Millennium and JCI Quality Improvement and
Patient Safety Accreditation Standards
September 1, 2008
Introduction
The purpose of this white paper is to present Cerner’s opinions concerning how it believes
Millennium and associated solutions can potentially support the efforts of clients to comply with
many of the standards contained in the Quality Improvement and Patient Safety (QPS) section
(pp. 139-154) of the 2007 Joint Commission International (JCI) Accreditation Standards for
Hospitals, 3rd Edition (effective January 2008).
The white paper and the information and opinions it contains have not been reviewed or
endorsed in any way by JCI. While every effort was made to ensure the accuracy and
completeness of information in the white paper when it was published, it should be used only for
reference purposes. Interested parties should contact Cerner directly to obtain the most up-todate information concerning solution offerings and functionality, and to discuss how they might
be used to address specific JCI standards.
General Focus of the Standards
The general focus of the accreditation standards in this area can be summarized as follows:
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That the healthcare provider collects data to monitor its performance
That the provider performs systematic analysis of performance data
That the analysis includes a focus on undesirable patterns or trends
That a process to identify and manage sentinel events is in place
That the data analysis contributes to changes to improve performance and patient safety
and to reduce the risks of sentinel events
That an ongoing proactive program of identifying and reducing unanticipated adverse
events and safety risks to patients is defined and implemented
Millennium’s Role in Enabling Compliance
The standards found within this section of the JCI accreditation standards are focused on how a
performance improvement program is defined and implemented, and supported by policy and
procedure, education, and training. The standards also call for active data collection, analysis,
and reporting activities to be carried out by the provider organization. However, there are some
key system roles that Millennium can play in support of these activities. At a summary level,
these can include:
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Providing for collection of data for analysis based on actual activity data entered into
patient records in the EMR
Supporting reporting on key quality management focus areas such as medication
management and restraint use
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Supporting risk management needs relative to ADEs for possible candidate identification,
benchmarking and trending, provided that relevant data is collected in the EMR and
Millennium source system (as opposed, for example, in separate, secure, nondiscoverable databases)
Providing dashboards for key quality metrics and operational metrics
The solution key to supporting these standards is PowerInsight.
Note: The solutions, solution functionality, and services referenced in this white paper may not
be available in all markets.
At a more granular level, Millennium can assist in enabling compliance with these standards in
the ways described below. (Specific JCI accreditation standards are stated followed by the
abilities of Millennium to enable compliance.) The JCI standards that are highlighted for
comment are those that seem to most directly imply a system role in compliance.
Leadership and Planning
QPS.1 – Those responsible for governing and managing the organization participate in planning
and monitoring a quality improvement and patient safety program.
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The organization’s leadership participates in developing the plan for the quality
improvement and patient safety program.
The organization’s leadership participates in monitoring the quality improvement and
patient safety program.
The organization’s leadership establishes the oversight process or mechanism for the
organization’s quality improvement and patient safety program.
The organization’s leadership reports on the quality and patient safety program to
governance.
As discussed in more detail in later sections of this paper, the system supports data collection
and analysis that can support leadership efforts to plan, monitor, and report on quality
improvement and patient safety programs.
QPS.1.1 – The organization’s leaders collaborate to carry out the quality improvement and
patient safety program.
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The organization’s leaders collaborate to carry out the quality improvement and patient
safety program. (Also see GLD.3.4, ME 2; SQE.11, ME 1; and SQE.14, ME 1; and
SQE.17, ME 1)
The system can support leadership efforts to implement such a program by capturing data for
outcomes analysis for certain areas for performance improvement from a quality standpoint
such as:
- Medication Management
- Blood/Blood Product Use
- Restraint Use
- Seclusion Use
- Behavior Management
- Operative and Other Invasive Procedures
- Resuscitation and Associated Outcomes
PowerInsight has been architected to benefit from point-of-care data capture of clinical
documentation, orders, and clinical events within the electronic medical record (EMR).
PowerForm documentation on restraint use, resuscitation, etc., is captured as a by-product of
care, and is made available for storage within the PowerInsight enterprise data warehouse
(EDW) for outcomes analysis.
If there is a defined evidence-based guideline that can be quantified from an external source
or based on organization practice, the system allows for comparison of the organization’s
performance against an established guideline assuming the data is available to support the
comparison in PowerInsight as fed from the EMR or other source system and the system can
link out to reference materials that provides information on the guideline. Also, the EMR
can provide capabilities to monitor patient level progress towards outcomes based on a
particular plan of care that reflects clinical practice guidelines, quality of care requirements,
or other purposes. PowerInsight can provide reporting on variance from patient care goals
(and the reasons for the variation) for a plan of care that may defined within the EMR.
In many areas, core and specialty content has been developed or is in the process of being
developed using PowerForms, PowerNote, Discern Expert, or Advisory rules and alerts
and/or other capabilities to provide for the capture of key clinical and operational data
elements important to measurement. This content is available through the Cerner Knowledge
Manager (CKM) web page accessible on Cerner’s client extranet through www.cerner.com.
For those areas where there are service bundles offered through Lighthouse, the guidelines
used to identify recommended practice are informed by evidence-based practice guidelines
so that desired benchmarks for outcomes can be defined. The delta from the benchmarks
contained within the practice guidelines at a point in time as well as over time can be
identified so the provider can see their current state at a point in time against the benchmark.
In 2008, areas identified for Lighthouse services include key areas of quality or service focus
as Falls Prevention, Pain Management, Pressure Ulcers, Medication Adherence, Activity
Tolerance, Post Op Anemia Management, Surgical Site Infection, MRSA, Heart Failure,
AMI, Total Hip, Knee, Shoulder or Other Major Joint Replacement, Labor and Delivery,
Supply Management, OR Utilization, Pre Admission Testing, Discharge Readiness, and
Preoperative Anesthesia Clearance.
The system also can support collection of risk management information for Adverse Drug
Events (ADEs) if that data is captured in the EMR.
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The program addresses the systems of the organization and the role of system design and
redesign in quality and safety improvement.
Through Cerner’s Lighthouse service bundles for certain clinical processes and clinical
conditions, Cerner leverages process modeling techniques to help map current state and
future state models of a given process. Through PowerInsight, reporting is provided to help
assess the performance of the current state process being modeled. The process modeling
approach can assist in determining what process steps should be automated based on
recommended practice, and on possible opportunities to reduce or consolidate other steps
based on available system capabilities. For example, specific areas of surgical services have
been studied and modeled to develop the basis of assumption for recommended practice so
that current state practice could be evaluated and process redesign recommendations made.
QPS.1.2 – The leaders prioritize which processes should be monitored and which improvement
and patient safety activities should be carried out.
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The leaders set priorities for monitoring activities.
The leaders set priorities for improvement and patient safety activities.
See response to QPS.1.1.
At this time, PowerInsight does not enable collection of data and analysis for information for
- Risk Management (unless relevant data is captured in Millennium, in which case
PowerInsight can usually report on some issues in this area)
- Utilization Management
- Infection Control Surveillance and Reporting (although PowerInsight currently can
report lab and microbiology data, compared to medication administration and
antibiotic use)
- Research
- Autopsies
See Prevention and Control of Infections white paper for information on how Millennium
can contribute data for Infection Control Surveillance and Reporting from PathNet
Microbiology.
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The priorities include the implementation of the International Patient Safety Goals.
See International Patient Safety Goals white paper.
QPS.1.3 – The leaders provide technological and other support to the quality improvement and
patient safety program.
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The leaders understand the technology and other support requirements for tracking and
comparing monitoring results.
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The leaders provide technology and support, consistent with the organization’s
resources, for tracking and comparing monitoring results.
See response to QPS.1.1.
PowerInsight uses Business Objects to do some statistical analyses and data display including
tables, charts, trends, etc. Data is collected every 24 hours through batch processes from
source systems. Data can be reported on an appropriate periodic basis. Methods of analysis
can include common statistical functions such as computing averages, medians, percentiles,
rank, standard deviations, running counts and averages, and other statistical measures. A
user may also design a control chart using Business Objects to support development of
dashboards for monitoring and analysis. PowerInsight supports most any kind of definition
of a relative data range as a unit of time for analysis of the data. PowerInsight also can
support most forms of graphing and trending of data based on Business Objects capabilities.
QPS.1.4 – Quality improvement and patient safety information is communicated to staff.
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Information on the quality improvement and patient safety program is communicated to
staff.
The system does not play a direct role in this activity. However, the system can enable the
use of an operations dashboard for the line management to use in reviewing information
relative to a given problem that is the focus of performance improvement activities. Through
Business Objects Infoview (user interface), related reports can be saved, modified, sent, and
exported for distribution or follow-up.
Design of Clinical and Managerial Processes
QPS.2. – The organization designs new and modified systems and processes according to quality
improvement principles.
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Quality improvement principles and tools are applied to the design of new or modified
processes.
Design elements a) through i) are considered when relevant to the process being
designed or modified.
[NOTE: The following section is from the intent statement.]
Good process design
a) is consistent with the organization’s mission and plans;
b) meets the needs of patients, families, staff, and others;
c) uses current practice guidelines, clinical standards, scientific literature, and other
relevant evidence-based information on clinical practice design;
d) is consistent with sound business practices;
e) considers relevant risk management information;
f) builds on available knowledge and skills in the organization;
g) builds on the best/better/good practices of other organizations;
h) uses information from related improvement activities; and
i) integrates and connects processes and systems.
Through Cerner’s Lighthouse service bundles, Cerner can assist in modeling certain clinical
or conditions based processes and through PowerInsight, provide measurement support for
identifying possible gap areas. Ongoing monitoring can be supported through PowerInsight
to help provide support for measuring improvement in outcomes. Through this process,
Lighthouse services that leverage process modeling can help identify the current state, define
a future state, support measurement of outcomes at relevant points in time to establish a basis
of comparison (through PowerInsight), and Cerner can provide recommended clinical and
decision support content at key points of decision making in a given process to effect
necessary changes for improving performance.
The value of the system is to assure that information entered through the process and course
of patient care is made available for process improvement activities. Such data is captured
and extracted into PowerInsight provided that clinical documentation forms are designed
with such data capture needs in mind. Most other types of discrete clinical data are also
available for inclusion in analysis.
As learning from monitoring and analysis activities is enabled, the system can help with the
definition of actionable rules and alerts for management of possible risk events as they may
occur or come to be recognized within the EMR. For example, if one of the particular
circumstances identified and trended as a possible ADE risk area also may be defined for
identification in real time as such a possible event occurs as the result of attempts to place
orders, alert rule conditions can be defined to trigger provider notification so that events may
be managed if not prevented at the point of care. If real issues do occur, the system can help
enable and contribute data to the identification of, and reporting on, adverse events.
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Indicators are selected to measure how well the newly designed or redesigned process
operates.
See responses to QPS.1.1 and QPS.1.2 as to which areas are directly enabled by the system
for measurement.
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Indicator data are used to evaluate the ongoing operation of the process.
See previous.
QPS.2.1 – Clinical practice guidelines and clinical pathways are used to guide clinical care.
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Leaders use clinical practice guidelines to guide patient care processes.
Leaders use clinical pathways to standardize care processes.
The organization follows the process described in a) through f) of the intent in
implementing clinical practice guidelines and clinical pathways.
[NOTE: The following section is from the intent statement.]
Clinical practice guidelines and clinical care pathways relevant to the organization’s
patient population and mission are
a) selected from among those applicable to the services and patients of the
organization (mandatory national guidelines are included in this process, if
present);
b) evaluated for their applicability and science;
c) adapted when needed to the technology, drugs, and other resources of the
organization or to accepted national professional norms;
d) formally approved or adopted by the organization;
e) implemented and monitored for consistent use and effectiveness;
f) supported by staff trained to apply the guidelines or pathways; and
g) periodically updated.
The system can use PowerPlan to provide a centralized location for each member of the care
delivery team to manage the plan of care. The solution is used to initiate orders for all
departments and direct care providers, specifying in detail to all caregivers what is expected
of each of them for every patient assignment. PowerPlan supports diagnosis-based and
structured methodologies for nursing services and multidisciplinary care planning. Problem/
clinical diagnosis-based plan suggestions provide appropriate plan options based on
documented problems. Links to third party nursing content as well as locally defined best
practice can be associated with any component within the plan of care. Reference text and
evidence may be defined at the plan level with hyperlinks to external and internal reference
databases supporting the viewing of evidence, policies, and procedures.
Data Collection for Quality Monitoring
QPS.3 – The organization’s leaders identify key measures (indicators) to monitor the
organization’s clinical and managerial structures, processes and outcomes and the International
Patient Safety Goals.
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Monitoring includes measures related to structures, processes, and outcomes.
The scope, method, and frequency are identified for each measure.
The monitoring is part of the quality improvement and patient safety program.
The results of monitoring are communicated to the oversight mechanism and periodically
to the leaders and governance structure of the organization.
Comments are made as to the system roles below. See also whitepaper Millennium and
International Patient Safety Goals.
Note: The clinical areas identified in standards QPS.3.1 through QPS.3.11 are included in the
organization’s quality monitoring.
QPS.3.1 – Clinical monitoring includes those aspects of patient assessment selected by the
leaders.
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Clinical monitoring includes the areas identified in the standard.
Clinical monitoring data are used to study areas targeted for improvement.
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Clinical monitoring data are used to monitor and evaluate the effectiveness of
improvements.
[NOTE: These measurable elements are the same for QPS.3.1 through QPS.3.11.]
As explained in QPS.2, the system can enable data collected during the course of patient care
to be made available for quality and process improvement activities by capturing it and
extracting it into PowerInsight. This assumes that the information is captured in a discrete
form for those elements desired for use in quality management activities. Assessment form
design should consider these requirements. The system supports the definition of
standardized assessment formats for performing initial assessments. These forms can be
elaborated to support specific patient conditions and needs. Many types of assessment forms
are available as predefined content, and as part of starter reference data for new
implementations. Such content is available through www.cerner.com through the Cerner
Knowledge Manager webpage.
QPS.3.2 – Clinical monitoring includes those aspects of laboratory services selected by the
leaders.
As discussed in the white paper Millennium and JCI Assessment of Patients Standards, the
system helps facilitate laboratory quality control activities in the manner described there.
The system can provide retrospective reporting on turnaround time (TAT) performance. For
example, in PathNet, there is an online monitor, called the TAT monitor, which tracks from
when a specimen is first received in lab and ages specimens based on the amount of time the
specimen has been in lab. Stoplight coding is used based on the status of how a given
specimen approaches being overdue (yellow) or is overdue (red). This monitor is intended to
be displayed in a common visible area within the collections management area. The monitor
uses rules to drive how the stoplight coding should be, but it does not show particular result
status. The status is more that specimen testing is not done, and the monitor is at the detail
test level to track criticality of results.
QPS.3.3 – Clinical monitoring includes those aspects of radiology and diagnostic imaging
services selected by the leaders.
The system does not play such a direct role in radiology or diagnostic imaging quality control
programs. However, through RadNet, the system provides monitoring capabilities to show
how long diagnostic exams have been in a radiologist queue for review, which supplies data
that can be used to help identify areas meriting improvements and benchmark and monitor
over time the effectiveness of measures taken to make them. Similar to PathNet, RadNet
also provides TAT reporting through PowerVision for order status from the time of order
through to the time a diagnostic image report has been reported out.
QPS.3.4 – Clinical monitoring includes those aspects of surgical procedures selected by the
leaders.
As mentioned in the response to QPS.1.1, the system helps facilitate analysis for operative
and other invasive procedures. Solution development in 2008 will allow perioperative data
captured through SurgiNet Anesthesia and Surgery to be used by Discern Expert analytics to
enable analysis and reporting on relationships among conditions, care, and outcomes in the
surgical theater, such as monitored vital signs (e.g., heart rate, body temperature) that drop
below or rise above set ranges and the results of particular interventions employed to address
those out-of-range events.
QPS.3.5 – Clinical monitoring includes those aspects of antibiotic and other medications use
selected by the leaders.
As mentioned in the response to QPS.1.1, the system helps facilitate analysis for medication
management if that data is captured in the electronic medical record (EMR). The ability to
collect such information is dependent on it being made available from the EMR.
The system enables documentation of monitoring and assessment activities associated to
administration of antibiotics and other medication. The system supports monitoring
responses for antibiotic and PRN-related events at the orderable level, the system can support
definition of tasks to monitor the effects of a medication on the patient such as a task for
monitoring vital signs. Discern Expert rules may also be defined in setting up other
monitoring conditions as may be required. PowerForms are typically used to document
monitoring activities including those for antibiotics and first dose response. In the ED using
FirstNet, no monitoring tasks are generated per se as may be the case in the inpatient setting.
Monitoring is documented as it occurs.
Lab values can be accessed from within PharmNet or for the direct patient care team through
Powerchart via the flowsheet or IView to make relevant lab results available for
consideration during monitoring of antibiotics and other medication.
Pain management responses can also be documented in the system for post-operative
monitoring while a patient is in recovery.
PowerInsight Explorer can be used to track and analyze data for antibiotic use such as
whether a particular antibiotic was administered within one hour prior to surgery incision,
whether the appropriate antibiotic based on quality, evidence-based measures was used for a
procedure, and whether the use of antibiotics was discontinued within 24 hours of the surgery
end time. PowerInsight can also be used to report on use of medications, including
antibiotics, and outcomes related to that use for any designated disease state, including
infections such as MRSA (methicillin-resistant Staphylococcus aureus), C. difficile,
pneumonias, and infections associated with catheters and ventilators.
QPS.3.6 – Clinical monitoring includes the monitoring of medication errors and near misses.
The system helps facilitate analysis for the identification of possible ADEs if that data is
captured in the EMR.
QPS.3.7 – Clinical monitoring includes those aspects of anesthesia and sedation use selected by
the leaders.
The system has not had much breadth of use for anesthesia process automation, but this is
being incorporated into the design of the solution offering for anesthesia.
The system can support documentation of sedation/anesthesia administration in surgical
documentation. The system can support documentation of monitoring activities during the
procedure in the same documentation. This can be done through telemetry interfaces with
the medical devices if available, and continuous posting of device or vital sign data is within
the scope of system use. Any alarms or notifications of possible patient distress would be a
function of the medical devices themselves. Solution development in 2008 will allow for
data on results (e.g., hematocrit) to be pushed directly from PowerChart to SurgiNet
Anesthesia Management so that the anesthesia provider can bookmark or add those results to
the patient’s anesthesia record and use this data to support efforts to enhance the quality and
timeliness of clinical decision-making and document reasons for treatment.
QPS.3.8 – Clinical monitoring includes those aspects of the use of blood and blood products
selected by the leaders.
As mentioned in the response to QPS.1.1, the system helps facilitate analysis for use of blood
and blood products.
QPS.3.9 – Clinical monitoring includes those aspects of availability, content, and use of patient
records selected by the leaders.
The system helps assure the availability of medical records both through the ongoing
availability of the electronic medical record, but also through the management of library
functions related to any paper records. The system supports the content requirements of
medical records, and helps assure the completion of those records through documentation
completion tracking and deficiency management within health information management
processes.
The system’s support of the use of standardized, codified data in electronic medical records
facilitates the use of that data to provide more accurate and comprehensive input to clinical
monitoring activities.
QPS.3.10 – Clinical monitoring includes those aspects of infection control, surveillance and
reporting selected by the leaders.
See white paper Millennium and JCI Prevention and Control of Infection Standards for more
information on this requirement.
QPS.3.11 – Clinical monitoring includes those aspects of clinical research selected by the
leaders.
The system is not customarily used to support clinical monitoring for research purposes. To
the extent that the system may serve as a source system for clinical research data abstraction,
this process may be facilitated. The PowerTrials solution supports enrollment and tracking
of patients enrolled on research protocols including documentation of on-study, offtreatment, and off-study dates. PowerTrial interoperability with PowerChart includes a
clinical trial indicator so clinicians can know that a patient is: "Currently Enrolled" or "Not
Currently Enrolled" on a trial. Clinicians with the appropriate security privileges have access
to the Clinical Trials tab in PowerChart which provides clinical trial enrollment information
(current and historic enrollment), access to protocol information, contact information for the
designated research contact for each study, and an interoperable workflow to facilitate the
screening and referring of potential research candidates. Making clinicians aware that a
particular patient is on a research protocol enhances patient safety and supports efforts to
avoid medications or procedures contraindicated by the research protocol.
Note: The managerial areas identified in standards QPS.3.12 through QPS.3.20 are included in
the organization’s quality monitoring.
QPS.3.12 – Managerial monitoring includes those aspects of the procurement of routinely
required supplies and medications essential to meet patient needs selected by the leaders.
 Managerial monitoring includes the areas identified in the standard.
 Managerial data are used to study areas targeted for improvement.
 Managerial data are used to monitor and evaluate the effectiveness of improvements.
[NOTE: These measurable elements are the same for QPS.3.12 through QPS.3.20.]
Through its ProCure solution, the system does enable the management of the supply chain
for routinely stocked supplies and medications including – tracking inventory levels,
monitoring stock outs and reorder points, managing requisitioning, purchasing and receiving
functions and assuring that such items are available for care through dispensing or routing of
supply items to the point of need.
Prospectively, RXStation (where available) helps prevent diversion by assuring only
authorized users gain access to controlled substances, and for items subject to controlled
substance controls, once the cabinet has been accessed, only one storage area opens at a time.
Millennium provides the context of what is being dispensed through a transaction that passes
to the device, and the device makes available what is being requested and nothing more –
there also is a less secure area that allows for access to non-controlled items that do not
require higher levels of security. The system provides reporting retrospectively on the
controlled substance dispensing activity to help support monitoring of controlled substances.
Millennium’s inventory management capabilities available through ProCure support ongoing
inventory management for RXStation on a consistent basis with any other inventory location.
Restocking is driven by reorder levels which determine if a medication item should show up
on a reorder list. The reorder level can be set for a particular low stock level and indicated as
critical if at a very low level which can generate a page alert or other notification.
For narcotics, RXStation helps enable a true perpetual inventory management approach in
that the device requires a true blind count back to be performed so the inventory level is
maintained at all times.
The system has an awareness of the type of medication in inventory for any inventory
location (including for RXStation), when it was introduced into inventory, and when and to
which patients it was dispensed as a matter of process. As of Millennium 2007.18, expiration
and lot numbers can be tracked to support traceability from inventory through to dispensing.
Lot and expiration date are also now available as codified data on the eMAR for vaccines.
QPS.3.13 – Managerial monitoring includes those aspects of reporting of activities as required
by law and regulation and selected by the leaders.
The use or ability of the system in this regard depends on the particular requirement at hand.
Most often, the system is a source for abstraction of data to be used in reporting internally for
performance management, but does not automate the actual submission of such reporting
externally.
QPS.3.14 – Managerial monitoring includes those aspects of risk management selected by the
leaders.
The system does not automate risk management monitoring or reporting at this time.
QPS.3.15 – Managerial monitoring includes those aspects of utilization management selected by
the leaders.
The system does not automate utilization management monitoring or reporting at this time.
QPS.3.16 – Managerial monitoring includes those aspects of patient and family expectations and
satisfaction selected by the leaders.
The system provides for the ability to analyze and report on patient satisfaction outcomes by
importing satisfaction survey results at the Business Objects report level. The system does
not provide a role in the actual collection of such survey data.
QPS.3.18 – Managerial monitoring includes those aspects of patient demographics and diagnoses
selected by the leaders.
The system supports the capture of an extensive set of patient demographic information and
diagnosis information. This information may be used for analysis as many aspects of it are
extracted into PowerInsight from the Cerner Millennium source system.
QPS.3.19 – Managerial monitoring includes those aspects of financial management selected by
the leaders.
The system provides some capabilities for financial management monitoring and reporting
provided it also supports the billing functions of the organization. The types of financial
reporting include management of billed and unbilled revenue, management of accounts
receivable, management of collections activity and reimbursement activity.
ProCure can provide reporting against individual cost centers and produce data to help
managers and other leaders determine trends for materials use in them over time, which can
support analyses of the role inventory and inventory management play in financial outcomes.
Value analysis reporting can enable comparisons of materials usage across different surgical
procedures and across clinicians performing the same procedures, and be used to help
analyze relationships among materials use and clinical and financial outcomes. This
reporting can be accomplished using combinations of PowerVision and Discern Explorer.
PowerInsight can pull financial data such as data on charges and charge reimbursements into
its data warehouse for analysis and reporting purposes.
QPS.3.20 – Managerial monitoring includes those aspects of the prevention and control of events
that jeopardize the safety of patients, families, and staff selected by the leaders, including the
International Patient Safety Goals.
As explained in QPS.3.6, the system can support the collection and reporting of data related
to ADEs (from medication management). It can also, to an extent, do the same for infection
control.
In addition, the system enables definition of assessment forms and provides predefined
content for admission assessments and other purposes that may be used to document risk
factors of the patient. Discern rules may be implemented to review patient medications for
possible candidate identification for management of the risk of falls for patients. Discern
Advisor rules can be implemented to suggest a fall risk prevention plan of care based on the
outcome of the patient assessment (based on the fall risk score). Such care plans can be
defined to include appropriate activities for minimizing the risk of falling such as through
identifying required measures to be taken in the care of that patient to reduce the risk.
Actions taken can be documented in nursing or other appropriate clinical documentation
forms.
Also, Lighthouse has service bundles for falls as a target area for process optimization. This
will include standard reports based on standard content that are under development to support
the reporting needs for evaluating performance improvement. Also, as long as the supporting
data capture is enabled through the EMR to feed into PowerInsight, the possibility exists to
use PowerInsight reporting capabilities to support a hospital’s own design for reporting on
falls. However, many hospitals may not choose to document these kinds of findings in the
EMR – but would use an incident reporting/risk management solution more aimed at
supporting a Risk Management function within the hospital. That choice may differ by the
provider as to what is discoverable and what is not depending on incidents being documented
in the record.
The system supports definition of content for inclusion on all appropriate assessment forms
to support the evaluation of a patient’s risk of suicide including all admission assessments,
patient histories, ED triage and assessment forms, and preadmission visit assessments.
Additional conditional assessment content can be automatically brought into the assessment
process if there is indication the patient may be at risk. The system also supports the
definition of care plans to support appropriate safety protocols for prevention or mitigation of
this risk.
See also whitepaper Millennium and International Patient Safety Goals.
Analysis of Monitoring Data
QPS.4 – Individuals with appropriate experience, knowledge, and skills systematically aggregate
and analyze data in the organization.
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Data are aggregated, analyzed, and transformed into useful information.
Statistical tools and techniques are used in the analysis process when suitable.
The Cerner Knowledge Index (CKI) provides assistance to map clinical concepts across
medical vocabularies, and to assure consistent meaning at a common level for reference data
that may be tagged with site specific labels, mnemonics, or display values. These help assure
that when data is aggregated from multiple sources into the electronic medical record that the
data can be seen as holding consistent meaning. This also is key to the system capability to
enable the capture and codification of regulatory or quality-related data important to quality
measurement or outcomes measurement along with operational reporting.
For management reporting, PowerInsight leverages the concept mapping defined with
Millennium to assure reliable consistent meaning for data. PowerInsight was designed to
externalize decision support data from the Millennium transactional domain into a separate
domain which enabled re-formatting of the data into a schema that more adequately
supported processor-intensive queries, retrospective analysis and summary-level reporting.
Many reports are created and provided through PowerInsight. These reports provide the
ability to study Key Performance Indicators (KPI) and other items of interest. KPIs are high–
level metrics that provide an organizational view of the selected data. They are an
intersection of a time dimension (last month) and a measure (mortality) that provides the user
with a view into the current state of a particular aspect of the organization. The end user is
provided access to predefined reports as well as the ability to produce their own.
Additionally, as data marts are added to the solution, new reports will be added.
PowerInsight uses Business Objects to do some statistical analyses and data display including
tables, charts, trends, etc. Data is extracted on a daily basis through batch processes from
source systems. Data can be reported on an appropriate periodic basis. Methods of analysis
can include common statistical functions such as computing averages, medians, percentiles,
rank, standard deviations, running counts and averages, and other statistical measures. A
user may also design a control chart using Business Objects to support development of
dashboards for monitoring and analysis. PowerInsight supports most any kind of definition
of a calendar period as a unit of time for analysis of the data. PowerInsight also can support
most forms of graphing and trending of data based on Business Objects capabilities.
QPS.4.1 – The frequency of data analysis is appropriate to the process being studied and meets
organization requirements.
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The frequency of data analysis is appropriate to the process under study.
The frequency of data analysis meets organization requirements.
See previous response.
QPS.4.2 – The analysis process includes comparisons internally, with other organizations when
available, and with scientific standards and desirable practices.
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Comparisons are made over time within the organization.
Comparisons are made with similar organizations when possible.
Comparisons are made with standards when appropriate.
Comparisons are made with known desirable practices.
PowerInsight can provide the ability for a client to define benchmarks for comparisons of
outcomes internally and to industry benchmarks, and to use such analysis techniques as
stoplight coding of the organization’s performance against such benchmarks.
Lighthouse can make use of comparative references for process redesign using recommended
practices based on industry peer-reviewed recommended practices.
QPS.5 – The organization uses a defined process for identifying and managing sentinel events.
As learning from monitoring and analysis activities is enabled, the system can help with the
definition of actionable rules and alerts for management of possible risk events as they may
occur or come to be recognized within the EMR. For example, if one of the particular
circumstances identified and trended as a possible ADE risk area also may be defined for
identification in real time as such a possible event occurs as the result of attempts to place
orders, alert rule conditions can be defined to trigger provider notification so that events may
be managed if not prevented at the point of care. If real issues do occur, the system can help
enable and contribute data to the identification and reporting on adverse events as is
discussed in the above means discussed in QPS.4 and QPS.6, whether for internal control or
for external reporting. The system does not typically automate risk management or external
adverse or patient safety incident reporting.
QPS.6 – Data are analyzed when undesirable trends and variation are evident from the data.
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Intense analysis of data takes place when adverse levels, patterns, or trends occur.
See response in QPS.1.3 above. Based on the type of trending or graphing, unfavorable
trends can be highlighted to identify underperforming metrics or unfavorable trends.
PowerInsight can support identification of a problem on the operations dashboard, and
support drill down into a given problem to review all aspects of the problem through solution
set metrics, taking action with other Cerner solutions to support monitoring/controlling of
that action, and supporting ongoing measurement of clinical and financial outcomes to
evidence continual improvement.
Lighthouse uses process models to highlight inefficient work processes that vary from
recommended practices.
QPS.7 – The organization uses a defined process for the identification and analysis of near-miss
events.
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The organization establishes a definition of a near miss and the type of events to be
reported. (Also see MMU.7.1 for medication near misses.)
The organization establishes the process for the reporting of near misses. (Also see
MMU.7.1 for medication near misses.)
The data are analyzed and actions taken to reduce near-miss events. (Also see MMU.7.1,
ME 3)
See response in QPS.5. If real issues do occur, the system can help enable and contribute
data to the identification and reporting on adverse events as described in QPS.3.5, QPS.4,
and QPS.6, whether for internal control or for external reporting. PowerInsight can extract
data from Millennium solutions for reporting and analysis purposes on how often alerts
related to drug interactions, etc., are fired, whether these alerts were overridden or accepted
and by whom, and the reason recorded by a care provider as to why an alert was overridden.
However, the system does not typically automate risk management or external adverse or
patient safety incident reporting.
Improvement
QPS.8 – Improvement in quality and safety is achieved and sustained.
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The organization uses a consistent process to plan and implement improvements.
The organization documents the improvements achieved and sustained.
The main system role in this area is through the collection and reporting of information as
noted elsewhere in this document.
QPS.9 – Improvement and safety activities are undertaken for the priority areas identified by the
organization’s leaders.
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The priority areas identified by the organization’s leaders are included in improvement
activities.(Also see QPS.3, ME 1)
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Human and other resources needed to carry out an improvement are assigned or
allocated.
Changes are planned and tested.
Changes that resulted in improvements are implemented.
Data are available to demonstrate that improvements are effective and sustained.
Policy changes necessary to plan, carry out and sustain the improvement are made.
Successful improvements are documented.
See other responses in this document, including those which contain references to Lighthouse
process modeling and PowerInsight monitoring capabilities.
QPS.10 – An ongoing program of identifying and reducing unanticipated adverse events and
safety risks to patients and staff is defined and implemented.
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The organization’s leaders adopt a process by which it identifies high-risk areas in terms
of patient and staff safety.
The organization’s leaders prioritize patient and staff safety risks at least once annually.
The organization conducts and documents use of a proactive risk-reduction tool at least
annually on one of the priority risk processes.
The organization’s leaders take action to redesign high-risk processes based on the
analysis.
See comments on Lighthouse elsewhere in this document.