Welcome to the Innovation Suite

Pixar Animation Studios Director and Executive Producer John Lasseter once said, “The art challenges the technology, and the technology inspires the art.”1 He’s right. The animators at Pixar may use tech to craft their vision, but without their creativity and imagination, the tool is merely an untapped resource. But as the technology advances, the limits of imagination expand with it.

This logic can be applied to those who work in hospitals and clinics – overlooked places where creative individuals are working to solve pressing issues and improve upon outdated systems. With that in mind, HMT profiles C-Suite Innovators who are leveraging HIT to turn inspiration into reality, and consequently expand upon the limitations outlined in the instruction manuals of the tools they wield.

Editors Note: The following has been edited for clarity and concision.

Shaun Ginter, MBA, CEO,
CareWell Urgent Care

Making smart use of big data

Shaun Ginter is President and CEO of the New England-based CareWell Urgent Care system. He holds a Bachelor of Science in Business Administration and a Masters of Business Administration from the University of Phoenix. He is also a member of the Board of Directors for the Urgent Care Association of America.

In an effort to make better use of the data being gathered by their athenahealth EHR, CareWell has adopted technology that enables raw data to be analyzed for the purpose of spurring real-world operational changes.

Nearly a year after implementing the athenaONE suite of products, Ginter spoke at HIMSS16 about how the partnership has changed CareWell’s business and improved the lives of its patients. Speaking with HMT, Ginter says it’s the analytics inside of athenaNet that gave his clinics the power to leverage patient data more effectively.

Where did the idea to start using the analytics platform inside athenaNet stem from?

For us, the adoption of athenaNet analytics was built out of the fact that a sophisticated electronic health record platform, like the athenahealth one CareWell uses, collects thousands of data points on a patient. Just the simple use of an electronic health record system allows us to timestamp every activity – everything we do for the business. We decided there was a lot of data here that could really help us improve the patient experience, and we could use it in an operation way to design a workflow using data.

Big concerns for us in the urgent care space are throughput time – that is, how well we get a patient into the building and out of the building, and on their way to feeling better. Managing the expectations of patients when it comes to registering and going through a paperwork process, or measuring how long they are actually in the lobby.

Also really important for us is how the end of that encounter goes and how the discharge process runs – so, how efficiently we are able to get people out the door, e-prescribe their prescriptions, get them their discharge notes, finalize their paperwork, and get them back on the street.

How do you aggregate and make sense of the data after you gather it from the EHR?

I’d like to tell you we hire super brilliant people, but it’s not that simple. After we collect the data, athenaNet gives us the ability to run the reports and filter or pivot them in any way we want. I can literally go into athenaNet, I can tell it the parameters that I want to look at, and it’ll run the reports, pull out the data; it’ll export it into Excel files for us, or it’ll make sophisticated graphs for reporting. And then we’re able to take that data and use
it internally.

For example, this morning I was looking at a throughput report and there are about 20 timestamps, following the patient through every step of every encounter in that building. I’m able to take that report, benchmark that, and I can then average it for the organization and prepare my stats with multiple sites. With 15 urgent care locations, it’s really important for us to identify what’s best-in-class from a performance perspective, and really do some comparisons.

What measurable improvements have you seen?

We’ve improved our door-to-door time by over 25 percent since we went live. We have seen dramatic improvement in our staffing and keeping appropriate staff levels, and a lot of that is due to the fact we can now see a history of when patients come in on a trend, and we’re able to appropriately staff our centers accordingly. We got those benefits right off the bat.

Being an urgent care facility, I imagine you share a lot of information. How do you overcome those challenges?

One of the biggest driving factors for CareWell selecting athena was we have hospital affiliation relationships, and it’s very important for us to be able to share the medical record and medical data with hospitals. Quite often, we’re seeing a patient that wasn’t able to get in to see their primary care physician – we see that patient and we do our best to send their medical record right back to their primary care doctor, so that they know one of their patients was seen after hours at an urgent care facility.

We’re also able to do that with the hospital systems. If for any reason we see a patient and we believe they need to have follow-up care with a specialist or need to be forwarded to the emergency room, we’re able to export all of the patient data right out of athena directly into our physician partner systems through interfaces athena has built.

Even if the hospital system uses a different vendor?

Yes, so for example, we regularly interface from athena into Allscripts – one of our hospital partners uses Allscripts – and we’re able to send everything right into the Allscripts system.

We’re also able to communicate through the Mass HIway, which is our local health exchange in the state of Massachusetts. We can transfer our data through the health exchange to any physician that is on that health exchange, regardless of platform. We can also send data to our Epic partners through the Epic interfaces.

Has this analytics technology ever been used in a way that has saved a person’s life?

We have not had that yet. One of the things we’re working with one of our hospital partners to do is to be able to see the patient record from the hospital side at the initial point of treatment. What we’re hoping for is that, if someone presents at urgent care, and we know what hospital system they’re with, we can actually view that patient record and potentially catch any issues on our side – like if we see a trend in their medical history.

And if their medical record doesn’t show us anything, when we’re done charting, we send our medical record back to them and the primary care physician or the hospital can watch for patterns and look for life-threatening issues – and hopefully catch something. The continuity of care is very, very important.

For those out there who struggle to make big data useful, what advice can you give them?

It takes a purposeful intent to be able to take the data out of the EHR and turn it into good, useful information to run your business. You have to be disciplined. The data is there, but with some work and very purposeful intent, you can make some real changes happen.

Catherine Keck, CFO,
Daviess Community Hospital

Outsourcing as an IT strategy

Catherine Keck is the Vice President and CFO of the Quorum-managed Daviess Community Hospital in Washington, IN. With over 30 years in healthcare, Keck arrived at the small 74-bed county hospital in 2012, after spending much of her career in larger health systems. It was immediately clear that IT at Daviess was not up to par. After exploring their options, Keck and the leadership at Daviess opted to do something a little unusual: outsource their IT department to a third party.

Where did the plan to outsource the Daviess IT department stem from?

In 2010, Daviess moved their electronic medical record from MEDITECH to Paragon, which is a McKesson product. When I got here to the hospital in 2012, there were problems – you know, in small little towns, when people leave they take the knowledge with them. When I arrived at our hospital, I really did see a problem with our IT system.

Daviess Community Hospital, Washington, IN

It was down more than I had seen at any other hospital I’ve worked at; we would be down three days at a time, and we’d be working on “downtime procedures” – paper procedures – and then we’d catch up electronically later when the system was back up. It was very
problematic.

So, I sat down with our McKesson account representative, and we decided we had to have something different in place. She brought to me the idea of IT outsourcing, where McKesson brings in professional leadership, they take over the leadership of our IT department, and they run our IT department as if it’s their own internal department.

We started that in June 2013, and it really made the difference here. We have less downtime, and we’ve been able to attract good people from McKesson for our IT management. The folks that are here, they work for a Fortune 500 company but they live in our rural town. Things just flow quite nicely.

Was it a big change for you to come to a small hospital, given your background in larger health systems?

Things that were common in a large system were just missing here. Healthcare is ever-changing, and we need documentation on so many levels – regulatory issues, accounting issues, patient security, patient satisfaction – we have to have data in all those areas, and I had to rely on information that wasn’t accurate. Admittedly, I wasn’t feeling warm and fuzzy about a lot of things when I got here.

This hospital is 100 years old. We had a server room – and I’m just going to be truthful with you – we had a server room with a Wal-Mart shower curtain over the top of it, because we had to keep the server room cold. Now we utilize McKesson remote hosting, where our data is stored elsewhere in a secure environment, and that’s certainly been a big help for us.

How have things improved? Has Daviess now made the switch from paper to electronic records?

I won’t say we’re 100 percent off paper, but we’re certainly further down the road to change than we were. We’re trying to meet Meaningful Use standards to help bring this hospital back to an electronic medical record. But it’s challenging. In rural hospitals, you wear a lot of hats. In larger systems, you have someone who works only on compliance, and another who wears the hat of only reimbursement. But in small hospitals, you have to wear a lot of hats. So, our first step was we needed to maintain our regulatory and compliance standards, and the McKesson plan was a way to accomplish that step. Outsourcing our IT capabilities allowed us to bring professional IT management to a rural area – and that’s a big thing.

In your opinion, is this a viable strategy for any rural hospital?

We should all want healthcare to be available, even if you’re in a rural area. But the truth is, county hospitals are closing in large numbers. When I go to Quorum meetings, I hear about what’s happening in other rural towns, and I hear stories about two or three hospitals collaborating to try and maintain a shared IT system, allocating each other a certain amount of server time – stuff like that. But I don’t see that as an advantage, and I reported to Quorum and said, “I think we have a better answer here.” This strategy of outsourcing IT works for us. I’ve had some other Quorum hospitals call me and ask how it works, and I’m happy to share that with them. I’ve attended insight meetings, and I share that this is an answer for rural areas – I’m sure it could be an answer for larger hospitals, too, but it works very well for a small one like Daviess.

Craig A. Bunnell, M.D., MPH, MBA, Chief Medical Officer, Dana-Farber Cancer Institute

Leveraging RTLS to improve patient care

Craig A. Bunnell, M.D., is the Chief Medical Officer of the Dana-Farber Cancer Institute – an NCI-designated Comprehensive Cancer Center located in Boston, MA. Dr. Bunnel is an oncologist specilizing in the treatment of breast cancer at Dana-Farber and an Associate Physician at the Brigham and Women’s Hospital. He was trained in medicine at the Harvard Medical School, where he still serves as an Associate Professor. He also holds a Masters in Public Health from Harvard School for Public Health and a Masters in Business Administration from the Massachusetts Institute of Technology.

Dr. Bunnell took on the role of CMO at Dana-Farber in 2012, and was part of the leadership team responsible for implementing RTLS technology as a means to improve physician workflow and decrease wait time for patients.

Dana-Farber Cancer Institute, Boston, MA

Where did the need to adopt an RTLS system come from?

This all really began because we realized the layout of the new building would be an issue in terms of managing resources. In cancer treatment, the two most prominent rooms where patients are seen are the exam room and the infusion room, where they get their treatment. And you have to be able to manage those resources for business reasons but also to manage wait time for patients. We began to look into what the options were, and chose an RTLS system from Versus.

We were actively constructing the building, so we were able to put thousands of sensors into the ceiling of clinical floors that use radio frequency and infrared technology with ID badges. The ID badges are worn by providers, administrative people – anyone who is coming into contact with a patient, as well as the patient themselves.

And this system helps you monitor workflow?

It does. What it does is it basically shows us where everybody is – we know where staff is on the floor, we know where patients are throughout their journey at the institute, and we know where all the different providers are. If I’m looking for a patient, I know where the patient is, I know who is with and around that patient, I know what that patient has already done and what they have yet to do.

Our plan is to implement this into our EMR; we just implemented Epic. The goal is to have those systems work in sync together, so we can connect the dots on what’s happening to what’s supposed to be happening, and have the system alert us to any issues accordingly.

In terms of timestamps, where are you seeing the biggest improvements?

We first piloted this on certain floors. We didn’t even turn the system on, but we began having people wear the badges. We did this to gather data to get a foundation for where we were.

The next step we took is we turned the screens on, so people could actually see what was happening on their floor, but we didn’t do anything else at that point. We didn’t create workflows for people, or set rules on how the system would be used. And it turns out that, just by turning the screens on, we saw a significant difference in wait time for patients at every step of the process.

How did the staff react to the change?

There was some reluctance with providers – particularly physicians. On some people’s part, there was a little bit of concern about “Big Brother” watching. What we tried to do is convince people this tracking wasn’t going to be used in a punitive way. I don’t need a system like this in order to know if somebody is working hard. I know if a person is working hard. The question is, how can we help them to work better and make their work easier for them? And so, we used the data from the RTLS to be able to do that. In the end, we saw a 10 percent increase in capacity without changing the number of rooms we had. Because of the workflow changes we made, we were essentially able to add two rooms to each floor, just by using that real estate more efficiently.

Throughout the process, we had to be very transparent about the implementation – we promised to show them the data and the improvements. And it turns out, because things were operating more smoothly, staff loved it. Doctors became the biggest advocates for it, because it made their life and their patient’s life better.

What’s the next step for this tech? What else are you hoping to improve?

When it comes to cancer care, we’re going to treat your particular tumor based on the genes of your specific tumor. So the question is, can we do that level of personalization on a different scale? Can we actually personalize your entire experience by looking at your plan for the day at the institute, and then make predictions to find the most efficient path for a specific patient? Who knows. That may be more than what’s even possible, but I think we need to not be confined by what we think is impossible. I’d like to have a scenario where a patient is walking toward an infusion room and that triggers a pharmacist to mix their chemotherapy, so a patient isn’t waiting.

Greater integration of all of our IT systems will help create a predictable and transparent experience for patients, really transform their experience. That’s where I see system implementation going. There are possibilities within this technology that we don’t think about right now, but the more we use it, the more we’re going to discover those uses. The potential to do everything from ironing out workflow clogs to lowering costs by improving efficiency and capacity is tremendous.

Matthew Kull, MBA, CHCIO, SVP, Chief Information Officer, Division of Information Technologies, Parkland Health & Hospital System

Crafting an IT strategy for a brand new hospital

Matthew Kull is the Senior Vice President and CIO of Parkland Health & Hospital System in Dallas, TX. A 20-year IT veteran with a background on the software vendor and consulting side, he began working in healthcare 14 years ago, with a resume that includes some of the largest hospitals, pharmacies, and utility systems in the United States.

Kull is a CHCIO – Certified Healthcare Chief Information Officer – and maintains professional affiliations with both the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS).

He joined Parkland in 2014, just in time to see the new facility open its doors in the summer of 2015, replacing the 70-year-old building across the street.

Can you tell me a little bit about the new Parkland facility?

In 2015, we opened our brand new 2.5-million-square-foot single facility. We are the Dallas County safety net for much of the uninsured and underserved populations.

The usable life on a hospital is hopefully about 60 years, and that’s about the cycle we’ve been working on. We just not only outgrew the old building, but we had any number of facility operation and technical restraints inside of a building that was built in 1954. We ran out of the ability to retrofit modern medicine-tech capabilities and infrastructure.

What specifically was the issue with the old hospital’s technology?

We had a number of disparate infrastructure systems, different facility systems; our entire computer fleet was a multitude of different technologies – it all lacked consistency. We also were largely – I don’t want to say an analog hospital – but our ability to have large broadband interconnective devices was somewhat constrained by the physical design of the building and an inability to retrofit the concrete structure that had been in place for the last 60 years.

Did the physical plan for the new building take into account the tech you may utilize?

Yeah, it did. The new Parkland hospital is one of the first truly digital hospitals in the United States. With exceptions, like our back-up emergency analog phones, the whole hospital is 100 percent digital. The new campus is filled with technology today that didn’t exist when we began planning. When planning, we looked not only at what the then-current technology was, but we looked at the future. What did we need to have in place from an infrastructure perspective to ensure that as we grew over the next 60 years in this facility, we’d be able to keep up with the pace? And you know, the future was pretty uncertain. It was hard to predict, but we looked at a lot of things – like, we knew we were going to need dense and reliable wireless interconnectivity throughout the hospital. So, we have hospital-grade Wi-Fi capabilities throughout the entire facility’s 2.5 million square feet, as well as some of the exterior areas.

What were some of the other modern technical advancements you adopted?

When we realized we were close to doubling the size of our hospital, we didn’t want to have to double the size of IT infrastructure support. Where we really got the big gains there was through our virtual desktop solution. By using the VDI platform, we were able to do a few things to affect how we deploy technology. All the point-of-care areas in our hospital are zero clients; so they all run an inexpensive, zero-footprint “dumb terminal,” if you will, that essentially repeats the VMWare Virtual Desktop that’s running in our data center.

What this enables – and this we found to be one of our largest physician engagements, technically speaking – is the tap-and-go solution. A provider walks in, they tap, and they turn and immediately interact with the patient. The virtual desktop is taking care of the rest.

Did you end up seeing a financial benefit?

It’s interesting you ask that, because one of the things we budgeted initially was we were required to salvage 40 percent of the best-performing equipment from our old hospital and move it to the new hospital, at the same approximate time we moved 700 patients from our old building to our new building.

What we found was, when we started evaluating the virtual desktop solution, our total cost allowed us to replace 100 percent of the point-of-care computers for the same budget that initially called for us to move 40 percent of our older equipment from across the street. We came in to our brand new hospital with an entire array of brand new equipment, and we reduced our patient risk by not having to move computers along with patients.

Did the new hospital take over the old’s operations immediately?

We had a day-one turn on. There were no phases or staged events – we moved all of the patients from our old hospital to our new hospital over two days. We brought all systems up day one, and we were working out of the gate. It was about the biggest bang we could possibly do, and we did it quite smoothly.

How confident were you things would go smoothly? Did you visit other facilities as part of your strategy?

We visited a number of other facilities as part of that decision process, but in a number of cases, we were kind of in some uncharted territories. We were the first people, or some of the largest people, to do some of these things, and in that vein, we partnered with a variety of vendors in development agreements to make sure we were helping to shape the product as we were implementing it.

In many areas, the technology we were moving forward with simply didn’t exist. This really allowed us to secure vendor engagement, because we were starting to shape products on their behalf or in partnerships with them – they’re going to want that product to work beyond us. I don’t want to call Parkland a test facility, but I will say we were a development partner for a lot of this technology.

Reference

  1. https://www.youtube.com/watch?v=uFbOOjAC_Fg

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