3 ways point-of-care digital documentation will change how trauma teams work

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Most trauma teams use a traditional paper flow sheet to document resuscitations. A smaller number of centers have adopted electronic documentation using an EMR. But according to an expert in trauma surgery, both EMR-based and paper-based systems share several major weaknesses.

“When you think about all the things that happen during a trauma resuscitation, you realize that neither paper nor electronic flow sheets capture much data,” said Morad Hameed, MD, MPH, FRCSC, FACS, Chief of Trauma and Acute Care Surgery at the University of British Columbia.

“Both methods miss an incredible amount of information we could be using to improve patient care,” Dr. Hameed said. “The other issue is timeliness. Even if a trauma registry is relatively accurate, that data is not available until months or even years after the fact.”

Dr. Hameed has spent years wrestling with the challenges of accuracy, depth and timeliness in trauma data. That is why he and a team of his cofounders created T6 — an innovative tablet-based documentation system that matches the speed and complexity of trauma care.

“The T6 system has an intuitive user interface that actually cuts documentation time by 40%,” Dr. Hameed said. “Just as important, it features powerful back-end computing that converts data into actionable insights.”

According to Dr. Hameed, early adopters are now using T6 to capture high-resolution data on severely injured patients at the point of care. The total number of patients resuscitated with the help of the software recently passed the 10,000-case mark. “Based on what we have seen at these hospitals, rich point-of-care documentation is transforming the way trauma teams work in three ways.”

1. Teams use point-of-care data to inform decisions in the trauma bay

Currently, trauma registry data can be used to monitor performance and answer some research questions. However, registry data is typically a snapshot of care delivered months or even years earlier. Recent research shows that the overall accuracy rate of trauma registry data is just 64%.

In contrast, the T6 point-of-care documentation system allows teams to capture accurate patient data instantaneously and use it immediately.

“We created the T6 mobile user interface to mirror the flow of trauma care,” Dr. Hameed said. “Users say the system’s patient avatars, responsive touchpads and flowcharts make data entry extremely fast.”

The system can automatically collect information from vital sign monitors and other data sources, and it uses smart algorithms to minimize documentation. For example, if your secondary survey reveals that there are no injuries to the face, the system automatically collapses all inputs related to facial injury.

“But rapid data collection is only one side of the story,” Dr. Hameed said. “The T6 system features real-time analytics that provide decision support at the point of care.” Outputs include clinical practice guidelines, checklists, prognostic scores, imminent threat alerts and suggested interventions.

“All action points are based on patient-specific data and scientific evidence,” Dr. Hameed said. “T6 also uses machine learning to create predictive models based on patient phenotype. Essentially, it helps the resuscitation team understand clinical patterns with increased clarity and act on them.”

According to Larissa Roux, MD, PhD, also a cofounder at T6, trauma teams are using the system to make data dynamic. “With T6, every touch of the screen flows point-of-care data into the analytical stream, generating valuable information about the patient’s condition.”

“This is very different from traditional documentation, where data entry is of no immediate value to the team,” Dr. Roux said. “T6 actually incentivizes data capture because it provides ‘value for data’ in real time.”

2. The focus of trauma performance improvement (PI) is shifting from failures to variances

In many programs, trauma performance improvement focuses on poor outcomes and individual failures — for example, an unexpected mortality or a long response time. Point-of-care documentation with T6 allows PI leaders to shift their focus from failures to the subtle process issues that drive performance.

“T6 time-stamps every data point, which enables the system to create a process map of every resuscitation,” Dr. Roux said. “PI teams are empowered to drill down on process maps individually or collectively, enabling sophisticated analysis of team performance.”

For example, how quickly are your head injury patients getting to the CT scanner? Using T6, the first step is to pull up the process maps for all head injury patients treated last month, or over the last 12 months.

“Because every step of the resuscitation is time-stamped, you can see very precisely where the process is slowing down,” Dr. Roux said. “And because data capture is so detailed, you can identify the ‘granular’ issues that are driving long times to CT.”

T6 also enables users to apply sophisticated data analysis to trauma processes. “The big opportunity here is using statistical process control, which is all about measuring and reducing variation,” Dr. Hameed said.

For instance, a PI question might be “can we improve the speed of our massive transfusion protocol?”

The T6 system can break down complex MTP processes into discrete steps. You can then analyze the time-stamped data to identify statistically significant variation within steps. Once you know which steps are “out of control,” you know exactly where you need to make changes.

“Reducing variation improves quality,” Dr. Hameed said. “So instead of reacting to failures, trauma teams are able to use data to find and fix quality issues, often before those issues lead to problems.”

3. Trauma program leaders are using T6 costing data to drive financial sustainability

Trauma program leaders find it very difficult to identify the cost of care. This creates real problems for financial management. What should we charge for different interventions and services? How can we improve our negotiations with payers? How do we set a defensible activation fee? Is our program anywhere near financial sustainability? T6 leverages data to solve all these problems.

In the near term, T6 can improve financial performance by improving billing. More accurate and complete documentation improves charge capture. In addition, the system automatically performs ICD-10 coding, which can improve patient risk scoring and lead to higher reimbursement under risk-based payment models.

In the longer term, the T6 system combines cost and clinical data to enable sophisticated financial management. The T6 breakthrough has been to bring the gold-standard technique of Time-Driven Activity-Based Costing (TDABC) into real time. Here’s how it works:

  • T6 works with you to break down and assign costs per minute to space, equipment and personnel, while supply costs are assigned as unit costs.
  • As your team captures data at the point of care, T6 automatically tallies related costs behind the scenes, by linking cost data directly with individual clinical data points along every process map.
  • The system lets you easily see accurate costs for any episode or period, from individual resuscitations to total annual department costs.

This enables trauma program leaders to partner with finance colleagues to establish an accurate and defensible activation fee, negotiate fair reimbursements, and work towards specific financial targets.

An end to the black box

“By providing process transparency, T6 takes away the black box that surrounds clinical and cost data, giving you an unprecedented look at your actual performance,” Dr. Roux said. “It lets trauma teams use their data to take their performance to the next level and provide better patient care than ever.”

Find out what your trauma team could do with high-resolution data. To learn more about how T6 is using point-of-care data capture and predictive analytics to transform trauma care, visit our website. To request a private demo for your trauma leadership team, click here.

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