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Using Health IT Beyond the EHR to Support Changing Care Models
Session NI4, February 11, 2019
MaryAnn Connor, MSN, RN-BC, CPHIMS, Director, Nursing Informatics, Memorial Sloan Kettering Cancer Center
Jean Adams, RN, BS, CNIO, ACIO, Geisinger
Ann Lockhart, MN, RN-BC, Assistant Vice President, Clinical Informatics and Transformation, Ochsner Health System
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MaryAnn Connor, MSN, RN-BC, CPHIMS, Director, Nursing Informatics, Memorial Sloan Kettering Cancer Center
Jean Adams, RN, BS, CNIO, ACIO, Geisinger
Ann Lockhart, MN, RN-BC, Assistent Vice President, Clinical Informatics and Transformation, Ochsner Health System
Have no real or apparent conflicts of interest to report.
Conflict of Interest
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• Outline what happens before and after patients are in acute care
including care transitions across the spectrum
• Discuss key indicators for demonstrating the impact of changing
care models and the role of health information and technology
• Share success stories for how an organization positively impacted
patient care and experience
Learning Objectives
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Ann Lockhart, MN, RN-BC, Assistent Vice
President, Clinical Informatics and
Transformation, Ochsner Health System
Virtual Innovative Patient (VIP) Nursing Care
Using Technology to Enhance Patient Care
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• Telemedicine technology
• Medical Surgical Nurses use technology to enhance nursing care
• Redesigned care model
• Virtual registered nurse (VN) who is an active supporting member of the care team
VIP Project
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VIP Model of Care
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Anticipated Benefits
• Improved HCAHPS scores for communication with nurses, pain management,
responsiveness of hospital staff, communication about medications, discharge
information
• Early intervention for patient deterioration
• Improved Patient Safety and Quality Outcomes
• Efficiency with Patient Throughput
• Leaner staffing model
• Improve Nursing Turnover rate
• Greater Employee Satisfaction
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VIP Project Teams
Clinical
• Pursuit of Value Black Belt ( project manager)
• Nursing Informatics – Quality and Safety team
• Nursing Research
• Nursing Unit Teams
• Nursing Leadership
Information Technology
• Nursing Informatics – Information technology ( project manager)
• EMR build team
• Information Technology Technical Team
• Telemedicine Team
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Implementation
• Scope of practice - LPN/RN/nursing assistant and Virtual Nurse
• Change management sessions- team building, change in practice
• Technology adoption and use strategy
• Operational standards for practice changes
• Go live readiness assessment
• Legal considerations related to video monitors
• Metrics selected and real time dashboard created
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TechnologyUse of Technology-Patient room monitors:
Hardware Configuration in patient room includes:
32 inch computer Monitor-clinician use
Pan, Tilt, Zoom Camera
Speaker & Microphone
Tablet
Monitor on patient wall displays: Room Number, Fall Risk, Pref Language, Treatment
Team, Schedule, ‘Paint Board’, Code/RRT event log
© 2019 Epic Systems Corporation. Used with permission.
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Technology
Use of Technology-Telemedicine Bunker
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TechnologyUse of Technology- Tablet for Patient use
• Each Tablet has a shared video account to allow for 2 way video between the patient and Virtual Nurse
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Big Wins
• Patient/Family expressing real time/anytime access to lab results and education
• Providers view x-rays in room with patient and family
• Nurse good catches
• Elevated K+, arranged dialysis
• Allergic reaction to a medication, notified response team
• Proactive care including early discharge planning
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Opportunities
•Technology selection
•Consistent use of technology
•Unit implementation at same time
•Nursing team Communication (report, during shift huddles)
•Handoff report structure and length
•Patient bed placement and assignment of staff nurse
•Geographical, acuity and repeat assignment
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Jean Adams, RN, BS, CNIO, ACIO, Geisinger
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Our Values and Strategy
Foundational elementsPatient and Member PartnershipValue & AffordabilityAccountabilityIntegrated Delivery
Our valuesKindnessExcellenceLearningInnovation
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Where We Care for People
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The Challenges
Significant efforts have been focused on improving health:
Patient-centered primary care Hospital TOC Post-acute network redesign Best practice pharmacy management
Primary care redesign
• Access
• Visit approach
• Quality
• Patient experience
• Staff experience
Care management expansion
• Primary Care
• Emergency Department
Specialty integration
• Hospital transitions
• Heart Failure
• Chronic pulmonary disease
• Biologics
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The solutionCare closer to home
Urgent Care
i
Home
TelemedicineNurse
Triage
Care
managers
Wellness and
Prevention
My Geisinger
Mobile
CareUrgent Care
Hospice
Mental
Health
Primary
Care
Tertiary/Quanternary
Hospital
Micro Hospital
Community
Hospital
$
Air medical
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Significant opportunity remainsSmall portion of patients drive majority of medical costs
Member Population
Total Medical Costs
8–10%
Medicare
patients
55–60%
Medicare
patient costs
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Creating a Care Model in our Communities- Supporting those with serious & significant health conditions
Longitudinal
Medical Care
• Comprehensive
assessment of
disease burden
• Condition
optimization &
management
• Close coordination
with PCP/SCPs
• Mobile
paramedics
• Case
Management
• Home Health
Geisinger at Home
Integrated Acute Care
Social & BH
• Social
determinants of
health
• Behavioral health
Advanced
Illness
• Plan of care
• Symptom
management
• Palliative care
• Timely transition to
hospice
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Who are we focused on? How are we identifying
them?
Multiple chronic conditions and
high utilization
Proactive identification from
claims analysis
Palliative care or advancing
illness
Provider or family referral,
claims
High risk hospital or emergency
department utilization
Transitions of care
Which individuals are we focused on?
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In-home team
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Regional Medical Director
1 AP
360–400 pts
1 AP
360–400 pts
1 AP
360–400 pts
1 AP
360–400 pts
4 RNS
3 direct care
1 acute
4 RNS
3 direct care
1 acute
4 RNS
3 direct care
1 acute
4 RNS
3 direct care
1 acute
1 CHA 1 CHA 1 CHA 1 CHA
Social Worker, Dietitian, Pharmacist, Behavioral Health, Palliative Care, Paramedic
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Geisinger at Home Enrollment Trending
4/6/2018
4/13/2018
4/20/2018
4/27/2018
5/4/2018
5/11/2018
5/18/2018
5/25/2018
6/1/2018
6/8/2018
6/15/2018
6/22/2018
6/29/2018
7/6/2018
7/13/2018
7/20/2018
7/27/2018
8/3/2018
8/10/2018
8/17/2018
8/24/2018
8/31/2018
9/7/2018
9/14/2018
9/21/2018
9/28/2018
10/5/2018
10/12/2018
10/19/2018
10/26/2018
11/2/2018
11/9/2018
11/16/2018
11/23/2018
11/30/2018
12/7/2018
Total Currently Enrolled 1 3 6 9 14 19 30 53 69 104 139 177 217 246 292 342 401 451 528 585 639 684 713 757 820 863 926 979 104 111 117 122 125 130 133 140
Total Disenrolled 0 0 1 1 3 3 5 5 5 9 14 15 17 18 20 21 23 24 25 25 25 25 25 30 34 37 47 59 74 82 86 91 113 121 139 149
Total Ever Enrolled 1 3 7 10 17 22 35 58 74 113 153 192 234 264 312 363 424 475 553 610 664 709 738 787 854 900 973 103 112 119 125 131 137 142 147 155
0
200
400
600
800
1000
1200
1400
1600
1800
Pa
tie
nt E
nro
llme
nt T
ota
ls
Enrollment As Of Date
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ROS
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Note for Provider after both ROS and PE have been completed:
all positives show in Red
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More than $500 PMPM improvement
PRE POST PRE POST
38% reduction
in ED visits
26% reduction
in IP admissions
(per 1,000)
More satisfied patients
More coordinated care
Lower utilization
28Restoring Meaning to there is no place like
home
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Using Health ITto SupportChanging Care Models
MaryAnn Connor, MSN, RN-BC, CPHIMS
Director, Nursing Informatics | Memorial Sloan Kettering Cancer Center
BEYOND THE EHR
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3
0
95
287
287
80
495
78
95
Manhattan
MSK Rockville CentreRockville Centre, NY
MSK CommackCommack, NY
MSKHauppaugue
Hauppauge, NY
MSK WestchesterWest Harrison, NY
MSKMonmouth
Middletown, NJ
MSK Basking RidgeBasking Ridge, NJ
N E W Y O R K
N E W J E R S E Y
CO N N E C T I C U T
MSK BergenBergen, NJ
MSK NassauNassau, NY
Planned location
MSK Locations
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2000
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1
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1880 1900 1920 1940 1960 1980 2020
Hospital moves to present location
Schwartz Research
Sloan Kettering Institute
Rockefeller Research
Labs
Hauppaugeoutpatient
Sleepy Hollowfirst regional
outpatient facility
Josie Robertson Surgery Ctr.
Zuckerman Research Ctr.
Basking Ridge outpatient
Nov. 2019
David H. Koch Center for
Cancer Care
Final large building project
Memorial Hospital
Rockefeller Outpatient Pavillion(53rd Street)
KimmelCenter
Commack outpatient
Denville
Rockvilleoutpatient
Westchester outpatient
BAIC
BIC
Monmouth outpatient
Bergen outpatient
AprilNassau
outpatient
First U.S. institutiondevoted to oncology
1884
New York Cancer Hospital
Building a Future
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By the Numbers
70%Total Visits at MSK performedin an Outpatient Setting
» Chemotherapy» Radiation Oncology» (OP/AXR) Surgery
36%
2016 2017 PCT
OP Sx 4,184 4,515 64%
AXR 2,338 2,524 36%
JRSC Surgical Visits 6,522 7,039
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Value-Based Care
Clinical Quality& Safety
Unmatched Patient
Experience
Efficiencyand Cost-
Effectiveness
Innovation, Collaboration,
and Continuous
Improvement
!
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Technologies Impacting MSK Care Models
Transitionsof Care
»MyMSK
› MSK Prepare
› MSK Engage
› My Learning
Key Indicators
»AHS and High Risk Referrals
»JRSC ElectronicCare Pathways
»Recovery TrackerPathways
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MyMSK MSK Prepare
MSK Engage
The Patient PortalAvailable to patients since 2006
New Patient
Health Information Systems
MyLearning
AppointmentScheduled
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
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3
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MyMSK
A digital resource designed to guide
people from their initial contact with
MSK to their first appointment
AppointmentScheduled
Health Information Systems
MyLearning
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
MSK Engage
MSK Prepare
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3
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MyMSK
Our electronic tool that enables the
collection and visualization of patient
generated health data (PGHD). MSK
clinicians can collect data from new and
active patients both remotely and on-site
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
Health Information Systems
MyLearning
AppointmentScheduled
MSK Prepare
MSK Engage
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3
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MyMSK
A self-reported form
completed by the patient
or designee prior to
receiving care
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
Health Information Systems
MyLearning
AppointmentScheduled
MSK Prepare
MSK Engage
Adult HealthScreening (AHS)
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3
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MyMSK
Used to assess
patient risk factors
and initiate appropriate referrals based on
positive screening factors and establishes
the nurse-patient relationship
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
Health Information Systems
MyLearning
AppointmentScheduled
MSK Prepare
MSK Engage
AHS andHigh Risk Referrals
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4
0
MyMSK
Patient EducationDocumentation Form (PEDF)
Enhanced RecoveryAfter Surgery (ERAS) Program
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
Health Information Systems
MyLearning
AppointmentScheduled
MSK Prepare
MSK Engage
Pre-Surgical Preparation
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MyMSK
Pathway Order Within
Order Set
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
Health Information Systems
MyLearning
AppointmentScheduled
MSK Prepare
MSK Engage
JRSC Electronic Care Pathways
CPOEOrders
Pathway –Specific Events
Flowsheets
Display Observations
CIS Status Board
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MyMSK
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
Health Information Systems
MyLearning
AppointmentScheduled
MSK Prepare
MSK Engage
Patient Education and Discharge Instructions
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MyMSK
New Patient
Outpatient Visit
Pre-Surgery
JRSC Surgery
OutpatientFollow-Up
Health Information Systems
MyLearning
AppointmentScheduled
MSK Prepare
MSK Engage
Recovery Tracker Pathway
Post-Op RN calls patient the next day
Patient receives recovery tracker
messages
Office Practice RN receives RT alert or referral from Post-Op
RN
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2017 JRSC Quality Metrics
36%
2,799/7,695AXR
Cases
0.8%Admission
Rate
3.2%UCC Visits
within30 Days
1.9%Readmission within 30 Days
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Questions