1. Successful Clinical Process Redesign in a Connected Healthcare Community Linus Diedling Allison Foley, MD Elliot Sternberg, MD Michelle Woodley, RN

2. AGENDA Care Redesign from 3 Perspectives –Chief Medical Officer: Elliot Sternberg MD –Nurse/IT Executive: Michelle Woodley RN –Physician: Allison Foley MD Questions?

3. St. Joseph Health System Highlights $3.0 billion in revenues 14 hospitals in 3 states Licensed beds range from 47 to 851 Home health agencies, hospice care, outpatient services, skilled nursing facilities, managed care operations, and multiple physician organizations In FY 2004, SJHS provided more than $310 million in community benefit and care for the poor services

4. Patient & Family Centered Care Safe & Effective Equitable Efficient & Timely SJHS Values and IOM Goals

5. What is CRD? “Care ReDesign…creating more holistic, patient- centered care that is technologically enabled, resulting in improved clinical excellence, customer satisfaction and operational performance.” 1. Computerized Physician Order Entry-CPOE 2. PACS Digital Radiology 3. Clinical Documentation-Hospital Setting 4. Ambulatory Electronic Medical Record 5. Physician / Clinician Web Portal

6. The “Wait State” of Health Care Sick Patient Well Patient Schedule Visit Lab Interpretation Re-schedule Re-Visit PrescribeConfirm Payer Verification Scheduling Voice to Voice Live Confirmation Manual Chart Storage & Retrieval Confirming Eligibility Checking, Re-checking Patient History Waiting for Confirmation Lower Patient Satisfaction Higher Cost Increased Errors Harmful Delays Wait State Value Add Waste / Rework Patient Dissatisfaction Medical Errors Frustrated Care-Givers Unnecessary Costs

7. Care ReDesign Objectives Improve patient care (safety, quality, satisfaction) Provide improved process and information access for caregivers Reduce inefficienies in the care delivery process

8. Four “I”s of an Initiative Information Involvement Incentives Investment

9. Involvement

11. Incentives System Fiscal Year Goals that affect AT RISK PAY

12. Investment Care ReDesign –CPOE –AEMR –Clinical Documentation –PACS –Clinical Data Repository –Web Portal Connectivity –EMAR –Bed Tracker –Evidence-based Support

13. CARE REDESIGN Regulate, Mandate, or Innovate? Clinical Transformation SJHS Care Redesign Initiative

14. 10 Year IT Innovation Strategy 98990001020304050607 AssessOrganizePrepareExecuteExcel Systemic Innovation Organizational Excellence Industry Leadership Core System Implementation IT Leadership Restructure Century Preparation Strategic IT Partnership Strategic Plan Foundation Organization Preparation Complete Vision Integration System Optimization Web Deployment Infrastructure Modernization Web Transformation IT Clinical Innovation (CPOE, Clin Doc, PACS, AEMR) Business Process Design Change Management Services Manage with Information Next Generation Technology Ubiquitous Access Transform Clinical Care

15. PATIENT SAFETY SJHS PRO-ACTIVE APPROACH Patient Safety

16. CRD STRATEGY Be Pro-Active, Not Re-Active Develop Key Partnerships Utilize Collaborative Design Process Deploy a Franchise-Model Approach Innovate Not Mandate Facilitate User Adoption Through Communication Plan

17. GOALS OF CRD Decrease preventable medical errors Reduce wait-state Decrease operational inefficiencies Drive efficiencies by redesigning processes using automated technologies Provide real-time access to patient information Aggregate information to support quality of care improvement activities

18. Care ReDesign Roadmap

19. CRD Collaborative Approach Involve stakeholders from the start Redesign process workflow –Multidisciplinary work teams –Optimize available Technologies Build a CRD Franchise Model with multidisciplinary work teams

20. CRD Implementation Strategy A Pilot Approach

21. CRD Implementation Strategy

22. CRD Change Management, Adoption and Communication

23. Preaching the Gospel of Innovation – 2001 In Healthcare, if Innovation is not MANDATED or REGULATED its usually PROCRASTINATED!

24. Care ReDesign Objective Improve patient care (safety, quality, satisfaction) Provide improved process and information access for caregivers Reduce inefficiencies in the care delivery process

25. Information Technology and Clinicians Clinical system must be built by clinicians Collaboration between technical team and clinicians key –Process Workflow ReDesign –Change Management –Optimize Available Technology Right Process with the Right Technology

26. Nursing’s Key Leadership Role in IT Clinical Integration Professional Paradigm Shift –Responsible for overall coordination of care –Legacy to develop processes and systems that will improve quality of care –Optimize efficient and effective workflow “With passion and working smart, nurses will make it happen”

27. Keys to Physician Adoption Broad envisioning physician leaders driving sponsorship and participation Early physician involvement in concept, design and testing of new processes and systems Start small; achieve early (“quick wins”) and build on continuous successes

28. CRD at St. Jude Medical Center 18 Months at SJMC: –95% of frequent admitters in pilot unit using CPOE –900 staff and 450 physicians using online Clinical Documentation in all units –Electronic Medication Administration Record in use in all units except ED –Over 140,000 exams completed on PACS

29. Success Factors Patients are at the center of healthcare technology Care ReDesign is a journey and requires executive commitment Leadership must have a passion for automation and clinical transformation Be willing to commit resources needed Talk about the “end goals” constantly to keep them in sight

30. Live from Orange County: Saint Jude Medical Center CRD Pilot Site

31. Monty Python: The Holy Grail The Medical Staff Perspective

32. Benefits to Physicians Immediate access to patient record Decreased call backs to clarify orders Best Practice and Communication Access anywhere anytime Electronic signature of transcribed reports and verbal orders Assist with medication dosing calculations Associated data brought to point of ordering Ability to avoid some complications

33. Benefits to Patients Allergy and adverse drug reaction checking Medical history retained visit to visit Reduction in duplicate questioning and testing Coordinated care by multiple care providers having access to same record

34. Importance of Physician Involvement Leadership in evolving technology Drive technology to support workflow Order set development Medical Informatics Committee

35. Questions?