anatomy of a pilot at health 2.0 provider symposium - clinical box and lowell general hospital
TRANSCRIPT
Health 2.0 Provider SymposiumLowell General Hospital CollaborationSeptember 25, 2016
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Managing patients across the transitions of care increasing in importance with the advent of episode of care payments
Source: Stead, Stan. How Do I Get Paid for the Perioperative Surgical Home, Perioperative Surgical Home Summit, June 2016.
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Procedure cancellations remain a significant clinical and financial challenge
Cancelled Case
Workup 20%
No RealCancellation
11.1%
Capacity 13.4%
26.7%
4.4%
13.3% Did not want operation
Preoperative instruction not followed
Intercurrent disease after schedule finalized
11.1%Instantaneous
lack of key specialized personnel
Surgery no longer indicated
Insufficient workup
Co-morbidities found after schedule finalized
Key patient information not reviewed
4.4%
6.7%
6.7%
2.2%
Scheduling error
IT system error
6.7%
4.4%
9.0%
4.4%
Overbooked – transferred to waitlist
Overbooked – rescheduled next day
Patient 44.4%
Specialized Personnel 11.1%
Source: Seim, A, Causes of Cancellations on the Day of Surgery at Two Major University Hospitals, Surgical Innovation, 2009.
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Financial pressures from payment reform require real changes to care coordination and patient engagement
Source: Stead, Stan. How Do I Get Paid for the Perioperative Surgical Home, Perioperative Surgical Home Summit, June 2016.
Surgical Home ChallengeSurgery day Joan recovers at
homeJoan needs an
operation
ReadmissionsCancellations
She has questions, is frustrated, apprehensive and isn’t prepared for the procedure
She doesn’t complete Critical pre-op tasks in time
Discharge instructions are not communicated clearly, resulting in innocent errors in care by all
Complications not caught because follow-up visit not scheduled, and patients don’t know what to look for
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Procedure is delayed or cancelled the day of surgery
Poor Patient Experience Burnout
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Goals of the pilot
Activate patients
Engage family members
Identify high risk patients
Coordinate providers
Measure cost/quality
88% of patients in the U.S. do not have proficient health literacy
80% of the care provided to the sickest 1% of patients that use 20% of healthcare expenditures is provided by family membersRisk prediction models only 55% accurate 9% of models include social support60% of readmitted patients had no foll0w-up visit
Costs, patient engagement, coordination, difficult to measure
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Perioperative Surgical Home
Diagram Source: American Society of Anesthesiologists – Perioperative Surgical Home (PSH)
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ClinicalBox powers care coordination & patient engagement for complex episodes of care
EHR
View the Episode of Care and Pathway for Each Patient with Tasks, Communication & Education Embedded by Stage
Tasks are Specific To Each Surgical Procedure and Tailored by Patient
Connections are Clear to the Coordinator for Follow-up Questions with Family and Healthcare Providers
Ron: Surgical Coordinator (Staff)“I coordinate with doctors and patients to make sure everything runs smoothly” Employer: HospitalBackground: BA Hospital Administration
Quick take on SallyQuick take on Ron
Computer skills Intermediate
Job situation Employee
Computer type DesktopSmartphone
Tools ExcelEMRReportingInternetPhone
Background AdministrationBusiness
Key goals:• Educate patients. • Make sure patients are prepared for
all surgeries and appointments• Ensure medical records are correct
and up to date• Ensure all external dependencies are
taken care of.• Ensure doctors know when and
where they need to be• Understand which patients need the
most time and effort• Minimize mistakes• Make sure patients are happy.• Be able to quickly and easily identify
a patient and their next steps.
Time:• 65%: Admin Duties (Phone. Scheduling,
Typing)• 20% Dr. Sally Personal Tasks/Errands• 15% Miscellaneous personal tasks
A day in the life:• 8am: Arrives at work
• First priority: Checks e-mails. ~10 from Dr. Sally & 20 from patients
• 930am-12pm: Makes calls to patients for upcoming surgeries
• Educates patients, provides direction, comfort and support
• 12pm: Too busy to eat lunch. Has to attend front desk/administrative staff meeting
• 2pm: Picks Dr. Sally’s children up from school and brings them to babysitter
• 3pm: Back at office• Has Dr. Sally waiting for her to
schedule new surgical consults• 4pm-6pm: Admin Duties
• Falls behind on sending out new patient packets
• Has 11 voicemails to answer• Unanswered e-mails and follow-
ups• 630pm: Leaves work later than
scheduled, tasks left until next day
How staff are different:They are power users. They will be using the application all day long to coordinate care
EXAMPLE OF USER PROFILE TEMPLATE USED TO INFORM UI/UX DESIGN
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Thoughtfully staging implementation is critical to success of pilot and further deployment
1-3
4-6
7-9
10-12
13-15
16-18
19-21
22-24
25-27
28-30
v01 v02 v03 v04Functionality Groupings
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Practices
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Key Figures and Results from Pilot
• Data on 13,134 patients processed• 2,310 high risk patients seen at
pre-screening coordinated• 761 patients with cardiologists• 1,770 patients speak a language
other than English• 1,877 pre-screening date/time
changes• 6,063 surgery date/time changes• 431 unique primary care
physicians• 25 unique cardiologists• 12,585 family members
• Examples of ClinicalBox impact• 94,118 pre-op tasks tracked (Main
OR only)• 747 consents signed and
exchanged • 289 phone calls avoided
• Demonstrated high scalability
• Ability to work and collaborate with existing IT systems and IT team
• High satisfaction and demand among key stakeholders:
• Surgeons• Surgeon staff• Nurses• Pre-screening staff• Major centers of
excellence• Critical tasks caught in time
to prevent cancellation or delay
• Higher efficiency achieved through process and workflow optimization.
Key Pilot Figures (of of 6/1/16) Results I never had visibility into the surgical pipeline I needed to manage until now.
ClinicalBox provided me with an effective channel of communication with the surgeon offices
ClinicalBox was able to turn around changes in days and weeks vs. months and years
The ClinicalBox team really took the time to clearly understand the patient experience
Surgeon Staff
Pre-screening staff
Nurse Liaison
Anesthesiologist
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Lessons Learned
Start small and build momentum with early adopters1
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Need to do one of three things: cut costs, increase revenue or make life easier
Generate enough value, for the right stakeholder, in the right amount, at the right time
Ensure that innovator and health system business models and incentives are aligned
Novelty creates excitement but it doesn’t necessarily generate adoption
Reduce the bureaucracy: no standing meetings, no steering committee, keep it fluid
At first do things that do not scale: not everything has to be fully automated
High-tech and high-touch are not mutually exclusive: help people to do their jobs better
Helicopter constantly between the health system leadership and front-line staff and clinicians
Persevere: pivot until you get traction. Healthcare is a tough industry, keep going!