Successful Clinical Process Redesign in a Connected Healthcare Community Linus Diedling Allison Foley, MD Elliot Sternberg, MD Michelle Woodley, RN
AGENDA Care Redesign from 3 Perspectives Chief Medical Officer: Elliot Sternberg MD Nurse/IT Executive: Michelle Woodley RN Physician: Allison Foley MD Questions?
St. Joseph Health System Highlights $3.0 billion in revenues 14 hospitals in 3 states Licensed beds range from 47 to 851 Home health agencies, hospice care, outpatient services, skilled nursing facilities, managed care operations, and multiple physician organizations In FY 2004, SJHS provided more than $310 million in community benefit and care for the poor services
SJHS Values and IOM Goals Patient & Family Centered Care Efficient & Timely Safe & Effective Equitable
What is CRD? Care ReDesign creating more holistic, patientcentered care that is technologically enabled, resulting in improved clinical excellence, customer satisfaction and operational performance. 1. Computerized Physician Order Entry-CPOE 2. PACS Digital Radiology 3. Clinical Documentation-Hospital Setting 4. Ambulatory Electronic Medical Record 5. Physician / Clinician Web Portal
The Wait State of Health Care Payer Verification Scheduling Voice to Voice Live Confirmation Manual Chart Storage & Retrieval Confirming Eligibility Checking, Re-checking Patient History Waiting for Confirmation Lower Patient Satisfaction Higher Cost Increased Errors Harmful Delays Sick Patient Well Patient Schedule Visit Lab Interpretation Re-schedule Re-Visit Prescribe Confirm Wait State Value Add Waste / Rework Patient Dissatisfaction Medical Errors Frustrated Care-Givers Unnecessary Costs
Care ReDesign Objectives Improve patient care (safety, quality, satisfaction) Provide improved process and information access for caregivers Reduce inefficienies in the care delivery process
Four I s of an Initiative Information Involvement Incentives Investment
Involvement
Incentives System Fiscal Year Goals that affect AT RISK PAY
Investment Care ReDesign CPOE AEMR Clinical Documentation PACS Clinical Data Repository Web Portal Connectivity EMAR Bed Tracker Evidence-based Support
CARE REDESIGN Clinical Transformation Regulate, Mandate, or Innovate? SJHS Care Redesign Initiative
10 Year IT Innovation Strategy 98 99 00 01 02 03 04 05 06 07 Core System Implementation IT Leadership Restructure Century Preparation Strategic IT Partnership Strategic Plan Foundation Organization Preparation Complete Vision Integration Web Deployment Infrastructure Modernization System Optimization Web Transformation IT Clinical Innovation (CPOE, Clin Doc, PACS, AEMR) Business Process Design Change Management Services Manage with Information Next Generation Technology Transform Clinical Care Assess Organize Prepare Execute Excel Systemic Innovation Ubiquitous Access Organizational Industry Excellence Leadership
PATIENT SAFETY SJHS PRO-ACTIVE APPROACH Patient Safety
CRD STRATEGY Be Pro-Active, Not Re-Active Develop Key Partnerships Utilize Collaborative Design Process Deploy a Franchise-Model Approach Innovate Not Mandate Facilitate User Adoption Through Communication Plan
GOALS OF CRD Decrease preventable medical errors Reduce wait-state Decrease operational inefficiencies Drive efficiencies by redesigning processes using automated technologies Provide real-time access to patient information Aggregate information to support quality of care improvement activities
Care ReDesign Roadmap Major CRD Phase Key Phase Deliverable Change Drivers Key Technology Components Change Process Management Process Timing Phase I Phase II Lay the Foundation Assess the Opportunity Implement Clinical Manage With Technology Strategy Information Improve Tie Relevant Operational Information Together Performance Conduct Comparative Improve Patient Studies Service Quality Produce Actionable Meet Industry Findings Demands Computerized Physician Order Entry Clinical Data Repository Enterprise Master Patient Index Clinical Documentation PACS Ambulatory EMR Facilitated Process ReDesign High Impact Teams (SJHS) SJHS Driven Technology Partner Aggregation Establish CRD Management Group Timeline Efficiencies 8 year timeline with incremental delivery milestones Clinically Focused Assessment Business Line Analysis Population Health Management Data Driven Marketing Phase III Transform Clinical Care Implement New Practices" Implement technology enabled best clinical practices Solidify Behavioral Change Measure Change Achievement Clinician Sponsored TBD Begins with Phase I System Delivery Milestones (incremental benefit follows IT enablement)
CRD Collaborative Approach Involve stakeholders from the start Redesign process workflow Multidisciplinary work teams Optimize available Technologies Build a CRD Franchise Model with multidisciplinary work teams
CRD Implementation Strategy A Pilot Approach
CRD Implementation Strategy CRD Pilot Site Implementation Strategy Franchise Franchise Development Development Strategy Strategy SJMC Implementation Strategy Implement Implement Pilot Pilot Physician Physician Pre-printed Pre-printed Order Order Sets Sets POM Pilot Pilot Unit POM Unit (CPOE) Go Go Live (CPOE) Live Ancillary Hosp-wide Ancillary Physician Hosp-wide Physician Hosp-wide Go POM Go Live Hosp-wide Live POM Go Nursing Go Live Live (CPOE) Nursing (CPOE) And MAR And MAR Unit Clinical Clinical Doc Unit Sec. Sec. Doc Implement Implement House-wide House-wide Physician Physician Pre-Printed Pre-Printed Order Order Sets Sets Aug. 31, 2003 Nov, 2003 Dec. 02, 2003 Jan - Mar 2004 POM POM (CPOE) (CPOE) Go Go Live Live Add l Add l Physician Physician Champions Champions Pilot Pilot Unit Unit Phased Phased Unit Unit POM POM Clinical Clinical (CPOE) (CPOE) Doc. Doc. Go Go Live Live Hosp-wide Hosp-wide Add l Add l Go Go Live Live Physician Physician Champions Champions Hosp-wide Hosp-wide System System Phased Upgrade Phased Unit Unit Upgrade POM MAR POM For MAR For (CPOE) Hosp-wide (CPOE) Advanced Hosp-wide Advanced Go Go Clinical Go Live Go Live Live Live Clinical Physicians Physicians Functions Functions Hosp-wide Hosp-wide CRD Phase 2 Jan. 31, 2004 April 6 November 15 1
CRD Change Management, Adoption and Communication
Preaching the Gospel of Innovation 2001 In Healthcare, if Innovation is not MANDATED or REGULATED its usually PROCRASTINATED!
Care ReDesign Objective Improve patient care (safety, quality, satisfaction) Provide improved process and information access for caregivers Reduce inefficiencies in the care delivery process
Information Technology and Clinicians Clinical system must be built by clinicians Collaboration between technical team and clinicians key Process Workflow ReDesign Change Management Optimize Available Technology Right Process with the Right Technology
Nursing s Key Leadership Role in IT Clinical Integration Professional Paradigm Shift Responsible for overall coordination of care Legacy to develop processes and systems that will improve quality of care Optimize efficient and effective workflow With passion and working smart, nurses will make it happen
Keys to Physician Adoption Broad envisioning physician leaders driving sponsorship and participation Early physician involvement in concept, design and testing of new processes and systems Start small; achieve early ( quick wins ) and build on continuous successes
CRD at St. Jude Medical Center 18 Months at SJMC: 95% of frequent admitters in pilot unit using CPOE 900 staff and 450 physicians using online Clinical Documentation in all units Electronic Medication Administration Record in use in all units except ED Over 140,000 exams completed on PACS
Patients are at the center of healthcare technology Success Factors Care ReDesign is a journey and requires executive commitment Leadership must have a passion for automation and clinical transformation Be willing to commit resources needed Talk about the end goals constantly to keep them in sight
Live from Orange County: Saint Jude Medical Center CRD Pilot Site
Monty Python: The Holy Grail The Medical Staff Perspective
Benefits to Physicians Immediate access to patient record Decreased call backs to clarify orders Best Practice and Communication Access anywhere anytime Electronic signature of transcribed reports and verbal orders Assist with medication dosing calculations Associated data brought to point of ordering Ability to avoid some complications
Benefits to Patients Allergy and adverse drug reaction checking Medical history retained visit to visit Reduction in duplicate questioning and testing Coordinated care by multiple care providers having access to same record
Importance of Physician Involvement Leadership in evolving technology Drive technology to support workflow Order set development Medical Informatics Committee
Questions?