the road to achieving the davies award! hilo medical center · the road to achieving the davies...
TRANSCRIPT
The Road to Achieving the Davies Award!
Hilo Medical Center
Wednesday, March 2nd 2016
Agenda
• Learning Objectives
• Introductions
• Brief Background
• The Road……
• Conclusion
• Questions
Learning Objectives • Recognize the necessity of appropriate organizational governance
• Illustrate and identify the Return on Investment (Value On Investment) as
reflected in the revenue cycle and clinical outcomes
• Identify how a rural community hospital with limited funding and resources has been able to achieve success
An Introduction of
How Benefits Were
Realized for the Value
of Health IT Reflecting upon the HIMSS Health IT
STEPS, our organization leveraged the
Savings category. This was evident by the
AR decreasing over 50% and realizing a
Value on Investment savings of $4M.
http://www.himss.org/ValueSuite
Introduction • Money S. Atwal
– The Queen’s Health System • Director, Finance & IT
– Affiliates – North Hawaii Community Hospital – Molokai General Hospital
– Hawaii Health Systems Corporation (HHSC), East Hawaii Region • Chief Financial Officer & Chief Information Officer
– Hilo Medical Center – Hale Ho’ola Hamakua – Ka’u Hospital – Yukio Okutsu State Veteran’s Home
Introduction • Gerry Bartley
– Health Systems Informatics, Inc. • Chairman & CEO
– 35+ Years Healthcare experience – Management Consultant – Executive Advisor to HHSC, East Hawaii Region – EHR system selection advisors – MEDITECH, Epic, & General Electric EHR
implementation experience – Former CIO
Hawai’i • Safety-net hospital providing significant
care to the uninsured, underinsured, and vulnerable populations.
• Service area: 100 miles
• Population: 111,217 people
• Medicare/Medicaid Payer Mix: 76%
• Per Capita Personal Income: $30,844
Brief Background
Hilo Medical Center • Hilo Medical Center (HMC) is the largest facility in the Hawaii Health Systems
Corporation (HHSC) – Largest employer on the island, over 1,000 employees – Government Union(s): HGEA & UPW – Civil Service – 276 licensed beds (157 acute care, 7 skilled nursing, 112 bed extended care) – 8,600 acute admits, 400 long term care admits – Specialties/Services
• Emergency Services – Level 3 Trauma Center (45,000 visits) • OB/GYN (1,100 births) • Surgery (3,200 patients) • Oncology • Intensive Care
– 8 Outpatient Clinics (32,000 visits)
Brief Background
Distinctions Accredited by The Joint Commission
Gold Seal of Approval for Home Care and Outpatient (2011)
Mountain Pacific Quality Health’s Quality Achievement award (2012 and 2013)
AHA Get with the Guidelines for Heart Failure (2012)
AHA Get with Guidelines Gold Level Award (2013)
Press Ganey- Top Improver Award for Patient Satisfaction (2012)
ARRA Meaningful Use Stage 1 & 2
HIMSS Stage 7
Davies Award Objectives
• Clinical Outcomes
• Financial Results
• Operational Efficiencies
• Technology Transformation
The Road Begins….
Technology Advancements
1876 Alexander Graham Bell makes first phone call
1973 Martin Cooper from Motorola makes first mobile phone call
2009 Money Atwal first mobile phone call in Hilo Medical Center
East Hawaii Strategic Vision
Patient
Record
Inpatient: Hilo Medical
Center Hale Ho'ola Hamakua
Ka'u Hospital
Outpatient: Hilo Medical Center
Clinics
Applications Lab
PACS eScription/PS 360
MUSE
Data Repository:
Medisolv
Timeline January 2009 EMR Vendor
Selection Process
April 2009 PACS
Implementation
Summer 2009 Board Approval for EMR system
January 2010 Installation of Wifi & Cellular
May 2010 HMC Live on
MEDITECH 6.0 Core Modules
March 2011 ORM, CWS, BMV
April 2011 Nuance
eScription
May 2011 Ka’u Hospital HMC live on
CPOE
Fall 2011 HMC & Ka’u
Attestation MU 1
July 2012 HHH Hospital
(Big Bang)
August 2012 GE MUSE
December 2012 Bed Board
December 2012 HHH Attestation
MU 1
January 2013 Nova/Telcor
April 2013 Admission
Assessment Optimization
July 2013 MT Financials
General Ledger
August 2013 Powerscribe 360
August 2013 Physician
Documentation
October 2013 Patient Portal
November 2013 MT Financials
Cost Accounting
January 2014 MT Forecasting
& Budgeting
July 2014 MU Stage 2 Attestation
October 2014 Patient Portal
Bill Pay
January 2015 MT Supply
Chain
May 2015 Kronos
Scheduler
MT Ambulatory Timeline
December 2011 Orthopedic
Clinic
February 2012 Neurology Clinic
April 2012 Urology &
Cardiology Clinic
June 2012 Surgical
Associates
August 2012 Pediatric Clinic
October 2012 Family Health
Clinic
January 2013 ENT Clinic
May 2015 Medical
Oncology
9 Clinics 16 Month Implementation
Enterprise Network
HMC CORPORATE
10 Megs
1 Gig
Enterprise Architecture
Staffing
Leadership & Governance
Governance
Medical Executive Committee
Pharmacy & Therapy
Committee Ethics Committee Quality
Committee
Infection Control Medical Records Committee UR Committee
Medical Informatics
Subcommittee Department of
Surgery & OB/GYN
Emergency Department
Department of Radiology
Internal Medicine Behavioral Health Hospitalist
Long Term Care Laboratory Pediatrics Quality Improvement & Patient Safety Committee
Executive Management Team
Application Steering Committees
Admissions Billing Imaging PCS/PCM Orders Management Pharmacy Laboratory Emergency
Department Quality
Management
Physician Governance Process
•Cross Sectional Department Representatives
•Health Connect team •Guest Speakers
iORF Identifies or
Reports Issue
•Dr. Kannass •Chris Takahashi •Invited physicians •Health Connect Team
PiORF Prioritizes Issue •Co-Chair: Dr. Kannass
& Money Atwal •Appointed Physician committee members
•HC Leadership MIS
Votes on proposed
changes to send to MEC
•Dr. Katt •Medical Executive Committee
MEC Votes on changes requested by MIS
integrated Operation Review Forum
Physician integrated Operation Review Forum
Medical Informatics Subcommittee
Integrated Forums
• iORF- Chaired by EHR Director & Project Management – Formal approval for EHR change control – Forum for integrated workflow discussion – Recommendations for PiORF – Collaborative discussion between key stakeholders – Opportunity to discuss optimizations or requests – System configuration change management – Project updates
Integrated Forums
• PiORF- Chaired by EHR Leadership & Physician Champion – Forum for integrated physician workflow discussion – Formal recommendations for MIS – Collaborative discussion between physician groups – Opportunity to discuss optimizations or requests – Pilot group for system changes – Barometer for suggested changes
Medical Informatics Subcommittee (MIS)
Medical Informatics
Subcommittee Department of
Surgery & OB/GYN
Emergency Department
Department of Radiology
Internal Medicine Behavioral Health Hospitalist
Long Term Care Laboratory Pediatrics
Physicians
Information Technology Leadership
Executive Management
• Strategic planning for IT initiatives
• Policy approvals • Identifies priorities • Education for physicians
• Feedback and enhancement discussions
• Formal recommendation to MEC • Formal approval to MEC • Project updates
Agenda
Nursing Change Management Process
• Receives list from PMO • Provides feedback on
feasibility and timeline • Completes enhancement(s)
as assigned
• Provides oversight to the process
• Assists in resource planning
• Ensures requests and optimization deadlines are met
• Reviews list for alignment with organizational goals
• Lends input, revises or makes changes to list
• Presents List to PMO Office
• Optimization requests collected by nurse managers
• Changes are compiled and ranked
• Nurse managers agree on top 5 enhancement requests
Nursing Nursing
Administration
Health Connect
Team Administrati
on
Value On Investment
“valueTRAX is a hybrid software and professional service that focuses on value generation and measurement based upon process improvement.”
Key points of valueTRAX are:
VALUE MANAGEMENT
Workflow Processes to measure the Fiscal Impact of Change. 2
1 Measure Benefits, Costs and Accountability.
3 “Organizational Initiatives” are the Drivers.
Provides an Executive Dashboard with Busines and/or Clinical Analytics. 4
5 Designed for applications with both Capital Initiatives as well as smaller Operational Projects.
Proprietary to HSi Inc. and shall not be shared without express written consent from HSi
Hilo Medical Center utilized valueTRAX® to assist in achieving and measuring both clinical and business objectives. Benefits measured were achieved from EHR
Installation, Stage 7 HIMSS Analytics, MU Stage 1 Attestation and Associated Process Improvements.
Proprietary to HSi Inc. and shall not be shared without express written consent from HSi
VALUE MANAGEMENT – Deployment Components
Stage I – Assess
Stage II – Implement
Stage III – Manage
• Profile • Initiatives • Leaders/Owners • Data Mapping • Process Mapping
Begins
• Accountability • Analytics and
Dashboards • Maintenance
• Customization • Training
Proprietary to HSi Inc. and shall not be shared without express written consent from HSi
Benefit KPI’s • Cost Reduction
Value Based Supply Chain Benefit: Decrease Supply Costs
• Revenue Enhancement Decrease Payment Denials Benefit: Increase Revenue
• Quality / Regulatory Decrease Hospital Acquired Ulcer Rate Benefit: Improved Outcomes and Patient Safety.
Reduced LOS and Resources • Satisfaction
Improved Employee Satisfaction Benefit: Reduces Hiring and Retention Costs
Value Proposition • Quantified Fiscal
Impact • Net Decreased Cost • Net Increased Revenue • Net Improved Quality /
Safety • Net Improved
Satisfaction
Total Cost KPI’s • Vendor Costs
• Software • 3rd Party • Etc.
• Organizational Costs
• Laptops • Wireless • Servers • Etc.
• Ongoing Annual Maintenance
VALUE MANAGEMENT – Basic Model
Benefits TCC VOI
VALUE MANAGEMENT
CASE STUDY – Hilo Medical Center (HMC)
“A Value Management Case Study”
GOAL: Make iT Meaningful and Measuring the Value of Change.
CASE STUDY
Assessment • Implementation of EHR • Data Capture • Current State Mapping • Best Practice Design • Gap Analysis/ Change Management Plan • Data Mapping • Targets Gross Benefits $34.3 M • Target Total Cost of Change (TCC) $31.0 M • Accountability Assignments
Implementation • Set up Customized Dashboards and Reporting Ongoing Management & Measurement • 5 years
Pre 2009
2014
CASE STUDY – Executive Dashboard
CASE STUDY – Benefits
CASE STUDY
CASE STUDY – Total Cost of Change (TCC)
CASE STUDY- Total Cost of Change
CASE STUDY – Metrics
CASE STUDY – Key Performance Indicators (KPI’s)
Benefits: $35,874,396 TCC: $31,890,769
VOI: Approx. $4.0M
CASE STUDY – Value On Investment (Cumulative)
Proprietary to HSi Inc. and shall not be shared without express written consent from
Value Proposition (Net Benefits)
CASE STUDY – Hilo Medical Center
* Benefits achieved from EHR Installation / Stage 7 HIMSS Analytics / MU Stage 1 Attestation and associated process improvements
$35,874,396 $31,890,769 $3,983,627
Total Cost KPI’s • Vendor Costs
• Organizational
Costs • Ongoing Annual
Maintenance
Benefit KPI’s* • Cost Reduction
• Revenue
Enhancement
• Quality / Regulatory
Benefits TCC VOI
ROI “Best Practices”
• Utilizing a tool that specializes in measuring and tracking the
accountability of the metrics associated to the organizational initiatives
• Strategy = Identify opportunities to increase nursing documentation compliance, thus capturing the appropriate IV charges
– PMO identified key stakeholders – Solutions discussed and presented at iORF to collaborate with all touch
points – Note: Previously Emergency Department and Nursing Management
opposed any changes to workflow – Through integrated discussions and education, all key stakeholders
agreed to require “Stop Time” to be documented in the system – Result: Nursing documentation compliance issue resolved and
revenue increased by $2.0M over 9 months
ROI “ Lessons Learned & Best Practices”
• Above all…Processes Drive Benefits….NOT Technology • PLAN for measuring outcomes….don’t just hope they come. You need
baselines, targets, variance reporting, owners, etc. before the process starts • Can’t manage what you can’t MEASURE…..valueTRAX • Must have ACCOUNTABILITY • Don’t stop at “go-live”…..this is the starting gate • Know where you start and where you want to finish….
Baselines and Targets • Develop detailed ROAD MAPS to close gaps between
current state and best practice • Regular VARIANCE REPORTING and analysis • When metrics are out of variance , look at processes first for solutions • Everybody agrees on metrics and definitions on the front end
to achieve buy in for accountability
Hospital Financial Performance AR Days
ROI Case Study: Outpatient Clinic AR
Hospital AR
Outpatient Clinic AR
A Summary of How Benefits Were Realized for the Value of Health IT Savings: Efficiency Savings Improved workflow efficiency Decreased ER Wait Times by 30%
Financial/Business Reduction in AR days Increased patient revenue 5% Increase
Improved financial results 3% Operating Margin Improvement
Operational Savings Improved Use of Space HIM & Revenue Cycle moved off-campus
http://www.himss.org/ValueSuite
48
Special Thanks: Dan Brinkman East Hawaii CEO Jon Martell, MD Medical Director Craig Shikuma, MD Physician Champion Dennis Lee, MD Medical Informatics Subcommittee Member Chris Takahashi, RN Regional Director, EHR & Physician Liaison Kris Wilson, RT(R)(MR)(CT), MHA, PMP Director, PMO
Questions • Money S. Atwal
• Gerry Bartley