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Evidence-Driven Quality Improvement, the Ascension Way

February 9, 2012
by Mark Hagland
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At Ascension Health, clinical informatics is supporting a cornucopia of process change for improved patient safety and care quality

St. Louis-based Ascension Health, one of the largest multi-hospital health systems in the U.S., has been a virtual beehive of process and performance improvement in recent years. Leaders of the 81-hospital system (with about 1,400 associated or affiliated care facilities) have been spreading performance improvement —both clinical and non-clinical—across all of its 30-plus regional organizations, known as Health Ministries, all with the goal, in the words of health system leaders, "transform healthcare by providing the highest-quality care to all, with special attention to those who are poor and vulnerable." And a core component of their work has been leveraging information technology to facilitate every type of process improvement in its hospitals and clinics.

Among the numerous performance improvement initiatives moving forward within Ascension Health are the following:
• The ongoing rollout of core electronic health record (EHR) and computerized physician order entry (CPOE) systems across all of the health system’s hospitals, on multiple platforms; about 40% of Ascension Health hospitals are live on CPOE at this time, (up from 17% last year) with the rest moving forward to implement within the next year or so.
• Access and use of a foundational set of evidence-based physician order sets (derived initially from a commercially developed set from the Los Angeles-based Zynx Health). The evidence-based order sets are adapted for optimized workflow on a facility-  and hHealth mMinistry -level after local clinician input. They contain key clinical process indicators that underscore quality and safety initiatives as ‘blue ribbon’ type items whenever evidence is present to suggest impact on improved quality or efficiency.
• Project Symphony:  a System-wide administrative data and process management and standardization project focused primarily on the domains of human resources, supply chain and finance, but also including a focus on the unification of such Enterprise Resource Planning data with aggregated clinical data from across the System known as the Ministry Intelligence Center
• Healing without Harm: a System-wide program to approach, monitor, record, and continuously improve patient safety and care reliability across all care environments

Clinical informatics, data analytics, performance improvement leadership and large-scale change and educational efforts have been critical to all these advances. Jeffrey Rose, M.D., vice president-clinical excellence, informatics for Ascension Health, has been involved with the teams facilitating work for each of these initiatives. Dr. Rose, who will present related information system initiatives with attendees of the Healthcare Informatics Executive Summit, to be held May 6-8 in Orlando, spoke recently with HCI Editor-in-Chief Mark Hagland, regarding the performance improvement and automation initiatives taking place at Ascension Health, and the role of informatics. Below are excerpts from that interview.
Where are you in the Ascension Health journey toward performance improvement and automation right now?
All of our acute-care facilities and ambulatory facilities are in various stages with implementation of point-of-care clinical information system infrastructure, in concert with parallel programs in quality, efficiency and operational process areas. The Informatics work has been focused on electronic health records, of course, but connected at every opportunity to the other safety and quality efforts, with the underlying goal of acquiring and using clinical and business intelligence knowledge from these efforts to connect caregiver communities and their patients.
As the numerous electronic health record projects progress, they do so in concert with system-wide administrative data, process management and standardization in the form of Project Symphony. Each of the Health Ministries is devoting great coordinated effort to the implementation of these business and clinical information systems. Such a massive transformative information-centered effort has different facilities in different stages of their plans with respect to the electronic health record projects, ranging from those who have fully attested for meaningful use to others are almost ready to go. Some organizations are at advanced stages according to the HIMSS Analytics schematic HIMSS stage attainments, and others are merely beginning their journey. We are comprised of an extremely diverse group of hospitals, using varied platforms for the clinical information system use, but all aimed at the core goals of improving care quality and information flow across the communities they serve.

Jeffrey Rose, M.D.

Tell us a bit more about your efforts around patient safety and care quality.                  
Ascension Health has an intensive program, Healing without Harm by 2014, which is focused on inculcating principles of high reliability and reduction of all preventable harmful events in our complex care processes in which all the Health Ministries are involved. While such error measurement and reduction projects obviously involve informatics and clinical processes, they are heavily focused on operational and associate interactions in culturally safe environments to communicate technically and interpersonally in the interest of safest clinical practices.


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