Provider
Jefferson Health
Pennsylvania
Tod
Simons
Product Director, Radiology and Laboratory Services IT
215-890-1228
Tod.Simons@jefferson.edu
Yes
National Decision Support Company
Thomas Jefferson University Hospitals embedded a tool for clinical decision support, or CDS, into the workflow for ordering high-end imaging in its electronic health record system. In evaluating EHR orders for advanced diagnostic imaging services such as CT, MRI, and PET, the integrated CDS tool:
• Reduces patient risk.
• Manages healthcare costs.
• Ensures benchmarking.
• Meets a federal mandate.
The decision support tool applies appropriate-use criteria based on evidence. It offers physicians guidance to order the right study for the right indication every time — without requiring telephone approvals. The tool allows providers to make the suitable decision when they order and not after the fact.
The Protecting Access Medicare Act, or PAMA, mandates documentation of high-end imaging consultations starting in 2020 for Medicare patients using a clinical decision support mechanism qualified by the Centers for Medicare and Medicaid Services, or CMS. Jefferson rolled out the CDS tool in June 2019 to give physicians time to adjust. The built-in appropriateness criteria launches seamlessly when providers select a study on the ordering screen. Although the tool offers alternatives, the EHR allows them to retain the original order with free-text explanations.
Employing CDS also promotes a culture of appropriate imaging tests. The CMS ranks TJUH below national and local benchmarks for appropriate imaging studies. A health insurance provider has indicated Jefferson utilizes more MRIs compared to peer institutions. Unnecessary high-end studies help patients avoid:
• Additional exposure and procedures.
• Extra copays and charges.
• Prolonged hospital stays.
Before rolling out the new CDS tool, the Jefferson Radiology chair and the Chief Medical Information Officer sent an announcement about the initiative to other chairs and the house staff. They met with clinical chairs and attended five department meetings of physicians who generally order high-end imaging studies. (See the attached presentation.) In addition, the implementation team added the process changes into EHR training program and provided tip sheets for reference in the online resource library. The healthcare IT communications team included notices about the new tool before and after its release in weekly messages about system updates.
The IT Radiology team accepts feedback to consider enhancements to the tool such as refining structured indications based on physician input. The team offers data analytics to improve patient service and give providers insight about ordering patterns compared to their associates. Other options under consideration may result in showing the costs of examinations and the relative radiation exposures to the ordering physician.
• Reduces patient risk.
• Manages healthcare costs.
• Ensures benchmarking.
• Meets a federal mandate.
The decision support tool applies appropriate-use criteria based on evidence. It offers physicians guidance to order the right study for the right indication every time — without requiring telephone approvals. The tool allows providers to make the suitable decision when they order and not after the fact.
The Protecting Access Medicare Act, or PAMA, mandates documentation of high-end imaging consultations starting in 2020 for Medicare patients using a clinical decision support mechanism qualified by the Centers for Medicare and Medicaid Services, or CMS. Jefferson rolled out the CDS tool in June 2019 to give physicians time to adjust. The built-in appropriateness criteria launches seamlessly when providers select a study on the ordering screen. Although the tool offers alternatives, the EHR allows them to retain the original order with free-text explanations.
Employing CDS also promotes a culture of appropriate imaging tests. The CMS ranks TJUH below national and local benchmarks for appropriate imaging studies. A health insurance provider has indicated Jefferson utilizes more MRIs compared to peer institutions. Unnecessary high-end studies help patients avoid:
• Additional exposure and procedures.
• Extra copays and charges.
• Prolonged hospital stays.
Before rolling out the new CDS tool, the Jefferson Radiology chair and the Chief Medical Information Officer sent an announcement about the initiative to other chairs and the house staff. They met with clinical chairs and attended five department meetings of physicians who generally order high-end imaging studies. (See the attached presentation.) In addition, the implementation team added the process changes into EHR training program and provided tip sheets for reference in the online resource library. The healthcare IT communications team included notices about the new tool before and after its release in weekly messages about system updates.
The IT Radiology team accepts feedback to consider enhancements to the tool such as refining structured indications based on physician input. The team offers data analytics to improve patient service and give providers insight about ordering patterns compared to their associates. Other options under consideration may result in showing the costs of examinations and the relative radiation exposures to the ordering physician.
Improved the care of patient populations
Provider
Houston Methodist
Texas
Nicholas
Desai, MD, MBA
Chief Medical Information Officer
346-324-6750
SDesai2@houstonmethodist.org
Yes
IllumiCare
WHAT AND WHY:
We saw a challenge to help our providers better understand what care costs for our patients and the need to take healthcare innovation to the next level. We wanted a solution to best meet the clinical needs of the patients while enabling a value-added financial and cost transparency tool platform for the providers. HM sought an innovative, electronic, easy to use, clinical tool. In partnership with IllumiCare, we created the HM smart ribbon for providers. This is a floating toolbar agnostic to Epic that delivers clinical, reference, and cost data directly to providers, in an unobtrusive way. This toolbar also contains a snapshot of patient’s labs, meds, and imaging, PDMP, and other clinical reference tools.
Our goal was to merge cost transparency in-line with clinical, financial, and patient safety data for real time HM provider decision making and to drive relevant clinical decisions, while providing efficient, cost-effective, and highest quality care to our HM patients.
WHO was Involved: We have had the buy-in and support of our system executive leadership, our HM system chief financial officer, HM Chief Physician Executive, a number of clinician stakeholders pharmacy, laboratory, IT stakeholders and leadership, and our HM local hospital medical executive committees across the system
RESULTS There are a number of financial or hard cost-savings benefits we have seen and soft savings from a value-add to the providers in terms of care efficiencies and clinical workflow with time saved per application click, and immediate access to trended patient results utilizing the IllumiCare toolbar.
Houston Methodist is projected to save the system approximately $15 million in lab, radiology, and medication costs. We continue to partner with our physician stakeholder groups to refine the toolbar, add additional tools as appropriate, refine workflows and allow for additional savings across the system in driving both relevant and meaningful, cost-conscious, clinical decision-making.
The value of this innovation did all four of the below: improved care of patient populations, enhanced patient experience by ultimately avoiding unnecessary care costs, improved the care provided to them, and improved the life of healthcare providers.
We saw a challenge to help our providers better understand what care costs for our patients and the need to take healthcare innovation to the next level. We wanted a solution to best meet the clinical needs of the patients while enabling a value-added financial and cost transparency tool platform for the providers. HM sought an innovative, electronic, easy to use, clinical tool. In partnership with IllumiCare, we created the HM smart ribbon for providers. This is a floating toolbar agnostic to Epic that delivers clinical, reference, and cost data directly to providers, in an unobtrusive way. This toolbar also contains a snapshot of patient’s labs, meds, and imaging, PDMP, and other clinical reference tools.
Our goal was to merge cost transparency in-line with clinical, financial, and patient safety data for real time HM provider decision making and to drive relevant clinical decisions, while providing efficient, cost-effective, and highest quality care to our HM patients.
WHO was Involved: We have had the buy-in and support of our system executive leadership, our HM system chief financial officer, HM Chief Physician Executive, a number of clinician stakeholders pharmacy, laboratory, IT stakeholders and leadership, and our HM local hospital medical executive committees across the system
RESULTS There are a number of financial or hard cost-savings benefits we have seen and soft savings from a value-add to the providers in terms of care efficiencies and clinical workflow with time saved per application click, and immediate access to trended patient results utilizing the IllumiCare toolbar.
Houston Methodist is projected to save the system approximately $15 million in lab, radiology, and medication costs. We continue to partner with our physician stakeholder groups to refine the toolbar, add additional tools as appropriate, refine workflows and allow for additional savings across the system in driving both relevant and meaningful, cost-conscious, clinical decision-making.
The value of this innovation did all four of the below: improved care of patient populations, enhanced patient experience by ultimately avoiding unnecessary care costs, improved the care provided to them, and improved the life of healthcare providers.
Reduced healthcare costs
Provider
Defense Health Agency
Texas
CDR Michael
Clay
Data Quality & Integration Manager
210-536-7286
michael.c.clay2.mil@mail.mil
Yes
The McVey Company Inc. (TMCi)
Multiple challenges were faced related to poor patient identity and multiple record issues. Among these challenges included missing, incomplete health histories leading to repeat studies, missed diagnoses, delay and/or denial of benefits for veterans, and poor population health metrics. CDR Michael Clay set out a vision to proactively identify and resolve patient identity and multiple record issues to address these challenges and empower clinicians, patients and other users to have data that is fit for use at the time it is needed. He secured funding and modified a contract to have the vendor, TMCi, implement a proactive data quality program. This effort required centralizing and synchronizing issues across 3 systems with over 100 separate databases globally. The team established a prioritization of efforts based upon the sheer magnitude of issues present for 3 decades worth of data. The team baselined each database resolving active patient records and established monitoring to capture and resolve newly created issues to ensure the problem would not continue to grow worse. It reduced incidents for patient identity issues by over 98%, resolving over 2.1M patient records for a cost avoidance of over $141M. These actions ensured bad data was not replicated into the new Electronic Health Record, prevented the delay/denial of benefits for hundreds of veterans each month, increased revenue by reducing the number of rejected claims and was instrumental in identifying system engineering changes to reduce the number of system generated problems. Clinicians can spend more time delivering care instead of searching for missing information or records or stopping their daily duties to submit incidents for issues experienced.
Improved the care of patient populations
Provider
TriHealth
Ohio
Terri
Hanlon-Bremer
Executive Sponsor, Corporate Health
513-977-0013
Terri_Hanlon-Bremer@trihealth.com
Yes
Cincinnati Consulting Consortium
As purchasers of health care, employers feel the pain of lack of motivation and action on the part of employees/patients to improve their health and reduce cost. Unhealthy behavior, increased health risks, chronic conditions, rising medical expenditures, absenteeism and decreased work productivity all add up for employers and they are demanding new ways to bend the cost curve. Lack of knowledge is not the problem; rather, it is lack of follow through and taking action . It is estimated that 69% of US healthcare costs are influenced by patient behavior, yet compliance rates with lifestyle changes to improve health is between 20 and 30 percent.
In response, TriHealth was awarded nearly $1 million from bi3 – Bethesda Inc.’s grantmaking initiative to transform health – to apply consumer sciences methodologies to healthcare that are traditionally used in consumer products industries (i.e. banking and retail) in a way that specifically drives sustainable behavior change, positively impacting health risk and outcomes, and enhancing consumer/patient satisfaction.
First, the project combined employer (e.g. attendance records), consumer (e.g. purchasing patterns) and clinical health data to provide a holistic view of an individual that enables health care providers to customize interventions to maximize engagement, activation, goal attainment, and consumer/patient satisfaction. ( TriHealth Corporate Health then paired behavioral data (what motivates consumers and how they form habits) to the existing body of data (demographic, health condition, medications) to inform providers (in this case, health coaches). Health coaches were able to customize plans to maximize engagement, activation, goal attainment and patient satisfaction. As a result, they could more effectively motivate patients to make lifestyle changes that lead to improved health outcomes., increasing adherence rates & improving health outcomes. Standardized metrics for coaching were developed for coaching interventions and integrated data into each patient’s electronic medical record.
The project piloted this approach with three employers from different corporate sectors. A total of 2,000 patients were engaged leading to multiple positive outcomes. Key outcomes of the project year vs the previous year’s data included:
• 10.4% increase in healthy behaviors
• 27.5% improvement in the elimination of health risks such as smoking or inactivity
• 39% improvement in the number of health risks eliminated
• 26.9% improvement in program satisfaction
• $621,000 in health savings for one employer in a single year
This project also assisted in the creation of best-practice for enhanced coordination and continuity of care. A comprehensive approach using repository with employer, TriHealth, and community resources was developed. A new repository is now in place to efficiently navigate TriHealth Corporate Health partner’s employees to the proper sources of care.
The project created, tested and validated a consumer-centric method that leverages consumer science technologies and techniques resulting in behavior change and improvements in measured health outcomes. TriHealth is a leader in this field, no other health care provider to our knowledge has developed a program of this scale.
bi3 provided funding needed to plan and implement the work. Based on outcomes achieved, a second investment was given to expand upon the work to other patient populations.
In response, TriHealth was awarded nearly $1 million from bi3 – Bethesda Inc.’s grantmaking initiative to transform health – to apply consumer sciences methodologies to healthcare that are traditionally used in consumer products industries (i.e. banking and retail) in a way that specifically drives sustainable behavior change, positively impacting health risk and outcomes, and enhancing consumer/patient satisfaction.
First, the project combined employer (e.g. attendance records), consumer (e.g. purchasing patterns) and clinical health data to provide a holistic view of an individual that enables health care providers to customize interventions to maximize engagement, activation, goal attainment, and consumer/patient satisfaction. ( TriHealth Corporate Health then paired behavioral data (what motivates consumers and how they form habits) to the existing body of data (demographic, health condition, medications) to inform providers (in this case, health coaches). Health coaches were able to customize plans to maximize engagement, activation, goal attainment and patient satisfaction. As a result, they could more effectively motivate patients to make lifestyle changes that lead to improved health outcomes., increasing adherence rates & improving health outcomes. Standardized metrics for coaching were developed for coaching interventions and integrated data into each patient’s electronic medical record.
The project piloted this approach with three employers from different corporate sectors. A total of 2,000 patients were engaged leading to multiple positive outcomes. Key outcomes of the project year vs the previous year’s data included:
• 10.4% increase in healthy behaviors
• 27.5% improvement in the elimination of health risks such as smoking or inactivity
• 39% improvement in the number of health risks eliminated
• 26.9% improvement in program satisfaction
• $621,000 in health savings for one employer in a single year
This project also assisted in the creation of best-practice for enhanced coordination and continuity of care. A comprehensive approach using repository with employer, TriHealth, and community resources was developed. A new repository is now in place to efficiently navigate TriHealth Corporate Health partner’s employees to the proper sources of care.
The project created, tested and validated a consumer-centric method that leverages consumer science technologies and techniques resulting in behavior change and improvements in measured health outcomes. TriHealth is a leader in this field, no other health care provider to our knowledge has developed a program of this scale.
bi3 provided funding needed to plan and implement the work. Based on outcomes achieved, a second investment was given to expand upon the work to other patient populations.
Improved the care of patient populations
Provider
Penn Medicine
Pennsylvania
Colleen
Mallozzi
Associate Clinical Informatics Officer, Office of the CMIO
215-279-2929
colleen.mallozzi@pennmedicine.upenn.edu
No
After transitioning to a new electronic health record, Penn Medicine sought a way to routinely and reliably assure that newly-admitted inpatients were screened for key conditions and interventions, notably pregnancy, MRSA carrier status, and indications for chlorhexidine bathing, influenza, and pneumococcal vaccination. An interdisciplinary health system team designed and implemented a Universal Screening Assessment solution, maximizing the clinical decision support capabilities of the electronic health record and partnering with operations to improve care processes. The project has been associated with reduced central line-associated bloodstream infection rates, earlier detection of previously unknown pregnancies, and higher rates of appropriate vaccination and MRSA screening. What is equally remarkable is that these meaningful improvements in clinical care have been accompanied by reduced variation in care across our organization, savings in provider time, and significant improvements in nursing workflows by virtue of consolidated screening assessments, reducing the nursing documentation burden by 15 to 25 clicks per admission. Indeed, the Universal Screening Assessment, already recognized with a health system quality and patient safety award, improves the care of patient populations, improves the lives of healthcare providers, and carries potential to reduce healthcare costs as well through reduced hospital acquired infections, to give just one example.
Improved the care of patient populations
Provider
Fellowship Square-Mesa
Arizona
Jon Scott
Williams
Executive Director, C.A.S.P.
(480) 654-1800
JonScott.Williams@ChristianCare.org
Yes
RCare, Inc.
In senior living communities, residents have pull cords and push button pendants that allow them to summon help in an emergency. But what happens when residents can’t reach a pull cord, or forgot to wear the pendant? What happens when they need help, but have no way to communicate with caregivers? Fellowship Square-Mesa is a senior living community that decided to solve that problem. Their answer? Smart, integrated technology using voice commands.
Located in Arizona, Fellowship Square-Mesa is a 385-bed senior community offering care across the continuum, including low-income assisted living. Always on a mission for innovative ways to help residents thrive, Fellowship Square-Mesa had an Amazon Alexa Dot installed into every residence. It provides residents with a simple voice technology to request concierge services, look up information, find out about the daily activities schedule and menu, and schedule appointments. The residents love the independence Alexa provided. According to Executive Director Jon Scott Williams, the impact was even more powerful for their low-vision residents, who are roughly ⅓ of their population.
With safety being a number one priority, Williams chose the RCare nurse call and monitoring technology. Although many of the community’s residents wear their push-button pendants routinely, he knew that there were still many residents who did not. He explained, “Until they’ve experienced their first crisis, our residents aren’t always as diligent about wearing the pendants as we would like them to be.” The longer residents wait for help, the more agitated and uncomfortable they can be, and the more serious the situation can become.
Williams wondered whether voice commands could be helpful to residents who needed staff assistance, but couldn’t press a button. He approached RCare with the request and his timing was impeccable. RCare had recently developed an Alexa skill to provide residents with a touchless and pendant-free option to verbally request help from anywhere in the community, using the simple command: “Alexa, tell my nurse I need help.” In addition, the integration also provided a way for residents to use voice commands for their daily check in.
With voice commands, residents can reach help even if they are unable to press a button or pull a cord. Caregivers use dedicated RPhones to receive calls. These RPhones let caregivers talk directly with the resident via an auto-answer communicator in the room, to reassure them that the call was received, and help is on the way.
Amazon was a major supporter of the RCare integration project. “They donated 75 Alexas as a gift from Amazon,” said Todd Carling, head of Business Development at Fellowship Square-Mesa. Amazon also sent two representatives for the initial launch, to meet with residents and answer questions.
For Tawnya Christensen, Assisted Living Manager, the length of time a resident waits for help is critical to their well-being. She conducts “empathy training” with her caregivers, in which they lay on the floor without access to a clock, and wait for help. Although the wait is only five minutes, a typical response time, the caregivers perceive that they’d waited much longer. It’s a powerful experience in the importance of receiving calls, responding promptly, and calling residents. Caregivers are excited about the introduction of voice commands for their residents as a way to help make sure residents can call for help when they need it. According to Christensen, “RCare is the one advocacy I know I can always depend on to let me know when someone is in need. It enables me to do person-centered care at its finest.” The residents are also excited about the expanded capabilities of Alexa voice commands. “It gives them a sense of security or safety. Anybody who feels safe will thrive.”
Located in Arizona, Fellowship Square-Mesa is a 385-bed senior community offering care across the continuum, including low-income assisted living. Always on a mission for innovative ways to help residents thrive, Fellowship Square-Mesa had an Amazon Alexa Dot installed into every residence. It provides residents with a simple voice technology to request concierge services, look up information, find out about the daily activities schedule and menu, and schedule appointments. The residents love the independence Alexa provided. According to Executive Director Jon Scott Williams, the impact was even more powerful for their low-vision residents, who are roughly ⅓ of their population.
With safety being a number one priority, Williams chose the RCare nurse call and monitoring technology. Although many of the community’s residents wear their push-button pendants routinely, he knew that there were still many residents who did not. He explained, “Until they’ve experienced their first crisis, our residents aren’t always as diligent about wearing the pendants as we would like them to be.” The longer residents wait for help, the more agitated and uncomfortable they can be, and the more serious the situation can become.
Williams wondered whether voice commands could be helpful to residents who needed staff assistance, but couldn’t press a button. He approached RCare with the request and his timing was impeccable. RCare had recently developed an Alexa skill to provide residents with a touchless and pendant-free option to verbally request help from anywhere in the community, using the simple command: “Alexa, tell my nurse I need help.” In addition, the integration also provided a way for residents to use voice commands for their daily check in.
With voice commands, residents can reach help even if they are unable to press a button or pull a cord. Caregivers use dedicated RPhones to receive calls. These RPhones let caregivers talk directly with the resident via an auto-answer communicator in the room, to reassure them that the call was received, and help is on the way.
Amazon was a major supporter of the RCare integration project. “They donated 75 Alexas as a gift from Amazon,” said Todd Carling, head of Business Development at Fellowship Square-Mesa. Amazon also sent two representatives for the initial launch, to meet with residents and answer questions.
For Tawnya Christensen, Assisted Living Manager, the length of time a resident waits for help is critical to their well-being. She conducts “empathy training” with her caregivers, in which they lay on the floor without access to a clock, and wait for help. Although the wait is only five minutes, a typical response time, the caregivers perceive that they’d waited much longer. It’s a powerful experience in the importance of receiving calls, responding promptly, and calling residents. Caregivers are excited about the introduction of voice commands for their residents as a way to help make sure residents can call for help when they need it. According to Christensen, “RCare is the one advocacy I know I can always depend on to let me know when someone is in need. It enables me to do person-centered care at its finest.” The residents are also excited about the expanded capabilities of Alexa voice commands. “It gives them a sense of security or safety. Anybody who feels safe will thrive.”
Enhanced the patient experience
Provider
Main Line Health
Pennsylvania
Sandhya
Chandrasekhar
Performance Measurement and Analytics Project Manager
484-337-8683
ChandrasekharS@mlhs.org
No
Executive Summary
Healthcare Analytics at our organization, like in every health system is in a continuous state of transformation.
“The constantly changing regulatory environment has complicated models of care and the relationships between hospitals and insurers. Shifting reimbursement has challenged hospitals across the country to improve performance and significantly reduce costs. Health systems are regularly and rapidly consolidating as market, regulatory and financial pressures push hospital leaders to seek new capabilities via mergers and acquisitions and other partnering arrangements.
"Our plan and your participation in the process have prepared us to address these issues and challenges. We are working together as a System to establish innovative and value-based solutions for the future.” - Stephen S. Aichele, Esq, Chair Main Line Health Board of Governors & Jack J. Lynch III, FACHE, President and Chief Executive Officer, Main Line Health
In 2018, our organization’s strategic focus was on the implementation of a new EMR with a future eye into an investment in improving analytics capabilities. Although the initial focus needed to be placed on the installation and embedment of the EMR, our Quality and Patient Safety (QPS) analytical team was challenged with providing better analytics and creating an interim bridging strategy to provide more timely, accurate and consistent report and analytical solutions. This required a transformation on how our department worked allowing a new focus on integrating previously disparate data into a central repository.
Our team’s primary focus is strategic and initiatives reporting, providing long-term trends, and tracking against benchmarks. Previously, different analysts supported various business units and independently performed most aspects of generating a QPS Dashboard and Clinical Environment Workgroup (CEW) reports: all of which follow the Institute for Healthcare Improvement (IHI) measure categories of Safe, Timely, Efficient, Effective, Equitable, and Patient Centered care (STEEEP). The QPS Dashboard and CEW STEEEP reports are sent to system and campus leaders within the organization, STEEEP reports are sent to system leadership. As our clinical and operational leaders depend on the Dashboard and STEEEP reports to monitor and prioritize work for organizational strategic initiatives, our Analytics team had to effectively address the following challenges:
• Become more effective and efficient in creating dashboards, reports and analysis
• Reduce work redundancy
• Reduce lag
• Create more dynamic reporting through trending and multi-level analysis
• Expand analytical support to business units and clinical leaders
• Develop a no-cost solution by leveraging existing resources and analytic tools
• Continue to support “business-as-usual” work
These challenges were met with an increasing need to prepare our team and the organization to the next phase in the analytics journey. Although the next step on the organization’s strategic priorities post EMR implementation is to improve our analytical infrastructure and solutions (e.g. data governance, data warehousing, analytical and visualization tools), our team needed to find ways to move forward with solutions that will put us on the path to meet the needs of today while getting ready to the solutions coming in the near future.
“I think that this work was critical so data and reports were made more readily available to the end users. The information helps to inform their work and to make decisions based on data.”
- Eileen Jaskuta, System Vice President Quality and Patient Safety, Main Line Health
Our project initiative, dubbed “Project Road Trip”, was the creation of
1) Data warehouse – where all raw data from multiple data sources (EMR, finance, benchmarking, HCAHPS, etc.) is stored and transformed to generate data for measures/metrics/KPIs that we measure;
2) Measure Repository – A centralized database tool for analysts to aggregate, trend, benchmark, and report on key indicators. Analysts also centrally create, manage and store metadata for all metrics; and
3) Visual Analytics Tool(s) – information displayed in a graphical, dynamic way with drill down capabilities.
Prior to “Project Road Trip”, it took 6 analysts, 1 data administrator and 1 Analytics Project Manager 1000 hours to develop the Q&S monthly Dashboard and 11 Quarterly STEEEP reports (Table 1). With the development of the above 3 solutions, leveraging existing tools and resources, within 2 years the team has:
• Reduced our development and data managements hours by 75%
• 100% elimination of duplicative work
• Increased security with centralized data into a more secure data warehouse
• 100% elimination of production lag time for all measures
• Increased analytical support via visual analytics and multi-level reporting across multiple data sources
• Built and standardized metadata for every metric reported from the department.
• Has become the foundation for our next generation of analytic solutions within the organization.
Project Team: Carrie Kanzinger, Deborah Lupica, Emily Goyne, Rosangely Cruz-Rojas, Sandhya Chandrasekhar, Sara Fritz, Valery Kotelnikov, Wan-Yin Li.
Healthcare Analytics at our organization, like in every health system is in a continuous state of transformation.
“The constantly changing regulatory environment has complicated models of care and the relationships between hospitals and insurers. Shifting reimbursement has challenged hospitals across the country to improve performance and significantly reduce costs. Health systems are regularly and rapidly consolidating as market, regulatory and financial pressures push hospital leaders to seek new capabilities via mergers and acquisitions and other partnering arrangements.
"Our plan and your participation in the process have prepared us to address these issues and challenges. We are working together as a System to establish innovative and value-based solutions for the future.” - Stephen S. Aichele, Esq, Chair Main Line Health Board of Governors & Jack J. Lynch III, FACHE, President and Chief Executive Officer, Main Line Health
In 2018, our organization’s strategic focus was on the implementation of a new EMR with a future eye into an investment in improving analytics capabilities. Although the initial focus needed to be placed on the installation and embedment of the EMR, our Quality and Patient Safety (QPS) analytical team was challenged with providing better analytics and creating an interim bridging strategy to provide more timely, accurate and consistent report and analytical solutions. This required a transformation on how our department worked allowing a new focus on integrating previously disparate data into a central repository.
Our team’s primary focus is strategic and initiatives reporting, providing long-term trends, and tracking against benchmarks. Previously, different analysts supported various business units and independently performed most aspects of generating a QPS Dashboard and Clinical Environment Workgroup (CEW) reports: all of which follow the Institute for Healthcare Improvement (IHI) measure categories of Safe, Timely, Efficient, Effective, Equitable, and Patient Centered care (STEEEP). The QPS Dashboard and CEW STEEEP reports are sent to system and campus leaders within the organization, STEEEP reports are sent to system leadership. As our clinical and operational leaders depend on the Dashboard and STEEEP reports to monitor and prioritize work for organizational strategic initiatives, our Analytics team had to effectively address the following challenges:
• Become more effective and efficient in creating dashboards, reports and analysis
• Reduce work redundancy
• Reduce lag
• Create more dynamic reporting through trending and multi-level analysis
• Expand analytical support to business units and clinical leaders
• Develop a no-cost solution by leveraging existing resources and analytic tools
• Continue to support “business-as-usual” work
These challenges were met with an increasing need to prepare our team and the organization to the next phase in the analytics journey. Although the next step on the organization’s strategic priorities post EMR implementation is to improve our analytical infrastructure and solutions (e.g. data governance, data warehousing, analytical and visualization tools), our team needed to find ways to move forward with solutions that will put us on the path to meet the needs of today while getting ready to the solutions coming in the near future.
“I think that this work was critical so data and reports were made more readily available to the end users. The information helps to inform their work and to make decisions based on data.”
- Eileen Jaskuta, System Vice President Quality and Patient Safety, Main Line Health
Our project initiative, dubbed “Project Road Trip”, was the creation of
1) Data warehouse – where all raw data from multiple data sources (EMR, finance, benchmarking, HCAHPS, etc.) is stored and transformed to generate data for measures/metrics/KPIs that we measure;
2) Measure Repository – A centralized database tool for analysts to aggregate, trend, benchmark, and report on key indicators. Analysts also centrally create, manage and store metadata for all metrics; and
3) Visual Analytics Tool(s) – information displayed in a graphical, dynamic way with drill down capabilities.
Prior to “Project Road Trip”, it took 6 analysts, 1 data administrator and 1 Analytics Project Manager 1000 hours to develop the Q&S monthly Dashboard and 11 Quarterly STEEEP reports (Table 1). With the development of the above 3 solutions, leveraging existing tools and resources, within 2 years the team has:
• Reduced our development and data managements hours by 75%
• 100% elimination of duplicative work
• Increased security with centralized data into a more secure data warehouse
• 100% elimination of production lag time for all measures
• Increased analytical support via visual analytics and multi-level reporting across multiple data sources
• Built and standardized metadata for every metric reported from the department.
• Has become the foundation for our next generation of analytic solutions within the organization.
Project Team: Carrie Kanzinger, Deborah Lupica, Emily Goyne, Rosangely Cruz-Rojas, Sandhya Chandrasekhar, Sara Fritz, Valery Kotelnikov, Wan-Yin Li.
Reduced healthcare costs
Provider
University of Mississippi Medical Center
Mississippi
Donald "Trey"
Clark III, MD MPH
Assistant Professor of Medicine-Cardiology
601-984-5640
dclark2@umc.edu
No
Hypertension is the leading contributor to cardiovascular disease, but blood pressure (BP) control rates are poor. Hypertension management is complicated in rural states like Mississippi where physician shortages and socioeconomic deprivation are associated with higher mortality rates. We sought to evaluate the feasibility and effectiveness of a home BP telemonitoring program for hypertension management.. We enrolled patients with uncontrolled hypertension at the University of Mississippi Medical Center (UMMC) in a prospective pilot project. Our team at the UMMC Center for Telehealth included a physician, pharmacist, nurse coordinator, and project manager. Patients were provided a home telemonitoring kit, including an electronic tablet with broadband connectivity and wireless BP cuff with Bluetooth capability. Patients were provided digital educational content on the tablet and asked to obtain daily BP measurements which were automatically transmitted to the UMMC electronic health record. Scheduled BP reviews occurred every 3 weeks by phone throughout the 6-month program. As needed, medications were adjusted by a pharmacist according to a protocol. To date, >100 patients have been enrolled, including a high proportion of minority, low-income, and rural participants. We have remotely implemented >700 BP reviews and 325 medication adjustments, achieving an average systolic BP reduction of 15 mmHg. This work is supported by the Health Resources and Services Administration and the American Heart Association. Attached are data accepted for presentation at the 2020 American College of Cardiology Scientific Sessions in Chicago, IL.
Improved the care of patient populations
Provider
Houston Methodist
Texas
LeTesha
Montgomery
Vice President, Operations and Patient Access
713-441-0727
lmontgomery@houstonmethodist.org
Yes
WELL Health
WHAT, the challenge: At Houston Methodist innovation always starts with the voice of our patients. In this case we heard our patients loud and clear…..they wanted us to totally change the way in which we interact with them. For years Houston Methodist and healthcare institutions in general have always communicated with patients in an antiquated fashion either via phone or fax machine and worst of all typically in a uni-directional manner which has put up barriers between us and the patients we care for . After years of ineffective one-way appointment reminders we sought out a new innovative platform that has transformed the way we interact with our patients. We wanted to improve our overall patient experience, and reduce our no-show rates, which are negatively impacted by ineffective communication.
WHO: We partnered with WELL Health (vendor) to implement their platform which has drastically improved the way in which we interact with our patients. The new innovative platform was a true team effort among operators, IT, front-line staff, clinicians, and even patients (leveraging their feedback).
WHAT the innovation entailed: The foundation of the innovation was to transform our traditional, rigid appointment reminder system into a personalized, bi-directional conversation with patients through text messaging. The conversation is generated via personalized automated text messages via the appointment scheduling process, but also allows patients to save the appointment to their phone calendar, get driving directions to the clinic, request their appointment to be adjusted, complete their check-in process early, activate a portal account and exchange text messages with the clinic staff for additional questions or needs they have. The platform is easy to use and supports operational processes and helps to drive patient compliance for a smoother healthcare experience. The platform also provides management with new insight between staff and patients to review their interactions and assist with identifying coaching opportunities and customer service training.
HOW, results: Since moving to the WELL platform we have seen tremendous results. Patient access has improved significantly with a 15% reduction in no-shows (equating to almost 10,000 appointments annually across the organization). Some specific specialty departments have seen improvements as high as 30% over the past two quarters. We also have more than quadrupled the number of patients that electronically check-in each day and doubled our organizational app activation rate. Most importantly we have heard and successfully responded to the voice of our patients. Since implementing the platform, for the first time in our history we have moved the needle in regards to our patient’s number one frustration which has been dealing with our telephone system and communicating with our clinics. Anecdotally patients have praised our new process and are increasingly asking us to move all communication we handle through this platform. We are thrilled with the results we have achieved and continue to maintain and are collaborating with WELL to further expand the platform to innovate in additional spaces within our organization.
WHO: We partnered with WELL Health (vendor) to implement their platform which has drastically improved the way in which we interact with our patients. The new innovative platform was a true team effort among operators, IT, front-line staff, clinicians, and even patients (leveraging their feedback).
WHAT the innovation entailed: The foundation of the innovation was to transform our traditional, rigid appointment reminder system into a personalized, bi-directional conversation with patients through text messaging. The conversation is generated via personalized automated text messages via the appointment scheduling process, but also allows patients to save the appointment to their phone calendar, get driving directions to the clinic, request their appointment to be adjusted, complete their check-in process early, activate a portal account and exchange text messages with the clinic staff for additional questions or needs they have. The platform is easy to use and supports operational processes and helps to drive patient compliance for a smoother healthcare experience. The platform also provides management with new insight between staff and patients to review their interactions and assist with identifying coaching opportunities and customer service training.
HOW, results: Since moving to the WELL platform we have seen tremendous results. Patient access has improved significantly with a 15% reduction in no-shows (equating to almost 10,000 appointments annually across the organization). Some specific specialty departments have seen improvements as high as 30% over the past two quarters. We also have more than quadrupled the number of patients that electronically check-in each day and doubled our organizational app activation rate. Most importantly we have heard and successfully responded to the voice of our patients. Since implementing the platform, for the first time in our history we have moved the needle in regards to our patient’s number one frustration which has been dealing with our telephone system and communicating with our clinics. Anecdotally patients have praised our new process and are increasingly asking us to move all communication we handle through this platform. We are thrilled with the results we have achieved and continue to maintain and are collaborating with WELL to further expand the platform to innovate in additional spaces within our organization.
Enhanced the patient experience
Provider
Lutheran Senior Services
Missouri
Michael
George
Director of Information Technology
314.218.6737
Michael.George@LSSLiving.org
Yes
Netsmart
WHAT the challenge you were looking to solve was
Risk is highest when a person transitions between care settings. That’s because important patient information is missing 73% of the time.
As a result, 3 out of 10 tests are reordered because results can’t be found; medication errors increase because new meds, allergies etc., don’t show up in the patient record; and patient experience suffers because the admission process is slow, delaying the time it takes for a patient to begin receiving the care they need.
LSS needed to solve the challenge of not being able to seamlessly share data back and forth with acute care provider SSM Health.
WHO was involved in the innovation
Lutheran Senior Services leadership
Netsmart, LSS’s collaborative technology partner
SSM Health, local acute-care provider
WHAT the Innovation Entailed
LSS leveraged the Carequality interoperability framework to be able to exchange data across different platforms. Carequality is an initiative that allows real-time, on-demand sharing of health data between providers who use different electronic health records (EHRs).
The St. Louis-based senior living and post-acute care provider also leveraged the powerful Netsmart network and EHR to make their organization efficient. The Netsmart network now has the largest community of connected post-acute and human services providers with more than 300 million transactions each month. Through this collaborative innovation, acute and post-acute providers are able to achieve true care coordination, which is vital to improving patient care and outcomes.
HOW it generated results
Through Carequality and the powerful Netsmart network and EHR, LSS can exchange data from its Netsmart EHR with nearby acute care provider SSM Health, which uses an EHR from Epic Systems. SSM is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest.
By exchanging relevant clinical data with SSM Health, LSS enables patients moving to care in their facility from SSM Health to receive the best care possible as they transition between healthcare settings. With instant access to critical clinical information, LSS saves time and improves transitions of care through enhanced referral management and care coordination. SSM Health can also query LSS for patient health data if, for example, a patient is transported to the SSM emergency department from an LSS location.
On a broader level, the reach of the Carequality network enables LSS to query patient data from most acute care or behavioral health providers nationwide, reducing the time for the admission process and enabling fully-informed decisions about care and services.
The timely availability of current authorized health data enabled by Netsmart and Carequality ensures that the right information gets to the right people at the right time, from referral staff to clinicians. It also enables each organization’s staff to work within their own familiar EHR and workflows and eliminates the need for error-prone re-keying of data.
This creates an impact that not only helps improve the speed and accuracy of referrals and admissions but also improves the time it takes for an individual to begin receiving care, making the transfer process much simpler.
Being able to do this as a Senior Living Provider puts LSS on the same page as many acute-care Hospital Systems (like SSM, OSF, and Mercy) have been for years. And it’s just another example of how innovation is making an impact in the lives that the organization serves.
Risk is highest when a person transitions between care settings. That’s because important patient information is missing 73% of the time.
As a result, 3 out of 10 tests are reordered because results can’t be found; medication errors increase because new meds, allergies etc., don’t show up in the patient record; and patient experience suffers because the admission process is slow, delaying the time it takes for a patient to begin receiving the care they need.
LSS needed to solve the challenge of not being able to seamlessly share data back and forth with acute care provider SSM Health.
WHO was involved in the innovation
Lutheran Senior Services leadership
Netsmart, LSS’s collaborative technology partner
SSM Health, local acute-care provider
WHAT the Innovation Entailed
LSS leveraged the Carequality interoperability framework to be able to exchange data across different platforms. Carequality is an initiative that allows real-time, on-demand sharing of health data between providers who use different electronic health records (EHRs).
The St. Louis-based senior living and post-acute care provider also leveraged the powerful Netsmart network and EHR to make their organization efficient. The Netsmart network now has the largest community of connected post-acute and human services providers with more than 300 million transactions each month. Through this collaborative innovation, acute and post-acute providers are able to achieve true care coordination, which is vital to improving patient care and outcomes.
HOW it generated results
Through Carequality and the powerful Netsmart network and EHR, LSS can exchange data from its Netsmart EHR with nearby acute care provider SSM Health, which uses an EHR from Epic Systems. SSM is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest.
By exchanging relevant clinical data with SSM Health, LSS enables patients moving to care in their facility from SSM Health to receive the best care possible as they transition between healthcare settings. With instant access to critical clinical information, LSS saves time and improves transitions of care through enhanced referral management and care coordination. SSM Health can also query LSS for patient health data if, for example, a patient is transported to the SSM emergency department from an LSS location.
On a broader level, the reach of the Carequality network enables LSS to query patient data from most acute care or behavioral health providers nationwide, reducing the time for the admission process and enabling fully-informed decisions about care and services.
The timely availability of current authorized health data enabled by Netsmart and Carequality ensures that the right information gets to the right people at the right time, from referral staff to clinicians. It also enables each organization’s staff to work within their own familiar EHR and workflows and eliminates the need for error-prone re-keying of data.
This creates an impact that not only helps improve the speed and accuracy of referrals and admissions but also improves the time it takes for an individual to begin receiving care, making the transfer process much simpler.
Being able to do this as a Senior Living Provider puts LSS on the same page as many acute-care Hospital Systems (like SSM, OSF, and Mercy) have been for years. And it’s just another example of how innovation is making an impact in the lives that the organization serves.
Enhanced the patient experience
Provider
Bridgemoor Transitional Care
Texas
Mark
Fritz
President
512-657-8585
mfritz@bridgemoorcare.com
Yes
Netsmart
WHAT the challenge you were looking to solve was
Value-based care (VBC) is fast evolving as the cornerstone of accountable care across much of the health care ecosystem, including skilled nursing and related providers. The shift to VBC from the longstanding fee-for-service payment model is especially impactful in post-acute care and has generated a market need for short-term, high-quality care for higher acuity patients. In addition, the recently-launched Patient-Driven Payment Model (PDPM) and other regulations require providers to make the shift from an episodic view to an outcomes-based perspective.
Unfortunately, more than half of post-acute providers are not leveraging health IT to adopt to value-based care models, according to the most recent Black Book Research survey. In addition, post-acute providers have traditionally been viewed as a required partner in the health care system, but not as an integrated partner. Post-acute providers also face the challenge of proving they are not only a quality partner, but also a cost-effective destination for patients who would have traditionally gone to a long-term acute care or inpatient rehab hospital.
Another significant challenge is that historical models of payer/provider relationships are based on reimbursements trickling through a health system before reaching post-acute providers.
Developing relationships with payers requires that post-acute providers have a defined strategy, appropriate technology and data insights that can prove value and produce predictive outcomes for the patients in their care.
Bridgemoor Transitional Care chose to embrace the path to VBC by launching a technology-enabled, patient-centered, outcomes-focused integrated care model. Bridgemoor provides personalized, cost-effective transitional care following a hospital visit that enables patients to regain their highest level of independence as quickly as possible.
Bridgemoor’s short-term rehabilitation model launched with its first location in Austin, Texas in February 2018. Bridgemoor currently has four locations in Texas, including Austin, Fort Worth, San Antonio and Webster.
While Bridgemoor knew that acute and primary care referral relationships are important, they also uniquely realized that establishing strong relationships with payers would be an effective way to maximize reimbursement potential, especially as payers begin to narrow their networks to providers who can integrate with them. While other providers focused solely on developing traditional referral relationships, Bridgemoor also did that—while simultaneously building deep, fully-integrated relationships with payers, especially managed care programs.
WHO was involved in the innovation
Bridgmoor leadership and staff
Netsmart, Bridgemoor’s collaborative technology partner
Bridgmoor payers
WHAT the Innovation Entailed
Central to the success of this innovative model is an integrated suite of technology solutions from Netsmart. Bridgemoor’s electronic medical records (EMRs) are fully integrated, where the managed care provider can see into Bridgemoor’s EMR and Bridgemoor can see relevant patient information from the managed care provider, as well as the longitudinal history of the patient. Doing so allows all parties to share authorized data, reducing the risk during care transitions. Technology capabilities include:
• An electronic medical record (EMR) solution that is comprehensive, user-friendly and accessible by phone, tablet or computer
• Dashboards that build custom data relative to the payer relationship, which revealed how Bridgemoor was the best destination for payers to send their members. Payers appreciate the ability to see what is going on with their members while Bridgemoor is treating them. Because Bridgemoor can coordinate care more closely, it can better predict the length of stay and improve outcomes for patients.
• Care coordination capabilities to enable the exchange of clinical and other patient information between care providers, regardless of the EMR they use
• An electronic pharmacy dispensing system that allows patients to receive medications when they are needed most
• A HIPAA-secure platform that allows Bridgemoor staff to customize reports that are shared across the care team in real-time
• Customized physician dashboards that report key quality metrics within minutes
• Customized physician orders and protocols embedded into Bridgemoor’s EMR
HOW it generated results
Bridgemoor enables all entities involved in a patient’s care and transition (payers, acute care providers and post-acute providers) to work together and share authorized patient information in real time. With an integrated technology platform and innovative strategy, Bridgemoor is achieving outcomes not traditionally seen in post-acute care:
• Reduced length of stay from the national average of 30 days to 12.6 days
• Faster recovery with a clear path to home—90.1% of patients who do not require continuing care return home
• Hospital readmission rate of less than 5%
• With average length of stay of less than two weeks, average Medicare A cost per patient is just $8,428.65
• High levels of patient satisfaction, with 98% of patients rating Bridgemoor 4 or 5 on a scale of 1 to 5 when recommending to a friend or loved one.
• Meeting and exceeding quality care metrics. Bridgemoor has three of the ten skilled nursing facilities in Texas to earn Joint Commission accreditation
By taking the additional step of integrating with payers, Bridgemoor has become a preferred destination for patients requiring post-acute transitional care. Payers also benefit from the unique relationship structure. By enabling more transparent and integrated care, payers who partner with Bridgemoor are able to keep their case managers from having to travel into the field. Payers are passing this cost savings to Bridgemoor through various negotiated benefits.
Bridgemoor has also forged stronger clinical partnerships with providers, doctors and hospitals via the ability to share patient information in real-time, 24/7, through cloud-based platforms. Direct secure messaging and Carequality frameworks enable Bridgemoor to import and export real-time data with partner hospitals. This technology provides additional insights about staff performance and adds a level of transparency that other providers can’t achieve with legacy technologies.
Further, by adopting a “technology first” strategy, Bridgemoor has created a paperless environment where its clinical teams have anytime/anywhere access to patient information. Bridgemoor physicians can review the full medical record from anywhere and provide HIPAA-compliant orders and feedback directly to the nursing staff. This facilitates an improved patient experience because the physicians can share the latest results (lab, x-ray, etc.) directly with the patients and their families, promoting patient-centered care. Integration also enables Bridgemoor to operate an in-house, moderately complex lab and in-house pharmacy dispensing system.
Value-based care (VBC) is fast evolving as the cornerstone of accountable care across much of the health care ecosystem, including skilled nursing and related providers. The shift to VBC from the longstanding fee-for-service payment model is especially impactful in post-acute care and has generated a market need for short-term, high-quality care for higher acuity patients. In addition, the recently-launched Patient-Driven Payment Model (PDPM) and other regulations require providers to make the shift from an episodic view to an outcomes-based perspective.
Unfortunately, more than half of post-acute providers are not leveraging health IT to adopt to value-based care models, according to the most recent Black Book Research survey. In addition, post-acute providers have traditionally been viewed as a required partner in the health care system, but not as an integrated partner. Post-acute providers also face the challenge of proving they are not only a quality partner, but also a cost-effective destination for patients who would have traditionally gone to a long-term acute care or inpatient rehab hospital.
Another significant challenge is that historical models of payer/provider relationships are based on reimbursements trickling through a health system before reaching post-acute providers.
Developing relationships with payers requires that post-acute providers have a defined strategy, appropriate technology and data insights that can prove value and produce predictive outcomes for the patients in their care.
Bridgemoor Transitional Care chose to embrace the path to VBC by launching a technology-enabled, patient-centered, outcomes-focused integrated care model. Bridgemoor provides personalized, cost-effective transitional care following a hospital visit that enables patients to regain their highest level of independence as quickly as possible.
Bridgemoor’s short-term rehabilitation model launched with its first location in Austin, Texas in February 2018. Bridgemoor currently has four locations in Texas, including Austin, Fort Worth, San Antonio and Webster.
While Bridgemoor knew that acute and primary care referral relationships are important, they also uniquely realized that establishing strong relationships with payers would be an effective way to maximize reimbursement potential, especially as payers begin to narrow their networks to providers who can integrate with them. While other providers focused solely on developing traditional referral relationships, Bridgemoor also did that—while simultaneously building deep, fully-integrated relationships with payers, especially managed care programs.
WHO was involved in the innovation
Bridgmoor leadership and staff
Netsmart, Bridgemoor’s collaborative technology partner
Bridgmoor payers
WHAT the Innovation Entailed
Central to the success of this innovative model is an integrated suite of technology solutions from Netsmart. Bridgemoor’s electronic medical records (EMRs) are fully integrated, where the managed care provider can see into Bridgemoor’s EMR and Bridgemoor can see relevant patient information from the managed care provider, as well as the longitudinal history of the patient. Doing so allows all parties to share authorized data, reducing the risk during care transitions. Technology capabilities include:
• An electronic medical record (EMR) solution that is comprehensive, user-friendly and accessible by phone, tablet or computer
• Dashboards that build custom data relative to the payer relationship, which revealed how Bridgemoor was the best destination for payers to send their members. Payers appreciate the ability to see what is going on with their members while Bridgemoor is treating them. Because Bridgemoor can coordinate care more closely, it can better predict the length of stay and improve outcomes for patients.
• Care coordination capabilities to enable the exchange of clinical and other patient information between care providers, regardless of the EMR they use
• An electronic pharmacy dispensing system that allows patients to receive medications when they are needed most
• A HIPAA-secure platform that allows Bridgemoor staff to customize reports that are shared across the care team in real-time
• Customized physician dashboards that report key quality metrics within minutes
• Customized physician orders and protocols embedded into Bridgemoor’s EMR
HOW it generated results
Bridgemoor enables all entities involved in a patient’s care and transition (payers, acute care providers and post-acute providers) to work together and share authorized patient information in real time. With an integrated technology platform and innovative strategy, Bridgemoor is achieving outcomes not traditionally seen in post-acute care:
• Reduced length of stay from the national average of 30 days to 12.6 days
• Faster recovery with a clear path to home—90.1% of patients who do not require continuing care return home
• Hospital readmission rate of less than 5%
• With average length of stay of less than two weeks, average Medicare A cost per patient is just $8,428.65
• High levels of patient satisfaction, with 98% of patients rating Bridgemoor 4 or 5 on a scale of 1 to 5 when recommending to a friend or loved one.
• Meeting and exceeding quality care metrics. Bridgemoor has three of the ten skilled nursing facilities in Texas to earn Joint Commission accreditation
By taking the additional step of integrating with payers, Bridgemoor has become a preferred destination for patients requiring post-acute transitional care. Payers also benefit from the unique relationship structure. By enabling more transparent and integrated care, payers who partner with Bridgemoor are able to keep their case managers from having to travel into the field. Payers are passing this cost savings to Bridgemoor through various negotiated benefits.
Bridgemoor has also forged stronger clinical partnerships with providers, doctors and hospitals via the ability to share patient information in real-time, 24/7, through cloud-based platforms. Direct secure messaging and Carequality frameworks enable Bridgemoor to import and export real-time data with partner hospitals. This technology provides additional insights about staff performance and adds a level of transparency that other providers can’t achieve with legacy technologies.
Further, by adopting a “technology first” strategy, Bridgemoor has created a paperless environment where its clinical teams have anytime/anywhere access to patient information. Bridgemoor physicians can review the full medical record from anywhere and provide HIPAA-compliant orders and feedback directly to the nursing staff. This facilitates an improved patient experience because the physicians can share the latest results (lab, x-ray, etc.) directly with the patients and their families, promoting patient-centered care. Integration also enables Bridgemoor to operate an in-house, moderately complex lab and in-house pharmacy dispensing system.
Improved the care of patient populations
Provider
Baby Memorial Hospital
Outside the United States
Saji
Mathew
Chief Operating Officer
+919747033366
saji.mathew@babymhospital.org
Yes
Endogreen
Internal transportation system is one of the critical services in a hospital. Rapid and timely transportation of patients and materials within the hospital is essential to ensure smooth functioning. But the various care providers in the hospital often experienced unacceptable delays when requesting for transportation services. Hence, there was a need to optimise the transportation system within the hospital.
The care team also faced challenges in identifying the location of the various portable biomedical equipment. This issue had great significance as the hospital was spread across 3 interconnected buildings. Critical equipment like ventilators, portable ultrasound machines and BiPAP machines need to be located rapidly and made available for the treatment of patients.
The project was conceptualised with the aim of harnessing technology to streamline the internal transportation system. The technology team at BMH sought innovative ideas for optimising the transportation system. We wanted to focus on lean principles to eliminate the transportation waste within the hospital. We also aimed to develop a system which empowers the transportation crew with technology and improve their morale and autonomy.
A real time location system similar to that used by various cab aggregator services like Uber was proposed. This would enable the transportation crew to accept requests raised from nearby locations without depending on a central control room for task assignment. The various systems commercially available systems were analysed for feasibility of implementation. But they were expensive when deployed at scale and required huge capital investment (approximately ₹50,00,000 / $70,000) and utilised proprietary hardware. The project team sought ways to develop an innovative and scalable system with low capital expenditure. A new system was envisaged which utilises low cost android smartphones and the Jio public Wi-Fi system which was already present in the hospital.
The system works on the principle of location triangulation using Wi-Fi access points. The hospital transportation staff are equipped with smartphones preloaded with the application. The hospital has a network of Jio public Wi-Fi access points throughout the building. By measuring the relative signal strength of the various Wi-Fi access points the real time location of the user can be identified.
The care team also faced challenges in identifying the location of the various portable biomedical equipment. This issue had great significance as the hospital was spread across 3 interconnected buildings. Critical equipment like ventilators, portable ultrasound machines and BiPAP machines need to be located rapidly and made available for the treatment of patients.
The project was conceptualised with the aim of harnessing technology to streamline the internal transportation system. The technology team at BMH sought innovative ideas for optimising the transportation system. We wanted to focus on lean principles to eliminate the transportation waste within the hospital. We also aimed to develop a system which empowers the transportation crew with technology and improve their morale and autonomy.
A real time location system similar to that used by various cab aggregator services like Uber was proposed. This would enable the transportation crew to accept requests raised from nearby locations without depending on a central control room for task assignment. The various systems commercially available systems were analysed for feasibility of implementation. But they were expensive when deployed at scale and required huge capital investment (approximately ₹50,00,000 / $70,000) and utilised proprietary hardware. The project team sought ways to develop an innovative and scalable system with low capital expenditure. A new system was envisaged which utilises low cost android smartphones and the Jio public Wi-Fi system which was already present in the hospital.
The system works on the principle of location triangulation using Wi-Fi access points. The hospital transportation staff are equipped with smartphones preloaded with the application. The hospital has a network of Jio public Wi-Fi access points throughout the building. By measuring the relative signal strength of the various Wi-Fi access points the real time location of the user can be identified.
Enhanced the patient experience
Provider
Cantex Continuing Care Network
Texas
DeAnn
Ogilvie
Director of Strategic Initiatives
214-954-4114
DOgilvie@cantexcc.com
Yes
Netsmart
WHAT the challenge you were looking to solve was
The referral process for when an individual moves from acute care to post-acute care can be the difference between a positive patient experience and a negative patient experience. Manual referral processes are often slow and cumbersome. They frustrate payers and providers, contribute to inefficient operations and can result in medical errors.
Referral processes that rely on phone calls, faxes and manual data entry will keep skilled nursing facilities (SNFs) from gaining valuable referrals, increasing quality of care and growing their census.
Hospitals are a primary source of referrals for SNFs. To survive in today’s integrated care environment and gain referrals, SNFs must build relationships and demonstrate value to these key partners. Technology can play a key role in this process. In fact, a recent report by Porter Research stated that 60% of referring providers said they would switch to a new post-acute care provider if that organization were able to accept electronic referrals.
WHO was involved in the innovation
Cantex leaders and Netsmart, together, launched an industry breakthrough solution, Netsmart Referral Manager. This innovative, Web-based solution has increased the number of processed referrals, driven operational efficiencies and established a competitive edge for Cantex and other senior living providers in a value-based care landscape. Referral Manager can be used as a standalone solution or integrated into any existing electronic health record.
WHAT the Innovation Entailed
Netsmart Referral Manager drives growth by combining various referral networks into a single solution and delivering a big-picture view into a patient’s clinical needs to simplify the accept/decline decision. The solution removed much cumbersome documentation and enabled seamless communication between Cantex and their hospital and other referral partners. This visibility and ease of documenting and viewing positively impacted staff satisfaction and work productivity. Implementation was fast and simple. Staff find the application user friendly and can breeze through forms and notes, whittling down their referral process.
HOW it generated results
After implementing Referral Manager throughout their entire network of 37 skilled nursing facilities, results have shown that qualified referrals increased, while the time required to process those referrals decreased by 73%.
The referral process for when an individual moves from acute care to post-acute care can be the difference between a positive patient experience and a negative patient experience. Manual referral processes are often slow and cumbersome. They frustrate payers and providers, contribute to inefficient operations and can result in medical errors.
Referral processes that rely on phone calls, faxes and manual data entry will keep skilled nursing facilities (SNFs) from gaining valuable referrals, increasing quality of care and growing their census.
Hospitals are a primary source of referrals for SNFs. To survive in today’s integrated care environment and gain referrals, SNFs must build relationships and demonstrate value to these key partners. Technology can play a key role in this process. In fact, a recent report by Porter Research stated that 60% of referring providers said they would switch to a new post-acute care provider if that organization were able to accept electronic referrals.
WHO was involved in the innovation
Cantex leaders and Netsmart, together, launched an industry breakthrough solution, Netsmart Referral Manager. This innovative, Web-based solution has increased the number of processed referrals, driven operational efficiencies and established a competitive edge for Cantex and other senior living providers in a value-based care landscape. Referral Manager can be used as a standalone solution or integrated into any existing electronic health record.
WHAT the Innovation Entailed
Netsmart Referral Manager drives growth by combining various referral networks into a single solution and delivering a big-picture view into a patient’s clinical needs to simplify the accept/decline decision. The solution removed much cumbersome documentation and enabled seamless communication between Cantex and their hospital and other referral partners. This visibility and ease of documenting and viewing positively impacted staff satisfaction and work productivity. Implementation was fast and simple. Staff find the application user friendly and can breeze through forms and notes, whittling down their referral process.
HOW it generated results
After implementing Referral Manager throughout their entire network of 37 skilled nursing facilities, results have shown that qualified referrals increased, while the time required to process those referrals decreased by 73%.
Improved the life of healthcare providers
Provider
OSF HealthCare
Illinois
Kirsten
Largent
Senior Vice President of Financial Operations
309-655-2838
kirsten.largent@osfhealthcare.org
Yes
Strata Decision Technology
For many health systems, the annual budgeting cycle spans over six months and requires thousands of hours from leadership yet produces a budget that is outdated within months. Then, throughout the fiscal year, even with a strong flex-budget, leaders continue to have to explain why performance is not tracking to budget. With a continuously shifting environment, not to mention the need for cost reduction, a traditional budget process and of focus on budget variance is too labor intensive and provides too little business value.
OSF HealthCare experienced just this. The 13-hospital system based in Peoria, Ill. spent at least 8-10 weeks every year in their annual budget cycle. Each year, the process was stressful and time-consuming. OSF HealthCare’s leaders wanted to produce a balanced budget that would project performance accurately for the next fiscal year. However, despite the thousands of hours, the budget was typically out of date within the first quarter. Managers continued to spend time explaining why they were not hitting budget targets rather than making course corrections to adjust to changing market dynamics.
To help, OSF HealthCare partnered with Strata Decision Technology to design and implement a dynamic planning approach using the company’s cloud-based StrataJazz platform. This approach involved 1) replacing the line-item budget with a baseline forecast at the entity level that aligns with the Long Range Financial Plan, 2) a quarterly re-forecast based on actual performance and shifting assumptions, during which leaders quantify the trajectory of their business and identify course corrections, and 3) monthly performance management where we evaluate department level financial stewardship and performance to protect against cost growth.
OSF HealthCare employed Strata’s Management Reporting tool in which managers review their area’s performance on well-defined KPIs that are generally within their control. Paired with a rigorous monthly accountability process, managers began focusing on how to improve financial and operational performance, not just to track their budget.
By having a consistent source of truth and well-defined metrics for performance management, managers spent considerably less time preparing for reviews. Leadership received more relevant and actionable information during the reviews. Tracking following up items heightened accountability.
Impact:
• 20,000 hours of leadership time previously spent on the budget has been freed up
• 75% reduction in time spent on the budget
• $1 million saved on overall budgeting efforts with resources redeployed to higher-value financial planning
Through this dynamic planning approach, OSF HealthCare decreased its annual planning cycle by six weeks, from eight weeks to two. Leaders throughout the organization were given thousands of hours back, with the equivalent of $1 million or 10 full-time employees redeployed to focus on improving operations and continuing to drive efficiency and cost improvements.
OSF HealthCare experienced just this. The 13-hospital system based in Peoria, Ill. spent at least 8-10 weeks every year in their annual budget cycle. Each year, the process was stressful and time-consuming. OSF HealthCare’s leaders wanted to produce a balanced budget that would project performance accurately for the next fiscal year. However, despite the thousands of hours, the budget was typically out of date within the first quarter. Managers continued to spend time explaining why they were not hitting budget targets rather than making course corrections to adjust to changing market dynamics.
To help, OSF HealthCare partnered with Strata Decision Technology to design and implement a dynamic planning approach using the company’s cloud-based StrataJazz platform. This approach involved 1) replacing the line-item budget with a baseline forecast at the entity level that aligns with the Long Range Financial Plan, 2) a quarterly re-forecast based on actual performance and shifting assumptions, during which leaders quantify the trajectory of their business and identify course corrections, and 3) monthly performance management where we evaluate department level financial stewardship and performance to protect against cost growth.
OSF HealthCare employed Strata’s Management Reporting tool in which managers review their area’s performance on well-defined KPIs that are generally within their control. Paired with a rigorous monthly accountability process, managers began focusing on how to improve financial and operational performance, not just to track their budget.
By having a consistent source of truth and well-defined metrics for performance management, managers spent considerably less time preparing for reviews. Leadership received more relevant and actionable information during the reviews. Tracking following up items heightened accountability.
Impact:
• 20,000 hours of leadership time previously spent on the budget has been freed up
• 75% reduction in time spent on the budget
• $1 million saved on overall budgeting efforts with resources redeployed to higher-value financial planning
Through this dynamic planning approach, OSF HealthCare decreased its annual planning cycle by six weeks, from eight weeks to two. Leaders throughout the organization were given thousands of hours back, with the equivalent of $1 million or 10 full-time employees redeployed to focus on improving operations and continuing to drive efficiency and cost improvements.
Reduced healthcare costs
Provider
Legacy-GoHealth Urgent Care
Oregon
Christopher
Lee
Marketing Specalist
(503) 545-1554
christopher.lee@gohealthuc.com
No
Who wouldn’t want to be cared for by high-quality providers from the comfort of their own home? In June 2019, Legacy-GoHealth Urgent Care launched a new virtual urgent care platform, enabling patients across the Pacific Northwest to quickly and easily schedule virtual visits with the same in-center clinicians they have come to know and trust. The platform seamlessly integrates into GoHealth Urgent Care’s consumer-focused retail-based approach, including a proprietary online registration tool that confirms insurance eligibility, provides real-time financial responsibility and quickly connects patients to providers. These virtual patients benefit from the same advantages provided by Legacy-GoHealth Urgent Care, including fully integrated electronic medical records and same day and next day referrals to specialists. The platform also supports virtual visit patients who need to be seen in-person to complete their care, ensuring quick and convenient access and eliminating the risk of any additional charges for the in-person visit. Utilization of the platform has grown significantly in just 6 months, and Legacy-GoHealth Urgent Care Virtual Visits have achieved an 84 Net Promoter Score.
Enhanced the patient experience
Provider
Prime Therapeutics
Minnesota
Jo-Ellen
Abou Nader
Vice president of fraud, waste, and abuse and supply chain optimization
612.777.2710
joellen.abounader@primetherapeutics.com
Yes
SAS
WHAT IS THE CHALLENGE?
The digitization of the health care industry has made it easier than ever for criminals to illegally profit from hospitals, insurers and the government. According to the National Health Care Anti-Fraud Association, fraud, waste and abuse (FWA) costs the U.S. health care system tens of billions of dollars each year. These losses affect all consumers by driving higher insurance premiums and health care costs.
Prevention and detection of FWA in the system is also a key patient safety issue. People may be exploited and undergo unnecessary or unsafe medical procedures. Medical records may be compromised, or real insurance information may be used to submit false claims.
WHO IS INVOLVED IN THE INNOVATION?
Prime Therapeutics (Prime), a leading pharmacy benefit manager (PBM), manages pharmacy benefits for more than 28 million members through its relationships with health plans, employers and government programs (including Medicare and Medicaid). Prime helps its clients make informed decisions about how to achieve better health outcomes at the lowest total cost. Rooting out fraud, waste and abuse ultimately supports that aim, saving plans money that would otherwise be lost and helping to control premiums.
WHAT DOES THE INNOVATION ENTAIL?
Working with SAS, Prime developed a first-of-its-kind, fraud-fighting analytics platform, first deployed in the fall of 2018. The SAS-powered platform enables Prime to integrate massive volumes of data –pharmacy data and medical data combined – to create what Prime calls a true “total drug management” approach.
The platform produces real-time, real-world actionable results that significantly reduce wasted dollars. Armed with key data, Prime applies advanced analytics to illuminate FWA in all its forms – from malicious billing for medications that were not ordered to unintentional data entry errors that can cost thousands of dollars each.
HOW IT GENERATED RESULTS
PBMs commonly have programs to detect FWA in drug prescribing and dispensing, but they lack visibility on the care delivery side. Before launching the SAS FWA platform, Prime’s investigators primarily focused on pharmacy data, but pharmacy and medical claims data are better together. When looking at one without the other, the whole picture can’t be seen.
Prime’s close partnerships with its health plan clients, combined with its new SAS platform, delivered the first holistic view at FWA inclusive of data from members, prescribers, and pharmacies, now fully integrated together. That complete data picture coupled with the platform’s robust artificial intelligence (AI) and machine learning capabilities allows Prime to detect FWA regardless of the cause or source and provides oversight when fraud occurs to help as quickly and efficiently as possible.
More broadly, the platform helps identify members who use deception to get prescriptions, whether it be through insurance fraud, collusion with a pharmacy or prescriber, or identity theft. The platform can also find prescribers who falsely diagnose patients, receive kickbacks for certain medications or submit duplicate claims.
INNOVATION RESULTS
Less than 12 months after first deploying the enhanced fraud, waste and abuse platform in late 2018, Prime saved the 23 Blue Cross plans it serves $279 million – $51 million in recovered payments, plus $228 million in cost avoidance (where Prime detected signs of FWA before claims were paid).
In the first nine months of 2019 alone, Prime investigators referred 721 cases involving activities by doctors, patients, and pharmacies to payers based on insights from the SAS platform and its new approach to FWA detection and prevention.
The initiative is also helping Prime and its health plans take aim at the nation’s growing opioid epidemic. Opioids were involved in 47,600 overdose deaths in 2017 (67.8% of all drug overdose deaths), according to the CDC. The platform helps Prime identify many forms of opioid FWA, such as when pharmacies or members create or alter prescription orders, or when prescribers overprescribe drugs beyond guidelines. It can also reveal “doctor shopping,” where members get more medicines than appropriate by seeing multiple doctors who may not know the members is receiving medicines elsewhere.
The results illustrate that, beyond saving money, Prime’s efforts in this arena are helping save lives.
The digitization of the health care industry has made it easier than ever for criminals to illegally profit from hospitals, insurers and the government. According to the National Health Care Anti-Fraud Association, fraud, waste and abuse (FWA) costs the U.S. health care system tens of billions of dollars each year. These losses affect all consumers by driving higher insurance premiums and health care costs.
Prevention and detection of FWA in the system is also a key patient safety issue. People may be exploited and undergo unnecessary or unsafe medical procedures. Medical records may be compromised, or real insurance information may be used to submit false claims.
WHO IS INVOLVED IN THE INNOVATION?
Prime Therapeutics (Prime), a leading pharmacy benefit manager (PBM), manages pharmacy benefits for more than 28 million members through its relationships with health plans, employers and government programs (including Medicare and Medicaid). Prime helps its clients make informed decisions about how to achieve better health outcomes at the lowest total cost. Rooting out fraud, waste and abuse ultimately supports that aim, saving plans money that would otherwise be lost and helping to control premiums.
WHAT DOES THE INNOVATION ENTAIL?
Working with SAS, Prime developed a first-of-its-kind, fraud-fighting analytics platform, first deployed in the fall of 2018. The SAS-powered platform enables Prime to integrate massive volumes of data –pharmacy data and medical data combined – to create what Prime calls a true “total drug management” approach.
The platform produces real-time, real-world actionable results that significantly reduce wasted dollars. Armed with key data, Prime applies advanced analytics to illuminate FWA in all its forms – from malicious billing for medications that were not ordered to unintentional data entry errors that can cost thousands of dollars each.
HOW IT GENERATED RESULTS
PBMs commonly have programs to detect FWA in drug prescribing and dispensing, but they lack visibility on the care delivery side. Before launching the SAS FWA platform, Prime’s investigators primarily focused on pharmacy data, but pharmacy and medical claims data are better together. When looking at one without the other, the whole picture can’t be seen.
Prime’s close partnerships with its health plan clients, combined with its new SAS platform, delivered the first holistic view at FWA inclusive of data from members, prescribers, and pharmacies, now fully integrated together. That complete data picture coupled with the platform’s robust artificial intelligence (AI) and machine learning capabilities allows Prime to detect FWA regardless of the cause or source and provides oversight when fraud occurs to help as quickly and efficiently as possible.
More broadly, the platform helps identify members who use deception to get prescriptions, whether it be through insurance fraud, collusion with a pharmacy or prescriber, or identity theft. The platform can also find prescribers who falsely diagnose patients, receive kickbacks for certain medications or submit duplicate claims.
INNOVATION RESULTS
Less than 12 months after first deploying the enhanced fraud, waste and abuse platform in late 2018, Prime saved the 23 Blue Cross plans it serves $279 million – $51 million in recovered payments, plus $228 million in cost avoidance (where Prime detected signs of FWA before claims were paid).
In the first nine months of 2019 alone, Prime investigators referred 721 cases involving activities by doctors, patients, and pharmacies to payers based on insights from the SAS platform and its new approach to FWA detection and prevention.
The initiative is also helping Prime and its health plans take aim at the nation’s growing opioid epidemic. Opioids were involved in 47,600 overdose deaths in 2017 (67.8% of all drug overdose deaths), according to the CDC. The platform helps Prime identify many forms of opioid FWA, such as when pharmacies or members create or alter prescription orders, or when prescribers overprescribe drugs beyond guidelines. It can also reveal “doctor shopping,” where members get more medicines than appropriate by seeing multiple doctors who may not know the members is receiving medicines elsewhere.
The results illustrate that, beyond saving money, Prime’s efforts in this arena are helping save lives.
Reduced healthcare costs
Provider
Houston Methodist
Texas
Debbi
Garbade
Director of System Patient Safety
713-443-4875
dgarbade@houstonmethodist.org
Yes
HD Nursing, LLC
Healthcare Innovations Annual Innovator Awards Program -- Houston Methodist
What:
Patient safety is a paramount endeavor for all healthcare providers. We all strive to provide the right care to the right patient at the right time – in all instances. In the recent past, the concept of High Reliability has begun to take root within our care designs and hospitals have worked to achieve the status of “Highly Reliable Organizations” providing care that is free from defect or harm. Organizations across the world encounter challenges with preventing patient falls on a daily basis with rates in the acute care setting ranging from 1.4 to 18.2 falls per 1000 patient days and 3-8% serious injury /death (DiBardino, Cohen, & Didwania, 2012, p. 1). Houston Methodist was not immune to these unfortunate events. In 2017, Houston Methodist was at a baseline fall of 1.65 with a fall injury rate of 0.49. When we changed to a new EMR System, we had an opportunity to change our Falls Risk Predictor and chose the evidence-based Hester Davis Scale. The Hester Davis Scale (HDS) is part of the HD Falls Program, a clinical decision support system for predicting and preventing falls and injuries across the continuum of care. The HD Falls Program has evidenced superior predictive ability and is instrumental in guiding the safety interventions to prevent patient injury. One of our deciding factors in the decision to use this tool was the published validation for integration with an electronic medical record. One of the highlights of the tool, based on the patient’s current condition, it calculates exactly what is needed for the patient at that point in time. The tool then populates the online nursing care plan with the HD interventions – thus guiding the nurses’ care for the day related to fall prevention.
Who:
Houston Methodist is an 8 hospital System (1-Academic Medical Center Hospital, 6-Regional Hospitals, and 1-Long Term Care Facility). We had 1.3 million patient encounters in 2019, 114,586 admissions, 23,669 employees, 6,973 physicians and 681 faculty. We began our journey to eliminating patient falls with enlisting the support of leaders across our system. The initial planning and development occurred between the Hester Davis Team, System Patient Safety, Information Technology, and nursing leadership. HD Nursing assisted with the provision of posters and flyers to raise awareness and generate excitement with the change. Specialized nursing educators partnered with the HD Nursing Team to develop customized training programs for nurses and PCA’s (Patient Care Assistants). The initial education was provided in a live environment with use of WebEx to allow for question and answer sessions and a computer-based learning system. Ongoing education has occurred with e-mail and safety huddle dissemination as we continue to learn throughout our journey. One important innovation we have implemented is our new Falls Safety Coach program which includes front line staff on a monthly coaching call. The Falls Safety Coaches are engaged staff who are looking to grow in their careers – usually with an eye to advancement in the management realms of their specialty or hospital. Each month, there is a brief (under 15 minutes) call where the coaches are given coaching tips to help train them in their personal and professional growth – such as how to interact with a staff member who is struggling to comply with a safety tool, and a “Fall Tip of the Month” is presented (based on falls that have occurred around the System so there is a case study presentation about an actual event.) The coaches can ask questions or share tips with each other on the calls as well.
What:
The HD Falls Program was integrated into our electronic medical record (EMR) and, based on scores, customized nursing safety interventions are triggered to be put in place to prevent patient fall or injury when possible. Patient status is not typically static while the patient is in the hospital and their care plans need to meet their needs always. For example, the interventions required post-operatively for a patient will often vary greatly from their pre-operative needs based on weakness or ambulation restrictions. Nursing was the primary driver of the program through provision of education, developing materials to assist in spreading the word about the change in risk scales, and ensuring that staff participated in the training. It was planned to have follow up review of the scoring and the completeness of intervention initiation to provide one on one teaching opportunities for nurses who may not have fully mastered the tool during training and additional support was provided ensure success. Each nursing unit did audits of both the tool accuracy as well as ensuring all interventions were in place. When opportunities arose, leaders would talk with the staff about what was found and how to correct it going forward. Staff could ask questions with individual examples at hand since they were working real time with the patient and the tool.
How:
We did a two-week education blitz and required documentation that 80% of the nursing/PCA staff had been trained before we would Go-Live with the tool in our EMR. Every hospital had to attest to meeting this goal or we had planned to hold on the use of the tool until they met compliance. The roll out of the tool was a mass activation throughout the system at the same time. This allowed for IT to support and assist without having multiple change requests that were vetted by different people at different times as has occurred in staged roll outs in the past. We held weekly WebEx calls to touch base with every hospital and included the HD Nursing Team to help with troubleshooting any issues with the tool, interventions, or fluidity of use of the tool in the EMR. After the first month, we moved to bi-weekly for a month, then monthly for the remainder of the year. These ongoing calls allowed opportunities for leaders to share tips they learned or interventions that were more effective for them. The HD Team provided some additional flyers and tips sheets to give to staff when we had identified needs. We formed the System-wide Falls Prevention Committee with representatives from every hospital and included pharmacy and physical therapy representatives to provide dialogue and support for the falls prevention work. In 2018 we also added a member from supply chain to assist in the review and acquisition of safety equipment related to fall prevention. Individual site visits by the System Patient Safety Department to the facility champion were conducted during the first year to ensure additional support was available to each facility. In 2018 (the first year) we decreased our fall with injury rate 17% and 2019 we were down an additional 11%. Overall from 2017 – 2019 our Falls Rate decreased 20% while our fall with injury rate decreased 26%. While a superior accomplishment for our organization, the real winner is the patients who had a safe hospitalization and were free from harm related to potential injuries with a fall. Houston Methodist will continue our journey to zero!
What:
Patient safety is a paramount endeavor for all healthcare providers. We all strive to provide the right care to the right patient at the right time – in all instances. In the recent past, the concept of High Reliability has begun to take root within our care designs and hospitals have worked to achieve the status of “Highly Reliable Organizations” providing care that is free from defect or harm. Organizations across the world encounter challenges with preventing patient falls on a daily basis with rates in the acute care setting ranging from 1.4 to 18.2 falls per 1000 patient days and 3-8% serious injury /death (DiBardino, Cohen, & Didwania, 2012, p. 1). Houston Methodist was not immune to these unfortunate events. In 2017, Houston Methodist was at a baseline fall of 1.65 with a fall injury rate of 0.49. When we changed to a new EMR System, we had an opportunity to change our Falls Risk Predictor and chose the evidence-based Hester Davis Scale. The Hester Davis Scale (HDS) is part of the HD Falls Program, a clinical decision support system for predicting and preventing falls and injuries across the continuum of care. The HD Falls Program has evidenced superior predictive ability and is instrumental in guiding the safety interventions to prevent patient injury. One of our deciding factors in the decision to use this tool was the published validation for integration with an electronic medical record. One of the highlights of the tool, based on the patient’s current condition, it calculates exactly what is needed for the patient at that point in time. The tool then populates the online nursing care plan with the HD interventions – thus guiding the nurses’ care for the day related to fall prevention.
Who:
Houston Methodist is an 8 hospital System (1-Academic Medical Center Hospital, 6-Regional Hospitals, and 1-Long Term Care Facility). We had 1.3 million patient encounters in 2019, 114,586 admissions, 23,669 employees, 6,973 physicians and 681 faculty. We began our journey to eliminating patient falls with enlisting the support of leaders across our system. The initial planning and development occurred between the Hester Davis Team, System Patient Safety, Information Technology, and nursing leadership. HD Nursing assisted with the provision of posters and flyers to raise awareness and generate excitement with the change. Specialized nursing educators partnered with the HD Nursing Team to develop customized training programs for nurses and PCA’s (Patient Care Assistants). The initial education was provided in a live environment with use of WebEx to allow for question and answer sessions and a computer-based learning system. Ongoing education has occurred with e-mail and safety huddle dissemination as we continue to learn throughout our journey. One important innovation we have implemented is our new Falls Safety Coach program which includes front line staff on a monthly coaching call. The Falls Safety Coaches are engaged staff who are looking to grow in their careers – usually with an eye to advancement in the management realms of their specialty or hospital. Each month, there is a brief (under 15 minutes) call where the coaches are given coaching tips to help train them in their personal and professional growth – such as how to interact with a staff member who is struggling to comply with a safety tool, and a “Fall Tip of the Month” is presented (based on falls that have occurred around the System so there is a case study presentation about an actual event.) The coaches can ask questions or share tips with each other on the calls as well.
What:
The HD Falls Program was integrated into our electronic medical record (EMR) and, based on scores, customized nursing safety interventions are triggered to be put in place to prevent patient fall or injury when possible. Patient status is not typically static while the patient is in the hospital and their care plans need to meet their needs always. For example, the interventions required post-operatively for a patient will often vary greatly from their pre-operative needs based on weakness or ambulation restrictions. Nursing was the primary driver of the program through provision of education, developing materials to assist in spreading the word about the change in risk scales, and ensuring that staff participated in the training. It was planned to have follow up review of the scoring and the completeness of intervention initiation to provide one on one teaching opportunities for nurses who may not have fully mastered the tool during training and additional support was provided ensure success. Each nursing unit did audits of both the tool accuracy as well as ensuring all interventions were in place. When opportunities arose, leaders would talk with the staff about what was found and how to correct it going forward. Staff could ask questions with individual examples at hand since they were working real time with the patient and the tool.
How:
We did a two-week education blitz and required documentation that 80% of the nursing/PCA staff had been trained before we would Go-Live with the tool in our EMR. Every hospital had to attest to meeting this goal or we had planned to hold on the use of the tool until they met compliance. The roll out of the tool was a mass activation throughout the system at the same time. This allowed for IT to support and assist without having multiple change requests that were vetted by different people at different times as has occurred in staged roll outs in the past. We held weekly WebEx calls to touch base with every hospital and included the HD Nursing Team to help with troubleshooting any issues with the tool, interventions, or fluidity of use of the tool in the EMR. After the first month, we moved to bi-weekly for a month, then monthly for the remainder of the year. These ongoing calls allowed opportunities for leaders to share tips they learned or interventions that were more effective for them. The HD Team provided some additional flyers and tips sheets to give to staff when we had identified needs. We formed the System-wide Falls Prevention Committee with representatives from every hospital and included pharmacy and physical therapy representatives to provide dialogue and support for the falls prevention work. In 2018 we also added a member from supply chain to assist in the review and acquisition of safety equipment related to fall prevention. Individual site visits by the System Patient Safety Department to the facility champion were conducted during the first year to ensure additional support was available to each facility. In 2018 (the first year) we decreased our fall with injury rate 17% and 2019 we were down an additional 11%. Overall from 2017 – 2019 our Falls Rate decreased 20% while our fall with injury rate decreased 26%. While a superior accomplishment for our organization, the real winner is the patients who had a safe hospitalization and were free from harm related to potential injuries with a fall. Houston Methodist will continue our journey to zero!
Improved the care of patient populations
Provider
Advocate Aurora Health
Illinois
Cori
Garner
Director, Patient Command Center
6304917436
cori.garner@advocatehealth.com
Yes
PerfectServe
Advocate's Patient Command Center serves as the organization's air traffic control tower for hospital bed management across 3,500 total beds and during transitions of care to boost patient satisfaction and loyalty. Advocate has over 1,000 transitions and admissions per month. Their goal was to standardize transitions across ten hospitals and hundreds of care locations to stop losing patients to other provider organizations.
Cori Garner, the Patient Command Center Director, headed up the project and multidisciplinary implementation. Lessons learned for other large organizations standing up patient command centers.
Challenge to Solve:
The Advocate leadership team faced growing capacity challenges, which ultimately decreased patient satisfaction due to delays between transitions in care. With over 1,000 patient transfers and admissions each month, Advocate saw an opportunity to support revenue recognition by streamlining admissions across the enterprise. The organization’s strategic goal was to stop losing high-level patients to regional competitors by closing gaps to ensure prompt and appropriate patient placement across all care settings while also gaining real-time operational visibility into thousands of complex patient care transitions.
Who was Involved:
Healthcare systems across the country are setting up command centers up at a rapid pace to drive efficiency, protect revenue, and enhance patient safety and satisfaction. Advocate Health Care launched its state-of-the-art Patient Command Center in March of 2019. Serving as Advocate’s air traffic control tower for hospital bed management, this centralized hub allows the health system to manage the safe and timely placement of patients across 3,500 total beds.
A cross-functional command center implementation team was formed, which included stakeholders from Advocate’s nine Chicagoland hospitals. Bringing the implementation down to its primary function of patient flow, standardizing workflows across the enterprise, and including all disciplines who interact with patient flow helped to ensure the overwhelming success of the Patient Command Center.
Once the Patient Command Center was in place, Advocate engaged multidisciplinary leadership teams, including representatives from the emergency department, nursing, transportation, care management, and any other department that interacts with the flow of patients to help launch, optimize and promote the command center.
What the innovation entailed:
The first stages of the project included the clear articulation of the command center’s objectives and performance metrics. Collaboration on a centralized technology platform was essential. Requirements included addressing specific physicians’ on-call schedules, escalation grids for communications, and accountability monitoring (read: ensuring schedule accuracy) across all care locations.
Once a vendor was selected, intensive consultation services were required to unify stakeholders across the enterprise, address the unique demands of each location and care team, and slowly roll out centralized control of patient flow.
The Patient Command Center solution team partnered with IT and the networking team to ensure a failsafe solution. During implementation, the team overcame hotspot challenges, redundancy issues, and the mislabeling of the command center as a level-2 network response group. It was later labeled a “critical high-level” networking assistance—the same label given to hospitals, which ensures an automated, immediate switchover in the event of any downtime.
How it generated results:
Advocate stakeholders noticed immediate results from the newly implemented Patient Command Center, including a significant boost in the efficient management of patient flow, real-time tracking of patient progress throughout the continuum, enhanced patient experience, and generally a more concerted effort by staff to make sure patient flow remains a top priority. By building a cross-functional hub for patient throughput that spans the health system, Advocate’s vision for the Patient Command Center has been realized while supporting the needs of patients and providers alike.
The following implementation results for five of ten Advocate sites converted to the Patient Command Center in 2019:
- Decreased patient placement timing (from when the patient is seen clinically to bed assignment)
- Increased patient engagement and satisfaction outcome levels through the patient flow process and care transition operations
- Since March, the Patient Command Center has prevented 63 high-level patients (and counting) from leaving Advocate to seek care at a competitor’s facility. These patients were transferred appropriately to level 1 trauma or vascular centers within the Advocate system, which has implications for 1) continuity of care and patient satisfaction on the patient side and 2) revenue protection on the provider side.
- Transitioned one to two sites to the Patient Command Center per month and are now placing over 1,000 patients each month. The Patient Command Center team is currently working with Case Management to secure the outbound patient transfer workflow and will eventually also manage this aspect of patient care transitions.
Cori Garner, the Patient Command Center Director, headed up the project and multidisciplinary implementation. Lessons learned for other large organizations standing up patient command centers.
Challenge to Solve:
The Advocate leadership team faced growing capacity challenges, which ultimately decreased patient satisfaction due to delays between transitions in care. With over 1,000 patient transfers and admissions each month, Advocate saw an opportunity to support revenue recognition by streamlining admissions across the enterprise. The organization’s strategic goal was to stop losing high-level patients to regional competitors by closing gaps to ensure prompt and appropriate patient placement across all care settings while also gaining real-time operational visibility into thousands of complex patient care transitions.
Who was Involved:
Healthcare systems across the country are setting up command centers up at a rapid pace to drive efficiency, protect revenue, and enhance patient safety and satisfaction. Advocate Health Care launched its state-of-the-art Patient Command Center in March of 2019. Serving as Advocate’s air traffic control tower for hospital bed management, this centralized hub allows the health system to manage the safe and timely placement of patients across 3,500 total beds.
A cross-functional command center implementation team was formed, which included stakeholders from Advocate’s nine Chicagoland hospitals. Bringing the implementation down to its primary function of patient flow, standardizing workflows across the enterprise, and including all disciplines who interact with patient flow helped to ensure the overwhelming success of the Patient Command Center.
Once the Patient Command Center was in place, Advocate engaged multidisciplinary leadership teams, including representatives from the emergency department, nursing, transportation, care management, and any other department that interacts with the flow of patients to help launch, optimize and promote the command center.
What the innovation entailed:
The first stages of the project included the clear articulation of the command center’s objectives and performance metrics. Collaboration on a centralized technology platform was essential. Requirements included addressing specific physicians’ on-call schedules, escalation grids for communications, and accountability monitoring (read: ensuring schedule accuracy) across all care locations.
Once a vendor was selected, intensive consultation services were required to unify stakeholders across the enterprise, address the unique demands of each location and care team, and slowly roll out centralized control of patient flow.
The Patient Command Center solution team partnered with IT and the networking team to ensure a failsafe solution. During implementation, the team overcame hotspot challenges, redundancy issues, and the mislabeling of the command center as a level-2 network response group. It was later labeled a “critical high-level” networking assistance—the same label given to hospitals, which ensures an automated, immediate switchover in the event of any downtime.
How it generated results:
Advocate stakeholders noticed immediate results from the newly implemented Patient Command Center, including a significant boost in the efficient management of patient flow, real-time tracking of patient progress throughout the continuum, enhanced patient experience, and generally a more concerted effort by staff to make sure patient flow remains a top priority. By building a cross-functional hub for patient throughput that spans the health system, Advocate’s vision for the Patient Command Center has been realized while supporting the needs of patients and providers alike.
The following implementation results for five of ten Advocate sites converted to the Patient Command Center in 2019:
- Decreased patient placement timing (from when the patient is seen clinically to bed assignment)
- Increased patient engagement and satisfaction outcome levels through the patient flow process and care transition operations
- Since March, the Patient Command Center has prevented 63 high-level patients (and counting) from leaving Advocate to seek care at a competitor’s facility. These patients were transferred appropriately to level 1 trauma or vascular centers within the Advocate system, which has implications for 1) continuity of care and patient satisfaction on the patient side and 2) revenue protection on the provider side.
- Transitioned one to two sites to the Patient Command Center per month and are now placing over 1,000 patients each month. The Patient Command Center team is currently working with Case Management to secure the outbound patient transfer workflow and will eventually also manage this aspect of patient care transitions.
Enhanced the patient experience
Provider
Thomas Jefferson University and Jefferson Health - DICE Group
Pennsylvania
Robert
Neff
Vice President of Digital Solution Development
2675843804
robert.neff@jefferson.edu
No
Being in the hospital is stressful. For many patients, it’s an unfamiliar setting where they have little control. The Digital Innovation and Consumer Experience (DICE) Group at Jefferson custom-built a voice assistant that gives patients power over their environment to make their stay more comfortable.
The Smart Rooms project has been an all-hands on deck endeavor with the DICE Group's design, development, and research teams collaborating with clinical stakeholders such as the director of nursing operations and patient care services, to ensure that the voice assistant would be a useful tool for patients.
By completing an array of non-clinical tasks and improving access to information in the hospital room, our HIPAA-compliant voice assistant improves the patient experience and gives staff more time to focus on the clinical needs of the patient. The tasks include but are not limited to controlling the TV, performing general internet searches, and looking up hospital information and phone numbers.
In its early stages with 39 patients enrolled, the Smart Rooms project generated an average of 21 interactions per patient per day providing insights on how we can continue to improve our patients' stays with voice technology.
The Smart Rooms project has been an all-hands on deck endeavor with the DICE Group's design, development, and research teams collaborating with clinical stakeholders such as the director of nursing operations and patient care services, to ensure that the voice assistant would be a useful tool for patients.
By completing an array of non-clinical tasks and improving access to information in the hospital room, our HIPAA-compliant voice assistant improves the patient experience and gives staff more time to focus on the clinical needs of the patient. The tasks include but are not limited to controlling the TV, performing general internet searches, and looking up hospital information and phone numbers.
In its early stages with 39 patients enrolled, the Smart Rooms project generated an average of 21 interactions per patient per day providing insights on how we can continue to improve our patients' stays with voice technology.
Enhanced the patient experience
Provider
Houston Methodist
Texas
Stephanie
Jones-Wood
Program Director - Provider Engagement & Resilience
713.441.0533
scjoneswood@houstonmethodist.org
Yes
Safe and Reliable Healthcare
WHAT: Mitigate clinician burnout; improve teamwork and communication; give frontline staff a “voice” for process improvement; enhance a sense of “community”; and create an environment for a learning health care system; WHO - ICU staff and leaders, corporate/system quality and patient safety (including process engineering), Safe and Reliable Healthcare (consults, IP owners of LENS technology); WHAT: standardized unit huddles during shift change using a digital learning boards; HOW: Units leaders report that standard huddles are helpful in communicating to their staff what is important in a limited amount of time, staff are sharing what is important to them – so unit leadership can prioritize and show their work on it; it is helping to keep process and performance improvement at the forefront so that it is part of “everyday” work and not set apart; process improvement work is archived; communications is streamlined and in one place; and managers are able to be more effective.
Improved the life of healthcare providers