Maryland Association of Healthcare Executives presents: Session #1 Innovation Changing the Face of Healthcare Delivery Our Expert Panel
Speakers:
1. Pius Aiyelawo Chief Operating Officer NIH, Clinical Center
2. Randy Komenski, FACHE, MBA, CPA, SSBB Administrator, Medicine- JHBMC Johns Hopkins Bayview Medical Center
3. Vamsee Potluri, MHA/MBA, CLSSBB Ambulatory Care Operations Director – Group Practice Manager VA Maryland Health Care System
Moderator: Patrick Vega Vice President, Corazon, Inc
2 National Institutes of Health (NIH) Clinical Center
Pius A. Aiyelawo, FACHE MACHE HEALTHCARE INNOVATION FORUM October 11, 2018
3 Agenda
National Institutes of Health (NIH) Overview NIH Clinical Center Overview NIH CC Leveraging of Technology to improve patient safety and engagement Completeness of Medical Record Antimicrobial Stewardship Management Patient Engagement Summary
4 Overview of National Institutes of Health
NIH is made up of 27 Institutes and Centers, each with a specific research agenda, often focusing on particular diseases or body systems. Conducts research in its own laboratories Supports research of non-federal scientists In universities, medical schools, hospitals, and research institutions throughout United States and overseas. Helps train research investigators Fosters communication of medical information
5 The NIH Clinical Center Overview: Our Unique Hospital
The largest clinical research center in the world
The NIH CC only admit patients as part of clinical studies
Patients can be referred to a study by their physician or they can self-refer by visiting – www.clinicaltrials.gov
No ER, L&D or Nursery
There are currently about 1,600 clinical studies in progress at the Clinical Center.
Languages translated to support the global audience of patients, staff, and visitors
153 NIH-supported researchers have become Nobel Laureates
6 NIH CC Medical Record Transition Timeline
The Clinical Center implements NIH Clinical Center sees its first Allscripts Sunrise Clinical Manager. HIMD implements mobile patients. Medical records are The medical record is now scanning on inpatient units to entirely on paper and are considered an electronic health ensure timeliness of entry of the microfilmed after five years of non- record. Paper generation remaining paper documents into patient care activity. Outpatient & decreases. Medical staff CRIS (primarily consents and inpatient documentation is documentation remains on paper. telemetry strips). The medical maintained in a unit record through Transitioning paper forms to record is 99% electronic. All a centralized Medical Record electronic documentation templates historical paper records are Department. begins. Microfiche conversion to scanned and microfiche digital image begins. converted to digital image. 1953 2004 2018
1980’s 2017 The Clinical Center implements The Clinical Center the TDS 7000 Medical establishes policy requiring Information System (MIS) and the that ALL medical staff Honeywell Laboratory Information documentation be entered System (LIS). The system directly into the electronic includes CPOE and nursing health record (CRIS). HIMD notes. The medical record is and DCRI collaborate to form primarily paper/microfilm. All MIS the Clinical Documentation 7 information is printed and filed in Control Board. the record. Maintaining and Ensuring Complete Medical Record
Multiple Documents from Institute systems are PDF
Admission Consent Transfusion Verification Advance Directives 12-lead Electrocardiogram Protocol Consents Cardiac Catheterization Ophthalmolog Laboratory Summary Reports y Consults Outside Reports Cardiac MRI Surgical Documentation Cardio Energetics Genetic Mutation Report Mammography Linked Images (EKGs, Radiology PACS, Wound Services, other non-DICOM images)
8 Completeness of Medical Record
99% of all Medical Record is Electronic ◦ Consents are scanned into EHR Orders – All Electronic Results – ◦ Imaging, laboratory, EEG, EMG, PFT, etc. ◦ Transfusion Medicine (Tests, HLA, Cell Processing) ◦ Procedures (-Oscopies, Intervention Radiology, cardiac cath) Documentation – ◦ Nursing ◦ Prescriber (Progress Notes, H&P, Discharge Summary, Consultations, Surgical Services, Anesthesia, etc.) ◦ Consents (surgical, research studies, admissions) ◦ Advanced Directives ◦ Hospital Epidemiology, Nutrition, Pharmacy, Social Work, Spiritual Care ◦ Psychology, Rehabilitation Medicine, Respiratory Therapy, Critical Care Administrations: ◦ Medication, Transfusion Medicine
9 Health Information Management Department Transition
Before… During… After…. . WoW . Scanning Prep, Regulatory Audit Scanning on Scanning & Quality Review Patient Care Control Units
10 Health Information Management Department Transition
• Saved 2500 square feet of
space
• 450 shelves
• Approximately 550,000 records
• Nearly 69,000,000 pages
• Years 1 & 2 - $2,000,000 saved
11 Using Technology to Improve Patient Engagement
• Background: Patient engagement for the NIH Clinical Center is much different than it is for physicians’ offices or in acute care settings. Focus is on the research study. • NIH CC Patient Portal Functionality • Access to documents and results • Communicate with the research team • Initial portal go-live – July 2013 • Upgraded to FollowMyHealth® Patient Portal – January 2017 • Over 15,000 active accounts • Future functionality • Patient recruitment • Pre-registration • Electronic consents 12 Accessible through the NIH CC home Invitations sent: page in the • Patients who had “Patient previous portal accounts Information” • Patients who had section. appointments/admissions in the past year • On a DAILY basis to patients who have an Sign-in link for appointment or are patients with discharged from an inpatient admission accounts. • Patients may also REQUEST an invitation by contacting the HIMD Patient Portal Support Team.
13 Inbox tab: • Messaging functionality • By default patients may message attending and primary clinicians assigned to them in the NIH CC electronic medical record • Other care providers may add themselves to the patient’s record in order to message • Messages sent by patients are attached to the electronic medical record • Expected response time from NIH staff – 3 business days
14 Current Document/Result Release Policies
Documents available in Portal – available immediately upon completion (final) • Discharge summaries • Discharge instructions • Outpatient first registration reports • Outpatient progress requested to be released by clinician • Procedure notes • History & physical exams • Rehabilitation medicine documents • Consultation reports (planned for future) • Results available in Portal - available immediately upon being finalized (with the exception of imaging results) • Imaging results available in 3 days • Sensitive test results require manual release to the portal (Pathology, HIV, etc.)
15 Referring Clinician Portal: • Secure website designed to provide clinicians who follow and/or refer patients to the NIH secure, electronic access to medical information about their patients generated while at the NIH.
• Patient must authorize referring clinicians to have access to his/her medical record.
• Referring clinician requests account using online request form.
• Health Information Management Department (HIMD) verifies clinician information and creates account.
• HIMD facilitates obtaining patient consent as needed.
• HIMD manages Portal Support Help Desk. 16 Future Enhancements
Forms completion/submission (demographics changes, family history for pedigrees, etc) • Pre-registration • Electronic consents for offsite patients • Medication list • Link through an app for patients to view images • Include patient portal survey questions in survey sent to all patients about hospital care • Vendor planning for future release ability to collate data related to what information patients are viewing in the portal • Inclusion of consultation reports
17 Use of EMR to Support and Improve Antimicrobial Management
Aims: Encourage judicious prescribing Reduce selective pressure that promote resistance Reduce incidence of Clostridium difficile infection
Elements: Restricted antimicrobials ID Consultation ASP PharmD review ASP Subcommittee Perioperative prophylaxis guidelines Antibiotic Time Out (QI project) Tools created by DCRI for tracking antimicrobial utilization at the patient/hospital level
18 Use of EMR to Support and Improve Antimicrobial Management
1. Retrospective chart review 2. Implement a CRIS prompt: Antibiotics of Interest Vancomycin IV Linezolid 3. Post-intervention review Piperacillin- Tedizolid tazobactam Daptomycin 4. Primary Outcomes: Meropenem Gentamicin IV Imipenem Amikacin IV • Proportion of injudicious antibiotic use Ertapenem Tobramycin IV Exploratory outcomes: Ceftriaxone Streptomicin IV Cefotaxime Aztreonam IV • Breakdown by antibiotic of interest Ceftazidime • Association of injudicious use with mortality • Association of injudicious use with C. difficile • Proportion with ID consults • Proportion with advance stop dates
19 Summary
• Our Focus is on achieving the highest standards for patient safety and clinical quality. • Leverage relationships and manage expectations • Other NIH Institutes/Centers • External Partners • Local community hospitals • Patients • Providers and Support Staff • NIH-CC consistently seeks opportunities and leverages technology to improve patient safety, quality, and experience of care for our patient volunteers.
20 Maryland Association of Health Care Executives Innovations in Healthcare – Care Delivery Redesign
Randy Komenski October 11, 2018 21 Johns Hopkins Medicine Organizations Johns Hopkins ($7.9 Billion in Annual Revenues) University (JHU)
Johns Hopkins School of Health System Medicine (JHHS) JOHNS HOPKINS (SOM) MEDICINE
Johns Johns Howard John Johns Hopkins Hopkins County Suburban Sibley Hopkins Hopkins Hospital Bayview General Hospital Memorial All Community Medical Hospital Hospital Children’s Physicians Center Hospital
Johns Johns Johns Hopkins Hopkins Hopkins Key Home Medicine HealthCare Care International Red = Part of JHM Group = Legal entity
= Unincorporated organization or division
22 Johns Hopkins Bayview Campus 1984
2018
23 Johns Hopkins Bayview Campus
130-acre park-like campus
Academic Medical Center with 342 acute hospital beds Bayview Campus Annual Total Revenue ~ $900 million Johns Hopkins Bayview Medical Center - $600 million Johns Hopkins School of Medicine - $200 million
Approximately 6,000 campus-based employees
24 Bayview History
. 1773 - Baltimore City and County Almshouse, located in West Baltimore: provided health care and shelter to sick and poor. . 1866 - Almshouse relocated to southeast Baltimore and renamed Bay View Asylum. . 1925 - Renamed Baltimore City Hospitals to reflect wide range of services. . 1982 - Baltimore City entered a management agreement with Johns Hopkins Hospital. . 1984 - Ownership of Baltimore City Hospitals was transferred to Johns Hopkins Hospital and University: renamed Francis Scott Key Medical Center. . 1986 - The Medical Center became part of Johns Hopkins Health System. . 1994 - Changed name to Johns Hopkins Bayview Medical Center concurrent with the opening of Francis Scott Key acute care pavilion. . 2002 – Full integration of Johns Hopkins faculty.
25 FY 2018 Operating Statistics – Johns Hopkins Bayview
• 18,646 Acute Admissions (excludes newborns) • 1,286 Births • 10,141 Operating Room Cases • 58,557 ER Visits • 212,649 Ambulatory Clinic Visits • 186,690 Community Psychiatry & Addiction Treatment Visits
26 Academic Division Dept of Medicine- Facts
27 Academic Division Dept of Medicine- Facts
28 Heart Failure Transition Clinic and Diuresis Program Initiative Johns Hopkins Bayview Medical Center Presented by: Randy Komenski
29 Heart Failure
What is Heart Failure? Why is it a problem? Why are readmissions high? What are we doing?
30 Why is Heart Failure a Problem? How Big of a Problem is it?
Leading Cause of admission and readmission in Medicare age group Poor outcomes for patients Extensive utilization of health care funds
Heart Failure discharges per year: FY17 - 770 FY18 - 840 FY19 YTD - 370
Heart Failure readmission: FY17 - 23.9% FY18 - 26.0% FY19 YTD- 21.7%
31 Leveraging Technology Top 20 Index Readmission APRDRGs January – May 2018
32 Leveraging Technology Tableau – Population Health Dashboard
Data Source: Health Services Cost Review Commission
33 Leveraging Technology Tableau – Population Health Dashboard
Data Source: Health Services Cost Review Commission
34 Why are Readmissions High?
WELL SICK ED
MD
Clinic
Barriers/Challenges Medication: complex, Hospital costly, confusing Length of stay, transportation, diet, Rehab comorbidities, COPD, comorbidities diabetes
NEED MULTIFACTED SOLUTIONS
35 Inpatient Heart Failure Efforts The most important inpatient work we have done is our inpatient patient/family education program that focuses on self efficacy Heart Failure Inpatient protocol Inpatient care plan standardized Heart Failure Emergency Department protocol developed In review process Education of Cardiology, Hospitalists, and House staff Ongoing Develop order set to optimize Class 1 Therapies
36 Outpatient Heart Failure Efforts
Physician champion within Cardiology (25% effort) Diuresis clinic and nurse support Interdisciplinary efforts: case management, social work, community health worker (CHW) nursing, home care, providers Goals: Focused, targeted, limited scope only by resource, optimize care, provide access, fully develop and implement heart failure transition clinic, and reduce readmission
37 Pre-Transition Clinic Access
38 Outpatient Heart Failure Transition Clinic
Hired, on-boarded and oriented Heart Failure NP Collaborative team development Education Patients Evaluating Metrics Intended for high risk Heart Failure patients discharged from inpatient and scheduled with 2 appointments followed by 2 additional appointments (total - four weekly appointments) in the Heart Failure Transition Clinic
39 Heart Failure Transition Clinic: April 2018
Outpatient Clinic Overview
Centralized scheduling and optimization (1 point of contact)
Monday to Friday (5 hospital discharge/Follow up daily appointments) Prior to discharge, patient scheduled with 2 appointments, once seen 2 additional appointments scheduled (total of 4 initially); nurse in clinic does patient education
Community health worker on boarded and trained Healthcare worker, but not licensed, dispatched to meet with patients in their home, ability to provide resources to reduce barriers (transportation, electricity, food)
Triage nurse available daily to answer patient questions and for warm handoff, healthcare provider initiated script, able to communicate patient issues to NP
Social Work expanded to Heart Failure team to assist with social challenges
Transition guide nurse Prior to discharge, transition guide meets with patient to offer assistance and explain HF transition clinic, does medication reconciliation (dependent on criteria, not all patients are eligible for transition guide nurse)
40 Hospital Discharge Transition Flow
Hospital Discharge Inpatient, Observation, Emergency department
Do they have an established PCP? No Yes Is it GIM Bayview?
Frequent readmissions, high No risk Heart Failure patients Yes
Scheduled with NP in Heart Scheduled with NP in GIM Failure Transition Clinic (complicated patients with Scheduled with partner co-morbidities) FQHC (uncomplicated Heart Failure patients)
41 Heart Failure Transition Clinic Data
42 Metrics and Process Measure
Evaluate % of discharge patients from inpatient and ED who see are either seen in Heart Failure Transition Clinic or General Internal Medicine
No show rate
Goal of being seen 1x a week for 4 weeks, able to get appointments, are patients showing up for appointments
Percent of patients that complete 4 weeks of visits with either provider are admitted to ED to inpatient with in 30 days
Percent of patients that accept transition guide assistance
Evaluate readmission rate reduction for patients in transition clinic
43 Takeaways
Patient and family engagement is CRITICAL Addressing what the patient/family identifies as important and Social Determinants of Health are CRUCIAL Team needs to be truly interdisciplinary and transcend the continuum of care Have executive sponsorship, guidance and support Foster continuous performance improvement LEVERAGE technology (internal and external)
44 Improving Access at VA Maryland Health Care System VA Maryland Health Care System Presented by: Vamsee Potluri, MHA/MBA, CLSSBB Ambulatory Care Operations Director –Group Practice Manager
45 VA Mission
Care for Veterans Research (https://www.research.va.gov/about/history.cfm) Education Disaster Relief
46 VA Overview (Patients and Staff)
Budget: $79.1 Billion (FY2020) Patient Care: 9,000,000+ Enrollees Staff: 306,000+ Education - Trainees: 120,000 trainees in over 40 health professions disciplines. 66.67% of all MDs have trained at the VHA
47 VA Overview (Sites of Care) Veterans Health Administration (VHA) is the largest integrated health care system in the US.
1,243 Sites of care throughout the U.S.** • 172 Medical Centers • 1,062 Outpatient Clinics • 135 Community Living Centers • 113 Domiciliary Rehabilitation Treatment Programs • 60 Mobile Sites of Care • 300 Readjustment Counseling (Vet) Centers • 80 Mobile Vet Centers
**NOTE: The number of sites of care is NOT a total of the categories listed below, as several of the sites are also listed in multiple categories (e.g., there are 135 CLCs within the 168 medical centers)
48 VAMHCS Sites- Rural & Urban Baltimore Perry Point Tertiary Care Mental Health Primary Care Long Term Care Mental Health Primary Care Baltimore Annex Clinics Loch Raven Cambridge Long Term Care Baltimore Co. Fort Meade Rehabilitation Glen Burnie Home Care Loch Raven Pocomoke
49 VAMHCS Vision
50 VA Maryland Health Care System Overview
Operating Budget: $630M+ Education: $10M funding for trainees Research: $26M Funding Operating Beds: 727 Sites of Care: 3 Medical Centers and 6 Community Based Clinics Staff: 3902 FTEE + 1265 Volunteers Veterans served: ~55,000/yr (7000+ Female Veterans) Outpatient visits: ~750,000/yr
51 Abstract/Background
In 2014/2015, VAMHCS had the 4th worst in Primary Care access , in VHA, and met only 21% of PCMH-SHEP (3/14) (Patient Satisfaction Measures).
In 2017, through systematic processes improvement, utilization of business intelligence tools, and active leadership, the VAMHCS climbed to the 10th best of 168 VHA Hospitals for access, reaching #1 in access in August 2017, and meeting 95% of PCMH-SHEP (19/20) (Patient Satisfaction Measures).
52 Opportunities
Low Staff Morale (2014/2015) High Turnover Lack of Patient Aligned Care Team (PCMH) Efficiency Reduced Access to Care High Emergency Room Utilization & Preventable Admissions Lack of Standardization & Strong Communication Lack of Actionable Information (Data Rich, Information Poor) Leverage Technology/Tele-Health
53 Goals
Access: Primary Care and Specialty Care Access within 30 days
Veterans First: Improved Patient Satisfaction (PCMH-SHEP)
Leveraging Best Practices/Technology : Business Intelligence Tools and TeleHealth
Employee Engagement: Interdisciplinary Approach
54 Strategy
Better Lean Six Business Active Outcomes Sigma Intelligence Leadership for Patients
55 Strategy
Continuous Process Improvement Reduce Variation and Waste Leadership by GEMBA Walks (aka Rounding) Respect for People
56 Leveraging Technology “Dashboards” vs Business Intelligence Operations Tool Design vs Implementation Tele-Health: MyHealthEVet Store and Forward (SFT) Clinical Video Tele-Health (CVT) VA Video Connect (Tele- health to patients cellphone/Tablet) VetText/Automated Call Distribution/ Kiosks Truthpoint Medallia
57 Leveraging Technology Takeaways “The future is not about eliminating physicians, it’s about leveraging physicians. Leveraging [physicians] by providing digital and other tools that work like they do in virtually all other industries — making our environments more supportive, providing the data we actually need in an organized, efficient way, and saving time so we can spend more of it with our patients.” -James Madara, MD, Executive Vice President & CEO, AMA “There are few sectors as resistant to change as government and health care. We count on their stability….. We need a culture of experimentation that embraces risk and recognizes that failure is not only an option, but is likely within the safe setting…” - Susannah Fox, CTO, HHS
58 Active Leadership
Vision/Concept of Care – Patient/Family & Staff Centered Clinical & Administrative COLLABORATION “Change happens at the speed of TRUST” – Dr. Stephen Covey& Dr. Peter Pronovost Trust is accumulated through helping people & strong communication (Ex: Huddling & Transparency) “Leadership is a contact sport” – Dr. Adam Robinson Accountability – Crucial Conversations & Coaching/Mentoring Advocacy – Take care of your people
59 What did you all do?
Active Leadership Support from Facility Leadership – PENTAD Daily Morning Huddles with all Primary Care Sites’ leadership team (Site Manager, Nurse Manager, Lead Physician) Weekly Discipline Specific Meeting (Lead MDs, Nurse Manages, and Site Managers Call) Data driven decision making (Business Intelligence Tools) and listening to front line employees to resolve issues timely. Proactive vs. Reactive Building strong relationships with other clinical and admin services to improve patient and staff satisfaction Clinical Efficiency: Standardizing Primary Care Provider Grids (80-90% Bookable Clinic Time) Eliminate Carve Out Appointments Increase number Nursing Appointments and Nursing Telephone Appointments Proactively contacting patient waiting greater than 30 days from their preferred date Expand Traditional PACT to Include: Mental Health – PCMHI, Social Work, Pharmacy, and Dietetics Manage/Review Re-revisit Rates Reduce Missed Opportunities through: Monitoring Missed Op by Provider Improved call responsiveness 60 What did you all do? (cont)
Customer Satisfaction:
Proactively contacting patient waiting greater than 30 days from their preferred date
Improved Access => Improved Customer Satisfaction
Telephone/MSA Scripting
Building meaningful Truth Point Surveys/questions
Implementing Clinic & Team Level Huddles
Staffing/HR
Leadership and Staff Accountability
Provider Salary Survey/Increase – $190K/200K
Proactively recruiting for vacancies (MDs, RNs, and MSAs) – DON’T WAIT
Hire 3 Contingency Nurse Practitioners
Filling PACT Team Vacancies – MSAs, LPNs, MDs
61 Better Outcomes for Patients Primary Care Access ER Utilization
All Pts. All Pts. 93.25% 99.89% New Pts. New Pts. 56.42% 92.2% 34,739 29,396 21.40% 95.00%
Missed Opportunity Rate ACSC Admissions
16.13% 13.70% 1,000 768
Specialty Care Wait Time From Primary Strategy Diffusion of Innovation Care Visit
46.8 Days 35.5 Days $$$$ $$$$
1 Site 36 Sites 62 FY15 FY17 Cost of Quality
63 64 Care Redesign
Expanded traditional PCMH Model to include Mental Health, Social Work, Dietetics, and CHF/COPD Clinics Improve collaboration and coordination with all Specialty care clinics Improved Efficiency & Care Delivery by utilizing Business Intelligence Tools Improved access, patient education, communication, and trust Improvement in overall Patient Satisfaction Reduced the need for preventable ER visits and admissions Improvement in overall Patient’s Quality of Life/Health
65 66 Spread of Innovation
FY15 1 VAMC FY17 36 VAMC Business Intelligence Dashboard 67 Acknowledgements
68 *Just a few of the amazing people who made this possible Acknowledgements Cont.
Dr. Adam M. Robinson Jr., Dr. Sandra Marshall, Dr. Martin Garcia-Bunuel, Dr. Greg Jolissaint, Christopher Chiu, Dr. Amit Khosla, Patricia Davis, CherylAnne Kraska, Edward Payton III, VAMHCS Primary Care Clinic Leaders, Dr. Marc Hochberg, Michael DelDuca, Dr. Douglas Turner, Pamela Johnson, Justin Decker, Ronald Hoffman, Jason Ratliff, Lindsey Crain, Mark Penner, Jason Brown, and Michael E. DeBakey VA Medical Center.
69 Musculoskeletal / Neuroscience Innovation Orthopedics / Spine / Neurosciences Value-based Reimbursement: CMS & commercial payers- Bundled payment- CJR, BPCI* • Population Health*
Physician alignment: employment & private, PSA, co-management, gainsharing • Patient engagement: web & technology enabled • Continued ambulatory/OP place of service • Comprehensive Spine
Quality measures, especially functional
Distribution of services in IDN’s/health systems
*Costs are known for episode of care (including post-acute),
*Achieving Triple Aim: Patient Satisfaction, Reduced Cost, Improved Population Health
© Corazon, Inc. All rights reserved. Key Factors to Drive Successful Outpatient Joint Program
Current CMS regulations reimburse for OP knee replacement (only) in a hospital-based outpatient setting, (HOPD)
Timeline for CMS reimbursement for free-standing ASC-performed joint replacement is uncertain. Once approved, joint cases will migrate and never return
This “head-start” for hospitals to expand orthopedic, market share ahead of competitive ASC’s and competitive health systems
Physician Champion who endorses rapid recovery model patient optimization, defined surgical and rehabilitation protocols
Partnership and Commitment from Senior Executives Develop Business Plan, understand OP reimbursement, develop mid- term strategy that addresses both growth of OP Joints and impact on IP joint replacement volume.
© Corazon, Inc. All rights reserved. Orthopedics- distribution of services
© Corazon, Inc. All rights reserved. Neuroscience- distribution of services
© Corazon, Inc. All rights reserved. Web enabled technology that engages patients -satisfaction… cost… population health
© Corazon, Inc. All rights reserved. Article resource-
The Future of Spine Care: Rethinking Collaboration Among Hospitals, Physicians, OEMs OrthoKnow August 2018 Patrick Vega, MS [email protected] 301 730-2595 Maryland Association of Healthcare Executives presents:
Session #2 Innovations in Rural Health
1 Our Expert Panel Speakers
1. Jo Wilson, MBA, FACHE, Vice President, Population Health at Western Md Health System - Cumberland
1. Karen Twigg, BSN, RN, CMCN, Director of Care Coordination and Integration at CalvertHealth Medical Center – Prince Frederick, Calvert County (Southern Maryland)
1. Lara Wilson, M.S., Exec. Director at MD Rural Health Association - Centreville, MD (Queen Anne’s County)
Moderator:
Scott D. Burleson, MBA, FACHE, President of MAHCE and educator/retired hospital administrator
2 Maryland Rural Health Association
www.MDRuralHealth.org
Mission: The Maryland Rural Health Association (MRHA) is a non-profit membership organization whose mission is to educate and advocate for the optimal health and wellness of rural communities and their residents. 3 State-Designated Rural Maryland
4 Federally-Designated Rural Maryland
5 Worrisome Trends in Rural Communities ❖ Declining use of hospital services puts existing hospitals and the health systems under stress
❖ Fear that the primary health care workforce is inadequate
❖ Constraints in transportation systems limit access to care outside local jurisdictions
❖ Declining hospital revenue and shrinking health care workforce limit the potential for innovation
❖ Despite increased access to insurance coverage and improved delivery models, there remains limited improvements in the health of the population 6 2018 Maryland Rural Health Plan
Rural Health Challenges in Maryland
1. Access to care
2. Sustainable funding mechanisms for
health services
3. Care coordination
4. Chronic disease prevention and
management
5. Health literacy and health insurance
literacy
6. Outreach and education 7 Rural Health Plan County Profiles
❖ Includes: ❖ County specific data ❖ County demographics ❖ Summary of findings from county focus groups – consumers & providers ❖ County priorities from the Community Health Needs Assessment 8 www.MDRuralHealthPlan.org
9 2018 Maryland Rural Health Conference
❖ Hyatt Regency Chesapeake Bay, Cambridge, MD
❖ October 22-23, 2018
❖ Telehealth Pre-Conf on Sunday, the 21st
❖ CME/CEUs available
10 Maryland Association of Healthcare Executives presents:
Population Health Western Maryland Health System’s Approach to Better Health for Our Community
11 WMHS Overview • System formed in 1996 w/ 464 beds • New hospital opened in 2009 • Located in Western Maryland • 275-bed not-for-profit hospital w/ an ADC of 160 • 250 physicians on staff • Level III Trauma Center • Stroke Center, MEIMSS • Cardiac Intervention Center, MEIMSS • Only open heart surgery west of Baltimore • Skilled nursing facility with 88 beds • Outpatient diagnostic centers • Three urgent care centers • Network of physician practices Facts About WMHS • $334 Million in operating revenues for FY18 • 11,556 adult admissions per year (Down from 15,521 in FY11) • 46,820 ED visits per year (Down from 55,183 in FY11) • 1,000 deliveries per year
• Over $300 million economic impact on the region annually • $41.5 million in Community Benefit for FY2017 Overall Ranking in Health Factors Overall Rankings in Health Outcomes 16 County Health Rankings and Roadmaps
17 The Cost of Chronic Conditions
18 So This is Why Population Health
● We focus on activities and programs to keep people out of the hospital and help them stay out of the hospital ● We focus on children and young adults to make generational changes
Patient Centered Care Continuum WMHS Population Health at a Glance
● Courtesy of the Region Transformation ● Behavioral Health Grant ● NP ● Hot Spot Clinic-NP/LPN ● Peers Support Specialist ● Population Health Centers ● BH Specialist-telehealth ● Care Coordinator and Social Worker in ● Porch visits CCR
● Inpatient Community Health worker ● Bridges To Opportunity
● Center for Clinical Resources ● Feed Children ● Chronic Care Management ● Make Healthy Choices Easy ● CHF
● COPD ● Garden/Orchard/Playsets
● DM ● Transportation ● Anticoag
● MTM ● Community Thanksgiving Dinner
● Food Farmacy ● Food Bank support
● Food upon discharge ● Farmer’s Market Vouchers
● Telemonitoring ● Support the Food Bank money and food ● HP, DM, COPD, CHF ● Wellness Ambassadors ● SNFist/Partnership to Perfection ● Free
● Wellness Coaching, Yoga, Exercise Classes, Weight Control Classes, Grocery Store Tours Outcomes
FY2011 FY2017 % Change Inpatient Admissions 15,848 11,556 -27.08%
Readmissions 14.54% 10.86% -25.31%
Behavioral Health Admissions 1,248 1,056 -15.38%
Readmissions 20.90% 12.19% -41.67%
ED Visits 55,183 46,820 -15.16% Outcomes Resources
Organization Website
Western Maryland Health System www.wmhs.com
26 CARES Program
Making a PACCT to CARE Leveraging Community Resources to Educate, Engage and Empower Patients
Karen Twigg, BSN, RN, CMCN [email protected] 27 CalvertHealth Medical Center is a 74 bed independent, not-for-profit, community hospital
Located in beautiful Prince Frederick, MD, CHMC provides inpatient and outpatient general medical / surgical and psychiatric care Founded in 1919, CHMC has been taking care of Southern Maryland families for almost 100 years In FY 2018
● 39,353 patients visited our emergency room ● We had 5,457 inpatient admissions & 3,018 observation stays ● Our physicians performed 1,306 inpatient & 7,263 outpatient surgeries ● Approximately 230 active & consulting physicians representing over 40 different specialties ● Approximately 1,200 dedicated employees help CMH provide the very best for our patients, with more than 200 volunteers helping to add those "special touches" ● In addition to our main hospital campus, 4 satellite medical office buildings ensure that quality care is no more than 15 minutes from anywhere in Calvert County Measuring Our Success
30 How are we doing it? Through patient, caregiver, community and team collaboration. CalvertHealth CARES!!
Collaborative Activation of Resources and Empowerment Services
31 ● Initiative CalvertHealth’s CARES Program: ▪ free “community benefit” program ▪ multi-faceted approach to meet the post-discharge needs of patients ▪ assists patients at moderate to high risk for readmission or ED overuse
● Team Physician, Nurse, Social Worker, Pharmacist ● Target Population Bridging the gap for patients who: ▪ Are unable to schedule a follow up physician appointment within 5 day post-discharge from ED, observation stay or inpatient admission ▪ Lack a primary care provider ▪ Can’t afford essential medications and/or those who need assistance managing multiple medications ▪ Need assistance securing transportation to health care appointments ▪ Can benefit from access to an array of post-acute care resources
Interventions Coaching phone calls and home visits, clinic, financial guidance It’s all about the relationship….. 32 Consistency, Collaboration, Communication = TRUST CARES Together, We Can Cross the Bridge to Wellness
Program Return on Investment Due to Improvements in:
▪ Health care spend per beneficiary - through reduced utilization and readmissions ▪ Safer patient environment - through reduced exposure to hospital associated conditions due to reduced hospital utilization ▪ Overall patient health - through provision of services in the patient home, care coaching, referrals to partnering service providers and discharge CARES clinic services ….. Through state incentive programs and grant opportunities (HSCRC and Rural Maryland Prosperity Investment Fund) CalvertHealth Medical Center has been awarded ≈ $2.6M over the past 4 years
The CalvertHealth CARES Program has received state and national recognition as a best practice 35
Senate Bill 707 Freestanding Medical Facilities – Certificate of Need, Rates, and Definitions ❖ Legislation established a process for a hospital to convert to a FMF
❖ Broadened the definition of hospital services to include observation stays and other outpatient services offered at the FMF, as determined by HSCRC in regulations
❖ Defined the findings MHCC must reach before issuing an exemption from CON review for a conversion
❖ Legislative debate highlighted significant public concern about the appropriateness of health system changes in rural communities
❖ Established a moratorium on hospital conversions in Kent County until July 2020
❖ Established a Rural Health Delivery Workgroup
38 Broad Categorizations of Recommendations
❖ Foster collaboration and build coalitions to serve rural communities
❖ Bring care as close as possible to the patients to improve access
❖ Foster innovation in statewide models and programs in Rural Maryland
39 Foster Collaboration and Build Coalitions
❖ Build a Rural Health Collaborative ❖ Convene local stakeholders to examine the health care needs of a single region ❖ Develop strategic directions for improvements in the health system ❖ Manage data collection and analysis to develop regional health and social needs assessments
❖ Launch a Rural Community Health Demonstration Program – “The Complex” ❖ Build a “one-stop-shop” for health and social service needs for patients ❖ Ensure access to essential care throughout a region ❖ Enable care coordination through the sharing of data and resources 40 Bring Care as Close to the Patient as Possible
❖ Strengthen workforce by improving both recruitment of healthcare professionals and training of healthcare professionals ❖ Establish Rural Primary Care Residency and Rural Specialty Care ❖ Residency Rotation Programs ❖ Establish Rural Health Scholarship Program ❖ Streamline M-LARP program
❖ Expand the availability of telehealth and mobile capacity ❖ Increase broadband and “last mile” connectivity ❖ Establish funding source for demonstration projects throughout the State
❖ Expand Mobile Integrated Health availability and sustainability
41 Foster Innovation in Statewide Models
❖ Develop the health care workforce needed for rural communities to succeed in Total Cost-of-Care Demonstration
❖ Establish Special Rural Community Hospital ❖ Consider the needs of small rural hospitals in maintaining access points for emergency and inpatient care ❖ Assist rural communities in succeeding under Total Cost-of-Care Demonstration
❖ Charge the Community Health Resources Commission with incubating pilot projects in rural communities ❖ Could be an important convener of rural health complex
42 Current Legislation
❖ Senate Bill 1056 – legislation to establish a Rural Collaborative Pilot Program in the Mid-Eastern Shore was signed in July 2018
❖ Senate Bill 682 – EMS Study Group for Mobile Integrated Health was signed July 2018
❖ Consideration of other legislation consistent with Rural Health Workgroup recommendations ❖ M-LARP streamlining ❖ Rural Health Scholarship Program ❖ Rural Residency Programs ❖ Innovative Transportation Models
43 Contact Information: Lara Wilson, Executive Director [email protected] (410) 693-6988
www.MDRuralHealth.org www.MDRuralHealthPlan.org
44 Questions?
45 What legislative/regulatory (HSCRC) changes impact the patients in the local area? How is your organization reacting to these changes?
What current health trends in the local population affect your organization? What health trends do you see becoming an issue in the future? What can you do to prepare?
How did you get the local providers – private and employed and ER to buy into the change?
46 Maryland Association of Healthcare Executives presents:
Session #3 Innovations in Healthcare Technology Our Expert Panel Speakers:
1. Neil Carpenter, MBA Vice President of Strategic Planning and Research, LifeBridge Health
2. William (Bill) Sheahan, MPA Corporate Vice President, MedStar Health and Director, MedStar Simulation Training & Education Lab (MedStar SiTEL)
3. Sathya Elumalai, MS, MBA Co-founder and CEO for Multisensor Diagnostics (MDX)
Moderator: Seth Martin, MD, MHS Global Forces Driving Innovation
Neil Carpenter, MBA Vice President of Strategic Planning and Research, LifeBridge Health
3 Mergers & Acquisitions: Not A Magic Pill For Health Care Health care M&A up 13% in 2017 Highest number in recent history
Payer / $70 Billion Pharma
Retail / Payer $69 Billion
Providers $28 Billion
M&A is not a magic pill, however… • Increased prices: Hospital consolidation generally results in higher prices by 20 to 40% • Increased costs: Consolidation can result in higher Medicare costs and higher medical costs for employers (predicted to increase at 6% rate in 2019) – Rate is not sustainable 4
4 https://www.kaufmanhall.com/news/healthcare-provider-ma-hit-record-breaking-pace-2017-and-signals-big-changes-ahead- https://www.journals.uchicago.edu/doi/10.1086/600079 according https://www.pwc.com/us/en/health-industries/health-research-institute/behind-the-numbers.html https://www.pwc.com/us/en/health-industries/publications/health-services-quarterly-deals-insights.html https://www.rwjf.org/en/library/research/2012/06/the-impact-of-hospital-consolidation.html Mega-Deal Mania Has Failed On Transformative Promise In The Past …Post-Merger Pre-Merger Promise… Reality Biggest merger in history 15 years later, lessons from the & the best evidence that old & failed AOL-Time Warner merger new media are converging
Final farewell to worst deal A pivotal moment in the in history unfolding of the Internet age $162 Billion Merger in This merger will launch the next 2000 Lessons from the AOL-Time Warner Internet revolution disaster
Other Industry “Transformative” Deals That Failed
http://fortune.com/2015/01/10/15-years-later-lessons-from-the-failed-aol-time-warner-merger/ https://learning.blogs.nytimes.com/2012/01/10/jan-10-2000-aol-and-time-warner-announce-merger/ https://www.telegraph.co.uk/finance/newsbysector/mediatechnologyandtelecoms/media/6622875/Final-farewell-to- https://www.wired.com/2000/01/aol-time-warner-to-merge/ worst-deal-in-history-AOL-Time-Warner.html 5 https://abcnews.go.com/Business/Decade/aol-buys-time-warner-162-billion/story?id=9279138 https://www.bloomberg.com/view/articles/2015-01-14/lessons-from-the-aoltime-warner-disaster How Could Health Care Be Really Different?
6 Source: LifeBridge Health Global Forces
01 02 03 04 Automation Globalization End of the New Revenue Middle Models $ $ $ 7 Framework For Accelerating Health Care Transformation
New Revenue Models End of the • Disrupting Middle traditional Globalization • A more value stream • When faced with segmented Automation competition & strategy that • Predictive resource aligns with a analytics constraints new paradigm • Patient engagement •AI
8 New Revenue Models End of the • Disrupting Middle traditional Globalization • A more value stream • When faced with segmented Automation competition & strategy that • Predictive resource aligns with a analytics constraints new paradigm • Patient engagement •AI
9 What if the inside of a hospital looked like a Tesla factory?
Source: https://www.google.com/search?q=tesla+factory+photos&rlz=1C1NHXL_enUS813US813&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiUno_cmLjdAhUpw1kKHdboAvIQ_AUIDCgD&biw=1887&bih=932#imgrc=GtgfpcvT7VAi_M: 10 Automation Is Transforming The Way We Engage With Our Patients
Source: LifeBridge Health; HealthLoop 11 Automation Will Allow Us To Focus Human Capital Where We Need It Most
More capacity for better care
https://commons.wikimedia.org/wiki/File:Pepper_the_Robot.jpg https://www.flickr.com/photos/myfuturedotcom/6052491503
https://kioskindustry.org/concern-data-protection-new-huddersfield-hospital-check-kiosk-system/ 12 Linking AI to Provider Performance: The Future of Clinical Teams
Using Predictive Analytics, A Baseball Team Of Undervalued Talent Is Built A Similar Revolution In Education:
13 Sources: https://c1.staticflickr.com/2/1075/748894499_a661813534_b.jpg; https://c1.staticflickr.com/8/7033/6837360817_1c6d2129ce_b.jpg; https://edanalytics.org/projects/ny-map-1 LifeBridge Health Is Beginning The Journey Of Deploying Automation Across The Care Continuum
Predictive Automated Continuous Care Analytics/ Triage/System Hospital Management Pophealth Entry
BaseHealth Exploring Teletriage Telehealth Current Partner
Source: https://pioneerinstitute.org/healthcare/study-telemedicine-14 can-reduce-healthcare-costs-improve-outcomes-patient- Source: LifeBridge Health Source: https://www.olea.com/product/verona-health-care-kiosk/ Source: https://aethon.com/products/ satisfaction/ New Revenue Models End of the • Disrupting Middle traditional Globalization • A more value stream • When faced with segmented Automation competition & strategy that • Predictive resource aligns with a new paradigm analytics constraints • Patient engagement • AI
15 Contact Centers Are Integral To The Modern Health Care System, But Are Often Resource Intensive
Judy Reitz Capacity Command Center ~$10 Million 5,200 sq.ft
16 Source: https://www.advisory.com/daily-briefing/2018/06/11/command-center LifeBridge Health Is Leveraging Global Talent To Develop Our Contact Centers At A Significantly Lower Cost
Manages inbound acute care Assists patients post- Allows physicians to establish transfers from throughout the discharge rules for when / how we region communicate with them about ? ? ? ? their patients ? ?
Israel Maryland
Philippines
17 New Revenue Models End of the • Disrupting Middle traditional Globalization • A more value stream • When faced with segmented Automation competition and strategy that • Predictive resource aligns with a Analytics constraints new paradigm • Patient Engagement • AI
18 Changing Consumer Preferences Are Creating New Market Segments
Personalized Care /Brand
LifeBridge Health is adapting across the continuum of care to meet this demand Cost
Cost
19 Sinai Is Positioning Itself To Be Highly Differentiated
Berman Brain and Spine Institute • Deep Brain Stimulation • Neurosurgery Cardiovascular Institute • Open Heart • WATCHMAN • TAVR
Rubin Institute for Advanced Orthopedics • Joint Revisions • Limb Lengthening
20 Partnering In Cutting-Edge Research To Meet Needs Of Patients With Complex Conditions
21 New Revenue Models End of the • Disrupting Middle traditional Globalization • A more value stream • When faced with segmented Automation competition & strategy that • Predictive resource aligns with a analytics constraints new paradigm • Patient engagement •AI
22 There Is Opportunity For Health Systems To Rethink Their Long Term Revenue Models
Health System Dollars Built these Cerner & Epic Corporate … And Research Places… that’s your Margin for Fixing and Implementing Universities Used to Not Mediocre Products… Monetize Their IP In 1967 Stanford was only generating $225 year for the University from its IP – Leslie Berlin’s Troublemakers: Silicon Valley’s Coming of Age
Photos from Epic website and glassdoor.com
23 A New Revenue Model: Creating Services & Companies We Own
A prototype that needs A product that needs over 80 hours of physician Idea generated in-house An off-the-shelf A product that needs clinical studies to validate time for inputs on that needs physician hours proven product use case studies technology development & initial support
Implementation Use Cases Clinical Validation Design Input Idea Creation
Those Of Us Who Can Make It To The Right Can Have A New Revenue Model
We Are Buyers/ Early Adopters We Are Partners We Are Inventors & Owners
24 Sources: LifeBridge Health; http://www.simonandschuster.com/books/Troublemakers/Leslie-Berlin/9781451651508 A New Revenue Model: LifeBridge Health Examples
• Automated pre and post visit questions and surveys • Automated reminders, checklists, and resources • Facilitates secure communication between patients and providers
LIFELINK CLINICAL CALL CENTER
25 Sources: LifeBridge Health; HealthLoop A New Revenue Model: Endowments (Following The University Model)
Newly Established Reichmister Endowment Fund At LBH To Support Orthopedics • LifeBridge Health established the Jerome P. Reichmister, M.D Chief of Orthopedic Surgery Endowment Fund in September 2018
• To date, the endowment fund has raised $2.5 million & will support Dr. Jerry Reichmister, chats with Dr. Jonathan Ringo, Orthopedic technology, research, & Sinai’s President and COO, and his wife, Dvora Ringo. staff However, the key limitation on an endowment/capital model for health systems is not the fight for local donors – it is the supply of VERY wealthy donors. The million and billion dollar donors…
26 Sources: LifeBridge Health Mega Donors Are A Huge Challenge In Baltimore… Which Lacks Those Super Zips Of Wealth…
Baltimore
ZIP CODE RANKING
20 40 60 80 Top 5% % % % %
Note: The term “Super Zip” was originally coined by Charles Murray of the American Enterprise Institute. It refers to zip codes in the U.S. with the highest per capita income and college graduation rates 27 https://www.washingtonpost.com/sf/local/2013/11/09/washington-a-world-apart/?noredirect=on&utm_term=.4a8774da3fa9 ….Which Is Part Of The Reason Why LifeBridge Health Is Creating An Economic Development Strategy For Baltimore & Maryland
LifeBridge Health is leading a coalition of providers & payers to develop an industrial cluster around health IT in Baltimore – building off our national strength in health care
Looking to build a new economic cluster in Baltimore & Maryland in an emerging industry
28 Sources: LifeBridge Health Telehealth
William (Bill) Sheahan, MPA, EMT-P Corporate Vice President, MedStar Health and Director, MedStar Simulation Training & Education Lab (MedStar SiTEL)
29 High-Level Framing of Telehealth
Teleconsultations Remote Care Virtual Visits Remote consultations among Management Care directly to patients clinicians Monitor Patient-Generated Health Data
30 A Few Questions….
1. Should telehealth still be considered an innovation?
2. Does your organization offer telehealth programs?
3. Have you done a telehealth visit in the past year?
31 Some Quick Thoughts & Data
I sure hope it’s still Innovative, or we need to rebrand our center! 76% of organizations report offering telehealth services, but only 6% report that these services are mature 1
14% of physicians report offering virtual care to their patients 2
18-23% of consumers have done a tele-visit, but 53-57% would consider doing one 2, 3
1 Foley 2017 Digital Health Survey 2 Deloitte 2018 Insights: Virtual Care 3 Telemedicine: Patient Perspectives, HIDA 2017
32 Telehealth Adoption
Low Health System Investment in Telehealth High
“Limping Along Aimlessly” “Bloated and Bleeding”
33 Technology Landscape
Many vendors for Single vendor many programs What are health systems using? for all programs
Narrow Telehealth Enterprise Telehealth Solution What are vendors selling? Platform
34 Lessons from the Telehealth Trenches 1. Virtual care has differences 2. Tech is a commodity (but implementation is hard) 3. Barriers are daunting 4. Capacity is king (aka pilots are easy)
35 Why Telehealth Innovation?
Workforce
Financial Quality & Performance Safety
Patient Market Experience Positioning
36 Building Telehealth Competence, Capacity and Enterprise Impact
Idea Generation & Pilot Development Pilot-scale operations build Competence & Capacity
Full-scale integrated operations
Sustainable Programs Through: • Joint operation with Agile pilot programs to clinical/operational service explore: lines Bringing together: • Technology Capabilities • Continual evaluation of • Clinical/Operational Needs • Value Analysis adjacent opportunities to gain • Telehealth Technologies • Clinical/Operational efficiency • Consumer Expectations Readiness, Workflow & Sustainability
37 Remote Monitoring
Sathya Elumalai, MS, MBA Co-founder and CEO for Multisensor Diagnostics (MDX)
38
On Body In Home In Body In Hospital & In Clinic In Community
Introduction Video
https://www.youtube.com/watch?v=3yUuDbyZePY
Questions?
74 Maryland Association of Healthcare Executives presents:
Session # 4 Innovations in Patient Experience
1 Our Expert Panel Speakers:
1. Barbara Courtney, MS, RCEP Director, Specialty Outpatient Services and Respiratory Therapy, and Patient Experience Leader Shady Grove Medical Center
2. Vishal Jain Vice President, IT University of Maryland Medical System
3. Katrina Rios Director of Strategic Partnerships - Public Health emocha Mobile Health
Moderator:
Amy Stowers, MS, RN, FACHE Senior Manager
Atlas Research 2 SGMC Patient Experience
Presented by: Barbara Courtney, MS, RCEP Director, Specialty Outpatient Services and Respiratory Therapy, and Patient Experience Leader
3 The Human Connection
Empathy: The Human Connection to Patient Care Cleveland Clinic
4 Patient Experience
The sum of all interactions, shaped by an
organization's culture, that influence patient perceptions across the continuum of care.
-Beryl Institute
5 HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Services
• DOCTOR COMMUNICATION • NURSE COMMUNICATION 32 • RESPONSIVENESS QUESTIONS • CARE TRANSITIONS • PAIN MANAGEMENT ADMINISTERE • MEDICATION COMMUNICATION D BY PHONE • DISCHARGE INFORMATION OR MAIL • ENVIRONMENT OF CARE
QUESTIONS LIKE: During this hospital stay, how often did nurses treat you with courtesy and respect? Never-Sometimes-Usually-Always 6 Nurse Communication – Key Driver, Studer Group Key Drivers of Patient Overall Rating of Hospital
Nurse Communication 0.772
Care Transitions 0.764
Responsiveness 0.666
Pain Management 0.661
Doctor Communication 0.656
Cleanliness 0.628
Communication About Meds 0.617
Quiet 0.568
Discharge Instructions 0.561
Pearson Correlation 7 Px Team Members
• Define Problem & Scope of Project Define • Determine Measurement Key Process 8 Indicators HCAHPS Questions: Nurse Communication Courtesy/Respect of Nurses:
During this hospital stay, how often did nurses treat you with courtesy and respect?
RNs Listening Carefully:
During this hospital stay, how often did nurses listen carefully to you?
RN Clear Communication:
During this hospital stay, how often did nurses explain things in a way you could understand?
9 Define: Project Charter
Nurse Communication Project Name: Improve Nurse Communication at SGMC Suboptimal patient experience; Nurse Communication HCAHPS Problem/Impact: scores are not meeting target; therefore, negatively impacting QBR Business Case Improve Nurse Communication Domain to meet target/world class, Expected Benefits: improve patient experience, receive incentive payment through QBR Financial Impact: QBR Incentive Payment Measure of Nurse Communication Success(s):
Objectives Proposed Target(s): Target = 80% Top Box, World Class = 87% Top Box Time Frame: December 2017 – June 2018 Strategic Alignment: Patient Experience In Scope: All Inpatients, Observation, ED, and Outpatient Surgical Patients Scope Out-of-Scope: Other outpatients Executive Sponsor: Joan Vincent, CNO Team Leader: Barbara Courtney Team Team Members: Patient Experience Entity Team Process Owner(s): Barbara Courtney Mgmt Review Team: Joan Vincent and PI Council Completion Date: September 30, 2018 Schedule Review with Joan Vincent Monthly, Review with AHC Patient Key Milestone Dates: Experience Council on request, and President’s Council on request 10 Measure: Defining The Gap
Nurse Communication Current Month n = 308 HCAHPS Score Target (CMS Top Box) World Class (CMS Max)
88%
86%
84% 83% 82% 82% 82% 82%
Percentage 80% 79%
78%
76%
74% Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 YTD
Baseline = 79% (Q3 Measure • Measure the Gap GAP 2017) • “Where Are We - Where Do We Want to Be?” Target = 82% : 11 Most Common Root Causes • Inconsistent staff communication - Doctor to nurse - Nurse to nurse - Care team to patient/family
• No standardized processes - Hourly rounding - White boards - Bedside shift report - Nurse leader rounding
• Lack of education/resources for patients and family members - What to expect during an inpatient admission - Normal turn around time for diagnostic testing
12 Countermeasures to Improve • Improve Staff Communication - Implement multidisciplinary (MD, RN,CNA) rounding with patients (Give patient 1 unified message) - Coach staff on effective bedside shift report to include the patient
• Create Standardized Processes (4 Must Haves) - Set a daily plan to allow for successful purposeful hourly rounding (RN round on the even hours and CNA on the odd) - Reeducate staff on the proper use of the White boards
• Develop and Implement informational resources for patients and family members around their plan of care - Create printed material to orient the patient to the unit and what to expect during their stay - Provide educational resources to patients and families about specific diagnoses and medication side effects 13 Improve: Our Progress
Nurse Communication n = 446 surveys HCAHPS Score Target World Class
88
86
84 83 82 82 82 82 81 81
Percentage 80 79
78
76
74 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 Q1 2018 Q2 2018
Initiatives: 1) Weekly Patient Experience Committee • Select & Test Countermeasures for meetings Improve Improvement 2) Unit-based DMAIC projects • Develop Implementation Plan 3) PCM, social media, and Patient Relations 14 feedback What We’re Learning…
• Monumental task to get “everyone” to work together • Importance of implementing proactive rounding by all hospital leaders • How to hardwire the 4 MUST HAVES? • Coaching and Accountability • Relationship Based Care is the KEY for Success!
15 MyPortfolio Bedside Pilot Project
Presented by: Vishal Jain Vice President, IT
16 About Us
17 Project Overview
Overview MyPortfolio Bedside is a tablet- based application that gives hospitalized patients and their families more information about their stay. • View vitals, current meds, Tablet View discharge planning, “Happening Soon”, etc. • Access educational materials • See treatment team member's role • Place non-urgent requests
18 Application View Project Goals/Objectives
• Inform- Engage and inform patient (and caregiver) • Improve- Increase patient and family knowledge base by providing education • Impact- Have an impact on the patient; Patient experience inpatient outpatient
• Yield Higher Patient Satisfaction Scores • Address Patient Expectations (Consumerism in Healthcare) • Continue to Innovate
19 Bedside Scope (Implementation and Considerations)
Feature Implemented? Considerations
Provisioning Yes Which roles will provision tablets My Health Yes Sensitive & Non-Sensitive – Lab Results Time to results released to patient Notes Patient Notes Only Provider notes not released to Bedside for patient to read. Video notes disabled. Happening Soon Yes UMMS radiology and imaging departments do not schedule inpatients to a time, those appointments would not display with exact time in Bedside. I Would Like Yes Stressed NON-urgent requests, limited options Taking Care of Me Yes Generic bios, first names only, photos difficult to access and standardize across multiple hospitals, Provider and Staff Photos
To Learn Yes Written education, inline education, video education embedded in IED records, other education resources difficult to access due to server structure Messages Yes Only treatment team members can respond Patient Signature No Did not have SU or Epic 2018 when initially implemented A few Questions Yes Only for Bedside Satisfaction Questionnaire Let’s eat No Unable to integrate with current dietary system and workflows MyChart Sign Up Yes Other: Games Yes On tablet, not accessed through Bedside app due to iOS challenges 20 Other: Movies No Wi-Fi bandwidth implications, security concerns Piloted Units • Consideration given when selecting piloting unit included • Unique Educational needs • High risk of readmission • Length of stay greater than 3 days • High patient engagement
• Below are units selected to pilot Bedside
Facility Department Go-Live Date UM SJMC GI (7 West) September 19, 2017 UMMC Cardiac Surgery Telemetry (G6 October 3, 2017 East/West) UM Midtown 4 North October 3, 2017 3 North January 23, 2018 UM Rehab Comprehensive Medical Rehab October 3, 2017
UM BWMC 2 South January 23, 2018 7 West 21 Bedside Technical Device Specifications Bring Your Own Tablet • iPad 9.7 Device (BYOD) Implemented in • Future Nova Flip Pad Feb.2018 Case (Medical Grade) Patients can use • Otterbox their own Android tablet or iPad. Charging • Balt 27541 Mobile Laptop Charging Cart Station
Mobile Device Management Solution • Jamf
(MDM) 22 Project Successes
Technical Operational - Epic produced build guide was - Front line and senior clinical staff clear and concise were engaged throughout project - Coordination between Ambulatory - Super Users motivated other staff (e-Health) and Inpatient (ClinDoc) - Unit staff engaged in Technical analysts to complete build Dress Rehearsal - Canto allowed capture of staff - Leadership buy in photos - Patients were happy with iPad - Welcome Video experience
23 Project Challenges
Technical Challenges Solutions
Medical grade case difficult for patient use Offered Otterbox case as alternative Educated on case “kickstand” Apple software updates difficult to System IT support went to all sites and manually coordinate updated devices Provider Photos Worked with Epic security to develop master - Not centralized spreadsheet and process - No set process for mass uploads Future discussion scheduled for centralized approach - Providers unhappy with photos
Operational Challenges Solutions Key decision makers absent Leadership enforced importance of attendance Lack of unit champions Unit managers assign champion Training structure Provide trainers with training iPad, Unit manager prioritize training, Disseminate training materials prior to class Workflow and responsibility concerns Ensure staff understands unique role Explain how Bedside can help staff 24 Measures of Success
Patient Bedside Usage Discharge Staff Post Go- Report Satisfaction Live Survey Questionnaire
Provider Post Press Ganey Go-Live Survey HCAHPS Scores
25 Bedside Usage Report
Activity Usage (Most to Least) Taking Care of Me
I Would Like Bedside Usage By Site My Health Happening Soon UMROI, 28, BWMC, 43, 10% 15% To Learn
Notes UMMS SJMC, 65, MTC, 37, 23% 13% Welcome Video A Few Questions Messag es 10 Hrs. MyChart Sign Up Average Time Spent Using UMMC, 108, 26 39% Bedside Patient Bedside Satisfaction Questionnaire What did you like most about MyPortfolio Bedside? Good to see information on my 47 health and tests Easy to use without asking 31 31 and 28 informative 20 # of responsesof # 16 I wish I had 14 14 13 gotten the 7 7 tablet sooner
Overall, I am satisfied in using MyPortfolio Bedside
Agree 85% Disagree 5% Very nice, very helpful in my communication with the doctor as there was something on my Neutral chart I did not know about; 9% allowed me to have a Did Not conversation with doctor to understand a concern. Use 27 1% Staff Post Go-Live Survey Support Equipment Additional Needs • Sign out/in • Case heavy & screen • Other things than • Educate patient & is not sensitive MyPortfolio: staff about device especially for movies, games, • Some patients need patient with arthritic internet more direction fingers. • Order diet • Patient messages: • @ transfer iPads • Updated Labs need to be logged in misplaced and • Educational video improperly stored • Competing means • Literacy level of communication: • Tablets: locked up phones, call bells, and 2 person sign etc. in/out. • Use own device MyPortfolio Bedside was a positive experience for me Strongly Strongly Disagre Positive Responses Neutral Responses Agree e 3% 5% • Time to orient • Positive experience Agree Disagre patient for patient 26% e 26% • Patient education • Managing iPad Negative Responses • Saved me time
Neutral 28 40% Provider Post Go-Live
SurveyMyPortfolio Bedside was a positive experience for me Provider Comments • Lack of awareness of Strongly patient use Disagree 0% Disagree • Suggest an alert flag in 4% Strongly Epic Agree • Device feedback 20% • Side effects of Neutral 44% medications
Positive Responses Agree • Messages 32% • Patient Education
Neutral Responses • Saved me time • Positive experience for
patient 29 HCAHPS – Generic Trend
Domain: Communication w Nurses Listen 100 Carefully Courtesy & 90 Respect 80 70 60 Bedside Explain 50 Implementati way to on understand 40 30 20 10 0
Communication Domain Domain: Communication w Doctors 100 90 80 Next Steps 70 60 50 40 Bedside • With larger N, correlate 30 Implementati on 20 responses of patients with & 10 without Bedside 0 • Consider impact of other PEx initiatives 30 Findings
• Overall, the patients liked MyPortfolio Bedside • Staff and Providers have mixed feelings on MyPortfolio Bedside • More analysis needed
• Looking at options for next steps • Repackage and add to MyChart Bedside platform • Add more games • Investigate enterprise movie subscription • Refine marketing materials (handouts to patients), add script for staff • Add manager checklist to implementation packet • Relook at MyChart Bedside configuration for activities • Relook at role ownership (unit clerk, patient experience, volunteers, techs) • Rollout strategy under discussion • What units • What release cycle • Refine training process • Update training video for staff • Make training mandatory 31 • Include “selling points” for nursing staff (ex: patient education) Empower Every Patient to Take Every Dose
Presented by: Katrina Rios Director of Strategic Partnerships - Public Health
32 Drugs don’t work in patients who don’t take them. - Surgeon General C. Everett Koop, 1985
33 50% of medication is not taken
Non-adherence is a $300B problem
34 Avoidable Costs Due to Medication Nonadherence
35 We leverage a solution from a hidden corner of our healthcare system called Directly Observed Therapy
36 emocha verifies every dose of medication through asynchronous video observation
37 38 Theory of Change
39 Created to Address High Priority Health Challenges
40 Clinical Validation
41 Process
42 Medication Adherence After Discharge
43 “I think overall, video DOT would be a positive thing, especially when you're first starting out . It would just help you take your meds on time and be connected to your providers. So, I'd be excited about it.”
44 Questions?
45 Save the Date – Maryland Association of Health Care Executives (MAHCE) Career Forum
Date: Thursday, November 15, 2018 Time: 5:30 PM to 9:00 PM Location: Orioles Camden Yards, Designated Hitter's Lounge (4th floor)
46