Clinical Box and Lowell General Hospital - Health 2.0 10th Health 2.0 Fall Conference

1. Health 2.0 Provider Symposium
Lowell General Hospital
Collaboration
September 25, 2016

2. 1
™
Managing patients across the transitions of care increasing in
importance with the advent of episode of care payments
Source: Stead, Stan. How Do I Get Paid for the Perioperative Surgical Home, Perioperative Surgical Home Summit, June 2016.

3. 2
™
Procedure cancellations remain a significant
clinical and financial challenge
Cancelled
Case
Workup
20%
No Real
Cancellation
11.1%
Capacity
13.4%
26.7%
4.4%
13.3% Did not want
operation
Preoperative instruction
not followed
Intercurrent disease after
schedule finalized
11.1%
Instantaneous
lack of key
specialized
personnel
Surgery no longer indicated
Insufficient workup
Co-morbidities found after
schedule finalized
Key patient information not reviewed
4.4%
6.7%
6.7%
2.2%
Scheduling error
IT system error
6.7%
4.4%
9.0%
4.4%
Overbooked – transferred
to waitlist
Overbooked –
rescheduled next day
Patient
44.4%
Specialized Personnel
11.1%
Source: Seim, A, Causes of Cancellations on the Day of Surgery at Two Major University Hospitals, Surgical Innovation, 2009.

4. 3
™
Financial pressures from payment reform require real
changes to care coordination and patient engagement
Source: Stead, Stan. How Do I Get Paid for the Perioperative Surgical Home, Perioperative Surgical Home Summit, June 2016.

5. Surgical Home
Challenge
Surgery day Joan recovers at
home
Joan needs an
operation
She has questions, is
frustrated, apprehensive
and isn’t prepared for
the procedure
She doesn’t
complete Critical
pre-op tasks in
time
Discharge instructions
are not
communicated clearly,
resulting in innocent
errors in care by all
Complications not caught
because follow-up visit not
scheduled, and patients
don’t know what to look for
8
8
8
8
8
Procedure is delayed or
cancelled the day of
surgery

6. 5
™
Goals of the pilot
Activate patients
Engage family members
Identify high risk patients
Coordinate providers
Measure cost/quality
88%of patients in the U.S. do not have
proficient health literacy
80%of the care provided to the sickest 1% of
patients that use 20% of healthcare expenditures
is provided by family members
Risk prediction models only 55%accurate
9% of models include social support
60% of readmitted patients had
no foll0w-up visit
Costs, patient engagement, coordination,
difficult to measure

7. 6
™
Perioperative Surgical Home
Diagram Source: American Society of Anesthesiologists – Perioperative Surgical Home (PSH)

8. 7
ClinicalBox powers care coordination & patient
engagement for complex episodes of care
EHR

9. View the Episode of Care and Pathway for
Each Patient with Tasks, Communication &
Education Embedded by Stage

10. Tasks are Specific To Each Surgical
Procedure and Tailored by Patient

11. Connections are Clear to the Coordinator for
Follow-up Questions with Family and
Healthcare Providers

12. Ron: Surgical Coordinator (Staff)
“I coordinate with doctors and patients to make sure
everything runs smoothly”
Employer: Hospital
Background: BA Hospital Administration
Quick take on SallyQuick take on Ron
Computer skills Intermediate
Job situation Employee
Computer type Desktop
Smartphone
Tools Excel
EMR
Reporting
Internet
Phone
Background Administration
Business
Key goals:
• Educate patients.
• Make sure patients are prepared for all
surgeries and appointments
• Ensure medical records are correct
and up to date
• Ensure all external dependencies are
taken care of.
• Ensure doctors know when and where
they need to be
• Understand which patients need the
most time and effort
• Minimize mistakes
• Make sure patients are happy.
• Be able to quickly and easily identify a
patient and their next steps.
Time:
• 65%: Admin Duties (Phone. Scheduling,
Typing)
• 20% Dr. Sally Personal Tasks/Errands
• 15% Miscellaneous personal tasks
A day in the life:
• 8am: Arrives at work
• First priority: Checks e-mails.
~10 from Dr. Sally & 20 from
patients
• 930am-12pm: Makes calls to patients for
upcoming surgeries
• Educates patients, provides
direction, comfort and support
• 12pm: Too busy to eat lunch. Has to
attend front desk/administrative staff
meeting
• 2pm: Picks Dr. Sally’s children up from
school and brings them to babysitter
• 3pm: Back at office
• Has Dr. Sally waiting for her to
schedule new surgical consults
• 4pm-6pm: Admin Duties
• Falls behind on sending out new
patient packets
• Has 11 voicemails to answer
• Unanswered e-mails and follow-
ups
• 630pm: Leaves work later than
scheduled, tasks left until next day
How staff are different:
They are power users. They will be
using the application all day long to
coordinate care
EXAMPLE OF USER PROFILE TEMPLATE USED TO INFORM UI/UX DESIGN

13. 12
™
Thoughtfully staging implementation is critical to
success of pilot and further deployment
1-3
4-6
7-9
10-12
13-15
16-18
19-21
22-24
25-27
28-30
v01 v02 v03 v04Functionality
Groupings
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Practices

14. 13
™
Key Figures and Results from Pilot
• Data on 13,134 patients processed
• 2,310 high risk patients seen at
pre-screening coordinated
• 761 patients with cardiologists
• 1,770 patients speak a language
other than English
• 1,877 pre-screening date/time
changes
• 6,063 surgery date/time changes
• 431 unique primary care
physicians
• 25 unique cardiologists
• 12,585 family members
• Examples of ClinicalBox impact
• 94,118 pre-op tasks tracked (Main
OR only)
• 747 consents signed and
exchanged
• 289 phone calls avoided
• Demonstrated high
scalability
• Ability to work and
collaborate with existing IT
systems and IT team
• High satisfaction and
demand among key
stakeholders:
• Surgeons
• Surgeon staff
• Nurses
• Pre-screening staff
• Major centers of
excellence
• Critical tasks caught in time
to prevent cancellation or
delay
• Higher efficiency achieved
through process and
workflow optimization.
Key Pilot Figures (of of 6/1/16) Results I never had visibility into the
surgical pipeline I needed to
manage until now.
ClinicalBox provided me with
an effective channel of
communication with the
surgeon offices
ClinicalBox was able to turn
around changes in days and
weeks vs. months and years
The ClinicalBox team really
took the time to clearly
understand the patient
experience
Surgeon Staff
Pre-screening staff
Nurse Liaison
Anesthesiologist

15. 14
™
Lessons Learned
Start small and build momentum with early adopters1
2
3
4
5
6
7
8
9
10
Need to do one of three things: cut costs, increase revenue or make life easier
Generate enough value, for the right stakeholder, in the right amount, at the right time
Ensure that innovator and health system business models and incentives are aligned
Novelty creates excitement but it doesn’t necessarily generate adoption
Reduce the bureaucracy: no standing meetings, no steering committee, keep it fluid
At first do things that do not scale: not everything has to be fully automated
High-tech and high-touch are not mutually exclusive: help people to do their jobs better
Helicopter constantly between the health system leadership and front-line staff and clinicians
Persevere: pivot until you get traction. Healthcare is a tough industry, keep going!