1. MeasureTargetBaseline Current (improved) % Improvement % of SSU cancer cases sent to Cancer Registry within 1 week of visit 80% 0% (12/31/14) 70% (4/6/15) 70% Weekly hours of SSH and SSU re- work tracking down information needed by the Cancer Registry 12 60 hours per week 18 hours per week 70% Clinical Integration IMPROVEMENT BULLETIN Specialist practices eliminate waste and improve information flow to South Shore Cancer Registry Start Date: September 4, 2014 Sponsors: Suniti Nimbkar, MD, South Shore Hospital; Joe Cahill, President and COO, South Shore Hospital; Luke O’Connell, MD, South Shore Urology (SSU), HPSO Chair Team: Nancy Hinchliffe, Manager (SSH); Laura Goldman, Registrar (SSH); Elizabeth Ledwell, Coordinator (SSH); Sandy Swanson, Office Manager (SSU) Background: South Shore Hospital (SSH) cancer patients must be registered in the SSH Cancer Registry as a regulatory requirement. Non-compliance can result in loss of accreditation. The current state process to enter Cancer Registry information for patients who had biopsies or office visits outside of SSH, Partners, or Atrius, takes up to 1 month (versus 2 hours for a patient from within those practices). This re-work for Registrars and office staff in specialist practices is costly and frustrating for staff, and can put us at risk of losing our accreditation. Goal: Increase the % of SSU patients’ pathology and visit information received by the Cancer Registry within one week of visit or procedure, from 0 to 80%, saving 1 hour of staff time per case. Progress: Almost to the goal of 80% of cancer cases within SSU. Next Steps: Continue spread to all SSU providers to achieve 80% target. Spread to other specialist practices in the south shore community. IMPROVEMENT METRICS Health Provider Services Organization Questions? Contact Luke O’Connell at Luke_O’Connell_MD@sshosp.org See page 2 for information on the process improvements that were made. TaskImpactWhen SSU – continue spread to all SSU providers, to achieve at least 80% of their cancer cases; sustain Save an additional 6 hours of staff time, weekly April 15 Spread and standardize the improved process to Dermatology and GI practices in the south shore X # of patient cases tracked by Cancer Reg August 31 Identify other specialist practices in the south shore to adopt the improved process X # of patient cases tracked by Cancer Reg Sept. 30 Next Steps

2. Clinical Integration IMPROVEMENT BULLETIN The table below is a summary of the process improvements that were made. ProblemCausesCountermeasuresResultsNext Steps SSU providers were not aware of the need to send patient pathology and visit information to the SSH Cancer Registry Workaround using letters, emails, and phone calls to request information was accepted by staff Identify the re-work (letters and phone calls) as “waste” Informed providers about the Registry process and waste All SSU providers are now aware Reminders as needed SSU lacked an easy way to send their patients’ pathology and visit information to the SSH Cancer Registry No one had identified this as a need, so a process was never created SSU developed a way to Cc the SSH Cancer Registry via fax for each patient visit or procedure, within their EMR Attached reminder notices to providers’ PC monitors SSU providers are now using this for 42% of patient cases Saving 25 hours weekly of staff time Continue to monitor weekly at SSU and the SSH Cancer Registry Sustain improvements with visual management Variation in use of the new process - some SSU providers still not using the new process for most of their patients. Some are at less than 20% The new process is still not familiar or standard to all providers, so they may forget Providers with less frequent cancer cases may have a harder time remembering Remind less frequent users Share weekly results with SSU providers, showing performance by provider -- % of patient cases CC’d to SSH Cancer Registry In Study phase Study and Act on results Health Provider Services Organization Find more bulletins on the Clinical Improvement Corner on the Medical Staff website. Email us at: hpso@sshosp.org.For internal distribution only.hpso@sshosp.org Rev date here