It's hard to imagine an organizational narrative following an individual leader's narrative as closely as has happened in the case of the 145-bed Children's Hospital and Medical Center and George Reynolds, M.D. Indeed, the personal-professional journey that Reynolds has been on since he joined the Omaha pediatric hospital in 1996 as the director of its pediatric ICU, eventually becoming its CMIO and then last year, its CIO, has been echoed in the evolution of the organization's Clinical Analytics and Business Intelligence Project, and the medical center's broader journey towards becoming a data-driven, continuous improvement-focused organization. So to understand the organization-wide phenomenon, one first needs to learn a bit about George Reynolds' personal story.
“For me, as a personal journey, this all started back when I started as the director of the pediatric ICU in 1996, and as I grew the unit over a period of years,” says Reynolds. “I also was running, and we still run, the pediatric ICU at the University of Nebraska,” he recalls. “And my motivation was to get a handle on the data of our own unit. How well were we doing with our patients? How often did we have central line infections? That kind of thing. We were doing a good job as an institution, but we were relying on those midnight-census Joint Commission reports,” and unable to produce a significant amount of analyzable clinical data. “And it all started with really simple things like our asking how many nurses we needed. We simply didn't know.”
Reynolds' curiosity on behalf of quality and efficiency in the ICU turned into a quest, one that only intensified when he became medical director of informatics in 2004 and then CMIO in 2006. By that time, he had relinquished a portion of his medical practice to focus on clinical informatics. Then last spring, the organization's CIO departed, and Reynolds was asked to take on the CIO role, while continuing as CMIO. By that time, he had become a crusader for clinical transformation, as he was seeing with his own eyes how data, when intelligently leveraged, could transform care delivery and outcomes.
MY MOTIVATION WAS TO GET A HANDLE ON THE DATA OF OUR OWN UNIT. HOW WELL WERE WE DOING WITH OUR PATIENTS? HOW OFTEN DID WE HAVE CENTRAL LINE INFECTIONS?-GEORGE REYNOLDS, M.D.
“My predecessor as CIO, Allana Cummings, and I had a great partnership, because we were both data-driven people,” Reynolds continues. “And as we started to do clinical projects like CPOE [computerized physician order entry], we started building metrics into implementations, including simple ones like who's using CPOE, and including clinical care goals. She was the founder of the data services division, and had a vision for creating a data warehouse, which we both felt was a necessity. We have Epic [Epic Systems Corp., Verona, Wis.] on the ambulatory side and formerly Eclipsys, now Allscripts [Allscripts Healthcare Solutions Inc., Chicago], on the inpatient side,” he adds. “So we always felt we needed a data warehouse to pull all this together.”
Thus was born the first dashboard, which was designed to determine which physicians were using CPOE, and in what ways. Over time, success with that first dashboard and with a few others that followed it led to a natural organic growth, as “this became very exciting for everyone, from finance to clinicians,” Reynolds says. At press time, the folks at Children's of Omaha had created 12 dashboards supporting inpatient care, 15 supporting the organization's affiliated pediatric physician practices, and others addressing financial performance and system-wide operational issues. Among the numerous departments that have adopted dashboards are the ED, pediatrics, the ICU, the perioperative area and OR, the NICU, the quality division, ambulatory care, finance, supply chain/materials management, and revenue cycle management. Indeed, Reynolds reports, virtually the entire leadership of the organization is now using dashboards of some kind at this point.
SPECTACULAR RESULTS, TEAM-BASED EFFORTS