Message from the CEO

There’s a lot to be learned about quality performance metrics by taking a look at work done by the Society of Thoracic Surgeons (STS), the feature of this newsletter. STS introduced “Public Reporting Online” this year, which extends the usefulness of their metrics and the underlying audited clinical data.

The STS public reporting tool reinforces a national trend toward improving clinical transparency, which encourages hospitals to both track and deliver high quality care. Capturing accurate and timely clinical data from high acuity areas is particularly challenging. The challenge for IT (an area where LiveData can help) is to develop systems that smoothly fit documentation processes into hospital workflow in a way that enables caregivers to remain fully focused on the patient. OR-Dashboard demonstrates how software can accomplish this; features for SCIP and the Surgical Safety Checklist make the documentation activity itself both easier and concurrent with giving care.

Cardiac Surgery Performance: Quality Performance Measures and Public Reporting 

This past year, STS introduced an offshoot of the STS Adult Cardiac Surgery Database called STS Public Reporting Online. Public Reporting Online scores participating hospitals and surgical groups across the nation on the quality of heart bypass surgery, specifically isolated coronary artery bypass grafting (CABG), with a multidimensional composite score. Each provider receives 1, 2, or 3 stars, representing comparative scores that are below average, average, or above average, respectively. 

The STS CABG Composite Score is one of 22 quality performance measures that STS generates for its participants on a regular basis. Of the 22 performance measures, 11 are for isolated CABG surgery and contribute to the composite score. The measures include both process and outcome, with all outcomes being adjusted for differences in patient risk. Thus, inherent to the composite score are factors specific to both patient and caregiving, such as patient health/age, complications (morbidities) from surgery, and whether standards of evidence-based care have been followed. For example, were beta blockers given within 24 hours preceding surgery? Was an internal mammary artery used as a part of operative care? 

STS groups the underlying 11 measures into 4 domains, gives each a score, and rolls them up into one aggregate called the CABG Composite Score. Also available on Public Reporting Online are the domain scores for risk-adjusted operative mortality, risk-adjusted morbidity, operative care process, and perioperative medications. Each domain score is comprised of different outcome measures. For example, the morbidity domain score is derived from 5 outcome measures for CABG surgeries with complications, such as deep sternal wound and postoperative renal failure. The domain score for perioperative medication is derived from 4 quality performance measures dedicated to assessing whether guidelines for required perioperative medications have been followed, such as administering preoperative beta blockers within 24 hours prior to surgery.

STS participants receive additional process measures for performance on selection, timing and duration of antibiotic prophylaxis. They also receive operative mortality outcome measures for patients undergoing aortic valve replacement (AVR), AVR & CABG, mitral valve (MV) repair, MV repair & CABG, MV replacement, and MV replacement & CABG surgeries. 

Clearly at the forefront of today’s climate of increased transparency, STS is setting the standard for public reporting. "I take personal pride in noting the great strides towards transparency that STS has taken with this initiative," says Dr. Lawrence Cohn, cardiac surgeon and Harvard Medical School professor. "However we must all be prepared to make the necessary technology investments to ensure that the data capture and subsequent utilization for quality improvement do not hamper us at the point of care." 

STS has taken a comprehensive approach to all factors involved in public reporting, such as the integrity of data sources, linkage to other registries, and interoperability of computerized systems. STS participants can have SCIP data submitted directly to the CMS Physician Quality Reporting System from the STS Adult Cardiac Surgery Database, eliminating the need to double document. STS envisions that its National Database will eventually be linked to various administrative sources such as Medicare fee-for-service claims data and the Social Security Death Master File. This will be an important component of healthcare reform because it permits analysis of long-term patient outcomes as opposed to 30-day survival probabilities. (“Public Reporting of Cardiac Surgery Performance”) 

Conference Update

STA Annual Meeting: Jan. 18–20, Palm Beach, FL 

STS 48th Annual Meeting: Jan. 28–Feb. 1; Fort Lauderdale, FL

2012 Military Health System Conference: Jan. 31–Feb. 1; National Harbor, MD

AAOS Annual Meeting: Feb. 7–11, San Francisco, CA 

HIMSS12 Annual Conference & Exhibition: Feb. 20–24, Las Vegas, NV

LiveData Milestones

New Installations

Massachusetts General Hospital deployed OR-Dashboard in all 28 operating rooms of the hospital’s newly constructed Lunder Building. The new building opened in August 2011. 

New Partnership

LiveData has signed a 6-year development and licensing agreement with Titan Medical Inc. Titan Medical will have an exclusive, worldwide license for LiveData RTI Server as an integration technology for the Company's Amadeus Composer robotic surgical platform. 

Awards

After a review of more than 400 active development projects, LiveData was identified by the US Army as one of the 25 participants in the 2011 Commercialization Pilot Program (CPP). As a part of CPP, the company received an additional $500,000 in funding from the Army to assist with the implementation of PeriOp Manager at Walter Reed National Military Medical Center. Development will begin with modules for Preop and OR Control Desk areas. The award follows LiveData’s successful SBIR work with the CIMIT Medical Device Plug-and-Play (MD PnP) group. The additional support CPP companies receive is intended to help transition innovative technologies to both the military and commercial markets. LiveData is the only 2011 CPP company focused on Healthcare IT.

Advances in LiveData Solutions

LiveData introduces PeriOp Manager, our comprehensive perioperative workflow management system. Building upon OR-Dashboard and its underlying RTI integration technology, PeriOp Manager extends LiveData’s footprint beyond the OR – monitoring and automating the flow of patients as they undergo pre-surgery assessment, the registration process, preoperative care, interventions in the OR and other procedure rooms, and recovery in the PACU. The system includes innovative displays for family waiting areas, staff break rooms, and other areas of the hospital where visibility into surgical workflow is important. PeriOp Manager delivers this via human-engineered clinical dashboards, wall, workstation & bedside displays, cell phones & pagers, and reports; and provides a full set of analytic tools for improving quality processes and OR workflow.

LiveData now offers a live, online OR-Dashboard Demo to hospitals interested in learning more about OR-Dashboard with Active Time Out. Along with viewing and navigating OR-Dashboard through all phases of the surgical case, hospitals can test drive OR-Dashboard’s full electronic version of the WHO Surgical Safety Checklist--pre-induction, pre-incision, and debriefing. 

Feedback from our customers confirms that the LiveData Compliance Monitoring & Reporting Service is effective in helping the hospital consistently monitor Surgical Safety Checklist and SCIP performance. This cost effective service provides reports and metrics to monitor checklist performance and measure compliance results on a regular basis, helping identify and create opportunities for improvements.