Provider
St. Josephs University Medical Center
New Jersey
Matthew
Ostroff
APN Vascular Access Coordinator and Team Leader
9176978731
ostroffm@sjhmc.org
Providing expedient treatment for patients admitted to St. Josephs during the COVID-19 crisis and at all times required the Vascular Access Team to step up to insert intravenous catheters that were necessary to begin medication administration. I would like to recommend Matthew Ostroff and the entire team at St. Josephs University Medical Center, for their innovation and superior collaboration with nursing and medical staff to establish a full-service vascular access team from peripheral to central catheter placement for all ages. This group has distinguished themselves in being able to insert intravenous catheters on brand new neonates up to octogenarians with almost 100% first stick success. I admire Matthew's energy and the teams' ability to get things done. His insights and abilities as a leader have allowed him to cut through roadblocks reaching success in vascular access device selection and insertion in the team's clinical practice. Each year the team has presented data and accomplishments to administrators and medical staff demonstrating tremendous improvement in reducing complications while providing the safest access for every patient.
What changed about care or practice that led to the development of the innovation? The team, under Matthew's leadership, has opened the door to a safer form of femoral access for those patient unable to receive upper body central catheters. The midthigh femoral picc with ultrasound guided needle access reduced infections and thrombosis commonly associated with this type of catheter. Matthew and the team teach the residents and physicians these techniques with instruction on how to use ultrasound for all central catheter insertions. In addition, with so many patients having difficult access, Matthew and his team revolutionized the ultrasound guided peripheral catheter approach aching 100% success with first attempts. Applying sterile technique and the use of longer catheters, dwell time was extended and catheter failure reduced to allow patients, in most cases, to receive one catheter for the entire course of treatment. I highly recommend the evidence based innovations of this team and their commitment to sharing with others through teaching, research and publication.
From the perspective of an infusion specialist, what infusion related workflow did the candidate develop or change in order to more effectively provide care during the COVID-19 Pandemic? Through an organized flow-process control, this team of highly trained clinicians were able to establish immediate vascular access with blood draws for lab testing in a way that gave the patients better chances for survival. St. Joseph’s University Medical Center was a very high volume COVID-19 site with tens of thousands of patients that had to be accessed and treated. Using the innovative insertion techniques of tunneling PICCs, for those without suitable veins, midthigh insertions, ultrasound-guided peripheral or midline insertions, all patients received the best and safest form of access. This team collaborated with all departments and clinicians to establish and maintain intravenous access, and in most cases central access, to effectively deliver the lifesaving treatments.
Was there a process or outdated institutional practice that was updated to current standards? Prior to the St. Joseph’s University Medical Center Vascular Access Team patients were managed in a very haphazard fashion, often receiving many attempts at peripheral and even central access before successful catheter insertion was completed. Application of infection prevention guidelines were inconsistent, dictated by the individual clinician inserter, rather than through an intentional policy for all insurers. The improvements over the last four years have reduced catheter attempts, almost eliminated insertion related complications for team insertions and established a culture of safety with the expectation of using evidence based practices for all patients.
Is there a method to evaluate the effectiveness of the innovative idea that was implemented? The success of this St. Joseph’s University Medical Center Vascular Access Team and Matthew OStroff have been published, recorded in public video and newspaper format, and made available in the annual administrative reporting of the team outcomes and accomplishments. Matthew Ostroff's publications and public speaking report the success of his team, their research, improvements, and innovative insertion procedures.Sonosite was so impressed with the successes and innovations of this team they created a video https://www.sonosite.com/blog/pocus-profile-nurse-practitioner-matt-ostroff. Becker Hospital reports published a $3.5 million dollar savings for St. Joseph's directly related to this team https://www.beckershospitalreview.com/quality/ultrasound-guided-vascular-access-program-saves-st-joseph-s-3-5-million.html
How did the innovative idea impact the customer (e.g. patient, colleagues, employer)? The successes of Matthew Ostroff, first as a single Vascular Access Sepcialist, and later as the coordinator of a full team, have been cataloged by Caucus New Jersey by Steve Adubato relating the patient response to this teams' successes in improving the patient experience with vascular access https://www.youtube.com/watch?v=gdRyNw4EbR8. Patients demonstrate their appreciation and support of the team by calling ahead to schedule appointments, as in the genetic clinic patients, and asking for the Vascular Access Team specifically for any intravenous catheter placement or even difficult blood draws. The patient appreciation is clearly evident in the youtube video and in the every day experiences of this team with patients. As was published in the The Record News media on March 23, 2016, Matt Ostroff has championed a new technique to reduce the number of sticks patients endure. Matthew and his team have increased public and professional awareness as was demonstrated in a New Jersey news article. This complete article highlighted patient cases, testimonials, hospital staff comments and support and closes by stating patients now don’t need to suffer with the help of this specialized vascular access team. This nursing specialty team innovation is now available for all patients at St Josephs to enhance the patient experience, improve patient care, while also reducing healthcare cost through less time needed and use of fewer supplies. Everyone wins. Clinician and nursing team change lives with Ultrasound IV Technology https://youtu.be/gdRyNw4EbR8. This really says it all in a video https://wnyt.com/news/health-beat-iv-access-improvement/5421149/
What changed about care or practice that led to the development of the innovation? The team, under Matthew's leadership, has opened the door to a safer form of femoral access for those patient unable to receive upper body central catheters. The midthigh femoral picc with ultrasound guided needle access reduced infections and thrombosis commonly associated with this type of catheter. Matthew and the team teach the residents and physicians these techniques with instruction on how to use ultrasound for all central catheter insertions. In addition, with so many patients having difficult access, Matthew and his team revolutionized the ultrasound guided peripheral catheter approach aching 100% success with first attempts. Applying sterile technique and the use of longer catheters, dwell time was extended and catheter failure reduced to allow patients, in most cases, to receive one catheter for the entire course of treatment. I highly recommend the evidence based innovations of this team and their commitment to sharing with others through teaching, research and publication.
From the perspective of an infusion specialist, what infusion related workflow did the candidate develop or change in order to more effectively provide care during the COVID-19 Pandemic? Through an organized flow-process control, this team of highly trained clinicians were able to establish immediate vascular access with blood draws for lab testing in a way that gave the patients better chances for survival. St. Joseph’s University Medical Center was a very high volume COVID-19 site with tens of thousands of patients that had to be accessed and treated. Using the innovative insertion techniques of tunneling PICCs, for those without suitable veins, midthigh insertions, ultrasound-guided peripheral or midline insertions, all patients received the best and safest form of access. This team collaborated with all departments and clinicians to establish and maintain intravenous access, and in most cases central access, to effectively deliver the lifesaving treatments.
Was there a process or outdated institutional practice that was updated to current standards? Prior to the St. Joseph’s University Medical Center Vascular Access Team patients were managed in a very haphazard fashion, often receiving many attempts at peripheral and even central access before successful catheter insertion was completed. Application of infection prevention guidelines were inconsistent, dictated by the individual clinician inserter, rather than through an intentional policy for all insurers. The improvements over the last four years have reduced catheter attempts, almost eliminated insertion related complications for team insertions and established a culture of safety with the expectation of using evidence based practices for all patients.
Is there a method to evaluate the effectiveness of the innovative idea that was implemented? The success of this St. Joseph’s University Medical Center Vascular Access Team and Matthew OStroff have been published, recorded in public video and newspaper format, and made available in the annual administrative reporting of the team outcomes and accomplishments. Matthew Ostroff's publications and public speaking report the success of his team, their research, improvements, and innovative insertion procedures.Sonosite was so impressed with the successes and innovations of this team they created a video https://www.sonosite.com/blog/pocus-profile-nurse-practitioner-matt-ostroff. Becker Hospital reports published a $3.5 million dollar savings for St. Joseph's directly related to this team https://www.beckershospitalreview.com/quality/ultrasound-guided-vascular-access-program-saves-st-joseph-s-3-5-million.html
How did the innovative idea impact the customer (e.g. patient, colleagues, employer)? The successes of Matthew Ostroff, first as a single Vascular Access Sepcialist, and later as the coordinator of a full team, have been cataloged by Caucus New Jersey by Steve Adubato relating the patient response to this teams' successes in improving the patient experience with vascular access https://www.youtube.com/watch?v=gdRyNw4EbR8. Patients demonstrate their appreciation and support of the team by calling ahead to schedule appointments, as in the genetic clinic patients, and asking for the Vascular Access Team specifically for any intravenous catheter placement or even difficult blood draws. The patient appreciation is clearly evident in the youtube video and in the every day experiences of this team with patients. As was published in the The Record News media on March 23, 2016, Matt Ostroff has championed a new technique to reduce the number of sticks patients endure. Matthew and his team have increased public and professional awareness as was demonstrated in a New Jersey news article. This complete article highlighted patient cases, testimonials, hospital staff comments and support and closes by stating patients now don’t need to suffer with the help of this specialized vascular access team. This nursing specialty team innovation is now available for all patients at St Josephs to enhance the patient experience, improve patient care, while also reducing healthcare cost through less time needed and use of fewer supplies. Everyone wins. Clinician and nursing team change lives with Ultrasound IV Technology https://youtu.be/gdRyNw4EbR8. This really says it all in a video https://wnyt.com/news/health-beat-iv-access-improvement/5421149/
Enhanced the patient experience
Provider
Fairfax Pediatric Associates
Virginia
Sandy
Chung
FPA Well Checks on Wheels
703-391-0900, ext 230
schung@fairfaxpeds.com
A pediatric practice, a pandemic, and a problem... children were missing their vaccines because families were afraid to come out due to COVID. Our practice Fairfax Pediatric Associates decided that we had to solve this problem to avoid having infants and children get sick from other preventable diseases such as measles, pertussis and meningitis. Between March and May, 1 out of every 3 babies were missing their vaccines and 3 out of every 4 adolescents missed their well checks with vaccines. We rented a mobile van and staffed it with a provider and a nurse and brought the vaccines to our families! FPA’s Well Checks on Wheels has delivered vaccines and well visits to hundreds of children during the pandemic and we continue to do so today!
Improved the care of patient populations
Provider
MetroHealth
Ohio
David
Margolius
Medical Director of Systems Improvement
216-536-1766
DMargolius@metrohealth.org
On Monday, March 9th, the first 3 cases of COVID-19 were diagnosed in Northeast Ohio. Four days later, we launched a 24/7 Nurse- and Physician-staffed telephone hotline to assess, advise, and treat individuals concerned about symptoms of or exposure to COVID-19. As of August 4th, 2020, our nurses have taken 27,100 calls resulting in 13,487 telephone visits with physicians. Through this innovation, our team has kept patients and caregivers safe by replacing in-person visits with telephone visits. When physicians determine that a patient needs a test, we order and schedule the test in one of our four drive-up testing locations. Patients who complete a physician telephone visit receive a follow-up call from a care coordinator to assess for any change in symptoms, food insecurity, or behavioral health needs. The care coordinator can connect the patient back to a physician, arrange for food delivery, or set up a follow-up call from a psychologist as needed. The hotline has lead to the creation of a hospital at home program for COVID-19 positive or presumed individuals and a cluster mass testing program to help test congregate living facilities.
The success of the innovation is a result of nurses, physicians, IT, network service center representatives, and care coordinators all coming together to deliver accessible equitable care to individuals throughout our community. We believe the work has helped to spare our emergency rooms and hospitals from a surge in COVID-19 cases and given countless individuals peace of mind with close follow-up as they recover from COVID-19.
The success of the innovation is a result of nurses, physicians, IT, network service center representatives, and care coordinators all coming together to deliver accessible equitable care to individuals throughout our community. We believe the work has helped to spare our emergency rooms and hospitals from a surge in COVID-19 cases and given countless individuals peace of mind with close follow-up as they recover from COVID-19.
Improved the care of patient populations
Provider
Stanford Health Care
California
Alpa
Vyas
Vice President, Patient Experience
650-521-6209
avyas@stanfordhealthcare.org
The MyHealth – Hospital View team represents a collaborative effort across multiple teams within Stanford Health Care. Each team brought a unique and necessary skillset to design, develop and implement a product to bring the organization a step closer in the aspirational patient experience vision to “enable, empower patients and families to focus on health, healing and recovery.” This vision is derived from the integrated strategic plan emphasis and focus on providing a highly personalized patient experience and engage with families, employers and payors to ensure enduring relationships. The product in in of itself is unique in the industry based upon the custom development that allows patients to access information seamlessly through a single, integrated platform on the patient or family member’s personal device. Other organizations are restricted by out-of-the-box solutions that created fragmented experiences in the inpatient environment. Through the creativity, skill and focus on addressing the unmet needs, this team was able to deliver a truly differentiated, unique digital experience that drives value for our patients and families.
Stanford Health Care’s challenge was to create a digitally driven patient experience that matched the majestic physical infrastructure of a brand new 824,000 square foot building. The new structure includes private patient rooms, four acres of outdoor gardens and green space, an expansive lobby, fountains and 400 pieces of original art. The service and experience need to complement and enhance this physical environment.
A yearlong design-thinking and discovery process lead teams to talk about digital experience across the care continuum. Technology & Digital Solutions, Patient Experience and Patient Care Services design teams worked to address unique needs of patients and families. Teams approached these questions with rigor, empathy, and structured user research – building into MyHealth, the organization’s patient/family engagement portal, an inpatient experience called Hospital View that strives to empower patients and their families with information and support throughout their hospital stay.
From a design and development perspective, the heavy lift came in being able to enhance existing location awareness capabilities and adding contextual awareness to the digital platform, so the app can contextually switch over to inpatient mode as soon as a patient is admitted – providing seamless access to Hospital View. In the Hospital View, patients have access to view members of their care team, test results, medications and side effects, progress against key goals including pain and mobility as well as helpful information to prepare for discharge. This is a unique feature to the MyHealth portal and has not been duplicated by other health systems.
As a result, 73% of our inpatients are enrolled in MyHealth and able to access this valuable information, test results being the most accessed feature at 40%.
During the early roll-out of the product patients, family members and staff all commented on utility of the app during an inpatient stay. Below are some of the comments:
• “Nice to have during the down time overnight to be prepared with questions in the morning.” Patient, B3
• “Beautiful that Stanford is being more transparent about a patient’s health. Glad that we can involve patients more.” Nurse, E1
• “…knowing that my medication is going to be injected better prepares me for it.” Transplant patient
• “He has had swallowing issues lately so when I see a tablet icon in medications, it helps me keep track and ask questions.” Caregiver, daughter, E3
• “I like that patients can see this information quickly - at times we get very busy and are not able to update them immediately.” Nurse, E1
• “When you’re under medication it’s hard to remember people. This is great because I could put a name to a face.” Patient
• “We can ask smarter questions when the doctors come by like, ‘What does this mean?’ and ‘Can you tell me the number we should really look for?’ My father is definitely not the average person.” Caregiver, daughter, E3
Stanford Health Care’s challenge was to create a digitally driven patient experience that matched the majestic physical infrastructure of a brand new 824,000 square foot building. The new structure includes private patient rooms, four acres of outdoor gardens and green space, an expansive lobby, fountains and 400 pieces of original art. The service and experience need to complement and enhance this physical environment.
A yearlong design-thinking and discovery process lead teams to talk about digital experience across the care continuum. Technology & Digital Solutions, Patient Experience and Patient Care Services design teams worked to address unique needs of patients and families. Teams approached these questions with rigor, empathy, and structured user research – building into MyHealth, the organization’s patient/family engagement portal, an inpatient experience called Hospital View that strives to empower patients and their families with information and support throughout their hospital stay.
From a design and development perspective, the heavy lift came in being able to enhance existing location awareness capabilities and adding contextual awareness to the digital platform, so the app can contextually switch over to inpatient mode as soon as a patient is admitted – providing seamless access to Hospital View. In the Hospital View, patients have access to view members of their care team, test results, medications and side effects, progress against key goals including pain and mobility as well as helpful information to prepare for discharge. This is a unique feature to the MyHealth portal and has not been duplicated by other health systems.
As a result, 73% of our inpatients are enrolled in MyHealth and able to access this valuable information, test results being the most accessed feature at 40%.
During the early roll-out of the product patients, family members and staff all commented on utility of the app during an inpatient stay. Below are some of the comments:
• “Nice to have during the down time overnight to be prepared with questions in the morning.” Patient, B3
• “Beautiful that Stanford is being more transparent about a patient’s health. Glad that we can involve patients more.” Nurse, E1
• “…knowing that my medication is going to be injected better prepares me for it.” Transplant patient
• “He has had swallowing issues lately so when I see a tablet icon in medications, it helps me keep track and ask questions.” Caregiver, daughter, E3
• “I like that patients can see this information quickly - at times we get very busy and are not able to update them immediately.” Nurse, E1
• “When you’re under medication it’s hard to remember people. This is great because I could put a name to a face.” Patient
• “We can ask smarter questions when the doctors come by like, ‘What does this mean?’ and ‘Can you tell me the number we should really look for?’ My father is definitely not the average person.” Caregiver, daughter, E3
Improved the care of patient populations
Provider
Seattle Children's Hospital
Washington
Daniel
Low
Associate Professor of Anesthesiology
206 660 1533
daniel.low@seattlechildrens.org
WHAT: 130 people die a day because of the opioid epidemic in the U.S. Surgery is now known to be a gateway to long term opioid use. 5% of adolescents and 7% of adults develop persistent opioid use following even minor surgery. WHO: Perioperative team at Seattle Children's Bellevue Surgery Center (anesthesiologists, CRNAs, surgeons and RNs). WHAT: Within 18 months reduced peri-operative opioid exposure for outpatient surgery to near zero. Deployed a AI solution - MDmetrix OR Advisor, that enabled to team to learn and adapt their protocols from real-world data captured by their electronic health records . HOW: Previously it took years to complete even one cycle of change when adjusting clinical protocols, now it takes weeks - MDmetrix allows clinicians to see across patients in the EMR (rather than just doing a deep dive on one patient). This means when the team changed from opioids to a alternative medications (drug A vs drug B) they were instantly able to understand if it was an improvement. Outcomes improved, complications from anesthesia (nausea and vomiting) almost eliminated.
Enhanced the patient experience
Provider
Summit Home Health & Hospice
Utah
Joshua
Simpson
Vice President of Clinical Operations
4357995827
Josh@summithomehealth.com
Summit Home Health & Hospice is a Medicare and Medicaid certified group dedicated to finding better ways to integrate patient care with customer service. We were early adopters of HIPAA-compliant mobile messaging, and after struggling with a number of platforms, eventually partnered with the Clinical Communication & Collaboration (CC&C) application Buzz by Skyscape. Our 90+ physical therapists, registered nurses and certified nursing assistants have leveraged the application to revolutionize communication within our institution as well as to revolutionize our home health care to seniors and other home-bound patients.
We have achieved transformative results by implementing and conceptualizing of Buzz as a comprehensive workflow tool. Our Vice President of Clinical Operations, Joshua Simpson, worked with our team to develop what we call “Patient Centric Workflows”—a protocol for standardizing and orienting clinical communication around particular patients. When a patient is admitted into our system, we create communication threads around that patient which allows all relevant clinical and administrative staff to share patient information, updates, and documents in one easy-to-access place. It even allows us to loop in community partners who care for the patient outside our institution, while maintaining full control of patient privacy. The result is a better informed staff, greater efficiency, better coordination, and, ultimately, better care. Since implementing these changes, we have cut rehospitalizations in half, won quality awards, and seen increases in our Medicare star ratings and HCAHPS scores. Our clinical and administrative staff as well as patients appreciate the difference. In the words of our Vice President of Care Navigation Shannon Cozzens, “I can’t remember how I delivered information to providers and contacts before Buzz, and I don’t want to.”
We’ve found that Buzz offers some significant benefits over its peers. One major advantage is that they have responsive and strong in-house developers, which has allowed us and other customers to shape the product we’re using. They continue to improve with new features like electronic medical record integration and “Buzz Phone,” which allows our staff to use their personal cell phones to connect with patients, while still displaying Summit’s office number. When COVID-19 created a barrier to patient access, Buzz was able to roll out reliable teleconferencing in a matter of weeks. The application was designed for medicine from the first line of code, and it shows.
We have achieved transformative results by implementing and conceptualizing of Buzz as a comprehensive workflow tool. Our Vice President of Clinical Operations, Joshua Simpson, worked with our team to develop what we call “Patient Centric Workflows”—a protocol for standardizing and orienting clinical communication around particular patients. When a patient is admitted into our system, we create communication threads around that patient which allows all relevant clinical and administrative staff to share patient information, updates, and documents in one easy-to-access place. It even allows us to loop in community partners who care for the patient outside our institution, while maintaining full control of patient privacy. The result is a better informed staff, greater efficiency, better coordination, and, ultimately, better care. Since implementing these changes, we have cut rehospitalizations in half, won quality awards, and seen increases in our Medicare star ratings and HCAHPS scores. Our clinical and administrative staff as well as patients appreciate the difference. In the words of our Vice President of Care Navigation Shannon Cozzens, “I can’t remember how I delivered information to providers and contacts before Buzz, and I don’t want to.”
We’ve found that Buzz offers some significant benefits over its peers. One major advantage is that they have responsive and strong in-house developers, which has allowed us and other customers to shape the product we’re using. They continue to improve with new features like electronic medical record integration and “Buzz Phone,” which allows our staff to use their personal cell phones to connect with patients, while still displaying Summit’s office number. When COVID-19 created a barrier to patient access, Buzz was able to roll out reliable teleconferencing in a matter of weeks. The application was designed for medicine from the first line of code, and it shows.
Enhanced the patient experience
Provider
Pediatric Home Service
Minnesota
Jill
Wall
BSN, CRNI
6516421825
jlwall@pediatrichomeservice.com
WHAT the problem you were looking to solve was: Pediatric Home Service (PHS) provides comprehensive home care to technology-dependent children with medical complexities. There is a shortage of qualified nurses to manage these patients, which contributes to delayed hospital discharge and increased health care costs. At PHS, up to 90% of newly hired home care nurses-often new grads-have little or no pediatric experience. PHS created a simulation center to increase the level of education, preparation and training of its learners.
WHO was involved in the innovation: PHS created a Simulation Team in 2017.
WHAT the innovation entailed: The simulation team toured existing simulation centers, attended education opportunities and conferences, and built relationships with simulation experts. They completed extensive research in high-fidelity mannequins. In 2018, PHS created a simulation center, purchased infant and five-year-old mannequins and conducted intensive simulation testing. The team developed curriculums for initial orientation and annual required training for home care nurses. PHS also partnered with local nursing programs to address a lack of clinical sites that help bridge the gap between the classroom and real-life experience for nursing students. As a result of the NCSBN’s National Simulation Study2, the MN Board of Nursing approved up to 50% of clinical training to come from simulation. This partnership provides exposure to the technology-dependent pediatric population and home care nursing. This can increase the level of preparation for, and potentially the pool of nurses interested in, pediatric home care. Virtual facilitation and creation of interactive videos for simulation have been implemented due to Covid-19.
HOW it generated results: The simulation center provides new home care nurses and nursing students exposure to hands-on learning in emergency scenarios, accelerates critical thinking, develops clinical reasoning and decision-making skills, improving safety, quality of care and overall outcome for this population. Since the inception, twenty-three new graduate nurses have been hired from the nursing schools PHS partnered with. The simulation center continues to operate with virtual options for the nursing schools.
WHO was involved in the innovation: PHS created a Simulation Team in 2017.
WHAT the innovation entailed: The simulation team toured existing simulation centers, attended education opportunities and conferences, and built relationships with simulation experts. They completed extensive research in high-fidelity mannequins. In 2018, PHS created a simulation center, purchased infant and five-year-old mannequins and conducted intensive simulation testing. The team developed curriculums for initial orientation and annual required training for home care nurses. PHS also partnered with local nursing programs to address a lack of clinical sites that help bridge the gap between the classroom and real-life experience for nursing students. As a result of the NCSBN’s National Simulation Study2, the MN Board of Nursing approved up to 50% of clinical training to come from simulation. This partnership provides exposure to the technology-dependent pediatric population and home care nursing. This can increase the level of preparation for, and potentially the pool of nurses interested in, pediatric home care. Virtual facilitation and creation of interactive videos for simulation have been implemented due to Covid-19.
HOW it generated results: The simulation center provides new home care nurses and nursing students exposure to hands-on learning in emergency scenarios, accelerates critical thinking, develops clinical reasoning and decision-making skills, improving safety, quality of care and overall outcome for this population. Since the inception, twenty-three new graduate nurses have been hired from the nursing schools PHS partnered with. The simulation center continues to operate with virtual options for the nursing schools.
Improved the care of patient populations
Provider
Cleveland clinic
Ohio
Lara
Jehi
chief research information officer
216-444-3309
jehil@ccf.org
WHAT challenge we were looking to solve:
COVID-19 presented incredible challenges to the healthcare system in this nation and the world. The challenge we focused on was insufficient healthcare resources, particularly shortage of testing capacity, and insufficient manpower to provide same level of care for all COVID patients.
WHO was involved in the innovation:
This was a team's effort. As the newly appointed chief research information officer for the Cleveland Clinic Health System (I was on the job for 2 months when COVID “hit”), I saw the opportunity to capture patient data related to Cleveland Clinic's immediate and extensive COVID-19 testing. So, I created a team of 25 people with researchers (led by Dr.Mike Kattan), data analysts, programmers, and collaborated with our medical informatics group to create a system-wide registry of all patients tested for COVID. Registry began March 17, 2020. As of August 27, it includes 30,000+ patients, with over 700 variables per patient, mostly collected through automated data pulls from the electronic health record using algorithms developed and validated by our team.
WHAT the innovation entailed:
Multiple deliverables came out of the Registry. The innovation we would like you to consider is the world’s first risk calculator that integrates a patient’s clinical characteristics, signs and symptoms, social determinants of health, medications, and vaccinations, to forecast an individualized risk of having COVID, and of progressing to severe disease. These calculators have been published in high impact academic journals (CHEST, the official journal of the American College of chest physicians), and are publicly available at https://riskcalc.org/COVID19/ and https://riskcalc.org/COVID19Hospitalization/ . Both calculators have been integrated in the clinical workflow across our healthcare system. Physicians answer a few simple questions about the patient, our informatics team developed a system to automate abstraction of 32 additional data elements that are linked through APIs and research algorithms to generate individualized risk predictions displayed instantaneously on the patient’s electronic health record (figure of a screenshot from a patient's EHR is uploaded). Press releases are also attached (both received national media attention).
HOW it generated results:
These calculators have significantly helped us tailor patient care.
Forecasting the risk of progression to severe disease has allowed us to prioritize high risk patients for closer follow-up after they test positive for COVID. Knowing that only 20% of all COVID positive patients ever progress to hospitalization, and being able to identify those 20% practically at the point of testing, has been crucial in making sure that patients who need care the most receive it first, and that our healthcare manpower resources are adequately targeting their efforts.
Forecasting the risk of having COVID has been adapted by several partners and collaborating institutions as validated "Symptom Checker" to screen patients, to identify who is safe to return to work or who needs to be tested.
COVID-19 presented incredible challenges to the healthcare system in this nation and the world. The challenge we focused on was insufficient healthcare resources, particularly shortage of testing capacity, and insufficient manpower to provide same level of care for all COVID patients.
WHO was involved in the innovation:
This was a team's effort. As the newly appointed chief research information officer for the Cleveland Clinic Health System (I was on the job for 2 months when COVID “hit”), I saw the opportunity to capture patient data related to Cleveland Clinic's immediate and extensive COVID-19 testing. So, I created a team of 25 people with researchers (led by Dr.Mike Kattan), data analysts, programmers, and collaborated with our medical informatics group to create a system-wide registry of all patients tested for COVID. Registry began March 17, 2020. As of August 27, it includes 30,000+ patients, with over 700 variables per patient, mostly collected through automated data pulls from the electronic health record using algorithms developed and validated by our team.
WHAT the innovation entailed:
Multiple deliverables came out of the Registry. The innovation we would like you to consider is the world’s first risk calculator that integrates a patient’s clinical characteristics, signs and symptoms, social determinants of health, medications, and vaccinations, to forecast an individualized risk of having COVID, and of progressing to severe disease. These calculators have been published in high impact academic journals (CHEST, the official journal of the American College of chest physicians), and are publicly available at https://riskcalc.org/COVID19/ and https://riskcalc.org/COVID19Hospitalization/ . Both calculators have been integrated in the clinical workflow across our healthcare system. Physicians answer a few simple questions about the patient, our informatics team developed a system to automate abstraction of 32 additional data elements that are linked through APIs and research algorithms to generate individualized risk predictions displayed instantaneously on the patient’s electronic health record (figure of a screenshot from a patient's EHR is uploaded). Press releases are also attached (both received national media attention).
HOW it generated results:
These calculators have significantly helped us tailor patient care.
Forecasting the risk of progression to severe disease has allowed us to prioritize high risk patients for closer follow-up after they test positive for COVID. Knowing that only 20% of all COVID positive patients ever progress to hospitalization, and being able to identify those 20% practically at the point of testing, has been crucial in making sure that patients who need care the most receive it first, and that our healthcare manpower resources are adequately targeting their efforts.
Forecasting the risk of having COVID has been adapted by several partners and collaborating institutions as validated "Symptom Checker" to screen patients, to identify who is safe to return to work or who needs to be tested.
Improved the care of patient populations
Provider
Health Services Support
Virginia
Yvonne
Hobson
Program Manager
(210) 536-7337
yvonne.a.hobson4.civ@mail.mil
Health Services Support (HSS) Program Management Office (PMO) has established user friendly resources to eliminate the restrictions and limitations COVID19 have caused and continue to meet the needs of the patient.
Improved the care of patient populations
Provider
Ascent Powered By Sober Grid
Ohio
Beau
Mann
CEO
8572060569
beau@sobergrid.com
The majority of people who. undergo medical treatment for Substance Use Disorders relapse after completion of. the SUD. treatment
We developed artificial intelligence that can accurately predict a person with Substance Use Disorder heightened risk of relapsing. We accomplished this by using natural language processing and deep learning algorithms.
This has allowed us to predict relapse. but knowing that someone is approaching a higher risk of relapse is not enough! You need to be able to do something about it. So we acquired a 24/7 telehealth mental health and substance use disorder recovery coaching business that will deliver interventions to those that are predicted to have a high risk of relapse. Doing so will lower the relapse and overdose death rates.
We have innovated in our space and have made measurable results to our field of addiction medicine.
We accomplished this with a team of researchers, scientists, and institutions.. Specifically Sober Grid had recruited a R&D team of individuals from Harvard Medical School and Univ of Pennsylvania Perelman School of Medicine. The National Institutes of Health sponsored the work
We developed artificial intelligence that can accurately predict a person with Substance Use Disorder heightened risk of relapsing. We accomplished this by using natural language processing and deep learning algorithms.
This has allowed us to predict relapse. but knowing that someone is approaching a higher risk of relapse is not enough! You need to be able to do something about it. So we acquired a 24/7 telehealth mental health and substance use disorder recovery coaching business that will deliver interventions to those that are predicted to have a high risk of relapse. Doing so will lower the relapse and overdose death rates.
We have innovated in our space and have made measurable results to our field of addiction medicine.
We accomplished this with a team of researchers, scientists, and institutions.. Specifically Sober Grid had recruited a R&D team of individuals from Harvard Medical School and Univ of Pennsylvania Perelman School of Medicine. The National Institutes of Health sponsored the work
Improved the care of patient populations
Provider
Stanford Health Care
California
Amy
Yotopoulos
Manager
650-407-8564
ayotopoulos@stanfordhealthcare.org
Under the direction and sponsorship of Alpa Vyas, the VP of Patient Experience at Stanford Health Care, our team created an innovative program to operationalize Stanford Medicine’s integrated strategic plan by putting “patients and caregivers at the center of the experience.” The data is clear: including family caregivers as an essential part of the care team results in higher quality care and better outcomes for the patients by, for example, improving medication management. It thus reduces long-term healthcare costs and also improves patient satisfaction scores. Certainly, while integrating caregivers is of vital importance, the challenge lies in bringing together the multidisciplinary team, and uniting them to achieve the goal.
In Stanford HealthCare’s newly opened hospital, we carved out a 2000 sq. foot space dedicated to supporting family caregivers. The Family Resource Center (FRC) is a unique place of connection, guidance and respite for caregivers, where the most common response when they enter is awe and “is this all really for me?” The Caregiver Center and Health Library are the anchors of the FRC. Anyone walking into the space is met “where they are” in the moment. As appropriate, caregivers and families are provided connection to our volunteer caregiver coaches, guidance on caregiving, or respite from the storm.
Now more than ever, our partnerships and collaborations are essential for meeting the needs of our caregivers. For people with unanswered health questions, our Health Librarians provide free research. Additionally, we co-create and cross-refer programming with our Supportive Care Program (Oncology and Neuroscience) and Palliative Care teams to offer free workshops and webinars to families as well as the community. We have built referral relationships with the Spiritual Care, Social Work/Case Management, and Volunteer Resources department, to ensure our caregivers get the support they need.
In the 4.5 months we were open prior to closing for COVID-19, we piloted rounding on a neuroscience unit and met 1:1 with 100 caregivers (for a total of over 900 minutes), in addition to assisting 2175 caregivers at the FRC. Since closing for COVID-19, we have pivoted to virtual support and conducted 69, 1:1 consultations with caregivers. Additionally, we have reached more than 3700 caregivers through webinars, blog articles, direct outreach, and on our website.
Our Caregiver program is a multi-disciplinary effort that is integrated into the clinical care delivery system. A broad variety of departments have come together to support patients, families, and caregivers, both virtually and in-person. We have created a specific area in our electronic health record (EPIC) to identify and document family caregivers, and we have streamlined our patient portal (MyHealth) app to increase ease of share (proxy) access for families. Working directly with individual units, we have rounded on patient floors to connect with caregivers, and now are able to do so virtually through partnering with Volunteer Services. In addition, we are able to support our large insurer groups with specialized information through webinars and specific products.
The uptick in our Patient Experience scores (80.5% FY19 to 82.3% FY20), as well as many sincere expressions of gratitude from caregivers shows that we are supporting our caregivers and ensuring they are essential to the care of their loved ones.
Supporting Documents:
https://scopeblog.stanford.edu/2019/06/24/designing-the-new-stanford-hospital-for-patients-and-caregivers/
https://scopeblog.stanford.edu/2020/07/20/message-to-family-caregivers-theres-help-even-during-covid-19/
https://scopeblog.stanford.edu/2019/11/25/thats-somebodys-mother-improving-the-patient-experience-a-podcast/
https://vimeo.com/444363587
In Stanford HealthCare’s newly opened hospital, we carved out a 2000 sq. foot space dedicated to supporting family caregivers. The Family Resource Center (FRC) is a unique place of connection, guidance and respite for caregivers, where the most common response when they enter is awe and “is this all really for me?” The Caregiver Center and Health Library are the anchors of the FRC. Anyone walking into the space is met “where they are” in the moment. As appropriate, caregivers and families are provided connection to our volunteer caregiver coaches, guidance on caregiving, or respite from the storm.
Now more than ever, our partnerships and collaborations are essential for meeting the needs of our caregivers. For people with unanswered health questions, our Health Librarians provide free research. Additionally, we co-create and cross-refer programming with our Supportive Care Program (Oncology and Neuroscience) and Palliative Care teams to offer free workshops and webinars to families as well as the community. We have built referral relationships with the Spiritual Care, Social Work/Case Management, and Volunteer Resources department, to ensure our caregivers get the support they need.
In the 4.5 months we were open prior to closing for COVID-19, we piloted rounding on a neuroscience unit and met 1:1 with 100 caregivers (for a total of over 900 minutes), in addition to assisting 2175 caregivers at the FRC. Since closing for COVID-19, we have pivoted to virtual support and conducted 69, 1:1 consultations with caregivers. Additionally, we have reached more than 3700 caregivers through webinars, blog articles, direct outreach, and on our website.
Our Caregiver program is a multi-disciplinary effort that is integrated into the clinical care delivery system. A broad variety of departments have come together to support patients, families, and caregivers, both virtually and in-person. We have created a specific area in our electronic health record (EPIC) to identify and document family caregivers, and we have streamlined our patient portal (MyHealth) app to increase ease of share (proxy) access for families. Working directly with individual units, we have rounded on patient floors to connect with caregivers, and now are able to do so virtually through partnering with Volunteer Services. In addition, we are able to support our large insurer groups with specialized information through webinars and specific products.
The uptick in our Patient Experience scores (80.5% FY19 to 82.3% FY20), as well as many sincere expressions of gratitude from caregivers shows that we are supporting our caregivers and ensuring they are essential to the care of their loved ones.
Supporting Documents:
https://scopeblog.stanford.edu/2019/06/24/designing-the-new-stanford-hospital-for-patients-and-caregivers/
https://scopeblog.stanford.edu/2020/07/20/message-to-family-caregivers-theres-help-even-during-covid-19/
https://scopeblog.stanford.edu/2019/11/25/thats-somebodys-mother-improving-the-patient-experience-a-podcast/
https://vimeo.com/444363587
Enhanced the patient experience
Provider
Memorial Health System
Illinois
Michael
Kos
Vice President, Revenue Cycle
217-588-2674
kos.michael@mhsil.com
Innovation can occur during a pandemic! Memorial Health System (“MHS”) recently underwent an affiliation with Decatur Memorial Hospital (“DMH”) on October 1, 2019. Prior to affiliation, our SVP and CFO had the foresight to establish regular meetings to help integrate DMH into the health system. At affiliation, DMH had a number of significant areas of opportunity within the revenue cycle. DMH currently utilizes EPIC for revenue cycle functionality – which is different from other MHS facilities. Through evaluation during the affiliation process, it was determined that adoption of lean six sigma methodology would benefit DMH
Enhanced the patient experience
Provider
Stanford Medicine/Department of Emergency Medicine
California
Sam
Shen
Clinical Associate Professor
5089656007
sshen01@stanford.edu
At Stanford Healthcare, a level 1 trauma center and academic medical center in Palo Alto, we designed and implemented an Emergency Department (ED) telemedicine drive through model for rapid Covid-19 testing at the beginning of the pandemic in March 2020. Early in the pandemic, Stanford Healthcare developed a molecular COVID-19 test and was one of the few institutions in the bay area with the capability to perform the test. We recognized how important it was to provide access to for symptomatic patients and eventually asymptomatic patients. The ability to quickly screen and test patients is critical for managing the COVID-19 outbreak. The ED often serves as a safety net to the community due to the 24/7 availability of health care professionals and resources to care for patients. In anticipation of the surge of patients we would likely encounter, we assembled a multidisciplinary team involving ED physicians, nurses, ED staff, representatives from disaster management, laboratory, registration, security, infection prevention, infectious diseases, and information technology. Through this team-based approach, we implemented a drive through model leveraging existing technologies to facilitate a rapid COVID-19 testing workflow that enabled patients to drive up to our ED and be tested for COVID-19 using our RT-PCT test within a 45 minutes window on average from start to finish. Specifically, the service involved a nurse wearing full personal protective equipment screening all patients arriving to the ED. based on a set of questions pertaining to specific symptoms in addition to a few vital signs, if the patient met criteria for potential COVID-19 infection, the patients would remain in the vehicle and a scan of their driver's license would be sent to a registration person in the garage. The patient would be directed to drive to our adjacent parking garage where a team of registration, RN, and tech would greet them to answer additional questions. An emergency medicine physician would be stationed in the ED and would perform a quick assessment with a telemedicine 2 way audio-visual cart that is pulled up to the window of the car. The patient would then be swabbed by the nurse and provided discharge paperwork. There were several benefits to this model. Besides providing an efficient access point for COVID-19 testing, it also enhanced healthcare worker and patient safety by reducing risk of infection transmission as well as reduce the use of personal protective equipment as the medical team did not have to routinely change N95 masks, gowns, and faceshields for every encounter. We have continued to rely on this model since the initial outbreak and have used it for asymptomatic testing of front line essential workers as well as those that are symptomatic or have been exposed. In summary, this was an innovative solution to increase critical access to testing while enhancing workforce and patient safety.
Improved the care of patient populations
Provider
Houston Methodist
Texas
Dr Nicholas
Desai
CMIO
2814138415
sdesai2@houstonmethodist.org
In today’s world, authentic human-to-human connections are becoming increasingly rare. As technology evolves, it can feel as if technology drives itself between us. The last place someone should feel divided by technology is with their doctor. How many times have you scheduled a visit with your doctor to find they spent most of the time hunched over their computer entering notes about the visit? Or had a resident scribing details of the visit for them? Clinical visits should only be enhanced with the presence of technology in the room. Providers are also having to learn to juggle an increasing number of tools and services. Managing appointments, high patient throughput, and a revolving door of technological solutions can lead to higher physician burnout rates.
Houston Methodist (Roberta Schwartz + Innovation Center), through key partnerships such as Pariveda Solutions is working to increase patient engagement and reduce physician burnout by leveraging today's latest AI and NLP powered tools. The Ambient Listen project vision is to create a central voice-powered collaboration and documentation tool: a clinical voice platform.
Through specialized hardware in the room, the solution will transcribe the doctor-patient interaction and draft the note for the doctor to post directly into their current EHR system with the push of a button. This integration provides a seamless workflow for the provider to review their appointments, patient charts, document the visit, and add back to the patient record using the latest in EHR interoperability protocols. All of this can be achieved through a single control device, moving with the physician from room to room. By automating this workflow, doctors are not only able to see more patients on any given day but focus on deeper connections with their patients. Their attention and focus moves away from the computer and back to the patient. By removing the need for doctors to jot down notes, or fiddle with complicated user interfaces, patients truly feel heard. Trust is built quicker and more deliberately with their doctor when they can have a face-to-face conversation unobstructed by technology.
Our solution is an inter-disciplinary effort; bringing together industry experts from multiple backgrounds allow for a higher diversity of thought and a more robust solution catering to many perspectives, from the patient to the physician. Pariveda’s technological expertise and process/workflow refinement experience, coupled with the best physicians from Houston Methodist, has resulted in a highly efficient, and
optimized provider workflow tool.
Ambient Listen is controlled through a personal carry size device that travels between rooms. The provider can authenticate against their EHR system and retrieve patient schedules and detailed information needed for their appointment. The control device can then be used to activate a specialized microphone array to capture the conversation once the details of the process have clearly been explained and the patient has provided consent. Transcription and processing AI is powered by a HIPAA compliant cloud backend. Security and patient privacy is a top concern, and we have worked to ensure we are up to date on networking and patient privacy guidelines. Once the conversation ends, the provider can turn back to their control device to generate a summary of the visit to be sent home with the patient and notes to be added to the patient’s EMR. Edit controls and overrides are provided so that the physician is always in control of the technology in the room and can validate the result before committing. Our integration with EHR systems utilizes the latest interoperability protocols and standards to ensure smooth integration across EHR vendors.
Our solution is an inter-disciplinary effort; bringing together industry experts from multiple backgrounds allow for a higher diversity of thought and a more robust solution catering to many perspectives, from the patient to the physician. Houston Methodist employs the world’s best physicians, and coupled with Pariveda’s technological expertise and process/workflow refinement experience, has resulted in a highly efficient, and optimized provider workflow tool.
Houston Methodist (Roberta Schwartz + Innovation Center), through key partnerships such as Pariveda Solutions is working to increase patient engagement and reduce physician burnout by leveraging today's latest AI and NLP powered tools. The Ambient Listen project vision is to create a central voice-powered collaboration and documentation tool: a clinical voice platform.
Through specialized hardware in the room, the solution will transcribe the doctor-patient interaction and draft the note for the doctor to post directly into their current EHR system with the push of a button. This integration provides a seamless workflow for the provider to review their appointments, patient charts, document the visit, and add back to the patient record using the latest in EHR interoperability protocols. All of this can be achieved through a single control device, moving with the physician from room to room. By automating this workflow, doctors are not only able to see more patients on any given day but focus on deeper connections with their patients. Their attention and focus moves away from the computer and back to the patient. By removing the need for doctors to jot down notes, or fiddle with complicated user interfaces, patients truly feel heard. Trust is built quicker and more deliberately with their doctor when they can have a face-to-face conversation unobstructed by technology.
Our solution is an inter-disciplinary effort; bringing together industry experts from multiple backgrounds allow for a higher diversity of thought and a more robust solution catering to many perspectives, from the patient to the physician. Pariveda’s technological expertise and process/workflow refinement experience, coupled with the best physicians from Houston Methodist, has resulted in a highly efficient, and
optimized provider workflow tool.
Ambient Listen is controlled through a personal carry size device that travels between rooms. The provider can authenticate against their EHR system and retrieve patient schedules and detailed information needed for their appointment. The control device can then be used to activate a specialized microphone array to capture the conversation once the details of the process have clearly been explained and the patient has provided consent. Transcription and processing AI is powered by a HIPAA compliant cloud backend. Security and patient privacy is a top concern, and we have worked to ensure we are up to date on networking and patient privacy guidelines. Once the conversation ends, the provider can turn back to their control device to generate a summary of the visit to be sent home with the patient and notes to be added to the patient’s EMR. Edit controls and overrides are provided so that the physician is always in control of the technology in the room and can validate the result before committing. Our integration with EHR systems utilizes the latest interoperability protocols and standards to ensure smooth integration across EHR vendors.
Our solution is an inter-disciplinary effort; bringing together industry experts from multiple backgrounds allow for a higher diversity of thought and a more robust solution catering to many perspectives, from the patient to the physician. Houston Methodist employs the world’s best physicians, and coupled with Pariveda’s technological expertise and process/workflow refinement experience, has resulted in a highly efficient, and optimized provider workflow tool.
Improved the life of healthcare providers
Provider
Mid-Atlantic Behavioral Health
Delaware
Traci
Bolander
Founder and CEO
302-224-1400 ext 304
tbolander@midatlanticbh.com
NeuroFlow's platform technology for behavioral health care enablement. The technology has delivered results for my organization, by aggregating data insights and helping me adopt a better system for telehealth during the pandemic.
Improved the care of patient populations
Provider
Peninsula Community Health Services
Washington
Aaron
Forster
CIO
360-475-6708
arforster@pchsweb.org
Everyone is talking about how telehealth is here for the forever future. One of the ways we have decided to embrace telehealth in an innovative way has nothing to do with where the debate will land on how it should be paid for, what documentation will need to look like, and how it will fit into the value-based payment/quality incentive world. We have found a way that anyone can utilize any investment they have made in infrastructure of hardware (we use tablets - but cell phones will work) with any HIPAA-compliance software platform (we use the free doxy.me platform) to enhance the patient experience during select patient encounters. We found that as we head back to our school-based centers, we can now use our telehealth technology to allow our parents/guardians to be an active part of our school-based visits. We had previously often needed to call parents/guardians to get consent to see their kids. Now, when we call, we ask the parent/guardian if they would like to join in on a virtual visit and stay for the face-to-face encounter we are having with the child. Similarly, we can now have our behavioral health patients invite the supportive individuals in their lives to attend visits virtually, especially during this time of COVID when we are limiting visitors to our clinics. As we do more enhancing of the face-to-face patient experience with telehealth, we foresee allowing grandparents from afar to attend newborn visits and deployed parents to see baby's first ultrasound. Although it seems like such an obvious solution, we simply did not have the widespread telehealth infrastructure or provider familiarly with a telehealth platform before COVID.
Enhanced the patient experience
Provider
Dartmouth Hitchcock Medical Center / Geisel School of Medicine at Dartmouth
New Hampshire
Nirav
Kapadia
Medical Director, The Susan and Richard Levy Healthcare Delivery Incubator
410-900-2668
nirav.s.kapadia@hitchcock.org
The Susan and Richard Levy Healthcare Delivery Incubator seeks to leverage the multidisciplinary nature of health care innovation by providing diverse teams the time and support to explore and solve a healthcare challenge affecting patients coping with serious illness. The Incubator primarily funds the team members' time, so that they can effectively meet and coordinate their health care redesign solution. Funding was announced in mid-2019, and the first cohort of teams is underway in their healthcare redesign work. Three teams were chosen as part of the initial cohort, focusing on:
1) Reducing length of stay for neonatal intensive care patients by transferring them home "The Hope Grows at Home" program
2) Diverting inpatient admission for patients requiring intravenous diuresis for congestive heart failure overload
3) Outpatient addiction antibiotic therapy for patients requiring inpatient admission for IV drug-related infectious complications.
In its first year, the Incubator received 15 applications for the 3 funded projects, In its second year, it received 38 applications and has committed to funding 4 projects, described below:
1) Providing accelerated mental health recovery through enhanced psychiatric boarding of pediatric patients
2) Reducing stigma and increasing access for patients with viral hepatitis, sexually transmitted Infections, and HIV
3) Using technology and team-based care to reduce readmissions, ED visits, and length of stay for patients at high risk of readmission
4) Reducing length of stay for elderly patients undergoing surgery
The COVID-19 pandemic introduced a delay to the workflow of the first cohort, but they have recently restarted work. The second cohort will begin work January 1, 2021.
We invite you and your team to meet with our leadership and project teams to better understand our deliberate approach to healthcare design.
1) Reducing length of stay for neonatal intensive care patients by transferring them home "The Hope Grows at Home" program
2) Diverting inpatient admission for patients requiring intravenous diuresis for congestive heart failure overload
3) Outpatient addiction antibiotic therapy for patients requiring inpatient admission for IV drug-related infectious complications.
In its first year, the Incubator received 15 applications for the 3 funded projects, In its second year, it received 38 applications and has committed to funding 4 projects, described below:
1) Providing accelerated mental health recovery through enhanced psychiatric boarding of pediatric patients
2) Reducing stigma and increasing access for patients with viral hepatitis, sexually transmitted Infections, and HIV
3) Using technology and team-based care to reduce readmissions, ED visits, and length of stay for patients at high risk of readmission
4) Reducing length of stay for elderly patients undergoing surgery
The COVID-19 pandemic introduced a delay to the workflow of the first cohort, but they have recently restarted work. The second cohort will begin work January 1, 2021.
We invite you and your team to meet with our leadership and project teams to better understand our deliberate approach to healthcare design.
Improved the care of patient populations
Provider
UCHealth
Colorado
Amy
Hassell
Nursing Director of Virtual Health Center
303-681-6063
amy.hassell@uchealth.org
Improving sepsis treatment is key to improving global health and wellness. There are an estimated 20 to 30 million cases of sepsis a year worldwide. Sepsis is a leading cause of death in U.S. hospitals—accounting for one in every five hospital deaths. Timely and effective care of sepsis, including adherence to evidence-based guidelines, continues to be a major priority.
Upon reviewing their sepsis data, UCHealth observed a significant variation in their EMR workflows and outcomes. Best practice alerts would fire frequently with the intent to aid in sepsis identification, taking valuable time away from health professionals. To increase and standardize sepsis care systemwide, UCHealth created a telemedicine-based sepsis detection and response system, using AI to implement a nurse-driven and physician-supported CMS care bundle.
In an effort to reduce burden on health professionals and enhance sepsis outcomes, UCHealth implemented a virtual sepsis response in a phased approach through their Virtual Health Center (VHC). The VHC provides coordinated for care health professionals, allowing remote teams to investigate warnings generated by alerts.
Acknowledging the ever-increasing demands on nurses—including increased prevalence of best practice alerts, clinical alert systems and alarm fatigue—the VHC provides remote surveillance for both deterioration and sepsis care in real time. The remote center utilizes AI, as well as two simple physiologic scoring tools, based on data from an acute care wearable device. The wearable allows for the continuous monitoring of vital signs and has the ability to ingest pre-validated data. Experienced critical care clinicians are able to use this multimodal alert system to provide earlier care locally.
UCHealth designed and implemented a nursing-driven workflow focused on sepsis treatment, utilizing both the local primary nurse and remote critical care nurse. Per CMS bundle guidelines, if initial workup results show signs of abnormalities, the remote center physician works in collaboration with the local physician to deliver care accordingly. If needed, the remote center physician is authorized to initiate the sepsis bundle in lieu of the bedside care team.
Using a phased approach, all UCHealth acute and progressive care units implemented the virtual sepsis program by May 2019. The rollout continued across the system, with hospitals in southern Colorado going live in October 2019 and hospitals in northern Colorado going live in January 2020. By March 2020, all UCHealth hospitals were enrolled—with 1,250 acute care inpatient beds available for sepsis monitoring.
Since implementing new nursing-driven workflows with increased standardization to evidence-based best practices, UCHealth has observed remarkable results:
• 59-minute reduction in time obtaining blood cultures
• 33-minute reduction in time administering antibiotics
• 63-minute reduction in time administering fluids
• 215,000+ best practice alerts avoided
• ~30% decrease in sepsis mortality
The reductions in time to metrics for sepsis care translated to a reduction of non- present on admission sepsis mortality from a 2.79 pre-baseline period (October 2018 to May 2019) to a 1.51 mortality index post intervention period ( October 2019 to May 2020).
Upon reviewing their sepsis data, UCHealth observed a significant variation in their EMR workflows and outcomes. Best practice alerts would fire frequently with the intent to aid in sepsis identification, taking valuable time away from health professionals. To increase and standardize sepsis care systemwide, UCHealth created a telemedicine-based sepsis detection and response system, using AI to implement a nurse-driven and physician-supported CMS care bundle.
In an effort to reduce burden on health professionals and enhance sepsis outcomes, UCHealth implemented a virtual sepsis response in a phased approach through their Virtual Health Center (VHC). The VHC provides coordinated for care health professionals, allowing remote teams to investigate warnings generated by alerts.
Acknowledging the ever-increasing demands on nurses—including increased prevalence of best practice alerts, clinical alert systems and alarm fatigue—the VHC provides remote surveillance for both deterioration and sepsis care in real time. The remote center utilizes AI, as well as two simple physiologic scoring tools, based on data from an acute care wearable device. The wearable allows for the continuous monitoring of vital signs and has the ability to ingest pre-validated data. Experienced critical care clinicians are able to use this multimodal alert system to provide earlier care locally.
UCHealth designed and implemented a nursing-driven workflow focused on sepsis treatment, utilizing both the local primary nurse and remote critical care nurse. Per CMS bundle guidelines, if initial workup results show signs of abnormalities, the remote center physician works in collaboration with the local physician to deliver care accordingly. If needed, the remote center physician is authorized to initiate the sepsis bundle in lieu of the bedside care team.
Using a phased approach, all UCHealth acute and progressive care units implemented the virtual sepsis program by May 2019. The rollout continued across the system, with hospitals in southern Colorado going live in October 2019 and hospitals in northern Colorado going live in January 2020. By March 2020, all UCHealth hospitals were enrolled—with 1,250 acute care inpatient beds available for sepsis monitoring.
Since implementing new nursing-driven workflows with increased standardization to evidence-based best practices, UCHealth has observed remarkable results:
• 59-minute reduction in time obtaining blood cultures
• 33-minute reduction in time administering antibiotics
• 63-minute reduction in time administering fluids
• 215,000+ best practice alerts avoided
• ~30% decrease in sepsis mortality
The reductions in time to metrics for sepsis care translated to a reduction of non- present on admission sepsis mortality from a 2.79 pre-baseline period (October 2018 to May 2019) to a 1.51 mortality index post intervention period ( October 2019 to May 2020).
Improved the care of patient populations
Provider
Solution Delivery Division of the Defense Health Agency
Virginia
Michael
Clay
Program Manager, Data Quality and Integration Office
210-536-7286
Michael.c.clay2mil@mail.mil
THE CHALLENGE:
Duplicate records and other patient identity issues continually plague the healthcare industry at levels as high as 22%. In 2016, patient identity issues in the Military Health System (MHS) were at about 10% equating to over 2 million duplicate, fragmented, and crossed patient health records worldwide affecting thousands of hospitals and clinics. That number continued to grow until DHA instituted a proactive data quality plan to resolve this challenge. Previously, these issues were only resolved after they impacted patient care or veteran benefits and were reported by a clinician to a Service Desk which takes away time from providing quality patient care. About 9,000 incidents were being reported each month. The Service Desk model proved to be slow and costly. Furthermore, these processes did not synchronize patient identities and health records across multiple Electronic Health Records (EHRs), oftentimes creating more errors.
WHO WAS IMPACTED & WHAT WAS INVOLVED IN THE INNOVATION:
Patients are impacted when identity issues exist in a number of ways including delay in care/treatment, treatment of the wrong patient (such as with multiple births), missed diagnoses and/or repeat tests or studies. Service members separating or retiring were experiencing delays or even denials of appropriate veteran benefits. Billing departments are left to deal with rejected claims and data scientists are challenged with poor population health metrics.
The DHA repurposed their reactive Service Desk model to a proactive model identifying and fixing patient identity issues before they impact users. Our team's vision is data that is “Fit for Use”, with the goal of ensuring each patient has a single identity and one complete health record synchronized across multiple systems. This required identifying the baseline of current patient identity issues, prioritizing records of current active beneficiaries, creating synchronized analysis and remediation processes in accordance with data flows to avoid re-work, and implementing operational monitoring and remediation to stop the growth of newly created issues.
WHAT THE INNOVATION ENTAILED:
Implementing a new, proactive, and automated enterprise-wide approach, the team leveraged IT to automatically identify and fix issues as they occur. The key factor to success was developing and implementing standardized identity trait matching rules and quality control logic to automate the resolution process. Speaking with our stakeholders, such as the Record Processing Centers (RPCs), permitted the team to hone these processes. Understanding their challenges, the team documented requirements and developed processes to prevent the delay or denial of veterans' benefits due to data issues.
THE RESULTS:
By January 2020, the DHA Data Quality & Integration team proactively remediated 2.030M patients identity issues in multiple systems, which cleaned all of the active patient population. This proactive clean-up dropped our duplicate record level to less than 5%, eliminated $194 million in future Service Desk costs and, reduced incoming tickets by 98%, from 9000 to 200 per month. In collaboration with the RPCs, the team resolved identified data issues preventing the delay and/or denial of benefits for thousands of service members. All EHR systems will generate new duplicate records and various other data quality issues, caused by operator workflow constraints to system errors. To meet our vision, the team implemented ongoing “Operational Monitoring” for over 9 million active beneficiaries to proactively identify, track and resolve patient identity quality data issues as they are created. By implementing ongoing Operational Monitoring and combining automated and manual remediation, a backlog of data issues will not occur nor will an existing backlog increase, resulting in overall cost avoidance and more accurate patient data.
SUMMARY:
EHR systems within the DHA, like all commercial systems, are subject to duplicate and fragmented records as well as other data quality issues. No system is immune. Proactive data quality practices with sound data governance are key to avoiding higher costs, poor care, and erosion of patient and provider confidence associated with bad data. Furthermore, innovation and continual service improvement has led to significant cost savings, better data, and improved patient outcomes within the DHA.
Duplicate records and other patient identity issues continually plague the healthcare industry at levels as high as 22%. In 2016, patient identity issues in the Military Health System (MHS) were at about 10% equating to over 2 million duplicate, fragmented, and crossed patient health records worldwide affecting thousands of hospitals and clinics. That number continued to grow until DHA instituted a proactive data quality plan to resolve this challenge. Previously, these issues were only resolved after they impacted patient care or veteran benefits and were reported by a clinician to a Service Desk which takes away time from providing quality patient care. About 9,000 incidents were being reported each month. The Service Desk model proved to be slow and costly. Furthermore, these processes did not synchronize patient identities and health records across multiple Electronic Health Records (EHRs), oftentimes creating more errors.
WHO WAS IMPACTED & WHAT WAS INVOLVED IN THE INNOVATION:
Patients are impacted when identity issues exist in a number of ways including delay in care/treatment, treatment of the wrong patient (such as with multiple births), missed diagnoses and/or repeat tests or studies. Service members separating or retiring were experiencing delays or even denials of appropriate veteran benefits. Billing departments are left to deal with rejected claims and data scientists are challenged with poor population health metrics.
The DHA repurposed their reactive Service Desk model to a proactive model identifying and fixing patient identity issues before they impact users. Our team's vision is data that is “Fit for Use”, with the goal of ensuring each patient has a single identity and one complete health record synchronized across multiple systems. This required identifying the baseline of current patient identity issues, prioritizing records of current active beneficiaries, creating synchronized analysis and remediation processes in accordance with data flows to avoid re-work, and implementing operational monitoring and remediation to stop the growth of newly created issues.
WHAT THE INNOVATION ENTAILED:
Implementing a new, proactive, and automated enterprise-wide approach, the team leveraged IT to automatically identify and fix issues as they occur. The key factor to success was developing and implementing standardized identity trait matching rules and quality control logic to automate the resolution process. Speaking with our stakeholders, such as the Record Processing Centers (RPCs), permitted the team to hone these processes. Understanding their challenges, the team documented requirements and developed processes to prevent the delay or denial of veterans' benefits due to data issues.
THE RESULTS:
By January 2020, the DHA Data Quality & Integration team proactively remediated 2.030M patients identity issues in multiple systems, which cleaned all of the active patient population. This proactive clean-up dropped our duplicate record level to less than 5%, eliminated $194 million in future Service Desk costs and, reduced incoming tickets by 98%, from 9000 to 200 per month. In collaboration with the RPCs, the team resolved identified data issues preventing the delay and/or denial of benefits for thousands of service members. All EHR systems will generate new duplicate records and various other data quality issues, caused by operator workflow constraints to system errors. To meet our vision, the team implemented ongoing “Operational Monitoring” for over 9 million active beneficiaries to proactively identify, track and resolve patient identity quality data issues as they are created. By implementing ongoing Operational Monitoring and combining automated and manual remediation, a backlog of data issues will not occur nor will an existing backlog increase, resulting in overall cost avoidance and more accurate patient data.
SUMMARY:
EHR systems within the DHA, like all commercial systems, are subject to duplicate and fragmented records as well as other data quality issues. No system is immune. Proactive data quality practices with sound data governance are key to avoiding higher costs, poor care, and erosion of patient and provider confidence associated with bad data. Furthermore, innovation and continual service improvement has led to significant cost savings, better data, and improved patient outcomes within the DHA.
Reduced healthcare costs
Provider
Solution Delivery Division of the Defense Health Agency
Virginia
James
Copeland
TRICARE Online Patient Portal portfolio manager
(703) 882-3876
james.d.copeland.civ@mail.mil
THE CHALLENGE:
The COVID-19 pandemic created a significant challenge to military health care providers as process adjustments were made to triage, evaluate and care for patients using methods that do not rely on in-person services. The Defense Health Agency (DHA) TRICARE Online Patient Portal (TOL PP) team innovativley met the challenge by minimizing patient contact while providing medical services. The TOL PP enabled the Medical Health Service expanded access to care at a time when the pandemic severely restricted patient's ability to see their doctors.
WHO WAS IMPACTED & WHAT WAS INVOLVED IN THE INNOVATION:
Involved in the innovations is James Copeland, TOL PP portfolio manager. A retired Air Force Officer, he manages two patient engagement systems for the Military Health System (MHS), TOL PP and Secure Messaging. The TOL PP team also partnered with the DHA Health Services Support Program Management Office Surgical Scheduling System team and the Cisco Telepresence Management System team.
He led the following three key health information technology innovations for the TOL PP team during the COVID-19 pandemic:
1. Virtual COVID-19 screening and virtual doctor visits
2. Rapid delivery of COVID-19 test results
3. Use of contact-less routine health care services
Copeland's team created a tool used to screen patients for COVID-19 and provided virtual doctor appointments. The system is known as the innovative Virtual Health Video Scheduling (VHVS) prototype. The VHVS enables MHS patients to access their providers via virtual appointments, allowing them to comply with social distancing guidelines reducing the spread of the virus. Inside the portal, patients provide a phone number and answer two screening questions before being allowed to make a COVID-19 virtual visit appointment. The short screening process allows the MHS to quickly assess whether patients have COVID-19 symptoms or some other ailment. If they don't have COVID-19 symptoms, they are told so, giving them reassurance. If they do have COVID-19 symptoms, they can make a virtual visit appointment, and a health care provider will contact them at the number they provided.
Mr. Copeland's team developed an update to the TOL PP that enables patients tested for COVID-19, or the flu, at military treatment facilities (MTFs) to receive expedited test results, letting them know they need to self-isolate. The TOL PP team successfully launched the update in less than 48 hours.
Mr. Copeland's team transformed the TOL PP into an indispensable resource for COVID-19 updates and routine health care resources.
RESULT:
Since March 2020, the TOL PP has processed more than one million contactless pharmacy refills, more than 20 million healthcare record views, and 100, 000 virtual appointments. Patients sent approximately 40% more messages to their healthcare team compared to pre-COVID-19. Since March 2020, Military hospitals and clinics sent over 6 million broadcast messages to patients to communicate changes in MTF hours and operations. Healthcare teams used TOL PP Secure Messaging to augment virtual care capability by allowing patients to send pictures from their patients.
Mr. Copelands' efforts directly resulted in improved access to care, better outcomes and a more efficient MHS. His contributions to TOL PP and the DHA make him a notable standout as a Health Care Innovator.
The COVID-19 pandemic created a significant challenge to military health care providers as process adjustments were made to triage, evaluate and care for patients using methods that do not rely on in-person services. The Defense Health Agency (DHA) TRICARE Online Patient Portal (TOL PP) team innovativley met the challenge by minimizing patient contact while providing medical services. The TOL PP enabled the Medical Health Service expanded access to care at a time when the pandemic severely restricted patient's ability to see their doctors.
WHO WAS IMPACTED & WHAT WAS INVOLVED IN THE INNOVATION:
Involved in the innovations is James Copeland, TOL PP portfolio manager. A retired Air Force Officer, he manages two patient engagement systems for the Military Health System (MHS), TOL PP and Secure Messaging. The TOL PP team also partnered with the DHA Health Services Support Program Management Office Surgical Scheduling System team and the Cisco Telepresence Management System team.
He led the following three key health information technology innovations for the TOL PP team during the COVID-19 pandemic:
1. Virtual COVID-19 screening and virtual doctor visits
2. Rapid delivery of COVID-19 test results
3. Use of contact-less routine health care services
Copeland's team created a tool used to screen patients for COVID-19 and provided virtual doctor appointments. The system is known as the innovative Virtual Health Video Scheduling (VHVS) prototype. The VHVS enables MHS patients to access their providers via virtual appointments, allowing them to comply with social distancing guidelines reducing the spread of the virus. Inside the portal, patients provide a phone number and answer two screening questions before being allowed to make a COVID-19 virtual visit appointment. The short screening process allows the MHS to quickly assess whether patients have COVID-19 symptoms or some other ailment. If they don't have COVID-19 symptoms, they are told so, giving them reassurance. If they do have COVID-19 symptoms, they can make a virtual visit appointment, and a health care provider will contact them at the number they provided.
Mr. Copeland's team developed an update to the TOL PP that enables patients tested for COVID-19, or the flu, at military treatment facilities (MTFs) to receive expedited test results, letting them know they need to self-isolate. The TOL PP team successfully launched the update in less than 48 hours.
Mr. Copeland's team transformed the TOL PP into an indispensable resource for COVID-19 updates and routine health care resources.
RESULT:
Since March 2020, the TOL PP has processed more than one million contactless pharmacy refills, more than 20 million healthcare record views, and 100, 000 virtual appointments. Patients sent approximately 40% more messages to their healthcare team compared to pre-COVID-19. Since March 2020, Military hospitals and clinics sent over 6 million broadcast messages to patients to communicate changes in MTF hours and operations. Healthcare teams used TOL PP Secure Messaging to augment virtual care capability by allowing patients to send pictures from their patients.
Mr. Copelands' efforts directly resulted in improved access to care, better outcomes and a more efficient MHS. His contributions to TOL PP and the DHA make him a notable standout as a Health Care Innovator.
Enhanced the patient experience