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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
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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
Patient & Family Centered Care Safe & Effective Efficient & Timely Equitable SJHS Values and IOM Goals
What is CRD? • “Care ReDesign…creating more holistic, patient-centered care that is technologically enabled, resulting in improved clinical excellence, customer satisfaction and operational performance.” • Computerized Physician Order Entry-CPOE • PACS Digital Radiology • Clinical Documentation-Hospital Setting • Ambulatory Electronic Medical Record • Physician / Clinician Web Portal
Impact Wait State • 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 Visit Schedule Lab Prescribe Confirm Re-Visit Re-schedule Interpretation Pain of Wait State • Waste / Rework • Patient Dissatisfaction • Medical Errors • Frustrated Care-Givers • Unnecessary Costs Wait State Value Add The “Wait State” of Health Care
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
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
Infrastructure Modernization Web Deployment • 10 Year IT Innovation Strategy Core System Implementation IT Leadership Restructure Century Preparation Strategic IT Partnership Strategic Plan Foundation Organization Preparation Complete Vision Integration 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 Ubiquitous Access
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
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 Change Management, Adoption and Communication
Preaching the Gospel of Innovation – 2001 In Healthcare, if Innovation is notMANDATEDor REGULATEDits usually PROCRASTINATED!
Care ReDesign Objective We Are Determined To • 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 Building the Alliance • 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
Success Factors • Patients are at the center of healthcare technology • 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
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 Physicians
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
Leadership in evolving technology Drive technology to support workflow Order set development Medical Informatics Committee Importance of Physician Involvement