Provider
Adventist Health System/West
California
Mara
Bryant
Operations Executive
323.268.5000
bryantmc@ah.org
Challenge:
Sepsis mortality is a top clinical initiative for Adventist Health. Sepsis is the leading cause of death across hospitals in the US. Each year approximately 1.7 million people are diagnosed with it, resulting in more than 275,000 deaths. Someone dies from sepsis in the US about every two minutes. In 2016, the CDC attributed sepsis to be the highest inpatient cost, consuming more than $27 billion in hospital costs annually.
At Adventist Health, we faced challenges in trying to move the needle on sepsis. We believe that early and accurate detection is critical to improving outcomes and reducing mortality. Despite implementing multiple strategies to tackle sepsis, we were not able to make significant improvements in clinical outcomes. We followed evidence based practice for Sepsis Screening, reviewing fallouts weekly, training staff but not moving the needle on mortality. In July 2019, we implemented a system wide 1 hour sepsis bundle requirement. The evidence based screening guidelines for the bundle were only about 48% accurate in identifying patients who present to the emergency department (ED) with sepsis. Our average compliance for our 1 hour sepsis bundle hovered around 40%.We were challenged in identifying patients with sepsis accurately at triage. We quickly learned simple sepsis screening algorithms miss a lot of patients with sepsis, delaying antibiotic administration, and of course Covid made everything harder given sepsis is a common comorbidity with Covid+ patients.
Involved Parties:
Our clinical and operational teams partnered with Mednition to develop the 1st of its kind, clinically accurate, real time, AI-powered Early Sepsis Detection Solution to help nurses accurately identify patients with sepsis at the door during ED triage and requiring no lab work.
Innovation:
Adventist Health partnered with Mednition to test the new AI Sepsis model within their existing KATE AI Triage service, Mednition’s clinical decision support solution designed for ED nurses. Implemented early in the COVID-19 pandemic (July 2020), the additional AI sepsis model helped identify patients with sepsis that did not meet the most commonly used criteria for screening at ED triage, two SIRS vitals and source of infection. The KATE service improved sepsis detection by 65% over this screening protocol. KATE is trained on the entirety of medical records, including all of the free text and patient history and has the ability to see patterns in recognizing sepsis which have evaded prior research efforts. KATE’s advanced NLP made this level of accurate sepsis detection within minutes of a patient's arrival to the Emergency Department, and allowed Adventist to dramatically improve their compliance with the one hour sepsis bundle.
Results:
“KATE is catching patients with sepsis at the door that would have been otherwise missed.” - Dr. Stephen Liu, ED Medical Director at AHWM.
KATE makes our ED more predictable, supports our nurses in real time, improves their triage acuity accuracy, and gives us a significant head start on Sepsis. The KATE innovation helped: improve early sepsis detection at Triage by 65% over the hospitals prior screening protocol of 2 SIRS vitals and confirmed source of infection; improve our 1-hour sepsis bundle compliance by 87%; reduce median triage to antibiotic administration time to just 19 minutes (from 42 minutes); and provide patients with sepsis the care they need, faster.
The care we provide our patients has improved, and so have our outcomes, by using KATE to help us identify these high risk patients at the front door of the hospital.
The nurses and providers have embraced KATE and the insight this new AI-powered solution is providing in real time. We have rolled KATE out across the Southern California region with similar benefits. We just approved KATE for system wide use.
We look forward to sharing additional findings and contributing back to the clinical community in the fight against Sepsis.
Sepsis mortality is a top clinical initiative for Adventist Health. Sepsis is the leading cause of death across hospitals in the US. Each year approximately 1.7 million people are diagnosed with it, resulting in more than 275,000 deaths. Someone dies from sepsis in the US about every two minutes. In 2016, the CDC attributed sepsis to be the highest inpatient cost, consuming more than $27 billion in hospital costs annually.
At Adventist Health, we faced challenges in trying to move the needle on sepsis. We believe that early and accurate detection is critical to improving outcomes and reducing mortality. Despite implementing multiple strategies to tackle sepsis, we were not able to make significant improvements in clinical outcomes. We followed evidence based practice for Sepsis Screening, reviewing fallouts weekly, training staff but not moving the needle on mortality. In July 2019, we implemented a system wide 1 hour sepsis bundle requirement. The evidence based screening guidelines for the bundle were only about 48% accurate in identifying patients who present to the emergency department (ED) with sepsis. Our average compliance for our 1 hour sepsis bundle hovered around 40%.We were challenged in identifying patients with sepsis accurately at triage. We quickly learned simple sepsis screening algorithms miss a lot of patients with sepsis, delaying antibiotic administration, and of course Covid made everything harder given sepsis is a common comorbidity with Covid+ patients.
Involved Parties:
Our clinical and operational teams partnered with Mednition to develop the 1st of its kind, clinically accurate, real time, AI-powered Early Sepsis Detection Solution to help nurses accurately identify patients with sepsis at the door during ED triage and requiring no lab work.
Innovation:
Adventist Health partnered with Mednition to test the new AI Sepsis model within their existing KATE AI Triage service, Mednition’s clinical decision support solution designed for ED nurses. Implemented early in the COVID-19 pandemic (July 2020), the additional AI sepsis model helped identify patients with sepsis that did not meet the most commonly used criteria for screening at ED triage, two SIRS vitals and source of infection. The KATE service improved sepsis detection by 65% over this screening protocol. KATE is trained on the entirety of medical records, including all of the free text and patient history and has the ability to see patterns in recognizing sepsis which have evaded prior research efforts. KATE’s advanced NLP made this level of accurate sepsis detection within minutes of a patient's arrival to the Emergency Department, and allowed Adventist to dramatically improve their compliance with the one hour sepsis bundle.
Results:
“KATE is catching patients with sepsis at the door that would have been otherwise missed.” - Dr. Stephen Liu, ED Medical Director at AHWM.
KATE makes our ED more predictable, supports our nurses in real time, improves their triage acuity accuracy, and gives us a significant head start on Sepsis. The KATE innovation helped: improve early sepsis detection at Triage by 65% over the hospitals prior screening protocol of 2 SIRS vitals and confirmed source of infection; improve our 1-hour sepsis bundle compliance by 87%; reduce median triage to antibiotic administration time to just 19 minutes (from 42 minutes); and provide patients with sepsis the care they need, faster.
The care we provide our patients has improved, and so have our outcomes, by using KATE to help us identify these high risk patients at the front door of the hospital.
The nurses and providers have embraced KATE and the insight this new AI-powered solution is providing in real time. We have rolled KATE out across the Southern California region with similar benefits. We just approved KATE for system wide use.
We look forward to sharing additional findings and contributing back to the clinical community in the fight against Sepsis.
Improved the care of patient populations
Provider
University of Illinois at Urbana-Champaign - McKinley Health Center
Illinois
Mel
Fenner, PhD
Associate Director of Health Technology Innovation
2172441730
mrfenner@illinois.edu
What’s the Challenge and those involved.
During the peak of the first wave of the COVID-19 pandemic, in April 2020, the University of Illinois quickly realized that to consider reopening campus in the fall, they would need fast, frequent testing and a digital ecosystem to manage the process. Out of that challenge, the University partnered with the McKinley Health Center (https://mckinley.illinois.edu/) and created SHIELD: Target, Test, Tell. SHIELD was a cross-functional collaboration that consists of chemists, biologists, behavioral researchers, application developers, system architects, and many others. Those teams had defined roles: Understand who to TARGET for COVID testing and their testing intervals, TEST those patients using the University’s recently FDA-EUA Approved PCR Saliva Test, and TELL the patient, Public Health, and other vital individuals about positives in mere hours, not days – including digital exposure notifications. Results and exposure notifications were made available via the Safer Illinois mobile app, leveraging the Rokwire platform. Rokwire (https://rokwire.org/) and the open-source mobile app initiative were created at the University of Illinois only a year before the pandemic.
What the innovation entailed
Overall, these innovations involved the McKinley Health Center and the university super-charging their existing healthcare technology ecosystem. For example, SHIELD Team 30 was created to deliver positive test results to patients and campus officials within 30 minutes of the lab results coming from the ThermoFisher device – a speed of notification not seen before. Those fast notifications and the connections to vital data streams allowed Public Health officials to isolate patients and quarantine close contacts rapidly – oftentimes, the same day a result was produced. SHEILD Team 30 is but one component of a complex ecosystem created to ensure the University of Illinois reopened in the Fall of 2020 and remained open for the remainder of the school year. Other critical elements of success included leveraging multiple AWS tools and services, text messaging platforms such as Twilio, enhancing the existing patient portal, vendor-created and in-house built web services, and APIs to push and pull data, as well as creating robust HL7 interfaces. The results from the vast amount of innovation required to accomplish this goal speak for themselves. Not only was the SHIELD Technology ecosystem duplicatable, but it was also modular. The duplicative nature of the SHIELD ecosystem sparked the creation of a K-12 playbook for schools around the country to consider.
How it generated Results
As the Authorizing Provider, the McKinley Health Center’s Director has ordered and collected two million tests with an all-time positivity rate of just over 0.3% on the Urbana-Champaign campus alone at the time of this submission (https://covid19.illinois.edu/on-campus-covid-19-testing-data-dashboard/). The digital ecosystem created to fight this pandemic allowed our patients to feel reassured that they and their classmates or colleagues were safe and protected. Further, the health technology ecosystem, including the covidSHIELD FDA-approved test, has been successfully implemented across Champaign-Urbana through SHIELD CU (https://shieldcu.illinois.edu/) and the state of Illinois through SHIELD Illinois (https://www.uillinois.edu/shield). These innovations were also implemented across the country at various other universities through SHIELD T3 (https://www.shieldt3.com/). This university-related organization has deployed variants of SHIELD Technology to 16 universities, dozens of K-12 school districts, and private companies. These tremendous innovations allowed the University of Illinois to become an industry leader in pandemic response and help many schools and businesses reopen across the globe. We consider that to be an incredibly impactful innovation.
During the peak of the first wave of the COVID-19 pandemic, in April 2020, the University of Illinois quickly realized that to consider reopening campus in the fall, they would need fast, frequent testing and a digital ecosystem to manage the process. Out of that challenge, the University partnered with the McKinley Health Center (https://mckinley.illinois.edu/) and created SHIELD: Target, Test, Tell. SHIELD was a cross-functional collaboration that consists of chemists, biologists, behavioral researchers, application developers, system architects, and many others. Those teams had defined roles: Understand who to TARGET for COVID testing and their testing intervals, TEST those patients using the University’s recently FDA-EUA Approved PCR Saliva Test, and TELL the patient, Public Health, and other vital individuals about positives in mere hours, not days – including digital exposure notifications. Results and exposure notifications were made available via the Safer Illinois mobile app, leveraging the Rokwire platform. Rokwire (https://rokwire.org/) and the open-source mobile app initiative were created at the University of Illinois only a year before the pandemic.
What the innovation entailed
Overall, these innovations involved the McKinley Health Center and the university super-charging their existing healthcare technology ecosystem. For example, SHIELD Team 30 was created to deliver positive test results to patients and campus officials within 30 minutes of the lab results coming from the ThermoFisher device – a speed of notification not seen before. Those fast notifications and the connections to vital data streams allowed Public Health officials to isolate patients and quarantine close contacts rapidly – oftentimes, the same day a result was produced. SHEILD Team 30 is but one component of a complex ecosystem created to ensure the University of Illinois reopened in the Fall of 2020 and remained open for the remainder of the school year. Other critical elements of success included leveraging multiple AWS tools and services, text messaging platforms such as Twilio, enhancing the existing patient portal, vendor-created and in-house built web services, and APIs to push and pull data, as well as creating robust HL7 interfaces. The results from the vast amount of innovation required to accomplish this goal speak for themselves. Not only was the SHIELD Technology ecosystem duplicatable, but it was also modular. The duplicative nature of the SHIELD ecosystem sparked the creation of a K-12 playbook for schools around the country to consider.
How it generated Results
As the Authorizing Provider, the McKinley Health Center’s Director has ordered and collected two million tests with an all-time positivity rate of just over 0.3% on the Urbana-Champaign campus alone at the time of this submission (https://covid19.illinois.edu/on-campus-covid-19-testing-data-dashboard/). The digital ecosystem created to fight this pandemic allowed our patients to feel reassured that they and their classmates or colleagues were safe and protected. Further, the health technology ecosystem, including the covidSHIELD FDA-approved test, has been successfully implemented across Champaign-Urbana through SHIELD CU (https://shieldcu.illinois.edu/) and the state of Illinois through SHIELD Illinois (https://www.uillinois.edu/shield). These innovations were also implemented across the country at various other universities through SHIELD T3 (https://www.shieldt3.com/). This university-related organization has deployed variants of SHIELD Technology to 16 universities, dozens of K-12 school districts, and private companies. These tremendous innovations allowed the University of Illinois to become an industry leader in pandemic response and help many schools and businesses reopen across the globe. We consider that to be an incredibly impactful innovation.
Improved the care of patient populations
Provider
Apollo Hospitals Enterprise Ltd.
Outside the United States
Wajida
Qaisar
Senior Manager, Operations
9678554202
wajida_q@apollohospitals.com
Covid gives birth to the innovation named “Comfort call”- This is an initiative to demonstrate highest level of care and compassions and effective communication through operational and clinical processes towards the family of covid patients admitted in the hospital premises. This is a monitoring mechanism has been put in place, with effect from Jul’20, to ensure effective communication between consultant and patient family so that we do not miss on any patients health status update and second, an assurance that he/she is taken care of in our hospital.
What gave birth to this thoughtful seed -
With the pandemic hitting and everyday changing new upgraded protocols, there was a pertinent area which sill posed a clinical, legal, operational and service implication. Due to restriction in movements, communication link was observed to be weakened particularly between the patients’ family and hospital. Three areas of concern/challenges identified were:
1. How to update on patient status to the family on a regular basis as family members are advisable not to loiter around the hospital premises, protocols laid were strict due to measures taken on prevention for spread of covid.
2. Addressing on ground issues and sharing feedback by the admitted covid patient in the form of complaints, compliments, suggestions and requests.
3. How to demonstrate care and re-live the motto of the organization in tender loving care and touching lives
Implementation phase: The ‘care team’ was identified which consisted of the clinical fraternity of consultants, doctors, nursing along with the support services team of operations at large.
To get this going, a process flow was designed with roles defined for all. Post this, all the consultants and doctors were briefed and explained the comfort call process on how they would receive support through reminders/calls on updating the patient family on a regular basis. This not only helped in developing a strong and sustained communication system but also provided the team enough data cuts on gathering valuable feedback and issues closed on real-time basis.
Review mechanism- A review mechanism and effective monitoring system was also put in place to ensure sustained and effective results. A dashboard was created for the leadership to review which is also a part of the morning huddle/meeting on a daily basis. Through this dashboard, various nuances of covid patient/family and our responsibility towards them is discussed. All cases of complaints, compliments, suggestion and requests are transparent to major stakeholders for quick and adept decision making.
Results: The results were quite encouraging. Based on analytics derived from this innovative process, ample areas of opportunity came into light. On ground delivery of care could be measured with the help of detailed interaction with the patient family and their expectations from this legacy brand of hospital. We segregated the indices into parameters covering clinical and operational areas, for example, Medical admin/team, Nursing, Housekeeping, Dietetics, F&B etc. An organic growth in performance was witnessed over a period of time (annexure attached). This also resulted in multiple appreciations received by the covid family members and simultaneously helped us to deliver best of our service especially during this pandemic.
The success of this innovation rested primarily on simplicity yet effective concept which is feasible for on ground implementation without any additional manpower or extra burden on the covid healthcare warriors.
For way forward, with about a year’s data gathered, we would take it to the next level of digitization.
To sum it up the Comfort call process entails four major pointers-
1. EFFECTIVE COMMUNICATION BETWEEN DOCTOR AND PATIENT FAMILY
2. A CUSTOMIZED AND ROBUST FEEDBACK & REVIEW MECHANISM
3. TRANSPARENCY OF INTER-DEPARTMENTAL OPERATIONS AND COVID +VE PATIENT/FAMILY
4. LIVING UP TO THE MOTTO OF THE ORGANIZATION- TENDER LOVING CARE AND DEMONSTRATE IN ACT
What gave birth to this thoughtful seed -
With the pandemic hitting and everyday changing new upgraded protocols, there was a pertinent area which sill posed a clinical, legal, operational and service implication. Due to restriction in movements, communication link was observed to be weakened particularly between the patients’ family and hospital. Three areas of concern/challenges identified were:
1. How to update on patient status to the family on a regular basis as family members are advisable not to loiter around the hospital premises, protocols laid were strict due to measures taken on prevention for spread of covid.
2. Addressing on ground issues and sharing feedback by the admitted covid patient in the form of complaints, compliments, suggestions and requests.
3. How to demonstrate care and re-live the motto of the organization in tender loving care and touching lives
Implementation phase: The ‘care team’ was identified which consisted of the clinical fraternity of consultants, doctors, nursing along with the support services team of operations at large.
To get this going, a process flow was designed with roles defined for all. Post this, all the consultants and doctors were briefed and explained the comfort call process on how they would receive support through reminders/calls on updating the patient family on a regular basis. This not only helped in developing a strong and sustained communication system but also provided the team enough data cuts on gathering valuable feedback and issues closed on real-time basis.
Review mechanism- A review mechanism and effective monitoring system was also put in place to ensure sustained and effective results. A dashboard was created for the leadership to review which is also a part of the morning huddle/meeting on a daily basis. Through this dashboard, various nuances of covid patient/family and our responsibility towards them is discussed. All cases of complaints, compliments, suggestion and requests are transparent to major stakeholders for quick and adept decision making.
Results: The results were quite encouraging. Based on analytics derived from this innovative process, ample areas of opportunity came into light. On ground delivery of care could be measured with the help of detailed interaction with the patient family and their expectations from this legacy brand of hospital. We segregated the indices into parameters covering clinical and operational areas, for example, Medical admin/team, Nursing, Housekeeping, Dietetics, F&B etc. An organic growth in performance was witnessed over a period of time (annexure attached). This also resulted in multiple appreciations received by the covid family members and simultaneously helped us to deliver best of our service especially during this pandemic.
The success of this innovation rested primarily on simplicity yet effective concept which is feasible for on ground implementation without any additional manpower or extra burden on the covid healthcare warriors.
For way forward, with about a year’s data gathered, we would take it to the next level of digitization.
To sum it up the Comfort call process entails four major pointers-
1. EFFECTIVE COMMUNICATION BETWEEN DOCTOR AND PATIENT FAMILY
2. A CUSTOMIZED AND ROBUST FEEDBACK & REVIEW MECHANISM
3. TRANSPARENCY OF INTER-DEPARTMENTAL OPERATIONS AND COVID +VE PATIENT/FAMILY
4. LIVING UP TO THE MOTTO OF THE ORGANIZATION- TENDER LOVING CARE AND DEMONSTRATE IN ACT
Enhanced the patient experience
Provider
Medcare Hospitals & Medical Centres, UAE Dubai
Outside the United States
Kowshik
Bhattacharjee
Head of Service Excellence
971563666406
kowshik.b@medcarehospital.com
Background of the Project: Why the Project? One Touch: This project was initiated to address the increasing need of patients requesting a faster and more efficient response time for call bell from nurses and other non-clinical allied services such as housekeeping, food & beverages and facilities. These insights came as a result of the feedback received from the Voice of Customer platform, which was launched by Medcare in October with the aim to capture data related to patient needs and satisfaction.
Brief Description of this Innovation: The need was to build an integrated application where patients and their families would register their requests online; for nurses to register these requests on behalf of patients, and assign tasks for other departments to address the needs – all within the same application.
The executive committee comprising Chief Nursing Officer/Service Excellence Team/Head of IT/COO and Group CEO wanted to deep dive and further understand the root cause of the challenge at the hospital level. When this data was analyzed, it was clear to the committee that high footfall hospitals and even wards have shown the same trend of poor satisfaction, irrespective of their location. One of the imminent fixes was to allocate more nurses in wards where these complaints were abundant, however it turned out to be an unviable solution. The business suggestion was to explore IT options to solve the matter, and to look at best practices that were being followed in other service industries. Each team member was assigned a task, and they were asked to report back their findings in next 30 days.
The Service Excellence team conducted a detailed time and motion study for all the tasks that nurses were performing during their duty hours. The results of the study showed that 35- 40% of nursing bandwidth was getting wasted doing non- clinical work and following up with auxiliary departments on various requests and job orders.
The nursing team was also tasked to do a further drill down of the time and motion study. They produced reports that were presented to the committee on insights related to non-clinical work such as following up with user departments on extra bed sheets, need for drinking water, climatization of the rooms, cleanliness of bathrooms, inaccuracy of food service; requests that were not answered efficiently as the nurses were busy running other errands.
The Service Excellence team did some benchmarking with other service industries such as hospitality, in which the concept of a one touch concierge service existed.
Following a series of deliberations, the suggestion was to merge the results of the benchmarking exercise and explore whether the concept of a “one touch button” could be developed for all non- clinical needs that could be deployed across all the facilities of Medcare Hospitals & Medical Centres. At the time, all hospitals were capturing their requests in manual registers, and there was no platform where these requests were reviewed against standard SLAs, which also did not exist for non- clinical requests.
An external partner was identified to work with the Service Excellence team and develop a unique application on which patients could raise non-clinical requests in real time. The platform was made available in the facility in August 2020. Some of its prominent features: a user-friendly application which is accessible from IOS, Android Devices and desktops; requests could be captured from all sources and assigned to the relevant stakeholders through notifications and SMS. Each request has a specific SLA and escalation pathway, which can be tracked in real time.
Upon completion of the request, the responsible department is mandated to close the ticket in the runner application to ensure the closure of the request. The team is also provided with the options of changing deadline, re- assigning to another team member or department. All such updates have also been scheduled to be sent as notifications to the Head of Department (HOD).
Salient Features of the One- Touch Application
One Touch is an “Inpatient assist system” for all “Non-medical or non-clinical” requests of inpatients and their attending family members.
It is an on-line database management system designed to capture and track all non-medical request from in-patients.
It ensures that all such requests are completed within the agreed SLA/TAT as per the benchmarking standards for more than 8,000 requests.
Requests not closed in TAT will be escalated to HODs and the follow-ups are done by HODs and not nurses.
A database management system of all non-medical requests. This database can be used for improving process efficiencies, manpower planning, CAPEX.
Brief Description of this Innovation: The need was to build an integrated application where patients and their families would register their requests online; for nurses to register these requests on behalf of patients, and assign tasks for other departments to address the needs – all within the same application.
The executive committee comprising Chief Nursing Officer/Service Excellence Team/Head of IT/COO and Group CEO wanted to deep dive and further understand the root cause of the challenge at the hospital level. When this data was analyzed, it was clear to the committee that high footfall hospitals and even wards have shown the same trend of poor satisfaction, irrespective of their location. One of the imminent fixes was to allocate more nurses in wards where these complaints were abundant, however it turned out to be an unviable solution. The business suggestion was to explore IT options to solve the matter, and to look at best practices that were being followed in other service industries. Each team member was assigned a task, and they were asked to report back their findings in next 30 days.
The Service Excellence team conducted a detailed time and motion study for all the tasks that nurses were performing during their duty hours. The results of the study showed that 35- 40% of nursing bandwidth was getting wasted doing non- clinical work and following up with auxiliary departments on various requests and job orders.
The nursing team was also tasked to do a further drill down of the time and motion study. They produced reports that were presented to the committee on insights related to non-clinical work such as following up with user departments on extra bed sheets, need for drinking water, climatization of the rooms, cleanliness of bathrooms, inaccuracy of food service; requests that were not answered efficiently as the nurses were busy running other errands.
The Service Excellence team did some benchmarking with other service industries such as hospitality, in which the concept of a one touch concierge service existed.
Following a series of deliberations, the suggestion was to merge the results of the benchmarking exercise and explore whether the concept of a “one touch button” could be developed for all non- clinical needs that could be deployed across all the facilities of Medcare Hospitals & Medical Centres. At the time, all hospitals were capturing their requests in manual registers, and there was no platform where these requests were reviewed against standard SLAs, which also did not exist for non- clinical requests.
An external partner was identified to work with the Service Excellence team and develop a unique application on which patients could raise non-clinical requests in real time. The platform was made available in the facility in August 2020. Some of its prominent features: a user-friendly application which is accessible from IOS, Android Devices and desktops; requests could be captured from all sources and assigned to the relevant stakeholders through notifications and SMS. Each request has a specific SLA and escalation pathway, which can be tracked in real time.
Upon completion of the request, the responsible department is mandated to close the ticket in the runner application to ensure the closure of the request. The team is also provided with the options of changing deadline, re- assigning to another team member or department. All such updates have also been scheduled to be sent as notifications to the Head of Department (HOD).
Salient Features of the One- Touch Application
One Touch is an “Inpatient assist system” for all “Non-medical or non-clinical” requests of inpatients and their attending family members.
It is an on-line database management system designed to capture and track all non-medical request from in-patients.
It ensures that all such requests are completed within the agreed SLA/TAT as per the benchmarking standards for more than 8,000 requests.
Requests not closed in TAT will be escalated to HODs and the follow-ups are done by HODs and not nurses.
A database management system of all non-medical requests. This database can be used for improving process efficiencies, manpower planning, CAPEX.
Enhanced the patient experience
Provider
Baptist Health South Florida
Florida
Michael
DeCoske
Assistant Vice President, Ambulatory Pharmacy
(412) 953-4627
michaeldec@baptisthealth.net
Baptist Health South Florida (BHSF) had approximately 300,000 Urgent Care (UCC) visits in 2020. BHSF also has two newly built Freestanding Emergency Departments (FSED) that are able to treat patients with even more serious acute health issues. When a patient leaves the UCC and FSED, they are often prescribed a medication to treat their acute health problem. Experience and literature has shown that patients may leave the visit and fail to pick up some or all of their medications prescribed for various reasons including cost, no convenient pharmacy access or other logistic issues.
To help improve access, the state of Florida allows a physician dispense model where providers can dispense select medications directly in a clinic, allowing the patient to skip the pharmacy. However, depending on the set-up, this process can be very tedious, regulatory-intensive and manual. Prior to 2020, BHSF had employed this manual physician dispense model and found it to be a reasonably convenient for patients but very onerous on the front line staff and physicians who had to oversee a lot of paper work.
In 2020, Baptist Health South Florida UCC and FSED implemented “Baptist Health RX Now” powered by InstyMeds. InstyMeds is a technology vendor based in Minnesota. BHSF partnered with InstyMeds to install an automated “vending” style cabinet that ties in closely with the BHSF electronic medical record to help safely dispense medications at discharge in a regulatory compliant and convenient manner. This innovation ensures that patients leave their visit with newly prescribed medications in hand.
The machine contains approximately 40 different medications representing 60-70% of all medications commonly prescribed for patients at discharge from their appointment. The inventory was developed after a robust analysis of prescribing patterns. A high priority was given to stocking commonly prescribed antibiotics (at least 10 different options) to help patients start therapy quickly and avoid potential worsening of their Upper Respiratory Tract Infections, Urinary Tract Infections, Ear Infections, etc. In 2020, medications were charged at $5 or $10 per prescription, depending on the specific medication. This price point allowed most patients to pick-up medications without a significant financial burden. A charity care option was provided for those who qualified.
In 2020, we dispensed 133,417 prescriptions for 76,077 unique patient encounters. We had a 99.89% fill rate (meaning the medication was available in stock when ordered) with no significant medication errors noted. The Net Promoter Score based on feedback solicited from patients after their experience was 97, well above the industry standard.
We received many anecdotal patient expressions of appreciation. Expressions such as: “This was an absolutely awesome experience. The technology is amazing! User friendly, fast and accurate!”; “The machine was convenient, affordable and easy to use. It even provided wipes to clean the screen!”; “I loved having this option. I am traveling, so don’t have a regular pharmacy in the area, plus I was really not feeling well, so being able to leave the urgent care with the medicine was amazing! I wish all doctor offices had this!”.
Overall, we believe that this innovation was a huge success for our system. This innovation provided value in multiple of the categories being assessed for this program. We charged a discounted rate on the medications which helped reduce cost for our patients and the overall healthcare ecosystem. The ability to leave the visit with many prescriptions already in hand was a major improvement of the patient experience. Healthcare providers appreciate the automated solution to minimize the paperwork and to ensure their patients have convenient access to medication. In the coming year, the innovation will continue to be rolled out at our hospital emergency departments to further improve the patient experience across our entire health system acute care facilities.
Making this happen was a true interdisciplinary team across various areas of our health system. The team who was involved in this innovation included pharmacy leadership, pharmacy informatics, front line pharmacists, the UCC and FSED leadership and front line staff, and the prescribing physicians/providers. Other departments around our health system partnered to help our success including facilities, networking, supply chain and marketing.
To help improve access, the state of Florida allows a physician dispense model where providers can dispense select medications directly in a clinic, allowing the patient to skip the pharmacy. However, depending on the set-up, this process can be very tedious, regulatory-intensive and manual. Prior to 2020, BHSF had employed this manual physician dispense model and found it to be a reasonably convenient for patients but very onerous on the front line staff and physicians who had to oversee a lot of paper work.
In 2020, Baptist Health South Florida UCC and FSED implemented “Baptist Health RX Now” powered by InstyMeds. InstyMeds is a technology vendor based in Minnesota. BHSF partnered with InstyMeds to install an automated “vending” style cabinet that ties in closely with the BHSF electronic medical record to help safely dispense medications at discharge in a regulatory compliant and convenient manner. This innovation ensures that patients leave their visit with newly prescribed medications in hand.
The machine contains approximately 40 different medications representing 60-70% of all medications commonly prescribed for patients at discharge from their appointment. The inventory was developed after a robust analysis of prescribing patterns. A high priority was given to stocking commonly prescribed antibiotics (at least 10 different options) to help patients start therapy quickly and avoid potential worsening of their Upper Respiratory Tract Infections, Urinary Tract Infections, Ear Infections, etc. In 2020, medications were charged at $5 or $10 per prescription, depending on the specific medication. This price point allowed most patients to pick-up medications without a significant financial burden. A charity care option was provided for those who qualified.
In 2020, we dispensed 133,417 prescriptions for 76,077 unique patient encounters. We had a 99.89% fill rate (meaning the medication was available in stock when ordered) with no significant medication errors noted. The Net Promoter Score based on feedback solicited from patients after their experience was 97, well above the industry standard.
We received many anecdotal patient expressions of appreciation. Expressions such as: “This was an absolutely awesome experience. The technology is amazing! User friendly, fast and accurate!”; “The machine was convenient, affordable and easy to use. It even provided wipes to clean the screen!”; “I loved having this option. I am traveling, so don’t have a regular pharmacy in the area, plus I was really not feeling well, so being able to leave the urgent care with the medicine was amazing! I wish all doctor offices had this!”.
Overall, we believe that this innovation was a huge success for our system. This innovation provided value in multiple of the categories being assessed for this program. We charged a discounted rate on the medications which helped reduce cost for our patients and the overall healthcare ecosystem. The ability to leave the visit with many prescriptions already in hand was a major improvement of the patient experience. Healthcare providers appreciate the automated solution to minimize the paperwork and to ensure their patients have convenient access to medication. In the coming year, the innovation will continue to be rolled out at our hospital emergency departments to further improve the patient experience across our entire health system acute care facilities.
Making this happen was a true interdisciplinary team across various areas of our health system. The team who was involved in this innovation included pharmacy leadership, pharmacy informatics, front line pharmacists, the UCC and FSED leadership and front line staff, and the prescribing physicians/providers. Other departments around our health system partnered to help our success including facilities, networking, supply chain and marketing.
Enhanced the patient experience
Provider
Orlando Health
Florida
John
Wawrzaszek
Manager, Solutions Development, Information Technology/Innovation
321.841.3537
John.Wawrzaszek@orlandohealth.com
Orlando Health custom-developed VaxMaxx, a fully configurable, mobile-ready website to simultaneously manage multiple, distinct vaccination campaigns with the ability to target vaccinations to audiences of interest.
VaxMaxx is a solution to manage vaccinations, to include user consent, vaccine lot management, vaccine crew education and recording of vaccination administration, at multiple locations across the hospital network and at remote locations. VaxMaxx provides the capability to schedule appointments in a series and track a series of vaccinations (as necessitated by the COVID-19 pandemic). VaxMaxx also formats and electronically transmits the data collected to the Florida Department of Health in near real-time.
VaxMaxx supports multiple – and the unique requirements of each – vaccine manufacturers regarding the vaccination series (e.g., multiple doses and different minimum number of days between doses), which became the basis for scheduling rules. The site supports end-user scheduling, based on the manufacturer rules, for the vaccine series for both team members and community members at multiple locations across the healthcare network. VaxMaxx also includes the ability to activate scheduling Access Codes per facility, giving Orlando Health the option to offer vaccines to smaller, niche groups as vaccine supply and demand necessitated. At the time of vaccination, VaxMaxx records who received the vaccination, who administered the vaccination, at what location it was administered, and in what part of the body it was administered.
The VaxMaxx site is fully configurable by an administrator; no code changes (or development resources) are required to add/remove vaccination sites, add/remove vaccine manufacturers or vaccine lots, add/remove vaccine crew members, configure valid scheduling days, times, and number of vaccination stations, or enter/modify consent verbiage and qualifying questions.
The primary challenges faced by the Orlando Health vaccine task force can best be described as developing through ambiguity and compressing normal development timelines to deliver a fully functioning solution before the first COVID-19 vaccine was available – as there was no other viable solution at the time. The challenges were manifested in extremely fluid requirements and laws, executive orders, and logistics, that changed almost daily.
Requirements were often provided without lead time, and necessary details were unknown until late in the development process. VaxMaxx had to be flexible enough to accommodate any new variation in the operational flow, without affecting the experience of the thousands of users trying to access the system at any given time. In addition, this had to be accomplished in a finite amount of time as determined by the first COVID-19 vaccination availability.
Orlando Health addressed these challenges by using a standard n-tier architecture with a standardized, adaptable development pattern that enabled the code base to be modified quickly. Also, VaxMaxx was to be configurable by an administrator, allowing for virtually unlimited changes with no downtime for users. Furthermore, the Orlando Health team combined the robust design and development with automated unit testing, automated user interface testing and continuous integration and continuous delivery pipelines to ensure minimum disruption and continuous releases as needed to compress development cycles as much as possible.
The Orlando Health vaccine task force consisted of software engineers, pharmacists, physicians, hospital leadership and representatives from hospital operations. The results from this task force simply can be listed as the successful, on-time release of VaxMaxx. But the real value of the innovation is exemplified in what VaxMaxx made possible:
On day one, in December 2020, Orlando Health was able to vaccinate several thousand people and, in hour one alone, was able to vaccinate approximately 300 individuals. As of March 2021, Orlando Health had scheduled, tracked and administered more than 90,000 vaccinations. All data are flowing in near real-time to the Florida Department of Health with no manual intervention. The scheduling provided for shorter user wait times and increased user satisfaction. At any given time, Orlando Health knows the current state of the campaign and what to expect. This includes current capacity, pending schedules, and vaccination counts, reducing the possibility of waste. A pending result of Orlando Health’s innovation can be summarized as expanding the possibility for future patient experience improvement, as Orlando Health looks to release VaxMaxx as Open Source software, making it available to healthcare organizations worldwide.
At the time of this innovation, the alternative to this custom software solution would have included the following:
1. Manually scheduling dates and times for first and second vaccinations
2. Manually recording user demographics and vaccination administration
3. Manually uploading data to the Florida Department of Health
4. Manually tabulating totals of vaccine consumed
5. Manually compiling reports (vaccinations per day, per location, scheduled, etc.)
The maximum number of vaccinations that would have been possible without VaxMaxx is estimated to be less than 50 percent of the those administered.
VaxMaxx is a solution to manage vaccinations, to include user consent, vaccine lot management, vaccine crew education and recording of vaccination administration, at multiple locations across the hospital network and at remote locations. VaxMaxx provides the capability to schedule appointments in a series and track a series of vaccinations (as necessitated by the COVID-19 pandemic). VaxMaxx also formats and electronically transmits the data collected to the Florida Department of Health in near real-time.
VaxMaxx supports multiple – and the unique requirements of each – vaccine manufacturers regarding the vaccination series (e.g., multiple doses and different minimum number of days between doses), which became the basis for scheduling rules. The site supports end-user scheduling, based on the manufacturer rules, for the vaccine series for both team members and community members at multiple locations across the healthcare network. VaxMaxx also includes the ability to activate scheduling Access Codes per facility, giving Orlando Health the option to offer vaccines to smaller, niche groups as vaccine supply and demand necessitated. At the time of vaccination, VaxMaxx records who received the vaccination, who administered the vaccination, at what location it was administered, and in what part of the body it was administered.
The VaxMaxx site is fully configurable by an administrator; no code changes (or development resources) are required to add/remove vaccination sites, add/remove vaccine manufacturers or vaccine lots, add/remove vaccine crew members, configure valid scheduling days, times, and number of vaccination stations, or enter/modify consent verbiage and qualifying questions.
The primary challenges faced by the Orlando Health vaccine task force can best be described as developing through ambiguity and compressing normal development timelines to deliver a fully functioning solution before the first COVID-19 vaccine was available – as there was no other viable solution at the time. The challenges were manifested in extremely fluid requirements and laws, executive orders, and logistics, that changed almost daily.
Requirements were often provided without lead time, and necessary details were unknown until late in the development process. VaxMaxx had to be flexible enough to accommodate any new variation in the operational flow, without affecting the experience of the thousands of users trying to access the system at any given time. In addition, this had to be accomplished in a finite amount of time as determined by the first COVID-19 vaccination availability.
Orlando Health addressed these challenges by using a standard n-tier architecture with a standardized, adaptable development pattern that enabled the code base to be modified quickly. Also, VaxMaxx was to be configurable by an administrator, allowing for virtually unlimited changes with no downtime for users. Furthermore, the Orlando Health team combined the robust design and development with automated unit testing, automated user interface testing and continuous integration and continuous delivery pipelines to ensure minimum disruption and continuous releases as needed to compress development cycles as much as possible.
The Orlando Health vaccine task force consisted of software engineers, pharmacists, physicians, hospital leadership and representatives from hospital operations. The results from this task force simply can be listed as the successful, on-time release of VaxMaxx. But the real value of the innovation is exemplified in what VaxMaxx made possible:
On day one, in December 2020, Orlando Health was able to vaccinate several thousand people and, in hour one alone, was able to vaccinate approximately 300 individuals. As of March 2021, Orlando Health had scheduled, tracked and administered more than 90,000 vaccinations. All data are flowing in near real-time to the Florida Department of Health with no manual intervention. The scheduling provided for shorter user wait times and increased user satisfaction. At any given time, Orlando Health knows the current state of the campaign and what to expect. This includes current capacity, pending schedules, and vaccination counts, reducing the possibility of waste. A pending result of Orlando Health’s innovation can be summarized as expanding the possibility for future patient experience improvement, as Orlando Health looks to release VaxMaxx as Open Source software, making it available to healthcare organizations worldwide.
At the time of this innovation, the alternative to this custom software solution would have included the following:
1. Manually scheduling dates and times for first and second vaccinations
2. Manually recording user demographics and vaccination administration
3. Manually uploading data to the Florida Department of Health
4. Manually tabulating totals of vaccine consumed
5. Manually compiling reports (vaccinations per day, per location, scheduled, etc.)
The maximum number of vaccinations that would have been possible without VaxMaxx is estimated to be less than 50 percent of the those administered.
Enhanced the patient experience
Provider
Women’s Clinic of Johnson County
Kansas
Michele
Newbanks
EMR Specialist/Assistant Administrator
912-856-4260
mary@arpr.com
When the World Health Organization officially declared COVID-19 a pandemic, Women’s Clinic of Johnson County (WCJC), a Kansas-based division of Mid America Physician Services, took swift action to ensure the safety of its staff and patients during the periods of quarantines and shutdowns. WCJC is an OB-GYN practice specializing in pregnancy, well woman exams, family planning, and infertility, with one office in Merriam and one in Olathe.
Telehealth was quickly implemented as an alternative to in-office visits that did not require a physical exam (e.g., follow-up visits, reviewing lab and test results, and discussing imaging results). In addition, the clinic utilized Greenway Health’s patient messaging and patient portal solutions to communicate important updates, COVID-19 procedures, and more to its patient population.
But as the pandemic continued well into 2020, WCJC also realized the impact that the public health emergency was having on its staff — particularly working mothers. These feelings of burnout were not unlike those experienced across the nation, with the U.S. averages showing that nearly two-thirds (64%) of physicians said the pandemic has intensified their sense of burnout.
In Kansas, as the fall school season approached, school districts in the area announced plans for virtual-only options. This left many WCJC parents scrambling to figure out how they would be able to continue working while also supporting their school-aged children and ensuring their education stayed intact.
To provide an alternative option for employees, many staff members at the clinic came together and created the WCJC Academic Support Academy.
Amanda Healy, MD, and CEO of WCJC; Colette Belcher, Administrator; and Michele Newbanks, EMR Specialist/Administrative Assistant came up with an idea to turn one of its less trafficked office pods into a virtual school for the children of its staff — provided at no cost to families. First, the team had to research and familiarize itself with the rules and regulations around creating such a temporary-type daycare/school environment, which led to the clinic obtaining its Alternative Care Facility Certification. Initial planning sessions occurred on Sunday evenings with Dr. Healy, Colette, Michele and other staff, outside of their normal work duties and hours. Then team then began transforming the patient care rooms into classrooms, adding desks, computers, whiteboards, and even taking “first day of school” photos to provide the children with a sense of normalcy during such an uncertain time.
The 25 children in the academy ranged from kindergarten through sixth grade and represented seven different school districts. The amount of coordination involved was no small feat: each student had different online learning sessions that commenced at different times, on different platforms and devices, in addition to coordinating meals and snacks. Two full-time tutors were hired, in addition to each parent/staff member working a 30-minute shift within the classroom environment — time for which they were still compensated as working in the practice.
The impacts of the academy were monumental. In fact, without it, the clinic estimates that at least 50% of its staff would not have been able to work during the fall school season due to lack of childcare options. A total of 18 employees used the academy for their children, 9 employees of whom were medical assistants. Since the practice only has 12 total medical assistants, the school legitimately enabled three-fourths of their medical assistants to be able to continue coming to work and serving patients. Considering the practice served an average of 228 patients a day during the period of time that coincided with the fall semester (September through December), the academy enabled the practice to serve their full volume of patients, as opposed to serving only one-half or even one-fourth of patients which a workforce deficit might have caused.
Simultaneously, while the staff was supported, there was also a direct impact on patient care. Industry studies show that four in five OB-GYNs reported that their practice experienced at least one financial or staffing challenge as a result of the COVID-19 pandemic. The most commonly cited experiences were reducing operating hours and clinician pay, as well as furloughing or laying off non-clinical staff. WCJC, however, ended the year with a higher volume of patients as compared to 2019, and was able to avoid any furloughs or layoffs.
Reflecting back on the WCJC Academic Success Academy, Dr. Healy noted, “From the start of COVID-19, our main priority was to ensure that we cared for both our patients and staff. In such times of uncertainty, we aim to provide clarity and reduce stress for our community at large. Knowing that not all of our staff had the luxury to hire private child care, if they had been lucky enough to even find it — nor did many have family close by to provide care — we knew that we needed an alternative solution. By developing WCJC Academic Success Academy, we were able to support our staff and prioritize their wellbeing, while also keeping our practice’s schedule full, maintaining business continuity.”
“My experience with the tutor at WCJC was extremely helpful in the time of need for my kids and myself,” said Grace V., a WCJC staff member and beneficiary of the WJCC Academic Support Academy. “If it wasn't for the help the providers gave us, I would have lost my job, or I might have been obligated to quit. There was not another way to have a full-time job and help my kids with their second and sixth grade classes at the same time. WCJC eliminated the stress and uncertainty for us about how our children would attend school and get the personal attention they deserved, while I was able to keep our caseload going and prioritize our patients’ care. I want to thank WCJC for all their help, going above and beyond to help their employees.”
Amid the challenges of the pandemic, the OB-GYN clinic found an innovative way to lighten the load of its staff, removing the burden of finding childcare in a difficult time. WCJC remains committed to helping patients achieve optimal health and wellness, while ensuring the safety and well-being of its staff.
Telehealth was quickly implemented as an alternative to in-office visits that did not require a physical exam (e.g., follow-up visits, reviewing lab and test results, and discussing imaging results). In addition, the clinic utilized Greenway Health’s patient messaging and patient portal solutions to communicate important updates, COVID-19 procedures, and more to its patient population.
But as the pandemic continued well into 2020, WCJC also realized the impact that the public health emergency was having on its staff — particularly working mothers. These feelings of burnout were not unlike those experienced across the nation, with the U.S. averages showing that nearly two-thirds (64%) of physicians said the pandemic has intensified their sense of burnout.
In Kansas, as the fall school season approached, school districts in the area announced plans for virtual-only options. This left many WCJC parents scrambling to figure out how they would be able to continue working while also supporting their school-aged children and ensuring their education stayed intact.
To provide an alternative option for employees, many staff members at the clinic came together and created the WCJC Academic Support Academy.
Amanda Healy, MD, and CEO of WCJC; Colette Belcher, Administrator; and Michele Newbanks, EMR Specialist/Administrative Assistant came up with an idea to turn one of its less trafficked office pods into a virtual school for the children of its staff — provided at no cost to families. First, the team had to research and familiarize itself with the rules and regulations around creating such a temporary-type daycare/school environment, which led to the clinic obtaining its Alternative Care Facility Certification. Initial planning sessions occurred on Sunday evenings with Dr. Healy, Colette, Michele and other staff, outside of their normal work duties and hours. Then team then began transforming the patient care rooms into classrooms, adding desks, computers, whiteboards, and even taking “first day of school” photos to provide the children with a sense of normalcy during such an uncertain time.
The 25 children in the academy ranged from kindergarten through sixth grade and represented seven different school districts. The amount of coordination involved was no small feat: each student had different online learning sessions that commenced at different times, on different platforms and devices, in addition to coordinating meals and snacks. Two full-time tutors were hired, in addition to each parent/staff member working a 30-minute shift within the classroom environment — time for which they were still compensated as working in the practice.
The impacts of the academy were monumental. In fact, without it, the clinic estimates that at least 50% of its staff would not have been able to work during the fall school season due to lack of childcare options. A total of 18 employees used the academy for their children, 9 employees of whom were medical assistants. Since the practice only has 12 total medical assistants, the school legitimately enabled three-fourths of their medical assistants to be able to continue coming to work and serving patients. Considering the practice served an average of 228 patients a day during the period of time that coincided with the fall semester (September through December), the academy enabled the practice to serve their full volume of patients, as opposed to serving only one-half or even one-fourth of patients which a workforce deficit might have caused.
Simultaneously, while the staff was supported, there was also a direct impact on patient care. Industry studies show that four in five OB-GYNs reported that their practice experienced at least one financial or staffing challenge as a result of the COVID-19 pandemic. The most commonly cited experiences were reducing operating hours and clinician pay, as well as furloughing or laying off non-clinical staff. WCJC, however, ended the year with a higher volume of patients as compared to 2019, and was able to avoid any furloughs or layoffs.
Reflecting back on the WCJC Academic Success Academy, Dr. Healy noted, “From the start of COVID-19, our main priority was to ensure that we cared for both our patients and staff. In such times of uncertainty, we aim to provide clarity and reduce stress for our community at large. Knowing that not all of our staff had the luxury to hire private child care, if they had been lucky enough to even find it — nor did many have family close by to provide care — we knew that we needed an alternative solution. By developing WCJC Academic Success Academy, we were able to support our staff and prioritize their wellbeing, while also keeping our practice’s schedule full, maintaining business continuity.”
“My experience with the tutor at WCJC was extremely helpful in the time of need for my kids and myself,” said Grace V., a WCJC staff member and beneficiary of the WJCC Academic Support Academy. “If it wasn't for the help the providers gave us, I would have lost my job, or I might have been obligated to quit. There was not another way to have a full-time job and help my kids with their second and sixth grade classes at the same time. WCJC eliminated the stress and uncertainty for us about how our children would attend school and get the personal attention they deserved, while I was able to keep our caseload going and prioritize our patients’ care. I want to thank WCJC for all their help, going above and beyond to help their employees.”
Amid the challenges of the pandemic, the OB-GYN clinic found an innovative way to lighten the load of its staff, removing the burden of finding childcare in a difficult time. WCJC remains committed to helping patients achieve optimal health and wellness, while ensuring the safety and well-being of its staff.
Improved the life of healthcare providers
Provider
Torrance Memorial Medical Center
California
Todd
Felker
Information Security Officer
310-325-9110
todd.felker@tmmc.com
Beginning in 2019, a cross-functional team at Torrance Memorial Medical Center that included security staff and biomed professionals realized the need to overhaul their outdated asset management and cyber security processes. The catalysts for change included awareness by senior leadership of the potentially devastating consequences of a cyber-attack and notably, knowledge by front-line staff that the right complement of improvements to Torrance’s existing “risk reduction workflows” would deliver significant enterprise business value. Given what Torrance described as “poor visibility” into existing connected assets, everyone understood that meaningful improvements, as promised by evaluated solution vendors, would be a game-changer, provided the underlying data were sufficiently detailed/actionable and asset coverage was comprehensive. Torrance’s team, led by Information Security Officer Todd Felker, conducted a thorough evaluation and selected its vendor partner Medigate for implementation within the Torrance system. Mr. Felker’s team worked closely with Medigate to ensure Torrance achieved the visibility promised (all connected assets). As part of that process, several outdated, manual routines were eliminated and the common data foundation provided by Medigate (i.e. a “real time” digital inventory that replaced physical processes) was quickly adopted to enhance and standardize the already converging workflows of biomed and security staffers. For example, known device vulnerabilities were instantly correlated to Torrance’s existing asset base and remediation work commenced immediately, providing project leadership a definitive way to quickly report meaningful progress to senior leadership.
Medigate was selected as it outperformed evaluated competitors, but a key tipping point in Torrance’s decision is notable. Unlike most competitive solution providers who sell across industry, Medigate is solely dedicated to healthcare --and that difference was obvious to Torrance. Medigate’s focus on medical device classes, also known as the Internet of Medical Things (IoMT), was competitively differentiated, as its cross-industry rivals placed more priority on what they know best, namely non-medical IoT. Furthermore, Medigate’s asset discovery and profiling techniques employ a deterministic methodology, where by comparison, its rivals rely on statistical approaches marketed as “Artificial Intelligence.” Medigate’s position is uniquely contrary in this respect, as while the company believes that “AI'' is powerful, it is not a good application for medical device identification and profiling (not in healthcare/not where patient safety is a concern). Torrance agreed. Case in point, following the implementation of Medigate in 2019, Medigate was able to identify, profile and locate 19% more connected medical devices than were estimated and 26% more non-medical IoT assets. In addition, Torrance was able to quickly conduct a comprehensive risk assessment because Medigate instantly correlates known and newly published vulnerabilities/threats to the potentially impacted assets in the client’s environment. Finally, although the term “actionable data” is often overused, Medigate’s profiling capabilities include more than 60 general and unique identifiers per device. Beyond make, model, MAC and IP addresses, Medigate provides serial number, location, status, security posture, device operating requirements, firmware-level-details and configuration-specifics such as OS and application versions. These insights proved especially timely to Torrance as the threat of Urgent/11 became known during the implementation phase. Urgent/11 preys on real time operating systems that use IPnet TCP/IP stack, so the data granularity provided by Medigate made correlations to Torrance’s environment instantaneous. As a result, yet another high profile “win” was promoted to management as Medigate saved the Torrance team weeks of estimated manual labor to assess potentially impacted devices.
The deep visibility into device status (offline/connected/in-use), location and utilization provided by Medigate delivers many practical benefits. In addition to obvious decision-making agility, including the health system’s ability to shorten asset restaging and more precisely re-allocate, Torrance’s new found “visibility comfort” had timely ramifications. Although the demand surge associated with the COVID-19 pandemic never manifested to the extreme it might have, Torrance understood that its Medigate investment had broadly positioned it to manage come-what-may. Importantly, because Torrance achieved total command of its assets, it was able to work tirelessly to shore up its monitoring and defense capabilities, knowing that bad acting cyber criminals were going to take advantage during the pandemic. Leveraging specific, additional insights provided by Medigate into non-authorized device communications, Torrance was able to dramatically improve its networking security posture enterprise-wide.
Medigate was selected as it outperformed evaluated competitors, but a key tipping point in Torrance’s decision is notable. Unlike most competitive solution providers who sell across industry, Medigate is solely dedicated to healthcare --and that difference was obvious to Torrance. Medigate’s focus on medical device classes, also known as the Internet of Medical Things (IoMT), was competitively differentiated, as its cross-industry rivals placed more priority on what they know best, namely non-medical IoT. Furthermore, Medigate’s asset discovery and profiling techniques employ a deterministic methodology, where by comparison, its rivals rely on statistical approaches marketed as “Artificial Intelligence.” Medigate’s position is uniquely contrary in this respect, as while the company believes that “AI'' is powerful, it is not a good application for medical device identification and profiling (not in healthcare/not where patient safety is a concern). Torrance agreed. Case in point, following the implementation of Medigate in 2019, Medigate was able to identify, profile and locate 19% more connected medical devices than were estimated and 26% more non-medical IoT assets. In addition, Torrance was able to quickly conduct a comprehensive risk assessment because Medigate instantly correlates known and newly published vulnerabilities/threats to the potentially impacted assets in the client’s environment. Finally, although the term “actionable data” is often overused, Medigate’s profiling capabilities include more than 60 general and unique identifiers per device. Beyond make, model, MAC and IP addresses, Medigate provides serial number, location, status, security posture, device operating requirements, firmware-level-details and configuration-specifics such as OS and application versions. These insights proved especially timely to Torrance as the threat of Urgent/11 became known during the implementation phase. Urgent/11 preys on real time operating systems that use IPnet TCP/IP stack, so the data granularity provided by Medigate made correlations to Torrance’s environment instantaneous. As a result, yet another high profile “win” was promoted to management as Medigate saved the Torrance team weeks of estimated manual labor to assess potentially impacted devices.
The deep visibility into device status (offline/connected/in-use), location and utilization provided by Medigate delivers many practical benefits. In addition to obvious decision-making agility, including the health system’s ability to shorten asset restaging and more precisely re-allocate, Torrance’s new found “visibility comfort” had timely ramifications. Although the demand surge associated with the COVID-19 pandemic never manifested to the extreme it might have, Torrance understood that its Medigate investment had broadly positioned it to manage come-what-may. Importantly, because Torrance achieved total command of its assets, it was able to work tirelessly to shore up its monitoring and defense capabilities, knowing that bad acting cyber criminals were going to take advantage during the pandemic. Leveraging specific, additional insights provided by Medigate into non-authorized device communications, Torrance was able to dramatically improve its networking security posture enterprise-wide.
Improved the life of healthcare providers
Provider
American Health Partners - TruHealth Division
Tennessee
Kami
Carlson
Director of Population Management - TruHealth
615-905-5461 or Mobile: 602-391-6123
kcarlson@OurTruHealth.com
TruHealth, a division of American Health Partners, provides a continuum of care that empowers people to obtain high-quality care healthcare with convenient access that helps them avoid expensive hospital stays, leads to measurably better outcomes and improves their quality of life. Achieving these results in our sickest elderly nursing home residents is one of the country’s greatest healthcare challenges.
American Health Partners, with seven divisions united around a single mission, has developed a care management model to partner with providers in diverse healthcare settings to expand care capabilities and coordination. The leadership of American Health Partners and its TruHealth division has created an innovative model of care that is redefining the way care is managed for patients who call long-term care facilities home.
To meet the needs of older nursing home patients, improve patient outcomes, and cut healthcare spending, TruHealth’s trains clinicians to develop proactive, individualized care plans to address the medical, mental health and social needs of patients in nursing homes and other communal residential facilities. This is a significant departure from the kind of custodial care these residents often receive. TruHealth practitioners collaborate with nursing home administrators, physicians and other caregivers to provide holistic care to the sickest and often most elderly long-stay nursing home residents; those who traditionally have been more likely to receive poorer care. TruHealth providers are also assigned to oversee the quality of care of older adults who must be transferred between care settings,
TruHealth’s innovative approach is intensely focused on the needs of the resident-patient in this model of care. TruHealth’s nurse practitioners and physician assistants expand access to care at the bedside, which results in more proactive care and reduced hospitalizations.
Working in the long-term care facility, TruHealth providers assess medical and psychiatric needs; develop and manage comprehensive treatment plans; diagnose and treat acute medical or psychiatric conditions; prescribe and adjust medications; collaborate with therapists and caregivers to ensure quality care; provide on-call coverage to deal with urgent medical needs, often without hospitalization; educate caregivers on best practices; and monitor patient outcomes.
In addition to their work within long-term care facilities, TruHealth providers utilize telemedicine technologies to make it easier to provide diagnostic and preventive services to residents onsite. Two-way video conferencing and live analytics provide for real-time medical consultations. This allows for a more thorough assessment with current diagnostics to create more accurate plans of care.
American Health Plans, another division of American Health Partners, works with nursing home operators to enhance patient care and incorporate TruHealth with institutional special needs plans, or I-SNPs. These plans improve the quality of life for patient-residents and helps them avoid unnecessary hospitalizations while reducing exposure to hospital-acquired illnesses, extensive wait times in emergency rooms and stressful ambulance rides.
Each year, approximately 25% of all long-stay and post-acute residents in nursing homes are hospitalized. CMS estimates as many as two-thirds of these hospitalizations are considered potentially avoidable. In 2020, American Health Plans collectively managed hospitalization rates at approximately 3.5%.
American Health Partners, which also operates 29 long-term care facilities through its division American Health Communities, has harnessed its divisions and leadership to develop an innovative model of care that works. Together, they’re forging committed partnerships with like-minded long-term care facility owners who are ready to invest at the bedside. The result is improved healthcare to improve the lives of a special population of long-stay resident-patients while lowering overall healthcare costs.
American Health Partners, with seven divisions united around a single mission, has developed a care management model to partner with providers in diverse healthcare settings to expand care capabilities and coordination. The leadership of American Health Partners and its TruHealth division has created an innovative model of care that is redefining the way care is managed for patients who call long-term care facilities home.
To meet the needs of older nursing home patients, improve patient outcomes, and cut healthcare spending, TruHealth’s trains clinicians to develop proactive, individualized care plans to address the medical, mental health and social needs of patients in nursing homes and other communal residential facilities. This is a significant departure from the kind of custodial care these residents often receive. TruHealth practitioners collaborate with nursing home administrators, physicians and other caregivers to provide holistic care to the sickest and often most elderly long-stay nursing home residents; those who traditionally have been more likely to receive poorer care. TruHealth providers are also assigned to oversee the quality of care of older adults who must be transferred between care settings,
TruHealth’s innovative approach is intensely focused on the needs of the resident-patient in this model of care. TruHealth’s nurse practitioners and physician assistants expand access to care at the bedside, which results in more proactive care and reduced hospitalizations.
Working in the long-term care facility, TruHealth providers assess medical and psychiatric needs; develop and manage comprehensive treatment plans; diagnose and treat acute medical or psychiatric conditions; prescribe and adjust medications; collaborate with therapists and caregivers to ensure quality care; provide on-call coverage to deal with urgent medical needs, often without hospitalization; educate caregivers on best practices; and monitor patient outcomes.
In addition to their work within long-term care facilities, TruHealth providers utilize telemedicine technologies to make it easier to provide diagnostic and preventive services to residents onsite. Two-way video conferencing and live analytics provide for real-time medical consultations. This allows for a more thorough assessment with current diagnostics to create more accurate plans of care.
American Health Plans, another division of American Health Partners, works with nursing home operators to enhance patient care and incorporate TruHealth with institutional special needs plans, or I-SNPs. These plans improve the quality of life for patient-residents and helps them avoid unnecessary hospitalizations while reducing exposure to hospital-acquired illnesses, extensive wait times in emergency rooms and stressful ambulance rides.
Each year, approximately 25% of all long-stay and post-acute residents in nursing homes are hospitalized. CMS estimates as many as two-thirds of these hospitalizations are considered potentially avoidable. In 2020, American Health Plans collectively managed hospitalization rates at approximately 3.5%.
American Health Partners, which also operates 29 long-term care facilities through its division American Health Communities, has harnessed its divisions and leadership to develop an innovative model of care that works. Together, they’re forging committed partnerships with like-minded long-term care facility owners who are ready to invest at the bedside. The result is improved healthcare to improve the lives of a special population of long-stay resident-patients while lowering overall healthcare costs.
Improved the care of patient populations
Provider
The Harris Center for Mental Health and IDD
Texas
Wayne
Young
CEO
7139707160
wayne.young@theharriscenter.org
Officers routinely respond to mental health calls with very limited expertise. Frequently there are negative outcomes associated with these interactions. As a result, a partnership between the Harris County Sheriff Office and The Harris Center for Mental Health and IDD was implemented to improve response to calls involving a person with mental illness. The Clinician Officer Remote Evaluation (CORE) program connects a law enforcement 1st responder with a mental health crisis clinician using a tablet and HIPAA-compliant technology. As result of the external evaluation of the 1 year pilot, we received $1M in funding and have distributed 200 tablets throughout HCSO first responders. The City of Houston POlice Department announced last week that they would be expanding this model to their department in partnership with The Harris Center.
Our goals were to:
- Increase public safety;
- Improve triage of mental health crisis calls in the field;
- Fill gaps of limited mental health workforce; and
- Prevent unnecessary transports to the Harris County Jail, treatment facilities, and hospital emergency rooms.
The University of Houston Downtown completed an external evaluation following a 1 year pilot project. In this evaluation we had the following direct impacts:
- 42% were resolved on scene with the patient remaining in the community
- 58% resulted in transportation to hospitals
- <2% person was transported to jail/juvenile detention
We had the following outcomes as reported by law enforcement partners via our external evaluation:
- 88% would you have called specialty response team if they did not have a tablet
- 78% would you have transported the consumer to the NPC/hospital/ER if they did not have the assistance of the clinician,
- 86% reported the clinician helped the officer de-escalate the consumer
- 89% indicated the clinician helped identify/access resources you would not otherwise have identified/accessed
- 93% indicated the clinician helped them decide what course of action to take with the consumer
- 88% reported the clinician helped them handle the call in a shorter period-of-time than if you responded without the clinician
The Harris Center for Mental Health and IDD is the public, safety-net mental health system for Harris County which is the 3rd largest county in the United States. This project was given an 202 Achievement Award from National Association of Counties (NACO) and the 2021 Excellence Award in Innovation at Work from the National Council on Behavioral Health.
Our goals were to:
- Increase public safety;
- Improve triage of mental health crisis calls in the field;
- Fill gaps of limited mental health workforce; and
- Prevent unnecessary transports to the Harris County Jail, treatment facilities, and hospital emergency rooms.
The University of Houston Downtown completed an external evaluation following a 1 year pilot project. In this evaluation we had the following direct impacts:
- 42% were resolved on scene with the patient remaining in the community
- 58% resulted in transportation to hospitals
- <2% person was transported to jail/juvenile detention
We had the following outcomes as reported by law enforcement partners via our external evaluation:
- 88% would you have called specialty response team if they did not have a tablet
- 78% would you have transported the consumer to the NPC/hospital/ER if they did not have the assistance of the clinician,
- 86% reported the clinician helped the officer de-escalate the consumer
- 89% indicated the clinician helped identify/access resources you would not otherwise have identified/accessed
- 93% indicated the clinician helped them decide what course of action to take with the consumer
- 88% reported the clinician helped them handle the call in a shorter period-of-time than if you responded without the clinician
The Harris Center for Mental Health and IDD is the public, safety-net mental health system for Harris County which is the 3rd largest county in the United States. This project was given an 202 Achievement Award from National Association of Counties (NACO) and the 2021 Excellence Award in Innovation at Work from the National Council on Behavioral Health.
Improved the care of patient populations
Provider
My Community Health Inc.
Outside the United States
Derek
Garniss
Physician, Medical Director Emergency Medicine, CMIO
7059896570
derek.garniss@shaw.ca
WHAT the challenge you were looking to solve was:
In Canada, the COVID-19 pandemic is still raging in certain provinces throughout the country and, overall, the nation lags
behind in vaccine distribution. The challenge is to improve the health and safety of communities in the screening and
contact tracing processes. There are many pieces in the management of the pandemic that organizations and individuals
need, including paper questionnaires, contact tracing forms, test results, and vaccination records. My Community Health
recognized the need to create a digital tool that helps manage and store all of these fragmented pieces of information.
This innovation is a crucial and important tool for Canada to help combat the pandemic and bring life back to a sense of
normalcy.
WHO was involved in the innovation:
The app, called CommunityPass, is the result of planning by Dr. Lucas Castellani, Sault Area Hospital (SAH) medical
director of infection prevention and control; Dr. Derek Garniss, Medical Director Emergency Medicine and CMIO at SAH;
Dr. Stephen Smith, Emergency physician at SAH; Dr. Matthew Solomon, Emergency physician at SAH; and Wendy Doda,
a local research coordinator. This group of individuals is collectively known in a business sense as My Community Health
Inc.
WHAT the innovation entailed:
Accelerated by the pandemic, a team of expert physicians and researchers looked to create a secure, electronic,
cross platform application (iOS, Android, Web) that would help improve access to patient health records. After
forming My Community Health Inc., the team developed a single go-to application, with one login, to address the
needs of organizations, healthcare providers, public health, and individual members of a community. The
organization then approached a local developer, Digital Grounds, Inc. to make the app a reality.
Designed to be a one-stop platform, CommunityPass was carefully designed to align with public health and safety
needs, as well as expectations around ease of use and the privacy and security of health records.
● Timestamps for when individuals check in to locations. This will assist local public health in contact tracing and
adds another layer of safety for each individual.
● Individuals are directly notified by local public health through push notifications if they have been exposed to
COVID-19.
● An integrated VaccinePass allows for the secure and convenient storage and retrieval of vaccination records.
● At no time does the app collect any real-time personal tracking or location information. The only information
recorded is the name of the organization that the individual selects when they check in, along with the date and
time of the occurrence.
● All data is securely recorded in a Canadian data center that complies with bank level security and encryption.
Local public health and Organization’s Health and Safety have access to the data only when contact tracing.
HOW it generated results.
CommunityPass is a new digital tool that is free to download from the Apple Store and Google Play Store. The app is
being deployed to several pilots in the community and some small and large organizations. Currently, a large number of
individuals are storing their vaccination records on it as well. The use of the app will result in improving public safety,
privacy, and the creation of digital COVID-19 health records in the following ways:
● By downloading CommunityPass individuals will be directly notified by local public health through push
notifications if they have been exposed to COVID-19. They will also receive push notifications when there is a
health and safety update. By using this app individuals are contributing to their community’s safety.
● Public Health Departments can easily send push notifications to businesses or personal users if they had a
high-risk close contact exposure to COVID-19.
● Individuals using the app will no longer need to physically sign in when entering businesses. Check-in will be
automatic as they enter the premises via the integrated beacon technology. They will also have peace of mind
knowing their personal data is not left with any specific organization and that it remains encrypted. Information is
available to public health departments if individuals need to be contacted for tracing of positive COVID-19
exposures.
● Organizations can digitally fulfill their provincial obligation to screen all entries to their places of business, whether
employees, clients or visitors.
● Individuals can set their personal homes as geolocations to screen visitors and facilitate contact tracing if needed.
● Participating venues using beacon technology within their communities may enable more people to return to
day-to-day activities.
How would you best categorize the value of this innovation?
● Enhanced the patient experience
● Improved the care of patient populations
● Improved the life of healthcare providers
In Canada, the COVID-19 pandemic is still raging in certain provinces throughout the country and, overall, the nation lags
behind in vaccine distribution. The challenge is to improve the health and safety of communities in the screening and
contact tracing processes. There are many pieces in the management of the pandemic that organizations and individuals
need, including paper questionnaires, contact tracing forms, test results, and vaccination records. My Community Health
recognized the need to create a digital tool that helps manage and store all of these fragmented pieces of information.
This innovation is a crucial and important tool for Canada to help combat the pandemic and bring life back to a sense of
normalcy.
WHO was involved in the innovation:
The app, called CommunityPass, is the result of planning by Dr. Lucas Castellani, Sault Area Hospital (SAH) medical
director of infection prevention and control; Dr. Derek Garniss, Medical Director Emergency Medicine and CMIO at SAH;
Dr. Stephen Smith, Emergency physician at SAH; Dr. Matthew Solomon, Emergency physician at SAH; and Wendy Doda,
a local research coordinator. This group of individuals is collectively known in a business sense as My Community Health
Inc.
WHAT the innovation entailed:
Accelerated by the pandemic, a team of expert physicians and researchers looked to create a secure, electronic,
cross platform application (iOS, Android, Web) that would help improve access to patient health records. After
forming My Community Health Inc., the team developed a single go-to application, with one login, to address the
needs of organizations, healthcare providers, public health, and individual members of a community. The
organization then approached a local developer, Digital Grounds, Inc. to make the app a reality.
Designed to be a one-stop platform, CommunityPass was carefully designed to align with public health and safety
needs, as well as expectations around ease of use and the privacy and security of health records.
● Timestamps for when individuals check in to locations. This will assist local public health in contact tracing and
adds another layer of safety for each individual.
● Individuals are directly notified by local public health through push notifications if they have been exposed to
COVID-19.
● An integrated VaccinePass allows for the secure and convenient storage and retrieval of vaccination records.
● At no time does the app collect any real-time personal tracking or location information. The only information
recorded is the name of the organization that the individual selects when they check in, along with the date and
time of the occurrence.
● All data is securely recorded in a Canadian data center that complies with bank level security and encryption.
Local public health and Organization’s Health and Safety have access to the data only when contact tracing.
HOW it generated results.
CommunityPass is a new digital tool that is free to download from the Apple Store and Google Play Store. The app is
being deployed to several pilots in the community and some small and large organizations. Currently, a large number of
individuals are storing their vaccination records on it as well. The use of the app will result in improving public safety,
privacy, and the creation of digital COVID-19 health records in the following ways:
● By downloading CommunityPass individuals will be directly notified by local public health through push
notifications if they have been exposed to COVID-19. They will also receive push notifications when there is a
health and safety update. By using this app individuals are contributing to their community’s safety.
● Public Health Departments can easily send push notifications to businesses or personal users if they had a
high-risk close contact exposure to COVID-19.
● Individuals using the app will no longer need to physically sign in when entering businesses. Check-in will be
automatic as they enter the premises via the integrated beacon technology. They will also have peace of mind
knowing their personal data is not left with any specific organization and that it remains encrypted. Information is
available to public health departments if individuals need to be contacted for tracing of positive COVID-19
exposures.
● Organizations can digitally fulfill their provincial obligation to screen all entries to their places of business, whether
employees, clients or visitors.
● Individuals can set their personal homes as geolocations to screen visitors and facilitate contact tracing if needed.
● Participating venues using beacon technology within their communities may enable more people to return to
day-to-day activities.
How would you best categorize the value of this innovation?
● Enhanced the patient experience
● Improved the care of patient populations
● Improved the life of healthcare providers
Enhanced the patient experience
Provider
Memorial Healthcare System
Florida
Monica
Puga
Vice President, Population Health
9542765334
mpuga@mhs.net
Memorial Healthcare System (MHS) has always strived to be a destination for technological advancements and in response to the public health emergency, the IT team from our Digital Innovation Office wasted no time in providing the vital infrastructure necessary for a comprehensive and effective pandemic response.
Our innovative contributions began in March 2020 operationalizing Memorial’s COVID testing site at CB Smith Park – which was cited as a “gold standard” model for use by the rest of the state and country. Florida’s Governor Ron DeSantis acknowledged Memorial as a model for a community COVID testing site.
Memorial was the first hospital system in Florida to open a COVID-19 drive-thru, community-based testing site in a park. There was no model to follow and staff had only two days to make it operational. MHS partnered with state and local agencies to create the site, but it was MHS’s leadership that transformed the testing site into an example of patient safety and quality that became the standard for other testing sites in the U.S.
Obtaining results in a timely fashion and creating a safe, effective process was of utmost importance. Staff quickly faced multiple challenges and developed innovative approaches to ensure quality patient testing and follow-up care was provided. These protocols helped contain the spread of the virus, decompress local EDs/Urgent Care Centers, and ensured COVID-19 suspected patients received quality care, isolation education and information on how to care for themselves while they awaited their results.
The site delivered improved access to testing, faster results, follow-up care, and education for the community. As of August 31, 2020, the site completed more than 100,000 tests and has become one of the most sophisticated and productive testing centers in the nation. The community-testing model was so successful that it has already been replicated at other testing sites around the nation. Our education tool – a one-page COVID-19 Self-Management Plan – and a book of standard operating procedures created by MHS are also being used at other testing sites throughout the country. We have become a best practice model for patient safety, quality and efficiency in COVID-19 testing.
The Memorial Healthcare System Community Based Test Site was a multi-agency effort that included support from: Broward County Parks and Recreation, Florida Department of Transportation, Florida Division of Emergency Management, Florida Department of Health, Florida Highway Patrol, Florida National Guard, Memorial Healthcare System, Pembroke Pine Police Department and Quest Diagnostics.
1. WHAT was the challenge?
In March 2020, South Florida emerged as a COVID-19 “hot spot.” Broward County, which includes the greater Fort Lauderdale area, led the state in cases and neighboring Miami-Dade County followed closely behind. Local residents converged on local emergency departments (EDs) seeking information, testing and treatment. This led to crowded waiting areas (which could be unsafe due to the contagious nature of the virus) and long waiting times. This caused delays for persons seeking care for life-threatening illnesses and injuries, and burdened local medical facilities.
The Governor activated Florida’s National Guard to assist Memorial in establishing the COVID-19 drive-thru, community-based testing site. The goal was to reduce the spread of the virus by decompressing medical facilities and providing immediate access to critical testing in a safe environment, while also providing education and connecting people to needed treatment during the pandemic.
Staff had only two days to open the center, and since the site was one of the first, there was no model to follow. Memorial rapidly partnered with other local agencies to develop a site plan for the park.
Memorial’s clinical and technical teams quickly developed testing protocols that incorporated quality, infection control and safety measures, along with processes for patients to obtain test results in a timely manner. Donned in the latest personal protective equipment, staff provided nasopharyngeal swab testing through car windows, which allowed patients to remain in the safety of their vehicle. The staff also provided important quarantine and self-care information.
Memorial then drew upon the expertise of its own pediatric facility, Joe DiMaggio Children’s Hospital, to add a child-friendly testing location within the park. Filled with colorful decorations, music and Child Life Specialists to help put children at ease, this pediatric site was one of the first in the state and became a model for others.
The most critical part of testing for COVID is notifying the patient of their test results and helping them with their next steps. For patients that received COVID testing (while in one of our emergency departments, urgent care centers or at our community testing site), we needed to follow up with the patients as soon as possible with their results. Though testing at many sites across the country took hours, at Memorial our COVID testing of patients was completed in under 30 minutes. In addition, our direct integration with Quest Laboratories added to our ability to quickly report results to patients and care givers.
2. WHO was involved in the innovation?
Memorial’s Population Health and Digital Innovation teams: IT – BI Development and Analytics, IT - Ambulatory, IT – Communications, Cisco, Broward County Parks and Recreation, Florida Department of Transportation, Florida Division of Emergency Management, Florida Department of Health, Florida Highway Patrol, Florida National Guard, Pembroke Pine Police Department and Quest Diagnostics.
3. WHAT the innovation entailed
Though we felt it critical to contact each patient as soon as their COVID testing results were received from the lab so that we could advise them of their result, we also felt it necessary to help them understand what symptoms to look for and what to do if their condition worsens or improves while waiting for their results - we provided guidance to all patients in the form of a “Zone” tool or self-management plan – with instructions to follow while waiting for their test results. Our overarching goal was to reduce the spread of the virus by providing immediate access to critical testing, education about the virus, protocols and connections to needed treatment.
As soon as we received results, for patients whose test result was positive, the results were routed directly to a shared in-basket where physicians or Population Health nurses would outreach to the patients as soon as the results were electronically received from the lab. MHS had implemented a direct interface with the lab and an automated workflow which pushed all positive test results directly into the “in-basket” of the providers and nurses that were staffing the Positive COVID Call-Back Program. Memorial also used existing infrastructure in a more integrated fashion to risk stratify the positive populations to assure appropriate outreach was provided. Also, Memorial used Care Companion (a Memorial licensed Epic EHR tool) for use by patients to communicate with staff and to continue connected follow-up after discharge.
In order to outreach to all negative COVID patients, we needed to develop an automated solution as the number of negatives were much larger than the number of positives. Working with Cisco, we developed an automated “BOT” (short for “robot”) program where patients that had negative COVID test results received an automated call from the BOT. By automating the call backs, all negative results could receive a quick response to their test results without taxing the already overwhelmed staff manning the COVID Positive call-back program. The BOT called patients at 3 different times (8am, 1pm and 6pm) to maximize the potential of reaching patients. Results were also immediately available in the patient’s MyChart and through the lab directly.
4. HOW it generated results
For Memorial, the dedicated testing site created an immediate decompression of medical facilities by redirecting persons seeking testing to the CB Smith Park. This enabled medical staff to either triage or treat persons with serious illnesses and injuries within the EDs and Urgent Care Centers, and quickly hospitalize individuals with the greatest need.
For the community, the site provided access to free, convenient and safe testing that was overseen by Memorial – an experienced and trusted medical provider. Each person received a COVID-19 Self-Management Plan with additional information, precautions and quarantine instructions. This was extremely important as we wanted our patients to understand that they needed to use isolation precautions while awaiting results including those who were asymptomatic.
Memorial provided an automated call for those persons testing negative while those testing positive received an immediate phone call to gather additional information on other chronic health conditions. Memorial risk stratified all persons testing positive based on their level of severity (high-medium-low) and Population Health nurses provided ongoing contact via telehealth visits as well as providing triage to any COVID related questions from all patients. Memorial’s follow-up services were often a lifeline for sick patients who were scared of their diagnosis and quarantined from their families. Many of these persons experienced difficulty in reaching their own primary care provider.
The innovation impacted value in all categories:
a) Enhanced the patient experience
i. Patients were informed quickly of their COVID test results
ii. Relief of patients, if negative – limit their time of uncertainty
iii. Validation of their symptoms if positive – inform of what do to if exacerbates
1. The phone call from providers gave clear direction and support to positive patients – what to do when (see self-management tool)
b) Improved the care of patient populations
i. Memorial’s self-management program, home monitoring of oxygen saturation and continued contact for 10 days post positive results allowed patients with elevated risk and reduced oxygen saturation levels to be quickly identified and interventions begun early to avoid catastrophic outcomes – getting them on the road to recovery sooner.
ii. Memorial connected more than 800 uninsured/underinsured persons who tested positive to Memorial Primary Care or other appropriate follow-up services
c) Improved the life of healthcare providers
i. Relieved overburdened providers of call backs to negative patients allowing more time to spend helping positive patients with next steps and understanding their self-management plan.
ii. Decompressed emergency departments and urgent care centers who were getting flooded with patients.
d) Reduced healthcare costs
i. Memorial’s self-management program, home monitoring of oxygen saturation and continued contact for 10 days post positive results allowed patients with elevated risk and reduced oxygen saturation levels to be quickly identified and interventions begun early to avoid catastrophic outcomes and costly hospitalizations and post-acute care.
As the clinical leader for Florida’s first COVID-19 drive-through testing site, Memorial did not have access to any relevant data sources or models to operationalize the site. While Memorial partnered with state and local agencies to create and operate the site, it was Memorial’s clinical and technical leadership that transformed the operation into an example of patient safety and quality that became the standard for others across the nation. This leadership was reinforced by Florida’s Governor and also from four-star generals who came to observe the site in action.
Rapid development of testing protocols helped contain the spread of the virus, decompress local emergency departments and urgent care centers, and ensured COVID-19 suspected patients obtained quarantine instructions, educational resources and immediate care, if needed.
Our innovative contributions began in March 2020 operationalizing Memorial’s COVID testing site at CB Smith Park – which was cited as a “gold standard” model for use by the rest of the state and country. Florida’s Governor Ron DeSantis acknowledged Memorial as a model for a community COVID testing site.
Memorial was the first hospital system in Florida to open a COVID-19 drive-thru, community-based testing site in a park. There was no model to follow and staff had only two days to make it operational. MHS partnered with state and local agencies to create the site, but it was MHS’s leadership that transformed the testing site into an example of patient safety and quality that became the standard for other testing sites in the U.S.
Obtaining results in a timely fashion and creating a safe, effective process was of utmost importance. Staff quickly faced multiple challenges and developed innovative approaches to ensure quality patient testing and follow-up care was provided. These protocols helped contain the spread of the virus, decompress local EDs/Urgent Care Centers, and ensured COVID-19 suspected patients received quality care, isolation education and information on how to care for themselves while they awaited their results.
The site delivered improved access to testing, faster results, follow-up care, and education for the community. As of August 31, 2020, the site completed more than 100,000 tests and has become one of the most sophisticated and productive testing centers in the nation. The community-testing model was so successful that it has already been replicated at other testing sites around the nation. Our education tool – a one-page COVID-19 Self-Management Plan – and a book of standard operating procedures created by MHS are also being used at other testing sites throughout the country. We have become a best practice model for patient safety, quality and efficiency in COVID-19 testing.
The Memorial Healthcare System Community Based Test Site was a multi-agency effort that included support from: Broward County Parks and Recreation, Florida Department of Transportation, Florida Division of Emergency Management, Florida Department of Health, Florida Highway Patrol, Florida National Guard, Memorial Healthcare System, Pembroke Pine Police Department and Quest Diagnostics.
1. WHAT was the challenge?
In March 2020, South Florida emerged as a COVID-19 “hot spot.” Broward County, which includes the greater Fort Lauderdale area, led the state in cases and neighboring Miami-Dade County followed closely behind. Local residents converged on local emergency departments (EDs) seeking information, testing and treatment. This led to crowded waiting areas (which could be unsafe due to the contagious nature of the virus) and long waiting times. This caused delays for persons seeking care for life-threatening illnesses and injuries, and burdened local medical facilities.
The Governor activated Florida’s National Guard to assist Memorial in establishing the COVID-19 drive-thru, community-based testing site. The goal was to reduce the spread of the virus by decompressing medical facilities and providing immediate access to critical testing in a safe environment, while also providing education and connecting people to needed treatment during the pandemic.
Staff had only two days to open the center, and since the site was one of the first, there was no model to follow. Memorial rapidly partnered with other local agencies to develop a site plan for the park.
Memorial’s clinical and technical teams quickly developed testing protocols that incorporated quality, infection control and safety measures, along with processes for patients to obtain test results in a timely manner. Donned in the latest personal protective equipment, staff provided nasopharyngeal swab testing through car windows, which allowed patients to remain in the safety of their vehicle. The staff also provided important quarantine and self-care information.
Memorial then drew upon the expertise of its own pediatric facility, Joe DiMaggio Children’s Hospital, to add a child-friendly testing location within the park. Filled with colorful decorations, music and Child Life Specialists to help put children at ease, this pediatric site was one of the first in the state and became a model for others.
The most critical part of testing for COVID is notifying the patient of their test results and helping them with their next steps. For patients that received COVID testing (while in one of our emergency departments, urgent care centers or at our community testing site), we needed to follow up with the patients as soon as possible with their results. Though testing at many sites across the country took hours, at Memorial our COVID testing of patients was completed in under 30 minutes. In addition, our direct integration with Quest Laboratories added to our ability to quickly report results to patients and care givers.
2. WHO was involved in the innovation?
Memorial’s Population Health and Digital Innovation teams: IT – BI Development and Analytics, IT - Ambulatory, IT – Communications, Cisco, Broward County Parks and Recreation, Florida Department of Transportation, Florida Division of Emergency Management, Florida Department of Health, Florida Highway Patrol, Florida National Guard, Pembroke Pine Police Department and Quest Diagnostics.
3. WHAT the innovation entailed
Though we felt it critical to contact each patient as soon as their COVID testing results were received from the lab so that we could advise them of their result, we also felt it necessary to help them understand what symptoms to look for and what to do if their condition worsens or improves while waiting for their results - we provided guidance to all patients in the form of a “Zone” tool or self-management plan – with instructions to follow while waiting for their test results. Our overarching goal was to reduce the spread of the virus by providing immediate access to critical testing, education about the virus, protocols and connections to needed treatment.
As soon as we received results, for patients whose test result was positive, the results were routed directly to a shared in-basket where physicians or Population Health nurses would outreach to the patients as soon as the results were electronically received from the lab. MHS had implemented a direct interface with the lab and an automated workflow which pushed all positive test results directly into the “in-basket” of the providers and nurses that were staffing the Positive COVID Call-Back Program. Memorial also used existing infrastructure in a more integrated fashion to risk stratify the positive populations to assure appropriate outreach was provided. Also, Memorial used Care Companion (a Memorial licensed Epic EHR tool) for use by patients to communicate with staff and to continue connected follow-up after discharge.
In order to outreach to all negative COVID patients, we needed to develop an automated solution as the number of negatives were much larger than the number of positives. Working with Cisco, we developed an automated “BOT” (short for “robot”) program where patients that had negative COVID test results received an automated call from the BOT. By automating the call backs, all negative results could receive a quick response to their test results without taxing the already overwhelmed staff manning the COVID Positive call-back program. The BOT called patients at 3 different times (8am, 1pm and 6pm) to maximize the potential of reaching patients. Results were also immediately available in the patient’s MyChart and through the lab directly.
4. HOW it generated results
For Memorial, the dedicated testing site created an immediate decompression of medical facilities by redirecting persons seeking testing to the CB Smith Park. This enabled medical staff to either triage or treat persons with serious illnesses and injuries within the EDs and Urgent Care Centers, and quickly hospitalize individuals with the greatest need.
For the community, the site provided access to free, convenient and safe testing that was overseen by Memorial – an experienced and trusted medical provider. Each person received a COVID-19 Self-Management Plan with additional information, precautions and quarantine instructions. This was extremely important as we wanted our patients to understand that they needed to use isolation precautions while awaiting results including those who were asymptomatic.
Memorial provided an automated call for those persons testing negative while those testing positive received an immediate phone call to gather additional information on other chronic health conditions. Memorial risk stratified all persons testing positive based on their level of severity (high-medium-low) and Population Health nurses provided ongoing contact via telehealth visits as well as providing triage to any COVID related questions from all patients. Memorial’s follow-up services were often a lifeline for sick patients who were scared of their diagnosis and quarantined from their families. Many of these persons experienced difficulty in reaching their own primary care provider.
The innovation impacted value in all categories:
a) Enhanced the patient experience
i. Patients were informed quickly of their COVID test results
ii. Relief of patients, if negative – limit their time of uncertainty
iii. Validation of their symptoms if positive – inform of what do to if exacerbates
1. The phone call from providers gave clear direction and support to positive patients – what to do when (see self-management tool)
b) Improved the care of patient populations
i. Memorial’s self-management program, home monitoring of oxygen saturation and continued contact for 10 days post positive results allowed patients with elevated risk and reduced oxygen saturation levels to be quickly identified and interventions begun early to avoid catastrophic outcomes – getting them on the road to recovery sooner.
ii. Memorial connected more than 800 uninsured/underinsured persons who tested positive to Memorial Primary Care or other appropriate follow-up services
c) Improved the life of healthcare providers
i. Relieved overburdened providers of call backs to negative patients allowing more time to spend helping positive patients with next steps and understanding their self-management plan.
ii. Decompressed emergency departments and urgent care centers who were getting flooded with patients.
d) Reduced healthcare costs
i. Memorial’s self-management program, home monitoring of oxygen saturation and continued contact for 10 days post positive results allowed patients with elevated risk and reduced oxygen saturation levels to be quickly identified and interventions begun early to avoid catastrophic outcomes and costly hospitalizations and post-acute care.
As the clinical leader for Florida’s first COVID-19 drive-through testing site, Memorial did not have access to any relevant data sources or models to operationalize the site. While Memorial partnered with state and local agencies to create and operate the site, it was Memorial’s clinical and technical leadership that transformed the operation into an example of patient safety and quality that became the standard for others across the nation. This leadership was reinforced by Florida’s Governor and also from four-star generals who came to observe the site in action.
Rapid development of testing protocols helped contain the spread of the virus, decompress local emergency departments and urgent care centers, and ensured COVID-19 suspected patients obtained quarantine instructions, educational resources and immediate care, if needed.
Improved the care of patient populations
Andres Nics
Provider
Andres
Nics
+1 202-763-0536
Auna Ideas Foundation
Outside the United States
Andres
Vasquez
Director, Health-Tech Innovation
2027630536
andres.vasquez@ideas-foundation.org
There is overcrowding of ER department with the covid pandemic.
A multidisciplinary group led by the cardiothoracic imaging division promoted an A.I-based project that seeks to optimize the diagnosis of patients with suspected covid in the ER with a rapid classification using diagnostic images to refer the patient while the RT-PCR result is available.
A rapid development using confirmed cases of COVID patients from institutions in Europe and the United States while the pandemic began in our country. The training was carried out with more than 2000 cases, achieving a precision of 90% and reducing the attention times in R.E. by 40% in the first institution.
A web application was developed to avoid integration problems and facilitate adoption by multiple institutions. We deliver the web application for multiple hospitals in Latam free of cost.
A multidisciplinary group led by the cardiothoracic imaging division promoted an A.I-based project that seeks to optimize the diagnosis of patients with suspected covid in the ER with a rapid classification using diagnostic images to refer the patient while the RT-PCR result is available.
A rapid development using confirmed cases of COVID patients from institutions in Europe and the United States while the pandemic began in our country. The training was carried out with more than 2000 cases, achieving a precision of 90% and reducing the attention times in R.E. by 40% in the first institution.
A web application was developed to avoid integration problems and facilitate adoption by multiple institutions. We deliver the web application for multiple hospitals in Latam free of cost.
Improved the care of patient populations
Kari Powelson
Provider
Kari
Powelson
+1 510-406-9118
Kaiser Permanente
California
Kari
Powelson
Executive Director IT
510-406-9118
kari.powelson@kp.org
Focus Home pilot aimed to create a 21st century experience for Kaiser Permanente’s Care at Home, on par with the best experiences in retail, hospitality, and technology. Advancing our care model from traditional medical office building and hospitals to the home-our future. Focus Home experience is made up of three main enablers.
• Patient-Putting tablets in the hands of patients’ to directly manage appointments, track tasks and set health progress goals.
• Home Care Team-Providing portable iPads to home care providers enabling increased efficiencies for appointment confirmations, patient condition summary and on the go documentation.
• Home Center Care Team-24/7 Command Center has full “birds eye view” of all the Home Care providers in the field at any given time, they are able to track and assist with scheduling as well as communicate and provide support directly to patients and Home Care Team.
To do this, a multi-disciplinary team of doctors, nurses, administrators, and technologist stood up systems that delivered new services to the home. New roles, skillsets were developed with custom purpose-based apps and portals. Leveraging new systems of intelligence and analytics with engines that power the Focus Home platform. With a Human Centered Design philosophy and SAFe/Agile implementation we were able to deliver a working proof of concept in 9 months.
As a result, we created the foundation for a seamless experience that enhanced engagement, scheduling, and care delivery for our home care providers, patients.
With our submission, there are 3 files as "teasers" for the Focus Home program. Full copies can be provided upon request. We also can provide 7 min recorded demo of working application. File sizes were prohibitive.
Thank you very much for your consideration. Enjoy!
Kari Powelson
• Patient-Putting tablets in the hands of patients’ to directly manage appointments, track tasks and set health progress goals.
• Home Care Team-Providing portable iPads to home care providers enabling increased efficiencies for appointment confirmations, patient condition summary and on the go documentation.
• Home Center Care Team-24/7 Command Center has full “birds eye view” of all the Home Care providers in the field at any given time, they are able to track and assist with scheduling as well as communicate and provide support directly to patients and Home Care Team.
To do this, a multi-disciplinary team of doctors, nurses, administrators, and technologist stood up systems that delivered new services to the home. New roles, skillsets were developed with custom purpose-based apps and portals. Leveraging new systems of intelligence and analytics with engines that power the Focus Home platform. With a Human Centered Design philosophy and SAFe/Agile implementation we were able to deliver a working proof of concept in 9 months.
As a result, we created the foundation for a seamless experience that enhanced engagement, scheduling, and care delivery for our home care providers, patients.
With our submission, there are 3 files as "teasers" for the Focus Home program. Full copies can be provided upon request. We also can provide 7 min recorded demo of working application. File sizes were prohibitive.
Thank you very much for your consideration. Enjoy!
Kari Powelson
Enhanced the patient experience
Jody Schneider
Provider
Jody
Schneider
+1 619-917-6810
Millennium Health
California
Dave
Henderson
Chief Information Officer
6199176810
jody.schneider@millenniumhealth.com
Over the past year, Millennium Health has been monitoring the shifting landscape of drug use and its impact on the health and well-being of those with substance use disorders (SUD) by analysing urine drug test (UDT) results. This UDT data allows clinicians, first responders, and those responsible for public health to be quickly informed about these changes to help prevent overdoses and save lives.
The company has been able to implement this initiative by utilizing its customer platform, IntelliumSM, which leverages over 10 years of laboratory excellence, proprietary data intelligence, and clinical expertise. Intellium allows clinicians to easily track test orders, access results in a HIPAA-compliant manner, and comprehensively manage patient information in addition to providing intuitive user support through live chat.
This data analytics offers the ability to view real-time clinical testing trends, which has become an important focus for the organization as the substance use epidemic has become a critical public health problem, evidenced by a record number of drug overdose deaths in 2019. The team determined there was an opportunity to encapsulate the analytics and developed the Millennium Health Signals Report™, a report that summarizes trends and key findings within this data. This research has also resulted in numerous peer-reviewed publications, including two published studies in JAMA Network Open.
While there is no single solution to the current epidemic, one of the U.S. Department of Health and Human Services’ (HHS) strategies for addressing this crisis is a call for timelier public health data and reporting from non-traditional sources, such as laboratories. In response to this call for more real-time data, Millennium Health used its analytics capabilities to create a nationwide initiative called the Emerging Threat Intelligence (ETI) Program™. The goal for this program is to provide meaningful, real-time insights into evolving trends in drug use nationwide and use these findings to aid the development of rapid health responses.
Since the creation of the ETI Program, Millennium Health has entered into collaborations with HHS and the Ohio Department of Public Safety to provide real-time data on an ongoing basis. As Assistant Secretary for Health Admiral Brett P. Giroir, M.D., said, “The donation of this data is a critical tool for reducing the occurrence of the substance use epidemic and reaching the people who need help most.”
The ongoing surveillance and reporting conducted by the Millennium Health team also helped identify significant changes in drug use during the COVID-19 pandemic. Based on these discoveries, the team released a COVID-19 Special Edition of the Millennium Health Signals Report™ that was followed by a more formal analysis co-authored with HHS. The findings from this study, published in JAMA, highlighted a national increase in UDT positivity rates during COVID-19 for non-prescribed fentanyl, methamphetamine, cocaine, and heroin; this report also identified significant changes at regional and state levels.
Based on the success of the ETI Program, additional national and state agencies have reached out to Millennium Health to explore potential partnerships, and multiple manuscripts are being developed to further educate the health care community about evolving substance use trends. Millennium Health is committed to making a difference in the lives of those with SUD.
The company has been able to implement this initiative by utilizing its customer platform, IntelliumSM, which leverages over 10 years of laboratory excellence, proprietary data intelligence, and clinical expertise. Intellium allows clinicians to easily track test orders, access results in a HIPAA-compliant manner, and comprehensively manage patient information in addition to providing intuitive user support through live chat.
This data analytics offers the ability to view real-time clinical testing trends, which has become an important focus for the organization as the substance use epidemic has become a critical public health problem, evidenced by a record number of drug overdose deaths in 2019. The team determined there was an opportunity to encapsulate the analytics and developed the Millennium Health Signals Report™, a report that summarizes trends and key findings within this data. This research has also resulted in numerous peer-reviewed publications, including two published studies in JAMA Network Open.
While there is no single solution to the current epidemic, one of the U.S. Department of Health and Human Services’ (HHS) strategies for addressing this crisis is a call for timelier public health data and reporting from non-traditional sources, such as laboratories. In response to this call for more real-time data, Millennium Health used its analytics capabilities to create a nationwide initiative called the Emerging Threat Intelligence (ETI) Program™. The goal for this program is to provide meaningful, real-time insights into evolving trends in drug use nationwide and use these findings to aid the development of rapid health responses.
Since the creation of the ETI Program, Millennium Health has entered into collaborations with HHS and the Ohio Department of Public Safety to provide real-time data on an ongoing basis. As Assistant Secretary for Health Admiral Brett P. Giroir, M.D., said, “The donation of this data is a critical tool for reducing the occurrence of the substance use epidemic and reaching the people who need help most.”
The ongoing surveillance and reporting conducted by the Millennium Health team also helped identify significant changes in drug use during the COVID-19 pandemic. Based on these discoveries, the team released a COVID-19 Special Edition of the Millennium Health Signals Report™ that was followed by a more formal analysis co-authored with HHS. The findings from this study, published in JAMA, highlighted a national increase in UDT positivity rates during COVID-19 for non-prescribed fentanyl, methamphetamine, cocaine, and heroin; this report also identified significant changes at regional and state levels.
Based on the success of the ETI Program, additional national and state agencies have reached out to Millennium Health to explore potential partnerships, and multiple manuscripts are being developed to further educate the health care community about evolving substance use trends. Millennium Health is committed to making a difference in the lives of those with SUD.
Improved the care of patient populations