Lakota Health System: eicu Pilot for Pine Ridge Indian Health Services Hospital

Lakota Health System: eicu Pilot for Pine Ridge Indian Health Services Hospital MMI 404 Health Enterprise Operations Group 1 Rhona Banayat Ralph Garcia Nicole Hawkins Mike Nowak November 20, 2011

Presentation Summary Introduction Lakota Health System Mission Pine Ridge Indian Reservation and Health Service Hospital eicu Pilot Program Proposal Rationale and Return on Investment Clinical Approach Implementation Technical Solution Plan and Schedule Cost Estimate Conclusion

Lakota Health System Lakota Health System Mission Our Mission... to deliver compassionate, high-quality health care services that improve the quality of life of Lakota Indians Our Goal... to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to Lakota Indians Pilot Program Request Approval to implement a satellite eicu tele-monitoring system at Pine Ridge Hospital The request includes temporarily reassigning PA & Nurse Personnel

Pine Ridge Indian Health Service Hospital Pine Ridge Indian Health Service Network 9 small reservation medical satellite facilities aligned with the Sanford Hospital in Sioux Fall S.D. Pine Ridge Hospital is the largest satellite facility 38-bed inpatient ward, including small ICU, OB/labor and delivery, emergency department, and surgery department 5 full-time physicians with a severe intensivist shortage Serves over 17,000 patients Sanford Hospital is the Hub Facility (Command Center) 545 licensed beds Over 24,000 annual admissions Over 32,000 ER responses each year Owns one helicopter and two fixed-wing aircraft

Pine Ridge Indian Reservation Demographics Approximately 40,000 persons and 35% are under the age of 18 Largest town on the reservation is Pine Ridge, pop. 5,720 people Employment Information Median income is approximately $2,600 to $3,500 per year 97% of the population lives below Federal poverty levels Living Conditions Most families live in rural areas, w/average 17 people per home Over 33% of the Reservation homes lack basic water and sewage systems and electricity Life Expectancy/Health Conditions The life expectancy is 48 years old for men and 52 for women The rate of TB is approximately 800% higher than the U.S. average

Map of Pine Ridge Indian Reservation Sanford Regional Hospital Sioux Falls, SD 540 miles There is no public transportation available on the Reservation Predominant form of transportation is hitchhiking Weather is extreme ranging from 110 F to 50 F Pine Ridge Hospital

eicu Pilot Program Proposal

Proposal - Rationale and Return on Investment Rationale - Enhance collaboration between intensivists at the main hospital (Sanford) and staff at the satellite hospital (Pine Ridge) - Provide continuous monitoring of patient data - Minimize complications and improve patient safety Return on Investment (ROI) - Save $30,000 per ICU bed (~$1 million/year) - Can generate additional revenue from decreased length of stay: ~$100,000/month - Reduce patient transfer costs to main hospital by $1 million/year

Proposal Clinical Approach Clinical Background Role of the Intensivist Central Monitoring Station at Sanford Command Center Pine Ridge Hospital ICU

Proposal - Clinical Approach Role of the Intensivist Physician who specializes in the treatment of critical care patients Typically work in the Intensive Care Unit setting Current national shortage of intensivists Most hospitals cannot afford an intensivist; only 10 to 15% of hospitals have a trained intensivist

Proposal Clinical Approach Central Monitoring Station At Sanford Command Center 24 hour staffing by intensivists Critical Care nurses assist intensivists with patient monitoring Patients monitored through a remote video camera Use advanced software for continuous, real time view of the patient Use electronic monitoring for vital signs; alarms activate if there are any changes in patient condition Use rule-based decision system

Proposal - Clinical Approach Pine Ridge Hospital Intensive Care Unit Nurse provides hands-on care at the patient bedside Nurse administers medication Nurses communicate by voice w/intensivist at main hospital Use house officers or ED physician to complete procedures such as intubation

eicu Implementation

Implementation Technical Implementation Goals & Objectives Implement imdsoft s MetaVision Central solution for ICU telemonitoring at Pine Ridge Hospital Partner with imdsoft and Sanford Health IT resources to complete implementation Complete implementation in 4 months 12-month pilot study

Implementation Technical Solution High-Level Technical Architecture Media Server MVCentral Server Pine Ridge Hospital Sanford Health System Internet VPN Video and Telemetry Feeds eicu Command Center Media Server MVCentral Server

Implementation Technical Solution Detailed Technical Architecture Pine Ridge Hospital / VPN VPN eicu Command Center

Implementation Cost Estimate Capital and One-Time Costs for eicu Implementation Capital and One-Time Costs for eicu Implementation (Year 1) Item# Expense Item Description Cost 1 Software License and Implementation Fees $ 100,000 2 ICU Equipment Including Computers $ 65,000 3 Network and Infrastructure Costs $ 38,000 4 Non-Licensing and Implementation Software Costs $ 25,000 5 Project Management and Consultant Costs $ 20,200 Total Implementation Costs $ 248,200 Ongoing System Maintenance Costs (Year 2 moving forward) Item# Expense Item Description Cost 1 Annual Software Maintenance Support Fees* $ 42,000 2 Annual Hardware Maintenance $ 6,000 Annual Maintenance Costs (for 5-ICU beds) $ 48,000 * 5% increase per year

Implementation Plan & Timeline High Level Implementation Plan & Timeline 16-Week Implementation Phase / Task 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Initiate Develop Workplan Identify & Obtain Resources Project Kick-off Install Hardware & Software Establish Network Connection Design Design eicu Workflow Design Application Execute Application Build / Config Equipment Install Functional/Integrated Testing End-User Training Deploy Activation Plan Go-Live Activation Activation Support Project Management

Conclusion In support of the Lakota Health System mission, the pilot program will provide continuous monitoring of critical care patients at the Pine Ridge satellite hospital. The pilot program will also improve patient outcomes and provide substantial cost savings for the Lakota Health System. We request approval to implement and conduct the eicu pilot program at Pine Ridge Hospital to provide high quality critical care services for the Lakota Indian community.

Link to eicu Video Demonstration Copy and paste this link (then click on the video screen under See tele-monitoring at LVH ) for a demo of how an eicu works: http://www.imd-soft.com/tele-monitoring

Thank You! Rhona, Ralph, Nicole and Mike

Appendix

Appendix A: Additional Information about Pine Ridge Indian Reservation Demographic Information 58.7% of the grandparents are responsible for raising their own grandchildren The school drop-out rate is over 70% Employment Information The unemployment rate is approximately 83-85% Little industry, technology or commercial infrastructure Living Conditions Many residents carry water (often contaminated) from local rivers for their personal use Most families live in rural and often isolated areas Few paved roads and the weather is extreme

Appendix A: Additional Information about Pine Ridge Indian Reservation Health Conditions Teenage suicide rate is 150% higher than the U.S. national average The infant mortality rate is about 300% higher than the U.S. national average More than half of adults battle addiction and disease Residents live without health care due to lack of public transportation Medical facilities are under-funded and under-staffed with outdated or non-existent equipment The rate of diabetes is 800% higher than the U.S. national average As a result of the high rate of diabetes on the Reservation, diabeticrelated blindness, amputations, and kidney failure are common Cervical cancer is 500% higher than the U.S. national average

Appendix B: Project Assumptions Lakota Health System will invest in new EMR application: imdsoft s MetaVision software Lakota Health System will invest in ICU tele-monitoring application: MVCentral software The pilot program will be conducted first at Pine Ridge Hospital to determine if eicus can be used at other satellite hospitals in the future Cost of staff intensivist, nurse practitioner and physician assistant will be paid by Sanford Regional Hospital

Appendix C Detailed Cost Estimates eicu Cost Estimates - Detail Detailed Cost Breakdown Item# Expense Item Description Total Cost 1 Software License and Implementation Fees $ 100,000 - S/W License $ 40,000 - Implementation Fees $ 60,000 2 ICU Equipment Including Computers $ 65,000 - Computer Hardware $ 20,000 - Video Equipment $ 10,000 - Media & Telemetry Servers $ 35,000 3 Network and Infrastructure Costs $ 38,000 - Network Hardware (Switches & Appliances) $ 30,000 - Internet Connection $ 8,000 4 Non-Licensing and Implementation Software Costs $ 25,000 5 Project Management and Consultant Costs $ 20,200-1 Project Manager (20 hrs at $185/hr) $ 3,700-1 Technical Consultant (35 hrs at $165/hr) $ 5,775-1 Integration Consultant (65 hrs at $165/hr) $ 10,725 Total Implementation Costs $ 248,200

Appendix D Additional ROI Information eicu ROI from Other Health Care Organizations Avera Health System, Sioux Falls, SD - Saved $6.4 million over 3 years - Continues to save $1,000 per patient day St Mary s Hospital, Jefferson City, MO - Increased revenue by $1.2 million in first 2 years-reduced LOS University of MA Memorial Health Center, Worcester, MA - Saved $5,000/case due to early detection of patient problems Resurrection Health Care, Chicago, IL - Over 2 years, saved 9200 ICU days (~$11.5 million)

Appendix E eicu Clinical, Quality and Cost Measures* Average patient length of stay Rate of ventilator associated pneumonia Rate of central line associated bloodstream infection Number of patients with pressure ulcers Reduction of nosocomial infections Patient mortality Patient satisfaction (pain management, provider responsiveness, quality of care) Provider satisfaction (staff communication, technology impact on workflow) Average eicu cost per patient *Measured quarterly during 12 month pilot eicu program

Appendix F Questions and Answers Question: Who will run the 12 month pilot study? Answer: A nurse manager from Sanford Hospital will act as the pilot study coordinator. Question: Who is responsible for data collection and reporting pilot study information to the board? Answer: The nurse manager will work with Sanford IT to mine data from eicu patient files and will present quarterly reports to the board (see Appendix E for quality & performance measures). Question: How will the project be evaluated after implementation? Answer: Staff from Sanford Hospital clinical and finance departments will analyze measures in Appendix E to determine the effectiveness and efficiency of the pilot eicu program.

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