Improved Process Example SCIP
Compliance
Example:
Outcomes
• Symptomatic CAUTIs,
add an estimated
$1,200–$4,700 to
patient costs
• YTD since we started
the reduction project in
Dec 2012 we have
reduced our volume by
116 CAUTIs
• Estimated $139,200 $545,200 in extra
patient costs
Value Derived: Outcomes (Enterprise)
Examples:
Lowered Mortality
Lowered Morbidity
Lowered Length of Stay
Overview
ROI
Clinical Value
Blood Mgmt
28
Patient Engagement
Change Mgmt 28
28
Value Derived Part 1: Process
Improvement (Ambulatory)
Patients age 65 and older who recieved pneumonia vaccination
100%
90%
80%
70%
60%
69%
71%
71%
71%
72%
Q1
2013
Q2
2013
Q3
2013
Q4
2013
Q1
2014
75%
64%
56%
58%
Q1
2011
Q2
2011
56%
58%
58%
60%
Q3
2011
Q4
2011
Q1
2012
Q2
2012
58%
Q3
2012
50%
40%
30%
20%
10%
0%
Q4
2012
Q2
2014
Value Derived Part 2: Outcomes
(ACO’s/Ambulatory)
• Examples: Improved Population Health
Lessons Learned
• Actionable and Replicable Lessons Learned, including cause
and solutions for failures
• Example:
– Many clinicians thought the flowsheet data was too prescribed, and
that interventions identified may not be appropriate in all cases. In
some instances, nurses called a “code blue” for a patient with a
high MEWS score, even though the patient did not meet the criteria
for a code blue. XXX added language to the flowsheet group,
indicating they were guidelines and should not replace a nurse’s
clinical thinking and assessment of a patient’s needs. We also
created additional guidance on how to manage patients within the
MEWS framework
• Discuss the change management structure. How are reports
and data used to change/alter provider and patient behavior?
What triggers a process improvement review? Provide
examples.
Financial Considerations
• Financial considerations (for example)
– Detail initial capital investment costs, including hardware,
software, interfaces, staffing, training etc.
– Detail on-going operational costs, such as software
updates, training, and new interfaces.
– Detail any new revenue streams or cost savings as result of
the initiative:
– Pay for Performance Contracting
– Patient Centered Medical Home
– Incentives from participation in an ACO
– Efficiency
– SHOW ROI SPECIFIC TO THE CASE STUDY
Financial Considerations Costs
Five Year Cost
Breakdown
Capital
$65,626,000
Operational Expenses
$163,540,000
-Hardware/Equipment
$19,380,000
-Software Rental/Licenses
$24,873,000
-Salaries & Benefits
$65,695,000
-Training
$7,415,000
Financial Considerations- ROI
Five Year Benefit Analysis
Reduced Forms Cost
Reduced HIM FTEs
Reduced Unit Clerk Chart
Meaningful Use Cost
Preventable ADEs 4
Reduce VTE/PE 1
MEWs
Reduced Falls
Med Errors
Total Measured Value $
$1,951,573
$3,745,353
$1,302,554
$63,800,000
$10,822,500
$6,060,000
$3,200,000
$1,003,950
$1,853,410
$22,939,860
How to Generate an ROI Calculation
Former Davies Winners Reapplying
1.
At minimum the majority of the following characteristics or dimensions should be
reflected in whatever menu topics they chose to submit/write about
a.
Culture change; the extent to which there is a culture of IT use and it is pervasive across the
entire organization
b. Significant and ongoing clinician involvement ( and that is all types of clinicians – physicians,
nurses, PT, OT, etc.)
c. Multi-disciplinary approach to design/development/implementation of IT
enhancement/systems
d. Demonstrated patient engagement; (something comparable to what we have seen on our last
few site visits – more than just number of patients with portal accounts)
e. Some type of formal IT governance with routine involvement from Executive Leadership
f. Some degree of analytics (and not just reporting) that is an ongoing operation in the
organization
g. Some degree of HIE
2.
Substantive activity in some new health care areas, for example:
3.
Extra “points”
a.
b.
c.
d.
Population health
Risk adjustment of data
Activity that focuses on the continuum of care, e.g., linking to home health or LTC facility
Activity that supports more effective care transitions
a. Some use of EHR/HIT that addresses health disparities/inequities
b. Some activity using IT/HIT that is truly innovative
c. Something that uses mobile technology in a novel way – not simply an application that is
accessible on someone’s mobile device (i.e., cell phone, table computer, etc.)
d. Some initiative that is tied to P4P and they have the data to demonstrate sustained
improvement in quality measures.
e. Some activity that is specifically targeted to Medicare and or Medicaid populations.
The Bottom Line for Two Time
Davies Winners
• To win a second Davies, an applicant should be
able to demonstrate significant value across the
organization from their use of EHR/HIT that has
built on their previous accomplishments as reflected
in their previous application/award.
Questions?
• Jonathan French, Director, Healthcare Information
Systems
• jfrench@himss.org
• @jfrenchhimss