horizons - winter 2010

A PUBLICATION FOR THE SPONSORS, BOARDS, REGIONAL LEADERSHIP, SYSTEM OFFICE AND COLLEAGUES OF CATHOLIC HEALTH EAST16

H O R I Z O N S

H O R I Z O N S

C A T H O L I C H E A L T H E A S TC A T H O L I C H E A L T H E A S T

In Pursuit of Clinical TransformationUnique Transplant Joins Two CouplesTelemonitoring Gives Patients Power Over Their HealthImproving Communities ... One Grant at a TimeACT Update: Progress on Hospital-Acquired ConditionsHomeless Outreach Across Catholic Health East

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1, 6 & 72

3, 8 & 94 & 5

710 & 11

continued on pages 6 & 7

Across the SystemReshaping Spiritual CareServices Throughout CHEInternational Street Medicine Symposium10 Minutes with ... Judy Persichilli, CHE COO & CEO Designate

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H O R I Z O N SIIn Pursuit of Clinical Transformation

J10 Minutes with... Judy Persichilli

udy Persichilli, R.N., B.S.N., M.A., joined Catholic Health East in 2003 as the executive vice president of the Mid-

Atlantic Division. She was promoted to executive vice president, acute care for the System in 2008. Prior to joining CHE’s System Office, she served for eight years as CEO at St. Francis Medical Center in Trenton, N.J. Judy received her nursing degree from the St. Francis Hospital School of Nursing, a bachelor of science in nursing from Rutgers University, and a master of arts in administration from Rider College, as well as an honorary doctor of health degree from Georgian Court University. She is a member of the American Nurses Association and the New Jersey State Nurses Association; and was inducted into the New Jersey State Nurses Association Hall of Honor in 2006. In December, Judy was named as CHE’s chief operating officer and CEO designate and will officially assume the latter role upon Robert Stanek’s retirement by the end of 2010.

What originally motivated you to get into the health care field? As long as I can remember, I wanted to be a nurse. The concept of being in service to others always appealed to me. Once I graduated and started working as a registered nurse, I was struck by how meaningful the work is. Every day you touch the lives of people in very real ways. As I started to participate more actively in committee work at the hospital and then assuming increasing responsibilities in leadership positions, it became clear to me that individuals with clinical backgrounds have the foundational knowledge to lead health care organizations through changes and challenges because at a very fundamental level they know the process of care and what is needed. What are some of your proudest achievements at CHE? My proudest achievement at CHE really comes through other colleagues. The development of individuals in their leadership roles and the fact that I may have played a

part in some way in their development I think is the greatest accomplishment and contribution a leader can make. I look around Catholic Health East and see many leaders and colleagues who I have mentored in some way and I am so proud of their accomplishments.

As you move into your new role as COO and CEO designate, what are your top priorities? My top priority is to continue the foundational strategy of person-centered care and Vision 2017. To do so, a focus on ministry formation linked closely with leadership development is imperative. The future of our System is dependent on the development of experienced, mission-driven leaders who embrace our vision, values and culture. Clinical transformation will be realized through the changes we must make to be responsive to the needs of our communities. It is an utmost priority to perform at the highest level of evidence-based care that supports superb clinical outcomes, quality and safety. Throughout the years our ministries have changed to meet the needs of the communities. That is and always has been a priority and the reason our ministries have sustained our mission over time. Also, developing creative physician alignment strategies in each RHC community is

necessary to continue our work. Our founding Sponsors are clear that our goal is to enhance the Catholic health care ministry in the Eastern United States. That goal requires us to be vigilant and responsive to opportunities for growth. Supporting our Continuing Care Management Services Network for growth along the continuum while also being responsive to strategic and selective opportunities in acute care will continue.

How is the ACT Initiative helping to transform CHE? The ACT Initiative focuses on some very fundamental changes in the way we deliver care; the location of where care is delivered and the relationships we develop with providers, individuals and the communities to more appropriately serve our communities. Advancing Clinical Transformation is our journey to person-centered care.

Why is person-centered care so important to the future of CHE? The Scriptures teach us that we are made in the image and likeness of God. Every person possesses innate dignity and deserves reverence and respect. This is the foundation of our understanding of person-centered care and the focus of Vision 2017. Person-centered care creates healing partnerships and relationships that honor each individual’s informed choices and respects their innate dignity as they strive to achieve optimal health and quality of life.

What are some of the biggest challenges that face our ministry in the years ahead? There are so many risks ahead of us but I think the most challenging is the actual “unknown” about health care reform and the impact on our current ministries. We are still a very acute care-centric system and as we continue our journey across the continuum, maintaining the present economic engines of acute care to provide the resources necessary to build into the future is, to me, our greatest challenge.

magine a world where all of your medical records are always accessible … instantan-eously. No matter where you are … at home, in a doctor’s office, your local hospital, or being treated in an emergency room far from home. Imagine a world where that same medical record is ALWAYS updated. That means the X-ray you had two weeks ago, the blood test you took two days ago, and the medication changes that your physician just made two hours ago are all part of your medical record.

Think of all of the locations and places that contain pieces of your medical history. In addition to your family doctor, you may see several specialists, a dentist, two pharmacies, treatment at three hospitals, a surgi-center, a freestanding MRI center and an urgent care center in the same year. All of these locations have paper or electronic files that don’t talk to one another. Imagine a world where your medical

history is not fragmented.

Imagine a world where treatments for many medical conditions are standardized—not subject to just one clinician’s opinion. Studies show that different doctors frequently have different answers to the same question. Rather than treatment of a life-threatening condition being based on the experience of

one clinician—no matter how skilled the individual—imagine creating a system that supports the decision-making of that one individual so that he/she is “hard-wired” to the hundreds of research findings and clinical trials and new ways to treat different conditions that arise constantly. Imagine a world where evidence-based care is the norm.

Catholic Health East is doing more than imagining this world … we are in the midst of planning—and building—it … one process at a time.

Evidence-based-care. Person-centered care. Comprehensive care management. Clinical transformation. All of these initiatives are interrelated, and are crucial to our future success as a health ministry. Supported by advanced information technology, CHE is transforming the way that we provide acute care to patients throughout our health ministry.

A Multi-Step Process Our health system has been on this track for several years. In 2006, based on input from board members, Sponsors, clinicians and leaders from throughout our ministry, we introduced the CHE Preferred Delivery Model. This model outlined where CHE planned to be by the year 2017 in terms of the delivery of care, as well as the organizational competencies required to make this transition.

Judy Persichilli, R.N., B.S.N., M.A.

CHE Chief Operating Officerand CEO Designate

HORIZONS is a publication for the Sponsors, Boards,Regional Leadership, System Office and Colleaguesof Catholic Health East.

Horizons Editorial Staff

Scott H. Share Vice President, System Communications

Maria Iaquinto Communications Manager

Meg J. Boyd Communication Specialist

Design, Production, Printing & Mailing Fulfillment by JC Marketing Communications • jcmcom.com • Southington, Conn.

Catholic Health East is a community of persons committed to being a transforming, healing presence within the communities we serve.

Locations: Located in 11 eastern states from Maine to Florida.

Workforce: Approx. 54,000 employees.

SponsorsCongregation of the Sisters, Servants of the Immaculate Heart of Mary, Scranton, Pa.Franciscan Sisters of Allegany, St. Bonaventure, N.Y. Hope Ministries, Newtown Square, Pa.Sisters of Charity of Seton Hill, Greensburg, Pa.Sisters of Mercy of the Americas: Mid-Atlantic Community, Merion Station, Pa. New York, Pennsylvania, Pacific West Community, Buffalo, N.Y. Northeast Community, Cumberland, R.I. South Central Community, Belmont, N.C.Sisters of Providence, Holyoke, Mass.Sisters of St. Joseph, St. Augustine, Fla.

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Please direct comments and suggestions to [email protected]

3805 West Chester Pike, Suite 100Newtown Square, PA 19073Phone 610.355.2000Fax 610.271.9600www.che.org

Bob Williams M.D., from Deloitte Consulting, facilitates a group of clinical colleagues who helped to make some key decisions during the Evidence-Based Care Initiative’s “Decision Day,” and also worked on the development of a standard template for an order set to be used across CHE.

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H O R I Z O N S W I N T E R E D I T I O N 2 0 1 0

C hronic kidney disease robbed Tamira Ferrer of her life’s passion. Thanks to a unique transplant

procedure, she’ll soon pursue it once again. On September 30, 2009 Ferrer and her husband, Carlos, participated in the first-ever successful “paired exchange” or “double swap” kidney transplant in the Philadelphia and southern New Jersey region at Our Lady of Lourdes Medical Center with another couple from New York. “The new kidney gives me a new lease on life,” she said, now freed from exhausting six-day-a-week dialysis treatments. “It gives me a second chance to do what I like to do, which is teach.”

Increasing Chances Twenty-six million Americans suffer from chronic kidney disease, which can cause heart and vascular disease, anemia, weak bones and nerve damage. Kidney failure eventually can result, requiring dialysis or a transplant. Carlos Ferrer, 37, sought to donate one of his kidneys to his 38-year-old wife, but he was not a compatible match. So, Lourdes transplant coordinators suggested the family register in a national paired exchange database and the New Jersey Sharing Network. In a paired exchange, two kidney recipients essentially “swap” willing donors. While medically eligible to donate, each donor has an incompatible blood type or antigens to his or her intended recipient. By agreeing to exchange recipients—giving the kidney to an unknown, but compatible individual—the donors can provide two patients with healthy kidneys where previously no transplant would have been possible. “It’s a big decision to make when you know your kidney is not going to your loved one,” said Stephen Guy, M.D., who along with Nasser Youssef, M.D., performed the minimally invasive surgeries on the Ferrers. “But by Carlos’ willingness to donate a kidney to a stranger, he increased the chances of his wife finding a suitable living donor.”

Prior to the swap, Tamira Ferrer, a mother of four, had been on the transplant waiting list for six months. Without it, she could have waited up to five years. “It’s unique, but it’s becoming more and more available,” said Arijit Chakravarty, M.D., transplant nephrologist at Lourdes.

The Match When a match was found, coordinators at Lourdes and a hospital in New York worked together to schedule the simultaneous surgeries. Once the healthy organs were removed from the donors, they were packed and transported by vehicle—likely passing on the New Jersey Turnpike—to their waiting recipients. “I’m happy I had the opportunity to be a blessing in someone else’s life through paired exchange,” said Carlos Ferrer, who works in law enforcement. “We’ve been married for 16 years and this is the least I can do for her.” Right before Thanksgiving, the Ferrers met Bronx, N.Y. couple Marta and Moises Chiqitos with whom they now share an unmistakable bond. “I will never take a day of my life for granted,” said Tamira. “I will live every day of my life as if it’s my last.”

Unique Transplant Two CouplesJoins International Street MedicineSymposium

Fast Facts on Paired ExchangeA relatively small number of kidney swaps have been performed nationwide, but they are gaining favor because such a swap can reduce the time on transplant waiting lists. Also, kidneys from living donors last twice as long as those from the deceased, according to Arijit Chakravarty, M.D., Lourdes transplant nephrologist.Here are some facts about paired exchange:

• Through paired donation, two or more sets of intended living donors and candidates are matched to provide compatible donors to each recipient.

• Prior to the operations, the matched pairs remain anonymous, and both donors undergo surgery simultaneously.

• The first paired exchange occurred in 2001.

• More than 83,000 Americans are waiting for kidneys, but only about 15,000 kidney transplants occurred last year because of the shortage of donors. Paired exchange helps increase the chances for a compatible organ.

Carlos and Tamira Ferrer (seated) with members of the Lourdes Transplant team: (from left) Loretta Aigner, A.V.P., renal/transplant services; Donna Collins, R.N., transplant coordinator; Dr. Ari Chakravarty, transplant nephrologist; Dr. Stephen Guy, transplant surgeon; and Maria Robinson, R.N., transplant coordinator.

C lose to 100 attendees gathered in Atlanta in November to share best practices in the emerging field of

street medicine. Now in its fifth year, the International Street Medicine Symposium allows physicians and administrative leaders who care for those living on the streets throughout the world to exchange information and benefit from programs specific to the needs of street medicine practitioners. The Symposium was co-founded by Operation Safety Net® (OSN) Founder and Medical Director Dr. Jim Withers and Program Director Linda Sheets. A program of the Pittsburgh Mercy Health System, OSN is a medical outreach program for the unsheltered and transitional homeless. OSN co-sponsored this year’s Symposium with Saint Joseph’s Mercy Care Services, part of Saint Joseph’s Health System in Atlanta, and Mary Hall Freedom House, a comprehensive residential recovery program for women. “We really appreciated being a part of the Symposium this year and it was very well received here in Atlanta,” said Tom Andrews, president, Saint Joseph’s Mercy Care Services, one of Atlanta’s oldest and largest community outreach programs serving the homeless, uninsured and immigrant populations. Sponsored by the Sisters of Mercy and Saint Joseph’s Health System, Mercy Care Services delivered care to more than 9,900 patients in its medical and dental programs in 2008. Speakers were global and spoke about their field experiences. Truly qualitative in measure, they shared their frustrations, their thoughts on teaching street medicine, approaches, human rights and volunteering. Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration of U.S. Department of Health and Human Services, provided the opening remarks. He leads the agency’s efforts to provide effective and accessible treatment to all Americans with addictive disorders. Other featured presentations included reducing the cost of homelessness, fostering culturally sensitive health care, establishing human rights for basic needs, and street

medicine programs and practices in other United States cities, such as Boston, Chicago, Honolulu and Nashville; and other cities around the world, including Calcutta, India; Copenhagen, Denmark; Lima and Mala, Peru; London, England; and Santiago, Chile.

The Symposium was sponsored by GlaxoSmithKline, Saint Joseph’s Mercy Foundation and the Robert Wood Johnson Foundation. Continuing education credits were provided to physicians, nurses and social workers who attended. “We assisted Linda and her organization in arranging some local tours of homeless service agencies and some actual street outreach activities for the Symposium participants. Over 80 individuals participated in these tours which resulted in a broader understanding and appreciation for the state of homelessness in Atlanta,” said Andrews. Among its many benefits, the Symposium

offered collaboration and implementation tips. In Pittsburgh previously, communication on hospital discharges had been done via the telephone on an inconsistent basis. In Atlanta, the Grady Health System emergency department and Saint Joseph’s Mercy Care Services, Inc. created a referral process between the hospital and the health care system that seemed to be more efficient. As a result of this meeting, OSN nurses and case managers met with hospital nurses and social workers and will begin to utilize the Grady-Saint Joseph’s form. “This referral process will begin to measure outcomes of the health and welfare status of street homeless individuals from the ER to OSN, primarily for insurance, psychiatry, the new legal service and medication. Individuals will be referred to area clinics for primary care, and preferably to a primary care physician who will be responsible for their medical care,” said Sheets. “In addition, we are exploring a mini-respite apartment arrangement similar to Atlanta in which individuals can recover from their illness and injuries instead of on the streets.” Sr. Julie Casey, I.H.M., CHE executive vice president, mission integration attended the symposium. “The symposium was truly global in nature. It was inspiring to be with persons from all over who cared about and cared for some of the most vulnerable persons in our world. There were also many local caregivers present. Their commitment and their enthusiasm is amazing,” she said.

Atlanta-based homeless service providers take part in a panel discussion at International Street Medicine Symposium V in November 2009. Topics discussed included health care, mental health and substance abuse, housing and advocacy. The discussion was led by Lucy Hall, executive director, Mary Hall Freedom House, and Tom Andrews, president, Saint Joseph’s Mercy Care Services.

}{The symposium was truly global in nature. It was inspiring to be with persons from all over who cared

about and cared for some of the most vulnerable persons in our world.

Sr. Julie Casey, I.H.M.,executive vice president,mission integration, CHE

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C hronic conditions, such as heart failure, COPD, diabetes and hypertension account for

“the overwhelming majority” of medical expenses in the U.S. In fact, they are responsible for 78 percent of the nearly $2 trillion spent on health care in the U.S. each year. In 2007, Catholic Health East facilities collectively had more than 14,000 Medicare patients discharged with a primary diagnosis in one of these four chronic conditions; approximately 18 percent of these patients ended up being readmitted within 30 days of their discharge, which translates into about 2,500 readmissions in one year throughout CHE. In an effort to help reduce the number of readmissions among patients with these conditions, several CHE facilities have implemented telemonitoring programs. Mercy Home Health, part of Mercy Health System of Southeastern Pennsylvania, has implemented telemonitoring programs at two of their locations: St. Mary Home Care, Langhorne, Pa., in May 2009 and Nazareth Home Care, Philadelphia, Pa., in August 2009. The programs provide chronic disease management for patients with heart failure, diabetes and/or COPD (chronic obstructive pulmonary disease), helping them to maintain healthier lifestyles and reduce the number of hospital readmissions through the daily monitoring of their vital signs. Patients are evaluated for the telemonitoring program by discharge planners. A patient must be able to perform the in-home monitoring either independently or with the help of a caregiver. A patient’s physician can also initiate the request for telemonitoring services. “The discharge planners look at the patients’ diagnoses and see if they meet the

criteria for home care and if they would benefit from telemonitoring services,” said Diana Parsons, R.N., C.C.R.N.-C.S.C., telehealth coordinator, Mercy Home Health. “Patients must qualify for less-than-daily home care visits. If a patient needs daily visits, then telemonitoring is not a benefit to them.” St. Mary and Nazareth have contracted with Philips Home Healthcare who provides the equipment and initial training. The equipment consists of: a blood pressure cuff; a talking digital scale, which is designed to fit under a walker if needed; a pulse oximeter, which measures the patient’s blood oxygen saturation level (SpO2); and a TeleStation, which uses a patient’s existing phone line to communicate data from each of the wireless devices to a central data processing center. When a patient uses any one of these devices, the information is transmitted

to a secure server where home care nurses can review and follow-up as necessary (see figures 1 and 2 on pages 8 & 9). “Telemonitoring gives patients the power and control over their disease that they didn’t have before,” said Parsons. “It also increases compliance with their regimen because it allows them to see the results of their actions.” Plus, she added, “Patients feel safe because they know that there are nurses always looking at their vital signs.” The system flags patients whose vital sign readings are out-of-range. Out-of-range data can be set up to trigger the delivery of surveys so additional assessments can be obtained. The patient’s data is flagged green, yellow or red—depending on the result—so the correct follow-up action can be taken.

Telemonitoring Gives PatientsPower over Their Health

}{“Their goal is simple: to help others. Yet, our volunteers tell usthe work helps them personally and professionally as much as

it helps the communities they serve.”

H istorically, the role of the hospital chaplain has been to provide spiritual care in

inpatient hospital settings. As such, their focus is on helping patients, families and staff deal with pain, suffering, loss and grief. They talk with and listen to patients in order to identify their needs, concerns and hopes and to determine appropriate actions necessary to address these issues. Chaplains enhance people’s use of their own spiritual resources and are prepared to minister to people of all faith traditions and non-traditional spiritual practices. Catholic Health East’s goal is to have a board-certified chaplain (B.C.C.) at each RHC. These chaplains are specially educated to deal with spiritual issues in the context of all faith traditions, or in some cases, the absence of faith. A board-certified chaplain has a master’s degree in theology and has completed a rigorous course of study and supervised clinical pastoral education (C.P.E.) leading to certification.

However, with the declining number of priests and sisters available to staff spiritual care departments and with the accelerating shift of care to the outpatient and home settings, the face of hospital chaplaincy is changing.

“The focus of care is shifting from illness and cure to prevention and wellness, therefore increased demands of time and place will necessitate inviting, coaching and working with qualified volunteers and the chaplains’ leadership skills will be tapped as they partner with faith communities to respond to the spiritual and emotional needs of an increasingly diverse population,” said Sr. Jane Connolly, vice president, mission, Marian Community Hospital (Maxis Health System). “For chaplains, person-centered care is both invitation and challenge. As professionals who routinely empower others to tap their own inner resources in response to what life presents, they will

now be called on to empower themselves and one another to new ways of ministering to God’s people.”

While spiritual care for patients admitted to the hospital will always be important, today’s professional chaplains have rededicated themselves to meeting the spiritual needs of patients, families and colleagues across the entire continuum of care.

Today’s chaplain must learn new skills and focus on prevention and wellness because person-centered care requires greater flexibility and accountability. They must also be able to adapt to new technologies in order to communicate effectively with patients, families and clinical staff.

“The Spiritual Assessment Task Force has recently created a spiritual assessment tool that will be a part of the patient’s electronic medical record throughout CHE,” said Mary A. Williams, director, pastoral care, Saint Joseph’s Hospital of Atlanta. “This common spiritual

assessment will enable other disciplines in the health care arena to utilize the tool as a vital component of person-centered care.”

Chaplains support CHE’s health ministry in many ways. They minister to colleagues who seek to find meaning in the midst of pain, suffering and sadness; provide information for patients and families to complete Advance Directives; conduct ethics consults; console and nurture patients, family and staff; and act as a liaison with leadership of local faith communities.

It is also crucial for clinicians and caregivers to understand the importance and value of spiritual care, and to be able to identify spiritual issues in order to make appropriate referrals when the need arises.

“When the role of the chaplain is understood by patients, families and the clinical staff, and his or her services are effectively utilized, there is the potential for a collaborative partnership that can produce very positive effects on the patient’s care,” said Sr. Karen Helfenstein, director, mission services and spirituality, CHE.

Mary Jo McGinley, R.S.M.,Executive Director, Global Health Ministry


In Athens, Ga., St. Mary’s Hospice chaplain Rev. Bill Hayes (left) talks with a hospice patient and his nurse at the patient’s assisted living community.

Caron Bitterlich, R.N., and Ashley Graham, R.N., test the new telemonitoring equipment at St. Mary Home Care. Participants receive a set of easy-to-use wireless devices that measure their weight, blood pressure, pulse and blood oxygen levels.

Reshaping Spiritual CareServices Throughout CHE

C hange is inevitable. With all the mergers, acquisitions, sales and closures, it’s not always good

news to those behind the “sold” sign and often time must lapse before the silver lining appears. But when it does, it can open the eyes to an even brighter future. Such could be considered the case for both Allegany Franciscan Ministries, Inc. (AFM), a supportive health corporation of CHE and McAuley Ministries, the grant-making arm of Pittsburgh Mercy Health System. Each has received assets from the sale of hospitals. Since the money was raised in and for non-profit institutions, it had to remain in and be used for the community’s benefit. Thus, AFM and McAuley Ministries were created to serve under-resourced communities.

Although one has been in existence for over 10 years, the other only a year, both remain steadfast to their roots of women religious and each shares a similar mission.

“We strive to be catalysts for systemic change, committing resources and working collaboratively to promote physical, mental, spiritual, environmental and cultural health and well-being in our communities,” said Eileen Boyle, president and chief executive officer, AFM.

In 1997 the Franciscan Sisters of Allegany joined with the Sisters of Mercy and the Sisters of Providence to form and sponsor Catholic Health East. At the same time, the Sisters divested of certain assets through their Florida health care partnerships, creating the base for the formation of foundations in three regions of Florida, thus creating AFM. Today, it continues to be guided by the tradition and vision of the Franciscan Sisters of Allegany, and provides grants to organizations in Miami-Dade County, Palm Beach, Martin and St. Lucie Counties, and the Tampa Bay area of Hillsborough and Pinellas Counties. In January 1999, the AFM Board made its first distributions—$1,025,000 to seven organizations. Since then, AFM has

awarded more than 2,700 grants totaling over $48 million to more than 1,200 organizations.

McAuley Ministries, named in honor of Catherine McAuley, who founded the Sisters of Mercy, is the grant-making arm of the Pittsburgh Mercy Health System. It was established in 2008 to administer the proceeds from the sale of Mercy Hospital of Pittsburgh.

They focus grant making on the Pittsburgh neighborhoods traditionally served by the Sisters of Mercy: the Hill District, Uptown and West Oakland, as well as in communities by sponsored ministries of the Sisters in southwestern Pennsylvania.

In 2009, McAuley Ministries, which recently celebrated its one-year anniversary, awarded 50 grants ranging from $75 to $364,000 and totaling $1.77 million.

By analyzing the data that was obtained by working with the planning office at CHE, reviewing existing community development plans, and conducting listening groups, Michele Rone Cooper, executive director, McAuley Ministries, knew where to start when she joined the organization in 2008.

“We concluded that the areas we

needed to focus on were health and wellness, particularly prevention initiatives, education, community development and capacity building. Capacity building is helping to strengthen those non-profit organizations that are already meeting basic needs in those communities,” said Cooper. “We heard directly from the residents … who either confirmed our findings or suggested new challenges and new opportunities in those neighborhoods.”

One growing concern was children who suffered from asthma in the targeted communities. With the help of a $150,000 grant over three years, the problem is being addressed through Healthy Home Resources.

Healthy Home Resources received the funding for their Asthma Trigger Home Evaluation (AT HOME) program, which for the past six years has addressed the rise in illnesses caused or complicated by the presence of indoor allergens.

“McAuley Ministries welcomes opportunities to create partnerships with organizations interested in developing healthy, safe and vibrant communities,” said Cooper. “And there’s a real need

Improving Communities …

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Volunteers from the Bucks County Chapter of the American Sewing Guild set up their sewing machines in the St. Mary Medical Center (Langhorne, Pa.) cafeteria and stitched dignity robes for women receiving breast cancer treatments. The robes are designed with Velcro center closures and Velcro-secured openings under each arm to provide a sense of privacy for patients while doctors and nurses are performing examinations.

Left to right: Renee Chenault-Fattah, NBC10 news anchor; Sr. Megan Brown, vice president, mission, Mercy Philadelphia Hospital; Kristen Welker, NBC10 news anchor; Kathy Conallen, CEO, Mercy Philadelphia Hospital; and Tracy Davidson, NBC10 news anchor.

In addition to health screenings and education, the Expo featured fitness instructions, healthy cooking and aerobic demonstrations, free hair and make-up consultations, massage therapy, products and services from local health and wellness

organizations, and panel discussions focusing on a variety of health topics. Performances from

area churches, schools and community groups provided entertainment. The NBC Peacock poses

with Ray Welch, CEO, Mercy Health System of Southeastern Pennsylvania; Brian Finestein, CEO,

Mercy Fitzgerald Hospital; and Renee Chenault-Fattah, NBC10 news anchor.

Mercy Health System of Southeastern Pennsylvania (Conshohocken, Pa.) joined forces with local TV affiliate NBC10 and area radio stations to present the first annual MPowerYourself Health & Wellness Expo last October.

CHE Colleagues Chronicle Peru Journey OnlineTwo CHE colleagues—Lois Greene, assistant vice president, ambulatory services, Saint Michael’s Medical Center, Newark, N.J., and Jenifer Harris, director, marketing and external affairs, St. Francis Hospital, Wilmington, Del.—were among the group of clinicians and support staff from throughout Catholic Health East who participated in Global Health Ministry’s recent surgical/primary care mission to Chulucanas, Peru.During their two weeks in Peru, Lois maintained an online journal—or “blog”—and Jen posted regular updates on her hospital’s Facebook® page, sharing thoughts, experiences and photographs with family, friends and hospital colleagues. Jen’s use of social media even resulted in coverage of her journey by a local newspaper, which helped to raise awareness about Global Health Ministry and its humanitarian mission.

While working as an operating room nurse in Peru, Saint Michael’s Medical Center’s Lois Greene takes a moment between surgical cases to update her blog.

St. Francis Hospital’s Jen Harris is pictured here with a young girl who was waiting to see a physician regarding treatment of her cleft palate.

St. Francis Hospital’s Facebook page with updates from the Peru mission.

The Healthy Home Resources staff attends a community event to raise awareness of asthma triggers in the home.


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Catholic Health (Buffalo, N.Y.) is participating in the development of a new HealthSciences Charter School slated to open in August 2010. The five-year high school program will focus on math and science, and provide hands-on learning experiences to prepare students for future careers in the health sciences and related professions.

Catholic Health also recently hosted a MASH (Medical Academy of Science & Health) Camp at Sisters of Charity Hospital, St. Joseph Campus to give students from Mt. Mercy Academy a behind-the-scenes look at various health care careers. Students participated in a variety of hands-on activities to find out if a career in health care might be right for them.

Ms. Lamurl Morris leads the Prince Avenue Middle School Performing Arts Class at the 10th annual lighting of the St. Mary’s Hospital (St. Mary’s Health Care System, Athens, Ga.) Love Lights Tree on December 1. Special guests included the Prince Avenue Middle School Performing Arts class and Candy Stoffel, mezzo soprano. Since its launch in 1998, the event has raised more than $258,000 for St. Mary’s Hospice Services, which uses the funds to provide care to patients who need hospice services, regardless of their ability to pay.

Students demonstrated their dancing skills outside LaFond Galleries where Mercy BehavioralHealth held a reception to launch Dancing Classrooms. Mercy Behavioral Health, part of

Pittsburgh Mercy Health System, brought Dancing Classrooms to Pittsburgh last September and culminated with the “Colors of the Rainbow” exhibition in January 2010. Dancing Classrooms was

founded in 1994 as the educational arm of the American Ballroom Theater Company. The program provides a systematic training model appropriate to the developmental needs of 10- and

11-year-olds to reinforce their social skills just before the onset of puberty. Today, Dancing Classrooms reaches more than 40,000 children in 400 schools across 13 cities.

The Marian Community Hospital Auxiliary, Maxis Health System, Carbondale, Pa., raised nearly $7,000 hosting its 11th Annual Taste of the Town Event, a unique dining experience where patrons browse at their own pace while sampling delicious foods prepared and donated by vendors from the community. Among those participating were colleagues representing the hospital’s food and nutrition services department. From left: Paul Tolerico, general manager, Sodexo; Fran Carachilo, chef, Marian Community Hospital; and Tom Singer, executive chef, Sodexo.


One Grant at a Time

Michele Rone Cooper, executive director, McAuley Ministries

Eileen Boyle, president and chief executive officer, Allegany Franciscan Ministries

because left unchecked, a child’s asthma leads to missed school days and educational disparities, increased time spent in emergency rooms, higher health care costs and a lessening of physical activity that can lead to obesity.”

Healthy Home Resources staff first inspects houses and apartments, educates families on how to reduce or eliminate asthma triggers, and provides cleaning supplies including a HEPA vacuum and air purifier, dehumidifier, professional dust mop and allergen trapping bed covers, as well as provide six months of follow-up to reduce or eliminate asthma triggers and decrease asthma symptoms for the child.

Studies suggest that people with low socioeconomic status and families living in inner cities are more likely to be affected by asthma due to higher exposure of environmental risk factors.

“Up to 300 children will receive assistance through this expanded effort, including 75 of those children in our target area,” said Cooper.

In Miami-Dade, where farming is a source of income for many, the extensive use of pesticides for agricultural production puts farm workers at high risk for exposure,

acute poisoning and related adverse health effects. In addition, farm workers may also face language barriers, fear of employer retaliation, lack of access to hand-washing and sanitary facilities, low wages, inadequate access to health care, substandard housing and unsafe transportation.

To address the issue, the Farmworker Association of Florida received $50,000 for a Pesticide Safety and Environmental Health Project from AFM. Through the grant, in addition to direct education and programs for farm workers, 52 health care providers in South Dade were trained on how to diagnose, treat and report pesticide exposure.

“Our grant has helped raise awareness among farm workers themselves, as well as, among health care providers and landowners in Miami-Dade, ultimately leading to healthier and safer conditions for workers,” said Boyle.

AFM receives hundreds of grant requests each year and awards grants ranging from $500 to $400,000 to local nonprofit organizations working to improve access to health care in the communities it serves. There are several types of grants and they are given from all three regions. Grant

money is based on investments that are managed by CHE as part of CHE’s Combined Investment Program.

“We plan to spend five percent of our total net assets on grants each year. In 2008, we awarded nearly $9 million in grants, in 2009 we awarded $5.7 million, and in 2010, we expect to award $6.1 million to meet critical health access needs in our communities,” said Boyle. “To us, it’s the impact—the purpose of the grant, not the dollar amount—that is important.”

Although grant-making is the main focus of AFM’s work, colleagues are actively engaged in their communities. “We believe that the ‘human resource’ we provide through our team members is invaluable,” said Boyle.

Cooper agreed: “We are just beginning to receive reports from the grants we have awarded. It is gratifying to know that McAuley Ministries was a small part of their success.”

When asked about the future, Boyle responded, “We are interested in how our experience and the grants we have made can support Catholic Health East’s learning journey into person-centered care.”

“We are evaluating care management and the integration of behavioral health and primary care, and we are also focusing on after-school programs to help under-resourced youth in our target neighborhoods with academic achievement and pursuing careers that will sustain them in life,” said Cooper.

Boyle added, “My hope is to never stop searching for solutions and advocating for a more just society.”

AFM grants help raise awareness among farm workers about the dangers of pesticides.

6


11

...continued from the cover

Health Care Delivery Model

In 2017, Catholic Health East is a Mission-driven health system that:

• Delivers compassionate, holistic person-centered care to all;

• Builds and fosters a values-based culture which attracts diverse individuals dedicated to the healing ministry;

• Demonstrates excellence in quality, service access and value;

• Leads in the provision of personal health data and professional advice and support that empowers persons to participate in managing their care and optimizing their health;

• Provides coordinated, integrated care management for persons across the continuum of care;

• Advocates for quality care, especially for those who are marginalized; and

• Collaborates broadly to serve persons in our communities.

One major step towards building this preferred delivery model is the ACT (Advancing Clinical Transformation) initiative, developed in 2008 and introduced throughout CHE in early 2009. This initiative challenges us to ensure excellence in quality and patient safety outcomes—every person, every place, every time. In 2009, RHC clinicians set goals for achieving targeted outcomes related to hospital-acquired conditions (e.g. zero tolerance for falls, ventilator associated pneumonia and central line infections), Medicare length-of-stay reductions, prevention of acute care readmission within 30 days, and decreasing the percentage of clinical denials of payment.

CHE’s ACT initiative is congruent with our efforts to assure Comprehensive Care Management for persons as they transition into and out of our facilities and programs. A major redesign of hospital care management was an important goal for our acute care facilities in 2009. With the support of System Office experts, the RHC hospital case managers collectively reviewed the hospital discharge planning processes, and broke down the “silos” among utilization review, discharge planning and care coordination. The new model, both data driven and outcomes focused, was designed with the clinical, financial and spiritual needs of the patient in mind. It integrates the function of care coordination, discharge planning and utilization review into one. The initiative, supported by MIDAS+ software that tracks essential data, was launched system-wide in June 2009.

Bridge to Person-Centered Care The efforts detailed here—clinical transformation,

comprehensive care management and our preferred health care delivery model for the year 2017—all have “person-centered care” at their core. The landmark 2009 Governance-Management Conference (Mission Possible: Building the Bridge to Person-Centered Health Care) brought hundreds of CHE clinicians, board members, Sponsors and leaders together to learn about and plan for the evolution of CHE into a person-centered health care system … focused on respecting and responding to individuals’ preferences, needs and values.

As described at that conference, CHE’s journey to person-centered care would take time; our ministry committed to working together to “build the bridge” to person-centered care over the next few years. Among the key components detailed at that meeting were IT Enabled Information (storing and accessing data from multiple sources, monitoring data, using data in evidence-based care and clinical decision making) and the development of electronic medical records.

The Focus on Evidence-Based Care The Journal of the American Medical Association defines evidence-based health care as “… the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based health care requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources.”

“Doctors, after all, are human beings,” said Tom Garthwaite, M.D., CHE’s chief medical officer and one of the champions of the movement towards evidence-based care. “First, it is not humanly possible to keep up with the latest scientific thinking across all medical disciplines. Further, a physician’s own personal experiences—for example, the success of a particular treatment modality with a particular patient—make a lasting impression, and understandably influence the way that physician treats similar patients in the future. This variable approach is especially common when there are not yet good tests to make the diagnosis with certainty.”

“In the case where there is considerable certainty of the diagnosis, there still may be too much variation in the care delivered,” continued Garthwaite. “C-section rates in some areas of the country are much higher than in other areas. Lengths of stay for cardiac surgery patients vary considerably, depending on location. Why? Are the patients fundamentally different? Is there a logical or scientific reason for the observed variations? No. The reality is that in the route to diagnosis, in the selection and administration of therapy, physicians often rely too heavily on experience, anecdote and dated information. Without routine processes and

information systems to guide physicians and other providers, patients will continue to get care that is not evidence-based.”

Added Incentive On February 19, 2009, President Obama signed into law The American Recovery and Reinvestment Act (ARRA) of 2009. This bill, created in an unprecedented effort to jumpstart the nation’s ailing economy, includes provisions that provide incentives and support for the adoption of certified electronic health records (EHRs). The Recovery Act authorizes bonus payments for hospitals participating in Medicare or Medicaid if they become “meaningful users” of certified EHRs. These bonus payments will help lessen the financial burden for many health care providers to adopt this technology.

Why is the government providing these incentives? Together with all of the health care reform efforts that are being contemplated, the belief is that the massive adoption of EHR nationwide is critical to reducing costs and improving quality. While CHE hospitals were already on the path towards implementing evidence-based care models and electronic health records systems, the opportunity to take advantage of ARRA stimulus money to help fund this enormous investment in information technology systems and staff proved to be an incentive for CHE to “fast-track” its implementation schedule.

“We estimate that our journey towards evidence-based care and the development of a ‘paperless’ medical records system via the use of EHRs will cost our hospitals nearly $300 million over the next 10 years,” said Garthwaite. “It’s something that we have been planning to do anyway to enhance quality, improve patient safety and become more efficient in our work flow and processes. Now, if we become ‘meaningful users’ by the government’s target date, we estimate that CHE facilities will be eligible for about $100 million in ARRA stimulus funds.”

“Meaningful use of EHRs will be measured based on process measures related to utilization of information system capabilities, but more importantly on clinical outcome, efficiency and safety measures reported for all patients not just those covered by Medicare and Medicaid,” said Donette Herring, chief information officer and vice president of information services, CHE. “For this reason, CHE’s approach to meaningful use will be through the effective use of information systems to support clinical decision making and advanced care processes based on industry leading practice and evidence.”

“There is strong alignment between CHE’s

In Pursuit of Clinical Catholic Health Eastback of a station wagon. Today, the 18-member Mercy Homeless Health Care (HCH) team provides primary care services onsite at 46 shelters, soup kitchens, job placement sites and transitional programs with services provided in three counties. Since its inception, Mercy HCH has cared for over 2,300 individuals in the Sisters of Providence Health System service area. “The Mercy HCH team follows a nursing model of health care, providing assessment, intervention, referrals, follow-up and education. Mercy Medical Center in Springfield, sponsored by the Sisters of Providence, is the cornerstone of the HCH program, providing laboratory, X-ray and inpatient services to clients,” said Fadus. CHE’s homeless outreach programs have a long history. In 2010, Saint Joseph’s Mercy Care Services will celebrate its 25th anniversary as a health care provider of Atlanta’s homeless population. Atlanta’s largest homeless outreach program, it also started simply, with doctors, nurses and sisters from Saint Joseph’s Hospital going to shelters with the first primary service being the ritual of washing feet. Mercy Care outreach staff today continue to frequent numerous sites and respond to the wide-ranging needs of “street bound” homeless persons. Named after Catherine McAuley, the foundress of the Sisters of Mercy, the McAuley Residence has been supporting women and children in a transitional setting for over 22 years. Part of Mercy Health System of Maine, the program provides women with a place to live and the opportunity to learn skills to lead more productive lives. Sandra Anthoine, executive director, said, “McAuley Residence offers hope to these women who often see no light at the end of the tunnel. We empower women here for the long haul.” Providing hope for women from across the state of Maine who suffer from abuse, poverty and homelessness, its philosophy is that each person deserves the basic human rights of ‘shelter, dignity and self-determination’. Another unique program has taken the homeless and placed them in a continuum care setting. The Lifelong Learning, Living and Growing Program is a health and wellness initiative developed for the residents of Saint Mary Home who live in the Frances Warde Towers Apartments, part of Mercy Community Health (MCH), West Hartford, Conn. Now in its third year, the program is designed to provide resources and forums to help educate residents; motivate them to improve their lives; encourage social

interaction and friendships; inspire their natural talents; offer a time for reflection and spiritual growth; and challenge their thinking on critical issues such as care for the environment and respect for different cultures. But the real growth is the connection that is made with those that once made their homes on the street. Reardon sees a bond among residents that underscores the importance of integration. Mercy Community Health’s collaborative program with Hartford’s Mercy Housing & Shelter organization (another ministry sponsored by the Sisters of Mercy) may not be large in size, but its impact on

homeless and human connection is. Formerly homeless people are now living with residents and giving back to those who live in shelters. They have connected with their new neighbors successfully and bonds are growing. They learn the dignity of each person and the value of being generous. Participants of the MCH/Mercy Housing & Shelter program live in the Frances Warde Towers Apartments and join other residents in programmed activities, daily meals and community gatherings. “By integrating these residents more fully into life at Saint Mary Home, we hope to minimize any feelings they may have of being socially

disenfranchised. They will know what it is to belong at Saint Mary Home, and by extension, they will better appreciate their important place in the world,” said Reardon. “We do a lot of work in terms of Mercy’s Core Values with the dignity of each person and the respect for the individual, and because so many of our residents have been homeless themselves, there is a real bond developing among them.” In Albany, another small program serves the homeless population. SPARC operates an 11-bed emergency shelter. However, with a desire to expand, growth is on the horizon. “We have been working in collaboration with other providers in our area who work with the homeless,” said Lape. “Recently we were part of a local group who applied for and received monies for the Homeless Prevention and Rapid-Rehousing Program. We received money and SPARC hired a full-time case manager to help implement this program.” Although eliminating homelessness continues to be an insurmountable quest, strides continue to be made by caregivers. Dolly Roman, B.S.N., speaks of Dr. Withers setting an example. “A soft-spoken man, he leads by example and gentleness. He sets an example for the staff and the incoming students, as only Mother Teresa of Calcutta said so well ‘treat them as Christ in disguise’.” “The fruit of one’s labors is not always apparent in the short term, but as one long-term Mercy Care employee commented, ‘The greatest satisfaction is in seeing hope where there was no hope before.’ It keeps everyone reaching out,” said Sr. Angela Ebberwein, vice president, Mercy Care Services. Fadus credits her staff and the system itself. “I am grateful to be in a health care system that not only supports the work we do but also honors us. We are not a backburner program. We are front and center in the minds of leadership in carrying out the mission of SPHS.” She continued, “However, my real hope for the future is that our services are needed less. That is always our long term goal.” For more information about CHE’s Healthcare for the Homeless contact Philip Boyle at [email protected] or 610.355.2063. *National Law Center on Homelessness & Poverty, www.nlchp.org

“The Rules”hang in Tent City, also known as “Transitional Park” in Camden, N.J., where a group of homeless reside; Project H.O.P.E. provides outreach and medical care here.

}{I am grateful to be in a health

care system that not only supports the work we do but

also honors us.Doreen Fadus, executive director,

community health, SPHS

10 7


person-centered care vision and the Department of Health and Human Services meaningful use vision. These include improving health outcomes, improving care coordination, engaging patients and their families, and improving public health. CHE’s plans will leverage existing information systems and introduce new system capabilities and industry standard clinical terminology to provide patients with their personal health information and exchange key clinical information with authorized entities and public health agencies. This multi-year journey is a daunting challenge that will be rewarding for those directly involved as we actualize CHE’s person-centered care vision and become a meaningful EHR user,” said Herring.

Pulling It All Together To have any chance for success, CHE’s leaders needed to all be “on board” with the Vision for change. All RHCs needed to work together to clinically transform our ministry to meet the needs and expectations of our patients, and to provide person-centered care using evidence-based care concepts … all while committing to work towards a paperless health system.

On September 17, 2009, RHC CEOs, CMOs and CIOs were invited to an in-person meeting at which the “game plan” for this massive, multi-year initiative was explained in detail. There was a great deal of discussion and healthy exchange of thoughts and ideas; by the end of that meeting, all RHC leaders in attendance agreed to move forward with the development and implementation of a system-wide evidence-based care/clinical transformation initiative.

The group agreed that in order to establish evidence-based care as the “norm” throughout CHE, specific measures, assessments and tasks needed to be established and accomplished. Among these were core measures, technology assessments, standardized documentation, order sets and computerized provider order entry (CPOE).

Sound complex? It certainly is … but the rewards for our patients and colleagues are almost incalculable. The promise of a better, safer, higher quality, person-centric health system demanded our commitment to change.

Change of this magnitude requires time … and the commitment of many individuals. One of the first highly visible “commitments” was the November 2009 meeting that was dubbed ”Decision Day.” More than 120 colleagues from across the system came together to discuss what key decisions would be ‘made together’ to drive our enterprise model for evidence-based care. There were breakout sessions for the steering committee, for clinical content (order sets and care plans) and for clinical process improvement and workflow. Participants included members of CHE’s Physician Leadership Council, chief quality officers, chief nursing officers, chief information officers, pharmacists and other clinicians from throughout CHE.

Progress! In December 2009, physicians and other clinical colleagues from throughout CHE met to initiate and actively participate in the order set design process. The 38 physicians present represented six specialty areas: internal medicine, emergency medicine, general surgery, cardiology, OB/GYN and orthopedics.

Other participating clinicians included nurses, pharmacists, physical and respiratory therapists, as well as a representative from spiritual care. The excellent participation, enthusiasm and interdisciplinary collaboration of the six work groups resulted in the development of 20 order sets over the two-day session; several additional “virtual” planning sessions were scheduled to run through early 2010 to enable the groups to complete their order sets.

The plan is to configure order sets for common procedures in all specialty areas that can be built, configured and tested during 2010; the first “go live” is currently scheduled for late 2010 at St. Mary Medical Center in Langhorne, Pa.; the next three RHCs (St. Peter’s in Albany, N.Y., St. Mary Health Care System in Athens, Ga., and Sisters of Providence Health System in Springfield, Mass.) plan to go live with the new order sets in 2011.

Development of interdisciplinary plans of care (IPOC) and patient assessments will follow a process similar to and be coordinated with order sets. Clinicians from throughout the health system will incorporate patient assessments using the new software—Zynx Care and Zynx Orders—purchased in December 2009 for use throughout CHE.

“Using ZynxOrders and ZynxCare, CHE will be able to incorporate the highest standards of physician and clinical care into our automated and paper based medical record systems,” said Ginny Davis, R.N., Ed.D., clinical informatics officer, CHE. “As evidence-based IPOC and assessments are developed and approved they will be incorporated into our current clinical documentation systems and available for immediate use in paper form.”

“While we have made a great deal of progress in a short period of time, we still have a long road ahead of us,” said Kathleen Meredith, vice president, clinical transformation at CHE. “Throughout this multi-year process, it is important that we all keep reminding ourselves of why we have embarked on this journey together. Improved patient care, safer care and more efficient and effective care are well worth the effort.”

TransformationHomeless Outreach Across

ACT Update: Progress onHospital-Acquired Conditions

When the Advancing Clinical Transformation (ACT) Initiative was kicked off at the beginning of 2009, one critical step taken was the decision to focus on several key hospital-acquired conditions as a way to affect clinical transformation throughout the entire health system. In early 2009, the Patient Care Executive Committee, comprised of the top patient care executives from each RHC, targeted five hospital-acquired conditions for reduction/elimination. It was felt that progress made on these five conditions would have significant impact on improving care and reducing costs throughout the ministry:

1. Catheter-associated urinary tract infections 2. Falls resulting in injury3. Central line infections 4. Ventilator-associated pneumonia 5. Hospital-acquired pressure ulcers

“Great progress has been made during the first full year of the ACT Initiative,” said Judy Persichilli, CHE’s chief operating officer and CEO designate. “Our patient care executives are committed to advancing clinical transformation and promoting safer, high quality care by eliminating hospital-acquired conditions.” Through the first nine months of 2009, six hospitals had experienced no incidences of ventilator-associated pneumonia:

• St. Mary’s Hospital, Athens, Ga.• Marian Community Hospital, Carbondale, Pa.

(Maxis Health System)• Nazareth Hospital, Philadelphia, Pa. (Mercy Health

System of Southeastern Pennsylvania)• St. James Mercy Hospital, Hornell, N.Y.• Mercy Medical Center, Springfield, Mass. (Sisters of

Providence Health System)

• St. Francis Hospital, Wilmington, Del.Three hospitals had no incidence of central line infections:

• Mercy Hospital, Miami, Fla.• Marian Community Hospital• Mercy Medical Center (Sisters of Providence

Health System)One hospital had no incidences of hospital-acquired pressure ulcers: • St. Mary’s Hospital, Athens, Ga.Congratulations to everyone at the hospitals mentioned above for all of their dedication, hard work and attention to detail that helped to eliminate these hospital-acquired conditions throughout the first three quarters of 2009!

M ost of us take having enough to eat and a “good night’s sleep” for granted. However, according to

the National Law Center on Homelessness & Poverty, approximately three million people—including over 1.3 million children—are likely to experience homelessness in a given year.* And given the nation’s economic conditions, this number is likely to rise. In 2010, all CHE RHCs are collaborating with their local communities to enhance services for homeless persons. They are identifying the number of homeless persons located in their service areas, developing plans to address programmatic gaps and setting up services for this under-resourced population. CHE’s Healthcare for the Homeless (HC4H) is an affinity group that helps facilitate this initiative. Facilitated by Philip Boyle, CHE’s vice president, mission and ethics, the group works to provide information sharing and to advance specific policy goals and other initiatives that support the health care needs of the homeless. The goal is to promote better communities in which everyone has access to safe, affordable housing and comprehensive health services. Stephen M. Lape, L.C.S.W., program manager, Morton Homeless Shelter, Shelter Plus Care, Outpatient/Day Rehab, Community Residence and St. Peter’s Addiction Recovery Center (SPARC), Albany, N.Y., said the HC4H group provides an essential networking opportunity to facilitate the exchange of ideas and new initiatives. “We post any grants we have written and received on the CHE portal designed for HC4H. It is good to know and speak with other providers within our own system who are providing similar services. Also, on a political/advocacy side, there is power in numbers,” said Lape. Maureen Reardon, R.S.M., Ph.D., senior vice president and chief mission and compliance officer for Mercy Community Health, West Hartford, Conn., also participates in CHE’s HC4H group. “I might take an idea from what is shared on those calls and implement it,” she said. Examples include providing retreats for her residents, some who were formally homeless, conducting a special remembrance Liturgy for National Homeless Memorial Day, or collecting warm clothing for a homeless shelter. “It is also helpful to get the global picture from CHE as demonstrated by a recent meeting when we discussed the broad issue of health

care reform,” said Doreen Fadus, executive director of community health, Sisters of Providence Health System (SPHS). “I think we are in the beginning stages of our development as a group and have many opportunities to develop.” The range of services and the means by which they sustain the programs is creative and varied. Several of the HC4H programs run Federally Qualified Health Centers (FQHCs) that focus solely on health needs of homeless persons. The federal government underwrites FQHCs at Saint Joseph’s Mercy Care Services in Atlanta, Project H.O.P.E. at Lourdes Health System in Camden, N.J., and Health Care for the Homeless at Sisters of Providence Health System in Springfield, Mass. Project H.O.P.E. (Homeless Outreach Program Enrichment), part of the Lourdes Health System, Camden, N.J., provides services to one of the most economically challenged areas in the nation. They provide: social services, a medical mobile van, primary health care and food packages for diabetic patients. As the single provider of medical care to the homeless of Camden County, Project H.O.P. E. has helped more than 11,000 individuals over the last 13 years. It is also one of the five FQHC homeless projects in New Jersey. According to Shana Kline, assistant director for Project H.O.P.E., “The process of a patient coming in and being very sick to the stabilization of their health is quite wonderful to see.”

In Pittsburgh, Operation Safety Net ® (OSN), a program of the Pittsburgh Mercy Health System (PMHS), is a health, housing and supportive service to the street homeless population of Pittsburgh and surrounding communities. Sponsored by the Sisters of Mercy, OSN was established in 1992 by Dr. Jim Withers, and serves over 1,500 individuals who are unsheltered and homeless, as well as individuals who are transitioning from the streets into housing. OSN’s mission is to provide direct care and to advocate for individuals living on the streets, as well as to provide pathways to healthier lives. Services are delivered by teams of volunteer clinicians who walk the streets and travel via a mobile medical van. Case managers assist clients with benefits, housing and treatment. Through a $43,700 seed grant from McAuley Ministries, the grant-making arm of PMHS, OSN also led the way in establishing a Pittsburgh-based Project HELP (Homeless Experience Legal Protection) program, modeled after a national program started to assist victims of Hurricane Katrina in New Orleans. OSN is partnering with the Allegheny County Bar Association Foundation, Neighborhood Legal Services, the Pittsburgh Paralegal Association, and eight Pittsburgh law firms and corporations to provide pro bono legal assistance. Some HC4H programs had humble beginnings. Twenty-five years ago in Massachusetts, Sr. Julie Crane, a Sister of Providence and nurse practitioner provided basic medical supplies to homeless persons out of the

Pamela Mieglitz, left, who has been homeless for several months, is interviewed by paralegal Michele Rosenblatt regarding Social Security benefits during the Project HELP clinic at Operation Safety Net held in December.

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...continued from page 3

Telemonitoring Gives Patients Power over Their Health

}{Telemonitoring gives patients

the power and controlover their disease that they

didn’t have before.Diana Parsons, R.N., C.C.R.N.-C.S.C.,

telehealth coordinator,Mercy Home Health

Currently, St. Mary Home Care has 30 patients utilizing telemonitoring services; Nazareth Home Care has 17 patients. Springfield Home Care in Delaware County, Pa., is scheduled to launch during the first quarter of 2010. Also slated to launch in early 2010 is the Saint Joseph’s Heart Failure Center (HFC) Telemonitoring Program. The goal of the HFC, part of Saint Joseph’s Health System, Atlanta, Ga., is to optimize each patient’s heart failure condition through effective self-management education and by implementing national heart failure guidelines of care. Ultimately, these efforts keep heart failure patients out of the hospital.

Telemonitoring is not new to CHE. Several RHCs already have telemonitoring programs in place with other vendors. RHCs with telemonitoring services include: Sisters of Providence Health System, Springfield, Mass.; St. Mary’s Health Care System, Athens, Ga.; Holy Cross Hospital, Ft. Lauderdale, Fla.; St. Peters Health Care Services, Albany, N.Y.; Catholic Health, Buffalo, N.Y.; BayCare Health System, Clearwater, Fla.; Mercy Community Health, West Hartford, Conn.; and Mercy Health System of Maine, Portland, Maine.

Together, these RHCs average about 400 people utilizing telemonitoring services on any given day. By 2010, we are expected to average 500 people per day; with a total of nearly 3,000 patients utilizing the service by years end (see CHE Telemonitoring graph).

Even with telemonitoring programs in each of these RHCs and with the launch of programs at Saint Joseph’s and Mercy Medical, Daphne, Ala., in 2010, there are still

many more patients who could benefit from telemonitoring services.

“Across our system we see more than 14,000 discharges of patients with a primary diagnosis of heart failure, COPD, diabetes or hypertension,” said Scott Ash, vice president, business development, CHE. “We would like to connect as many of them with telemonitoring as possible. As a result, we are looking for other ways to scale our telemonitoring.”

One such way is to utilize a kiosk system for facilities such as nursing homes and assisted living communities. With this system, a kiosk or several kiosks could be placed in common areas where individuals could log in to a secure network via computer or telephone line and be led through the process of taking and recording their vital signs. This method eliminates the need to provide equipment for each individual patient and eliminates the need to provide installation and maintenance for each of those systems.

Another way is to partner with a vendor who provides device-free telemonitoring services. One such vendor, Pharos, offers a device-free, technology-based platform solution which utilizes an available telephone or Internet connection to gather and report symptom information. The system walks the patient through a short series of symptom-related questions and allows the patient to enter his/her vital signs. Patients can use their own scale, glucose monitor, etc., without the need of additional equipment. Similar to Philips, the patients’ responses are monitored and alerts are sent to caregivers when a patient is out of range.

The Pharos solution will be tested at Saint Joseph’s, along with the Philips system. Most likely, those at highest-risk will utilize the Philips hardware and devices, while those not eligible for a home device system will be able to utilize the device-free Pharos solution. Saint Joseph’s use of telemonitoring is unique within CHE because they are not utilizing it through a home care program, rather they will implement a “hospital-based” program.

“All patients hospitalized at Saint Joseph’s Hospital with a primary heart failure diagnosis are candidates for the home telemonitoring program,” said Kathleen Halvey, N.P., heart failure and transplant practitioner, Saint Joseph’s Hospital. “Each patient will be monitored for 30 days by a nurse practitioner with specialized knowledge in the management of heart failure. Once enrolled, patients will receive individualized ongoing feedback from the nurse practitioner regarding their vital signs, weight trends and survey responses.”

The timing of feedback is important for “teachable moments” about heart failure self-management. Plus, the primary physician will receive communication reports regarding the status of their patient. All home monitored patients are provided a face-to-face appointment in the HFC one week after hospital discharge allowing the practitioner to validate the patient’s clinical status. At the end of the 30-day monitoring period, the telemonitoring nurse practitioner will utilize best-practice care coordination to transition the patient back to his/her primary physician.

Telemonitoring is only one step toward what CHE hopes to provide in terms of

telemedicine. Looking to the future, CHE also hopes to provide a more interactive element to the telemedicine program. In this scenario, it would be possible for a patient’s profile to be individualized to their specific condition so that physician order sets can be created. This would allow a nurse to instantly order a medication based on answers to a scheduled patient survey or based on their current vital signs—without having to go to the physician each time. Scheduled surveys can also ask a patient if they took their medications, if they went to their doctor’s appointment or if they have any questions.

In addition, future goals could include a centralized CHE call center. “There probably is potential for centralized review and monitoring of patients data from within CHE,” said Ash. This would eliminate the need to use an outside vendor for data processing.

“Our goal is to make telemonitoring available to every person in our health care system who is living with chronic heart failure, COPD, hypertension or diabetes, so that we assure that they get the right care, at the right time in the right setting every time,” said Ash.

Figure 1

Figure 2

The wireless devices measure weight, blood pressure, pulse and blood oxygen levels. Data is sent through an existing phone line to a telehealth coordinator, who reviews the patient’s health status and, under the direction of a physician, initiates clinical interventions as needed.

CHE Telemonitoring

Easy-to-use wireless devices are installed in the patient’s home to measure and track their vital signs. Clockwise from top: digital scale, TeleStation, ECG/Rhythm strip recorder, pulse oximeter and blood pressure cuff.

10 7


person-centered care vision and the Department of Health and Human Services meaningful use vision. These include improving health outcomes, improving care coordination, engaging patients and their families, and improving public health. CHE’s plans will leverage existing information systems and introduce new system capabilities and industry standard clinical terminology to provide patients with their personal health information and exchange key clinical information with authorized entities and public health agencies. This multi-year journey is a daunting challenge that will be rewarding for those directly involved as we actualize CHE’s person-centered care vision and become a meaningful EHR user,” said Herring.

Pulling It All Together To have any chance for success, CHE’s leaders needed to all be “on board” with the Vision for change. All RHCs needed to work together to clinically transform our ministry to meet the needs and expectations of our patients, and to provide person-centered care using evidence-based care concepts … all while committing to work towards a paperless health system.

On September 17, 2009, RHC CEOs, CMOs and CIOs were invited to an in-person meeting at which the “game plan” for this massive, multi-year initiative was explained in detail. There was a great deal of discussion and healthy exchange of thoughts and ideas; by the end of that meeting, all RHC leaders in attendance agreed to move forward with the development and implementation of a system-wide evidence-based care/clinical transformation initiative.

The group agreed that in order to establish evidence-based care as the “norm” throughout CHE, specific measures, assessments and tasks needed to be established and accomplished. Among these were core measures, technology assessments, standardized documentation, order sets and computerized provider order entry (CPOE).

Sound complex? It certainly is … but the rewards for our patients and colleagues are almost incalculable. The promise of a better, safer, higher quality, person-centric health system demanded our commitment to change.

Change of this magnitude requires time … and the commitment of many individuals. One of the first highly visible “commitments” was the November 2009 meeting that was dubbed ”Decision Day.” More than 120 colleagues from across the system came together to discuss what key decisions would be ‘made together’ to drive our enterprise model for evidence-based care. There were breakout sessions for the steering committee, for clinical content (order sets and care plans) and for clinical process improvement and workflow. Participants included members of CHE’s Physician Leadership Council, chief quality officers, chief nursing officers, chief information officers, pharmacists and other clinicians from throughout CHE.

Progress! In December 2009, physicians and other clinical colleagues from throughout CHE met to initiate and actively participate in the order set design process. The 38 physicians present represented six specialty areas: internal medicine, emergency medicine, general surgery, cardiology, OB/GYN and orthopedics.

Other participating clinicians included nurses, pharmacists, physical and respiratory therapists, as well as a representative from spiritual care. The excellent participation, enthusiasm and interdisciplinary collaboration of the six work groups resulted in the development of 20 order sets over the two-day session; several additional “virtual” planning sessions were scheduled to run through early 2010 to enable the groups to complete their order sets.

The plan is to configure order sets for common procedures in all specialty areas that can be built, configured and tested during 2010; the first “go live” is currently scheduled for late 2010 at St. Mary Medical Center in Langhorne, Pa.; the next three RHCs (St. Peter’s in Albany, N.Y., St. Mary Health Care System in Athens, Ga., and Sisters of Providence Health System in Springfield, Mass.) plan to go live with the new order sets in 2011.

Development of interdisciplinary plans of care (IPOC) and patient assessments will follow a process similar to and be coordinated with order sets. Clinicians from throughout the health system will incorporate patient assessments using the new software—Zynx Care and Zynx Orders—purchased in December 2009 for use throughout CHE.

“Using ZynxOrders and ZynxCare, CHE will be able to incorporate the highest standards of physician and clinical care into our automated and paper based medical record systems,” said Ginny Davis, R.N., Ed.D., clinical informatics officer, CHE. “As evidence-based IPOC and assessments are developed and approved they will be incorporated into our current clinical documentation systems and available for immediate use in paper form.”

“While we have made a great deal of progress in a short period of time, we still have a long road ahead of us,” said Kathleen Meredith, vice president, clinical transformation at CHE. “Throughout this multi-year process, it is important that we all keep reminding ourselves of why we have embarked on this journey together. Improved patient care, safer care and more efficient and effective care are well worth the effort.”

TransformationHomeless Outreach Across

ACT Update: Progress onHospital-Acquired Conditions

When the Advancing Clinical Transformation (ACT) Initiative was kicked off at the beginning of 2009, one critical step taken was the decision to focus on several key hospital-acquired conditions as a way to affect clinical transformation throughout the entire health system. In early 2009, the Patient Care Executive Committee, comprised of the top patient care executives from each RHC, targeted five hospital-acquired conditions for reduction/elimination. It was felt that progress made on these five conditions would have significant impact on improving care and reducing costs throughout the ministry:

1. Catheter-associated urinary tract infections 2. Falls resulting in injury3. Central line infections 4. Ventilator-associated pneumonia 5. Hospital-acquired pressure ulcers

“Great progress has been made during the first full year of the ACT Initiative,” said Judy Persichilli, CHE’s chief operating officer and CEO designate. “Our patient care executives are committed to advancing clinical transformation and promoting safer, high quality care by eliminating hospital-acquired conditions.” Through the first nine months of 2009, six hospitals had experienced no incidences of ventilator-associated pneumonia:

• St. Mary’s Hospital, Athens, Ga.• Marian Community Hospital, Carbondale, Pa.

(Maxis Health System)• Nazareth Hospital, Philadelphia, Pa. (Mercy Health

System of Southeastern Pennsylvania)• St. James Mercy Hospital, Hornell, N.Y.• Mercy Medical Center, Springfield, Mass. (Sisters of

Providence Health System)

• St. Francis Hospital, Wilmington, Del.Three hospitals had no incidence of central line infections:

• Mercy Hospital, Miami, Fla.• Marian Community Hospital• Mercy Medical Center (Sisters of Providence

Health System)One hospital had no incidences of hospital-acquired pressure ulcers: • St. Mary’s Hospital, Athens, Ga.Congratulations to everyone at the hospitals mentioned above for all of their dedication, hard work and attention to detail that helped to eliminate these hospital-acquired conditions throughout the first three quarters of 2009!

M ost of us take having enough to eat and a “good night’s sleep” for granted. However, according to

the National Law Center on Homelessness & Poverty, approximately three million people—including over 1.3 million children—are likely to experience homelessness in a given year.* And given the nation’s economic conditions, this number is likely to rise. In 2010, all CHE RHCs are collaborating with their local communities to enhance services for homeless persons. They are identifying the number of homeless persons located in their service areas, developing plans to address programmatic gaps and setting up services for this under-resourced population. CHE’s Healthcare for the Homeless (HC4H) is an affinity group that helps facilitate this initiative. Facilitated by Philip Boyle, CHE’s vice president, mission and ethics, the group works to provide information sharing and to advance specific policy goals and other initiatives that support the health care needs of the homeless. The goal is to promote better communities in which everyone has access to safe, affordable housing and comprehensive health services. Stephen M. Lape, L.C.S.W., program manager, Morton Homeless Shelter, Shelter Plus Care, Outpatient/Day Rehab, Community Residence and St. Peter’s Addiction Recovery Center (SPARC), Albany, N.Y., said the HC4H group provides an essential networking opportunity to facilitate the exchange of ideas and new initiatives. “We post any grants we have written and received on the CHE portal designed for HC4H. It is good to know and speak with other providers within our own system who are providing similar services. Also, on a political/advocacy side, there is power in numbers,” said Lape. Maureen Reardon, R.S.M., Ph.D., senior vice president and chief mission and compliance officer for Mercy Community Health, West Hartford, Conn., also participates in CHE’s HC4H group. “I might take an idea from what is shared on those calls and implement it,” she said. Examples include providing retreats for her residents, some who were formally homeless, conducting a special remembrance Liturgy for National Homeless Memorial Day, or collecting warm clothing for a homeless shelter. “It is also helpful to get the global picture from CHE as demonstrated by a recent meeting when we discussed the broad issue of health

care reform,” said Doreen Fadus, executive director of community health, Sisters of Providence Health System (SPHS). “I think we are in the beginning stages of our development as a group and have many opportunities to develop.” The range of services and the means by which they sustain the programs is creative and varied. Several of the HC4H programs run Federally Qualified Health Centers (FQHCs) that focus solely on health needs of homeless persons. The federal government underwrites FQHCs at Saint Joseph’s Mercy Care Services in Atlanta, Project H.O.P.E. at Lourdes Health System in Camden, N.J., and Health Care for the Homeless at Sisters of Providence Health System in Springfield, Mass. Project H.O.P.E. (Homeless Outreach Program Enrichment), part of the Lourdes Health System, Camden, N.J., provides services to one of the most economically challenged areas in the nation. They provide: social services, a medical mobile van, primary health care and food packages for diabetic patients. As the single provider of medical care to the homeless of Camden County, Project H.O.P. E. has helped more than 11,000 individuals over the last 13 years. It is also one of the five FQHC homeless projects in New Jersey. According to Shana Kline, assistant director for Project H.O.P.E., “The process of a patient coming in and being very sick to the stabilization of their health is quite wonderful to see.”

In Pittsburgh, Operation Safety Net ® (OSN), a program of the Pittsburgh Mercy Health System (PMHS), is a health, housing and supportive service to the street homeless population of Pittsburgh and surrounding communities. Sponsored by the Sisters of Mercy, OSN was established in 1992 by Dr. Jim Withers, and serves over 1,500 individuals who are unsheltered and homeless, as well as individuals who are transitioning from the streets into housing. OSN’s mission is to provide direct care and to advocate for individuals living on the streets, as well as to provide pathways to healthier lives. Services are delivered by teams of volunteer clinicians who walk the streets and travel via a mobile medical van. Case managers assist clients with benefits, housing and treatment. Through a $43,700 seed grant from McAuley Ministries, the grant-making arm of PMHS, OSN also led the way in establishing a Pittsburgh-based Project HELP (Homeless Experience Legal Protection) program, modeled after a national program started to assist victims of Hurricane Katrina in New Orleans. OSN is partnering with the Allegheny County Bar Association Foundation, Neighborhood Legal Services, the Pittsburgh Paralegal Association, and eight Pittsburgh law firms and corporations to provide pro bono legal assistance. Some HC4H programs had humble beginnings. Twenty-five years ago in Massachusetts, Sr. Julie Crane, a Sister of Providence and nurse practitioner, provided basic medical supplies to homeless persons out of the

Pamela Mieglitz, left, who has been homeless for several months, is interviewed by paralegal Michele Rosenblatt regarding Social Security benefits during the Project HELP clinic at Operation Safety Net held in December.

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...continued from the cover

Health Care Delivery Model

In 2017, Catholic Health East is a Mission-driven health system that:

• Delivers compassionate, holistic person-centered care to all;

• Builds and fosters a values-based culture which attracts diverse individuals dedicated to the healing ministry;

• Demonstrates excellence in quality, service access and value;

• Leads in the provision of personal health data and professional advice and support that empowers persons to participate in managing their care and optimizing their health;

• Provides coordinated, integrated care management for persons across the continuum of care;

• Advocates for quality care, especially for those who are marginalized; and

• Collaborates broadly to serve persons in our communities.

One major step towards building this preferred delivery model is the ACT (Advancing Clinical Transformation) initiative, developed in 2008 and introduced throughout CHE in early 2009. This initiative challenges us to ensure excellence in quality and patient safety outcomes—every person, every place, every time. In 2009, RHC clinicians set goals for achieving targeted outcomes related to hospital-acquired conditions (e.g. zero tolerance for falls, ventilator associated pneumonia and central line infections), Medicare length-of-stay reductions, prevention of acute care readmission within 30 days, and decreasing the percentage of clinical denials of payment.

CHE’s ACT initiative is congruent with our efforts to assure Comprehensive Care Management for persons as they transition into and out of our facilities and programs. A major redesign of hospital care management was an important goal for our acute care facilities in 2009. With the support of System Office experts, the RHC hospital case managers collectively reviewed the hospital discharge planning processes, and broke down the “silos” among utilization review, discharge planning and care coordination. The new model, both data driven and outcomes focused, was designed with the clinical, financial and spiritual needs of the patient in mind. It integrates the function of care coordination, discharge planning and utilization review into one. The initiative, supported by MIDAS+ software that tracks essential data, was launched system-wide in June 2009.

Bridge to Person-Centered Care The efforts detailed here—clinical transformation,

comprehensive care management and our preferred health care delivery model for the year 2017—all have “person-centered care” at their core. The landmark 2009 Governance-Management Conference (Mission Possible: Building the Bridge to Person-Centered Health Care) brought hundreds of CHE clinicians, board members, Sponsors and leaders together to learn about and plan for the evolution of CHE into a person-centered health care system … focused on respecting and responding to individuals’ preferences, needs and values.

As described at that conference, CHE’s journey to person-centered care would take time; our ministry committed to working together to “build the bridge” to person-centered care over the next few years. Among the key components detailed at that meeting were IT Enabled Information (storing and accessing data from multiple sources, monitoring data, using data in evidence-based care and clinical decision making) and the development of electronic medical records.

The Focus on Evidence-Based Care The Journal of the American Medical Association defines evidence-based health care as “… the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based health care requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources.”

“Doctors, after all, are human beings,” said Tom Garthwaite, M.D., CHE’s chief medical officer and one of the champions of the movement towards evidence-based care. “First, it is not humanly possible to keep up with the latest scientific thinking across all medical disciplines. Further, a physician’s own personal experiences—for example, the success of a particular treatment modality with a particular patient—make a lasting impression, and understandably influence the way that physician treats similar patients in the future. This variable approach is especially common when there are not yet good tests to make the diagnosis with certainty.”

“In the case where there is considerable certainty of the diagnosis, there still may be too much variation in the care delivered,” continued Garthwaite. “C-section rates in some areas of the country are much higher than in other areas. Lengths of stay for cardiac surgery patients vary considerably, depending on location. Why? Are the patients fundamentally different? Is there a logical or scientific reason for the observed variations? No. The reality is that in the route to diagnosis, in the selection and administration of therapy, physicians often rely too heavily on experience, anecdote and dated information. Without routine processes and

information systems to guide physicians and other providers, patients will continue to get care that is not evidence-based.”

Added Incentive On February 19, 2009, President Obama signed into law The American Recovery and Reinvestment Act (ARRA) of 2009. This bill, created in an unprecedented effort to jumpstart the nation’s ailing economy, includes provisions that provide incentives and support for the adoption of certified electronic health records (EHRs). The Recovery Act authorizes bonus payments for hospitals participating in Medicare or Medicaid if they become “meaningful users” of certified EHRs. These bonus payments will help lessen the financial burden for many health care providers to adopt this technology.

Why is the government providing these incentives? Together with all of the health care reform efforts that are being contemplated, the belief is that the massive adoption of EHR nationwide is critical to reducing costs and improving quality. While CHE hospitals were already on the path towards implementing evidence-based care models and electronic health records systems, the opportunity to take advantage of ARRA stimulus money to help fund this enormous investment in information technology systems and staff proved to be an incentive for CHE to “fast-track” its implementation schedule.

“We estimate that our journey towards evidence-based care and the development of a ‘paperless’ medical records system via the use of EHRs will cost our hospitals nearly $300 million over the next 10 years,” said Garthwaite. “It’s something that we have been planning to do anyway to enhance quality, improve patient safety and become more efficient in our work flow and processes. Now, if we become ‘meaningful users’ by the government’s target date, we estimate that CHE facilities will be eligible for about $100 million in ARRA stimulus funds.”

“Meaningful use of EHRs will be measured based on process measures related to utilization of information system capabilities, but more importantly on clinical outcome, efficiency and safety measures reported for all patients not just those covered by Medicare and Medicaid,” said Donette Herring, chief information officer and vice president of information services, CHE. “For this reason, CHE’s approach to meaningful use will be through the effective use of information systems to support clinical decision making and advanced care processes based on industry leading practice and evidence.”

“There is strong alignment between CHE’s

In Pursuit of Clinical Catholic Health Eastback of a station wagon. Today, the 18-member Mercy Homeless Health Care (HCH) team provides primary care services onsite at 46 shelters, soup kitchens, job placement sites and transitional programs with services provided in three counties. Since its inception, Mercy HCH has cared for over 2,300 individuals in the Sisters of Providence Health System service area. “The Mercy HCH team follows a nursing model of health care, providing assessment, intervention, referrals, follow-up and education. Mercy Medical Center in Springfield, sponsored by the Sisters of Providence, is the cornerstone of the HCH program, providing laboratory, X-ray and inpatient services to clients,” said Fadus. CHE’s homeless outreach programs have a long history. In 2010, Saint Joseph’s Mercy Care Services will celebrate its 25th anniversary as a health care provider of Atlanta’s homeless population. Atlanta’s largest homeless outreach program, it also started simply, with doctors, nurses and sisters from Saint Joseph’s Hospital going to shelters with the first primary service being the ritual of washing feet. Mercy Care outreach staff today continue to frequent numerous sites and respond to the wide-ranging needs of “street bound” homeless persons. Named after Catherine McAuley, the foundress of the Sisters of Mercy, the McAuley Residence has been supporting women and children in a transitional setting for over 22 years. Part of Mercy Health System of Maine, the program provides women with a place to live and the opportunity to learn skills to lead more productive lives. Sandra Anthoine, executive director, said, “McAuley Residence offers hope to these women who often see no light at the end of the tunnel. We empower women here for the long haul.” Providing hope for women from across the state of Maine who suffer from abuse, poverty and homelessness, its philosophy is that each person deserves the basic human rights of ‘shelter, dignity and self-determination’. Another unique program has taken the homeless and placed them in a continuum care setting. The Lifelong Learning, Living and Growing Program is a health and wellness initiative developed for the residents of Saint Mary Home who live in the Frances Warde Towers Apartments, part of Mercy Community Health (MCH), West Hartford, Conn. Now in its third year, the program is designed to provide resources and forums to help educate residents; motivate them to improve their lives; encourage social

interaction and friendships; inspire their natural talents; offer a time for reflection and spiritual growth; and challenge their thinking on critical issues such as care for the environment and respect for different cultures. But the real growth is the connection that is made with those that once made their homes on the street. Reardon sees a bond among residents that underscores the importance of integration. Mercy Community Health’s collaborative program with Hartford’s Mercy Housing & Shelter organization (another ministry sponsored by the Sisters of Mercy) may not be large in size, but its impact on

homeless and human connection is. Formerly homeless people are now living with residents and giving back to those who live in shelters. They have connected with their new neighbors successfully and bonds are growing. They learn the dignity of each person and the value of being generous. Participants of the MCH/Mercy Housing & Shelter program live in the Frances Warde Towers Apartments and join other residents in programmed activities, daily meals and community gatherings. “By integrating these residents more fully into life at Saint Mary Home, we hope to minimize any feelings they may have of being socially

disenfranchised. They will know what it is to belong at Saint Mary Home, and by extension, they will better appreciate their important place in the world,” said Reardon. “We do a lot of work in terms of Mercy’s Core Values with the dignity of each person and the respect for the individual, and because so many of our residents have been homeless themselves, there is a real bond developing among them.” In Albany, another small program serves the homeless population. SPARC operates an 11-bed emergency shelter. However, with a desire to expand, growth is on the horizon. “We have been working in collaboration with other providers in our area who work with the homeless,” said Lape. “Recently we were part of a local group who applied for and received monies for the Homeless Prevention and Rapid-Rehousing Program. We received money and SPARC hired a full-time case manager to help implement this program.” Although eliminating homelessness continues to be an insurmountable quest, strides continue to be made by caregivers. Dolly Roman, B.S.N., speaks of Dr. Withers setting an example. “A soft-spoken man, he leads by example and gentleness. He sets an example for the staff and the incoming students, as only Mother Teresa of Calcutta said so well ‘treat them as Christ in disguise’.” “The fruit of one’s labors is not always apparent in the short term, but as one long-term Mercy Care employee commented, ‘The greatest satisfaction is in seeing hope where there was no hope before.’ It keeps everyone reaching out,” said Sr. Angela Ebberwein, vice president, Mercy Care Services. Fadus credits her staff and the system itself. “I am grateful to be in a health care system that not only supports the work we do but also honors us. We are not a backburner program. We are front and center in the minds of leadership in carrying out the mission of SPHS.” She continued, “However, my real hope for the future is that our services are needed less. That is always our long term goal.” For more information about CHE’s Healthcare for the Homeless contact Philip Boyle at [email protected] or 610.355.2063. *National Law Center on Homelessness & Poverty, www.nlchp.org

“The Rules”hang in Tent City, also known as “Transitional Park” in Camden, N.J., where a group of homeless reside; Project H.O.P.E. provides outreach and medical care here.

}{I am grateful to be in a health

care system that not only supports the work we do but

also honors us.Doreen Fadus, executive director,

community health, SPHS

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Catholic Health (Buffalo, N.Y.) is participating in the development of a new HealthSciences Charter School slated to open in August 2010. The five-year high school program will focus on math and science, and provide hands-on learning experiences to prepare students for future careers in the health sciences and related professions.

Catholic Health also recently hosted a MASH (Medical Academy of Science & Health) Camp at Sisters of Charity Hospital, St. Joseph Campus to give students from Mt. Mercy Academy a behind-the-scenes look at various health care careers. Students participated in a variety of hands-on activities to find out if a career in health care might be right for them.

Ms. Lamurl Morris leads the Prince Avenue Middle School Performing Arts Class at the 10th annual lighting of the St. Mary’s Hospital (St. Mary’s Health Care System, Athens, Ga.) Love Lights Tree on December 1. Special guests included the Prince Avenue Middle School Performing Arts class and Candy Stoffel, mezzo soprano. Since its launch in 1998, the event has raised more than $258,000 for St. Mary’s Hospice Services, which uses the funds to provide care to patients who need hospice services, regardless of their ability to pay.

Students demonstrated their dancing skills outside LaFond Galleries where Mercy BehavioralHealth held a reception to launch Dancing Classrooms. Mercy Behavioral Health, part of

Pittsburgh Mercy Health System, brought Dancing Classrooms to Pittsburgh last September and culminated with the “Colors of the Rainbow” exhibition in January 2010. Dancing Classrooms was

founded in 1994 as the educational arm of the American Ballroom Theater Company. The program provides a systematic training model appropriate to the developmental needs of 10- and

11-year-olds to reinforce their social skills just before the onset of puberty. Today, Dancing Classrooms reaches more than 40,000 children in 400 schools across 13 cities.



One Grant at a Time

Michele Rone Cooper, executive director, McAuley Ministries

Eileen Boyle, president and chief executive officer, Allegany Franciscan Ministries

because left unchecked, a child’s asthma leads to missed school days and educational disparities, increased time spent in emergency rooms, higher health care costs and a lessening of physical activity that can lead to obesity.”

Healthy Home Resources staff first inspects houses and apartments, educates families on how to reduce or eliminate asthma triggers, and provides cleaning supplies including a HEPA vacuum and air purifier, dehumidifier, professional dust mop and allergen trapping bed covers, as well as provide six months of follow-up to reduce or eliminate asthma triggers and decrease asthma symptoms for the child.

Studies suggest that people with low socioeconomic status and families living in inner cities are more likely to be affected by asthma due to higher exposure of environmental risk factors.

“Up to 300 children will receive assistance through this expanded effort, including 75 of those children in our target area,” said Cooper.

In Miami-Dade, where farming is a source of income for many, the extensive use of pesticides for agricultural production puts farm workers at high risk for exposure,

acute poisoning and related adverse health effects. In addition, farm workers may also face language barriers, fear of employer retaliation, lack of access to hand-washing and sanitary facilities, low wages, inadequate access to health care, substandard housing and unsafe transportation.

To address the issue, the Farmworker Association of Florida received $50,000 for a Pesticide Safety and Environmental Health Project from AFM. Through the grant, in addition to direct education and programs for farm workers, 52 health care providers in South Dade were trained on how to diagnose, treat and report pesticide exposure.

“Our grant has helped raise awareness among farm workers themselves, as well as, among health care providers and landowners in Miami-Dade, ultimately leading to healthier and safer conditions for workers,” said Boyle.

AFM receives hundreds of grant requests each year and awards grants ranging from $500 to $400,000 to local nonprofit organizations working to improve access to health care in the communities it serves. There are several types of grants and they are given from all three regions. Grant

money is based on investments that are managed by CHE as part of CHE’s Combined Investment Program.

“We plan to spend five percent of our total net assets on grants each year. In 2008, we awarded nearly $9 million in grants, in 2009 we awarded $5.7 million, and in 2010, we expect to award $6.1 million to meet critical health access needs in our communities,” said Boyle. “To us, it’s the impact—the purpose of the grant, not the dollar amount—that is important.”

Although grant-making is the main focus of AFM’s work, colleagues are actively engaged in their communities. “We believe that the ‘human resource’ we provide through our team members is invaluable,” said Boyle.

Cooper agreed: “We are just beginning to receive reports from the grants we have awarded. It is gratifying to know that McAuley Ministries was a small part of their success.”

When asked about the future, Boyle responded, “We are interested in how our experience and the grants we have made can support Catholic Health East’s learning journey into person-centered care.”

“We are evaluating care management and the integration of behavioral health and primary care, and we are also focusing on after-school programs to help under-resourced youth in our target neighborhoods with academic achievement and pursuing careers that will sustain them in life,” said Cooper.

Boyle added, “My hope is to never stop searching for solutions and advocating for a more just society.”

AFM grants help raise awareness among farm workers about the dangers of pesticides.

C hange is inevitable. With all the mergers, acquisitions, sales and closures, it’s not always good

news to those behind the “sold” sign and often time must lapse before the silver lining appears. But when it does, it can open the eyes to an even brighter future. Such could be considered the case for both Allegany Franciscan Ministries, Inc. (AFM), a supportive health corporation of CHE and McAuley Ministries, the grant-making arm of Pittsburgh Mercy Health System. Each has received assets from the sale of hospitals. Since the money was raised in and for non-profit institutions, it had to remain in and be used for the community’s benefit. Thus, AFM and McAuley Ministries were created to serve under-resourced communities.

Although one has been in existence for over 10 years, the other only a year, both remain steadfast to their roots of women religious and each shares a similar mission.

“We strive to be catalysts for systemic change, committing resources and working collaboratively to promote physical, mental, spiritual, environmental and cultural health and well-being in our communities,” said Eileen Boyle, president and chief executive officer, AFM.

In 1997 the Franciscan Sisters of Allegany joined with the Sisters of Mercy and the Sisters of Providence to form and sponsor Catholic Health East. At the same time, the Sisters divested of certain assets through their Florida health care partnerships, creating the base for the formation of foundations in three regions of Florida, thus creating AFM. Today, it continues to be guided by the tradition and vision of the Franciscan Sisters of Allegany, and provides grants to organizations in Miami-Dade County, Palm Beach, Martin and St. Lucie Counties, and the Tampa Bay area of Hillsborough and Pinellas Counties. In January 1999, the AFM Board made its first distributions—$1,025,000 to seven organizations. Since then, AFM has

awarded more than 2,700 grants totaling over $48 million to more than 1,200 organizations.

McAuley Ministries, named in honor of Catherine McAuley, who founded the Sisters of Mercy, is the grant-making arm of the Pittsburgh Mercy Health System. It was established in 2008 to administer the proceeds from the sale of Mercy Hospital of Pittsburgh.

They focus grant making on the Pittsburgh neighborhoods traditionally served by the Sisters of Mercy: the Hill District, Uptown and West Oakland, as well as in communities by sponsored ministries of the Sisters in southwestern Pennsylvania.

In 2009, McAuley Ministries, which recently celebrated its one-year anniversary, awarded 50 grants ranging from $75 to $364,000 and totaling $1.77 million.

By analyzing the data that was obtained by working with the planning office at CHE, reviewing existing community development plans, and conducting listening groups, Michele Rone Cooper, executive director, McAuley Ministries, knew where to start when she joined the organization in 2008.

“We concluded that the areas we

needed to focus on were health and wellness, particularly prevention initiatives, education, community development and capacity building. Capacity building is helping to strengthen those non-profit organizations that are already meeting basic needs in those communities,” said Cooper. “We heard directly from the residents … who either confirmed our findings or suggested new challenges and new opportunities in those neighborhoods.”

One growing concern was children who suffered from asthma in the targeted communities. With the help of a $150,000 grant over three years, the problem is being addressed through Healthy Home Resources.

Healthy Home Resources received the funding for their Asthma Trigger Home Evaluation (AT HOME) program, which for the past six years has addressed the rise in illnesses caused or complicated by the presence of indoor allergens.

“McAuley Ministries welcomes opportunities to create partnerships with organizations interested in developing healthy, safe and vibrant communities,” said Cooper. “And there’s a real need

Improving Communities …

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Volunteers from the Bucks County Chapter of the American Sewing Guild set up their sewing machines in the St. Mary Medical Center (Langhorne, Pa.) cafeteria and stitched dignity robes for women receiving breast cancer treatments. The robes are designed with Velcro center closures and Velcro-secured openings under each arm to provide a sense of privacy for patients while doctors and nurses are performing examinations.

Left to right: Renee Chenault-Fattah, NBC10 news anchor; Sr. Megan Brown, vice president, mission, Mercy Philadelphia Hospital; Kristen Welker, NBC10 news anchor; Kathy Conallen, CEO, Mercy Philadelphia Hospital; and Tracy Davidson, NBC10 news anchor.

In addition to health screenings and education, the Expo featured fitness instructions, healthy cooking and aerobic demonstrations, free hair and make-up consultations, massage therapy, products and services from local health and wellness

organizations, and panel discussions focusing on a variety of health topics. Performances from

area churches, schools and community groups provided entertainment. The NBC Peacock poses

with Ray Welch, CEO, Mercy Health System of Southeastern Pennsylvania; Brian Finestein, CEO,

Mercy Fitzgerald Hospital; and Renee Chenault-Fattah, NBC10 news anchor.

Mercy Health System of Southeastern Pennsylvania (Conshohocken, Pa.) joined forces with local TV affiliate NBC10 and area radio stations to present the first annual MPowerYourself Health & Wellness Expo last October.


While working as an operating room nurse in Peru, Saint Michael’s Medical Center’s Lois Greene takes a moment between surgical cases to update her blog.

St. Francis Hospital’s Jen Harris is pictured here with a young girl who was waiting to see a physician regarding treatment of her cleft palate.

St. Francis Hospital’s Facebook page with updates from the Peru mission.

The Healthy Home Resources staff attends a community event to raise awareness of asthma triggers in the home.


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C hronic conditions, such as heart failure, COPD, diabetes and hypertension account for

“the overwhelming majority” of medical expenses in the U.S. In fact, they are responsible for 78 percent of the nearly $2 trillion spent on health care in the U.S. each year. In 2007, Catholic Health East facilities collectively had more than 14,000 Medicare patients discharged with a primary diagnosis in one of these four chronic conditions; approximately 18 percent of these patients ended up being readmitted within 30 days of their discharge, which translates into about 2,500 readmissions in one year throughout CHE. In an effort to help reduce the number of readmissions among patients with these conditions, several CHE facilities have implemented telemonitoring programs. Mercy Home Health, part of Mercy Health System of Southeastern Pennsylvania, has implemented telemonitoring programs at two of their locations: St. Mary Home Care, Langhorne, Pa., in May 2009 and Nazareth Home Care, Philadelphia, Pa., in August 2009. The programs provide chronic disease management for patients with heart failure, diabetes and/or COPD (chronic obstructive pulmonary disease), helping them to maintain healthier lifestyles and reduce the number of hospital readmissions through the daily monitoring of their vital signs. Patients are evaluated for the telemonitoring program by discharge planners. A patient must be able to perform the in-home monitoring either independently or with the help of a caregiver. A patient’s physician can also initiate the request for telemonitoring services. “The discharge planners look at the patients’ diagnoses and see if they meet the

criteria for home care and if they would benefit from telemonitoring services,” said Diana Parsons, R.N., C.C.R.N.-C.S.C., telehealth coordinator, Mercy Home Health. “Patients must qualify for less-than-daily home care visits. If a patient needs daily visits, then telemonitoring is not a benefit to them.” St. Mary and Nazareth have contracted with Philips Home Healthcare who provides the equipment and initial training. The equipment consists of: a blood pressure cuff; a talking digital scale, which is designed to fit under a walker if needed; a pulse oximeter, which measures the patient’s blood oxygen saturation level (SpO2); and a TeleStation, which uses a patient’s existing phone line to communicate data from each of the wireless devices to a central data processing center. When a patient uses any one of these devices, the information is transmitted

to a secure server where home care nurses can review and follow-up as necessary (see figures 1 and 2 on pages 8 & 9). “Telemonitoring gives patients the power and control over their disease that they didn’t have before,” said Parsons. “It also increases compliance with their regimen because it allows them to see the results of their actions.” Plus, she added, “Patients feel safe because they know that there are nurses always looking at their vital signs.” The system flags patients whose vital sign readings are out-of-range. Out-of-range data can be set up to trigger the delivery of surveys so additional assessments can be obtained. The patient’s data is flagged green, yellow or red—depending on the result—so the correct follow-up action can be taken.

Telemonitoring Gives PatientsPower over Their Health

}{“Their goal is simple: to help others. Yet, our volunteers tell usthe work helps them personally and professionally as much as

it helps the communities they serve.”

H istorically, the role of the hospital chaplain has been to provide spiritual care in

inpatient hospital settings. As such, their focus is on helping patients, families and staff deal with pain, suffering, loss and grief. They talk with and listen to patients in order to identify their needs, concerns and hopes and to determine appropriate actions necessary to address these issues. Chaplains enhance people’s use of their own spiritual resources and are prepared to minister to people of all faith traditions and non-traditional spiritual practices. Catholic Health East’s goal is to have a board-certified chaplain (B.C.C.) at each RHC. These chaplains are specially educated to deal with spiritual issues in the context of all faith traditions, or in some cases, the absence of faith. A board-certified chaplain has a master’s degree in theology and has completed a rigorous course of study and supervised clinical pastoral education (C.P.E.) leading to certification.

However, with the declining number of priests and sisters available to staff spiritual care departments and with the accelerating shift of care to the outpatient and home settings, the face of hospital chaplaincy is changing.

“The focus of care is shifting from illness and cure to prevention and wellness, therefore increased demands of time and place will necessitate inviting, coaching and working with qualified volunteers and the chaplains’ leadership skills will be tapped as they partner with faith communities to respond to the spiritual and emotional needs of an increasingly diverse population,” said Sr. Jane Connolly, vice president, mission, Marian Community Hospital (Maxis Health System). “For chaplains, person-centered care is both invitation and challenge. As professionals who routinely empower others to tap their own inner resources in response to what life presents, they will

now be called on to empower themselves and one another to new ways of ministering to God’s people.”

While spiritual care for patients admitted to the hospital will always be important, today’s professional chaplains have rededicated themselves to meeting the spiritual needs of patients, families and colleagues across the entire continuum of care.

Today’s chaplain must learn new skills and focus on prevention and wellness because person-centered care requires greater flexibility and accountability. They must also be able to adapt to new technologies in order to communicate effectively with patients, families and clinical staff.

“The Spiritual Assessment Task Force has recently created a spiritual assessment tool that will be a part of the patient’s electronic medical record throughout CHE,” said Mary A. Williams, director, pastoral care, Saint Joseph’s Hospital of Atlanta. “This common spiritual

assessment will enable other disciplines in the health care arena to utilize the tool as a vital component of person-centered care.”

Chaplains support CHE’s health ministry in many ways. They minister to colleagues who seek to find meaning in the midst of pain, suffering and sadness; provide information for patients and families to complete Advance Directives; conduct ethics consults; console and nurture patients, family and staff; and act as a liaison with leadership of local faith communities.

It is also crucial for clinicians and caregivers to understand the importance and value of spiritual care, and to be able to identify spiritual issues in order to make appropriate referrals when the need arises.

“When the role of the chaplain is understood by patients, families and the clinical staff, and his or her services are effectively utilized, there is the potential for a collaborative partnership that can produce very positive effects on the patient’s care,” said Sr. Karen Helfenstein, director, mission services and spirituality, CHE.

Mary Jo McGinley, R.S.M.,Executive Director, Global Health Ministry


In Athens, Ga., St. Mary’s Hospice chaplain Rev. Bill Hayes (left) talks with a hospice patient and his nurse at the patient’s assisted living community.

Caron Bitterlich, R.N., and Ashley Graham, R.N., test the new telemonitoring equipment at St. Mary Home Care. Participants receive a set of easy-to-use wireless devices that measure their weight, blood pressure, pulse and blood oxygen levels.

Reshaping Spiritual CareServices Throughout CHE

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C hronic kidney disease robbed Tamira Ferrer of her life’s passion. Thanks to a unique transplant

procedure, she’ll soon pursue it once again. On September 30, 2009 Ferrer and her husband, Carlos, participated in the first-ever successful “paired exchange” or “double swap” kidney transplant in the Philadelphia and southern New Jersey region at Our Lady of Lourdes Medical Center with another couple from New York. “The new kidney gives me a new lease on life,” she said, now freed from exhausting six-day-a-week dialysis treatments. “It gives me a second chance to do what I like to do, which is teach.”

Increasing Chances Twenty-six million Americans suffer from chronic kidney disease, which can cause heart and vascular disease, anemia, weak bones and nerve damage. Kidney failure eventually can result, requiring dialysis or a transplant. Carlos Ferrer, 37, sought to donate one of his kidneys to his 38-year-old wife, but he was not a compatible match. So, Lourdes transplant coordinators suggested the family register in a national paired exchange database and the New Jersey Sharing Network. In a paired exchange, two kidney recipients essentially “swap” willing donors. While medically eligible to donate, each donor has an incompatible blood type or antigens to his or her intended recipient. By agreeing to exchange recipients—giving the kidney to an unknown, but compatible individual—the donors can provide two patients with healthy kidneys where previously no transplant would have been possible. “It’s a big decision to make when you know your kidney is not going to your loved one,” said Stephen Guy, M.D., who along with Nasser Youssef, M.D., performed the minimally invasive surgeries on the Ferrers. “But by Carlos’ willingness to donate a kidney to a stranger, he increased the chances of his wife finding a suitable living donor.”

Prior to the swap, Tamira Ferrer, a mother of four, had been on the transplant waiting list for six months. Without it, she could have waited up to five years. “It’s unique, but it’s becoming more and more available,” said Arijit Chakravarty, M.D., transplant nephrologist at Lourdes.

The Match When a match was found, coordinators at Lourdes and a hospital in New York worked together to schedule the simultaneous surgeries. Once the healthy organs were removed from the donors, they were packed and transported by vehicle—likely passing on the New Jersey Turnpike—to their waiting recipients. “I’m happy I had the opportunity to be a blessing in someone else’s life through paired exchange,” said Carlos Ferrer, who works in law enforcement. “We’ve been married for 16 years and this is the least I can do for her.” Right before Thanksgiving, the Ferrers met Bronx, N.Y. couple Marta and Moises Chiqitos with whom they now share an unmistakable bond. “I will never take a day of my life for granted,” said Tamira. “I will live every day of my life as if it’s my last.”

Unique Transplant Two CouplesJoins International Street MedicineSymposium

Fast Facts on Paired ExchangeA relatively small number of kidney swaps have been performed nationwide, but they are gaining favor because such a swap can reduce the time on transplant waiting lists. Also, kidneys from living donors last twice as long as those from the deceased, according to Arijit Chakravarty, M.D., Lourdes transplant nephrologist.Here are some facts about paired exchange:

• Through paired donation, two or more sets of intended living donors and candidates are matched to provide compatible donors to each recipient.

• Prior to the operations, the matched pairs remain anonymous, and both donors undergo surgery simultaneously.

• The first paired exchange occurred in 2001.

• More than 83,000 Americans are waiting for kidneys, but only about 15,000 kidney transplants occurred last year because of the shortage of donors. Paired exchange helps increase the chances for a compatible organ.

Carlos and Tamira Ferrer (seated) with members of the Lourdes Transplant team: (from left) Loretta Aigner, A.V.P., renal/transplant services; Donna Collins, R.N., transplant coordinator; Dr. Ari Chakravarty, transplant nephrologist; Dr. Stephen Guy, transplant surgeon; and Maria Robinson, R.N., transplant coordinator.

C lose to 100 attendees gathered in Atlanta in November to share best practices in the emerging field of

street medicine. Now in its fifth year, the International Street Medicine Symposium allows physicians and administrative leaders who care for those living on the streets throughout the world to exchange information and benefit from programs specific to the needs of street medicine practitioners. The Symposium was co-founded by Operation Safety Net® (OSN) Founder and Medical Director Dr. Jim Withers and Program Director Linda Sheets. A program of the Pittsburgh Mercy Health System, OSN is a medical outreach program for the unsheltered and transitional homeless. OSN co-sponsored this year’s Symposium with Saint Joseph’s Mercy Care Services, part of Saint Joseph’s Health System in Atlanta, and Mary Hall Freedom House, a comprehensive residential recovery program for women. “We really appreciated being a part of the Symposium this year and it was very well received here in Atlanta,” said Tom Andrews, president, Saint Joseph’s Mercy Care Services, one of Atlanta’s oldest and largest community outreach programs serving the homeless, uninsured and immigrant populations. Sponsored by the Sisters of Mercy and Saint Joseph’s Health System, Mercy Care Services delivered care to more than 9,900 patients in its medical and dental programs in 2008. Speakers were global and spoke about their field experiences. Truly qualitative in measure, they shared their frustrations, their thoughts on teaching street medicine, approaches, human rights and volunteering. Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration of U.S. Department of Health and Human Services, provided the opening remarks. He leads the agency’s efforts to provide effective and accessible treatment to all Americans with addictive disorders. Other featured presentations included reducing the cost of homelessness, fostering culturally sensitive health care, establishing human rights for basic needs, and street

medicine programs and practices in other United States cities, such as Boston, Chicago, Honolulu and Nashville; and other cities around the world, including Calcutta, India; Copenhagen, Denmark; Lima and Mala, Peru; London, England; and Santiago, Chile.

The Symposium was sponsored by GlaxoSmithKline, Saint Joseph’s Mercy Foundation and the Robert Wood Johnson Foundation. Continuing education credits were provided to physicians, nurses and social workers who attended. “We assisted Linda and her organization in arranging some local tours of homeless service agencies and some actual street outreach activities for the Symposium participants. Over 80 individuals participated in these tours which resulted in a broader understanding and appreciation for the state of homelessness in Atlanta,” said Andrews. Among its many benefits, the Symposium

offered collaboration and implementation tips. In Pittsburgh previously, communication on hospital discharges had been done via the telephone on an inconsistent basis. In Atlanta, the Grady Health System emergency department and Saint Joseph’s Mercy Care Services, Inc. created a referral process between the hospital and the health care system that seemed to be more efficient. As a result of this meeting, OSN nurses and case managers met with hospital nurses and social workers and will begin to utilize the Grady-Saint Joseph’s form. “This referral process will begin to measure outcomes of the health and welfare status of street homeless individuals from the ER to OSN, primarily for insurance, psychiatry, the new legal service and medication. Individuals will be referred to area clinics for primary care, and preferably to a primary care physician who will be responsible for their medical care,” said Sheets. “In addition, we are exploring a mini-respite apartment arrangement similar to Atlanta where individuals can recover from their illness and injuries instead of on the streets.” Sr. Julie Casey, I.H.M., CHE executive vice president, mission integration attended the symposium. “The symposium was truly global in nature. It was inspiring to be with persons from all over who cared about and cared for some of the most vulnerable persons in our world. There were also many local caregivers present. Their commitment and youthful enthusiasm is amazing,” she said.

Atlanta-based homeless service providers take part in a panel discussion at International Street Medicine Symposium V in November 2009. Topics discussed included health care, mental health and substance abuse, housing and advocacy. The discussion was led by Lucy Hall, executive director, Mary Hall Freedom House, and Tom Andrews, president, Saint Joseph’s Mercy Care Services.

}{The symposium was truly global in nature. It was inspiring to be with persons from all over who cared

about and cared for some of the most vulnerable persons in our world.

Sr. Julie Casey, I.H.M.,executive vice president,mission integration, CHE

A PUBLICATION FOR THE SPONSORS, BOARDS, REGIONAL LEADERSHIP, SYSTEM OFFICE AND COLLEAGUES OF CATHOLIC HEALTH EAST16

H O R I Z O N S

H O R I Z O N S

C A T H O L I C H E A L T H E A S TC A T H O L I C H E A L T H E A S T

In Pursuit of Clinical TransformationUnique Transplant Joins Two CouplesTelemonitoring Gives Patients Power Over Their HealthImproving Communities ... One Grant at a TimeACT Update: Progress on Hospital-Acquired ConditionsHomeless Outreach Across Catholic Health East

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Across the SystemReshaping Spiritual CareServices Throughout CHEInternational Street Medicine Symposium10 Minutes with ... Judy Persichilli, CHE COO & CEO Designate

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H O R I Z O N SIIn Pursuit of Clinical Transformation

J10 Minutes with... Judy Persichilli

udy Persichilli, R.N., B.S.N., M.A., joined Catholic Health East in 2003 as the executive vice president of the Mid-

Atlantic Division. She was promoted to executive vice president, acute care for the System in 2008. Prior to joining CHE’s System Office, she served for eight years as CEO at St. Francis Medical Center in Trenton, N.J. Judy received her nursing degree from the St. Francis Hospital School of Nursing, a bachelor of science in nursing from Rutgers University, and a master of arts in administration from Rider College, as well as an honorary doctor of health degree from Georgian Court University. She is a member of the American Nurses Association and the New Jersey State Nurses Association; and was inducted into the New Jersey State Nurses Association Hall of Honor in 2006. In December, Judy was named as CHE’s chief operating officer and CEO designate and will officially assume the latter role upon Robert Stanek’s retirement by the end of 2010.

What originally motivated you to get into the health care field? As long as I can remember, I wanted to be a nurse. The concept of being in service to others always appealed to me. Once I graduated and started working as a registered nurse, I was struck by how meaningful the work is. Every day you touch the lives of people in very real ways. As I started to participate more actively in committee work at the hospital and then assuming increasing responsibilities in leadership positions, it became clear to me that individuals with clinical backgrounds have the foundational knowledge to lead health care organizations through changes and challenges because at a very fundamental level they know the process of care and what is needed. What are some of your proudest achievements at CHE? My proudest achievement at CHE really comes through other colleagues. The development of individuals in their leadership roles and the fact that I may have played a

part in some way in their development I think is the greatest accomplishment and contribution a leader can make. I look around Catholic Health East and see many leaders and colleagues who I have mentored in some way and I am so proud of their accomplishments.

As you move into your new role as COO and CEO designate, what are your top priorities? My top priority is to continue the foundational strategy of person-centered care and Vision 2017. To do so, a focus on ministry formation linked closely with leadership development is imperative. The future of our System is dependent on the development of experienced, mission-driven leaders who embrace our vision, values and culture. Clinical transformation will be realized through the changes we must make to be responsive to the needs of our communities. It is an utmost priority to perform at the highest level of evidence-based care that supports superb clinical outcomes, quality and safety. Throughout the years our ministries have changed to meet the needs of the communities. That is and always has been a priority and the reason our ministries have sustained our mission over time. Also, developing creative physician alignment strategies in each RHC community is

necessary to continue our work. Our founding Sponsors are clear that our goal is to enhance the Catholic health care ministry in the Eastern United States. That goal requires us to be vigilant and responsive to opportunities for growth. Supporting our Continuing Care Management Services Network for growth along the continuum while also being responsive to strategic and selective opportunities in acute care will continue.

How is the ACT Initiative helping to transform CHE? The ACT Initiative focuses on some very fundamental changes in the way we deliver care; the location of where care is delivered and the relationships we develop with providers, individuals and the communities to more appropriately serve our communities. Advancing Clinical Transformation is our journey to person-centered care.

Why is person-centered care so important to the future of CHE? The Scriptures teach us that we are made in the image and likeness of God. Every person possesses innate dignity and deserves reverence and respect. This is the foundation of our understanding of person-centered care and the focus of Vision 2017. Person-centered care creates healing partnerships and relationships that honor each individual’s informed choices and respects their innate dignity as they strive to achieve optimal health and quality of life.

What are some of the biggest challenges that face our ministry in the years ahead? There are so many risks ahead of us but I think the most challenging is the actual “unknown” about health care reform and the impact on our current ministries. We are still a very acute care-centric system and as we continue our journey across the continuum, maintaining the present economic engines of acute care to provide the resources necessary to build into the future is, to me, our greatest challenge.

magine a world where all of your medical records are always accessible … instantan-eously. No matter where you are … at home, in a doctor’s office, your local hospital, or being treated in an emergency room far from home. Imagine a world where that same medical record is ALWAYS updated. That means the X-ray you had two weeks ago, the blood test you took two days ago, and the medication changes that your physician just made two hours ago are all part of your medical record.

Think of all of the locations and places that contain pieces of your medical history. In addition to your family doctor, you may see several specialists, a dentist, two pharmacies, treatment at three hospitals, a surgi-center, a freestanding MRI center and an urgent care center in the same year. All of these locations have paper or electronic files that don’t talk to one another. Imagine a world where your medical

history is not fragmented.

Imagine a world where treatments for many medical conditions are standardized—not subject to just one clinician’s opinion. Studies show that different doctors frequently have different answers to the same question. Rather than treatment of a life-threatening condition being based on the experience of

one clinician—no matter how skilled the individual—imagine creating a system that supports the decision-making of that one individual so that he/she is “hard-wired” to the hundreds of research findings and clinical trials and new ways to treat different conditions that arise constantly. Imagine a world where evidence-based care is the norm.

Catholic Health East is doing more than imagining this world … we are in the midst of planning—and building—it … one process at a time.

Evidence-based-care. Person-centered care. Comprehensive care management. Clinical transformation. All of these initiatives are interrelated, and are crucial to our future success as a health ministry. Supported by advanced information technology, CHE is transforming the way that we provide acute care to patients throughout our health ministry.

A Multi-Step Process Our health system has been on this track for several years. In 2006, based on input from board members, Sponsors, clinicians and leaders from throughout our ministry, we introduced the CHE Preferred Delivery Model. This model outlined where CHE planned to be by the year 2017 in terms of the delivery of care, as well as the organizational competencies required to make this transition.

Judy Persichilli, R.N., B.S.N., M.A.

CHE Chief Operating Officerand CEO Designate

HORIZONS is a publication for the Sponsors, Boards,Regional Leadership, System Office and Colleaguesof Catholic Health East.

Horizons Editorial Staff

Scott H. Share Vice President, System Communications

Maria Iaquinto Communications Manager

Meg J. Boyd Communication Specialist

Design, Production, Printing & Mailing Fulfillment by JC Marketing Communications • jcmcom.com • Southington, Conn.

Catholic Health East is a community of persons committed to being a transforming, healing presence within the communities we serve.

Locations: Located in 11 eastern states from Maine to Florida.

Workforce: Approx. 54,000 employees.

SponsorsCongregation of the Sisters, Servants of the Immaculate Heart of Mary, Scranton, Pa.Franciscan Sisters of Allegany, St. Bonaventure, N.Y. Hope Ministries, Newtown Square, Pa.Sisters of Charity of Seton Hill, Greensburg, Pa.Sisters of Mercy of the Americas: Mid-Atlantic Community, Merion Station, Pa. New York, Pennsylvania, Pacific West Community, Buffalo, N.Y. Northeast Community, Cumberland, R.I. South Central Community, Belmont, N.C.Sisters of Providence, Holyoke, Mass.Sisters of St. Joseph, St. Augustine, Fla.

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Please direct comments and suggestions to [email protected]

3805 West Chester Pike, Suite 100Newtown Square, PA 19073Phone 610.355.2000Fax 610.271.9600www.che.org

Bob Williams M.D., from Deloitte Consulting, facilitates a group of clinical colleagues who helped to make some key decisions during the Evidence-Based Care Initiative’s “Decision Day,” and also worked on the development of a standard template for an order set to be used across CHE.

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