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iHT2 Health IT Summit San Francisco 2013 - Davin Lundquist, MD, CMIO, Dignity Health Medical Foundation, Case Study: "Leveraging technology to build an organizational strategy fostering staff competency & physician satisfaction"


Davin Lundquist, MD …

Davin Lundquist, MD
Dignity Health Medical Foundation

Case Study: "Leveraging technology to build an organizational strategy fostering staff competency & physician satisfaction"

Health IT systems will never please all users however providers are employing strategies that can significantly improve user satisfaction. Staff re-education and continually measuring the effectiveness of initiatives can make a positive impact on an organization’s ability to realize gains with IT. This presentation will explore Dignity Health’s lessons learned and organizational strategy to ensure staff competency levels and physician satisfaction.

Dignity Health is a family of more than 60,000 caregivers and staff delivering excellent care to diverse communities across 17 states. Founded in 1986 and headquartered in San Francisco Dignity Health is the fifth largest hospital provider in the nation and the largest hospital system in California.

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  • 1. Organizational Strategy toAddress Staff Competencyand Physician SatisfactionDavin Lundquist, M.D.Chief Medical Information OfficerDignity Health Medical Foundation 1
  • 2. “Better to remainsilent and be thought afool than to speak andremove all doubt.” - Abraham Lincoln 2
  • 3. Dignity Health (formerly Catholic Healthcare West) • 5th Largest Hospital Provider in the Nation • 60,000 caregivers and staff across 17 states • Founded in 1986 and headquartered in San Francisco • 1200 Employed Physicians • 10-12,000 Affiliated Physicians 3
  • 4. Outline• My Informatics Journey• DH Medical Foundation Story• New Organizational Strategy• Technologies Deployed and/or Envisioned• Lessons Learned 4
  • 5. 5
  • 6. Family Medicine ResidencyNaval Hospital in Bremerton, Washington 6
  • 7. Microsoft Access Database “EMR Lite” 7
  • 8. Microsoft Access Database 8
  • 9. Microsoft Access Database 9
  • 10. Naval Ambulatory Care Clinic Ventura, California 10
  • 11. Navy EMR 11
  • 12. Navy EMR 12
  • 13. Ranks #1 in Obesity Mississippi 13
  • 14. Magee General Hospital 14
  • 15. Centers for Family Health Ventura, California 15
  • 16. “Cut the Cord” to Paper Charts 16
  • 17. On day 1, there were No Charts 17
  • 18. • 550+ Physicians• 10 Medical Groups• Multi-specialty 18
  • 19. 19
  • 20. • Upgrade from v10 to v11 in Summer 2011• Felt more like a downgrade 20
  • 21. “I had some eyeglasses.I was walking down thestreet when suddenlythe prescription ranout.“ - Stephen Wright 21
  • 22. Root Cause Analysis• Following the v10 – v11 upgrade, all sites participated in a Root Cause Analysis (RCA) exercise to understand what went wrong and take those ‘lessons learned’ and apply them to ensure the current environment, future releases and upgrades are successful.• The ultimate goal of this exercise was to provide better patient care, provider and staff satisfaction.• One of the causes that was identified was our Organizational structure was not equipped to meet the demands of the upgrade process 22
  • 23. Diginty Health Dignity Health Medical Foundation IT Connectivity IT Manager Help Desk Software Learning & Analysts And Clinical &Development Application Implementation (Training) Support Support Team Dell Field Service Team (Hardware) 23
  • 24. Took a trip to Sharp 24
  • 25. President & CEO Chief Medical Information Officer EHR Operations Director Director Physician Clinical Informatics Physician Clinic IT Practice HealthIntegration Information Executive Executive Executive Executive Executive Director, Executive Director Executive Director Director, Director, Greater Bay Director, Stockton, Grass Director, Bakersfield, Sacramento Woodland Area Ventura Valley North State Merced Clinical Clinical Clinical Clinical Clinical Informatics Informatics Informatics Informatics Informatics Manager Manager Manager Manager Manager Clinical Clinical Clinical Clinical Clinical Support Suppor Support Support Support Specialist Specialist Specialist Specialist Specialist Clinical Clinical Clinical Clinical Clinical Support Support Support Support Support Specialist Specialist Specialist Specialist Specialist Clinical Clinical Clinical Support Support Support Specialist Specialist Specialist Clinical Clinical Support Support Specialist Specialist 25
  • 26. Clinical Informatics ManagersClinical Support Specialists• First line of defense• At the elbow• Single source of truth 26
  • 27. Chief Information Chief Medical Officer (EVP) Officer (EVP) Chief Medical Vice President Information Officer IT Connectivity (VP) Director Director Director Director Community HIE & Data Patient EngagementPhysician Clinic IT Physician IT Management & Telehealth 27
  • 28. Vice President IT Connectivity Director Director FinanceClinical Informatics Physician Clinic IT Customer Physician Implementation IntegrationInformaticist Experience Solutions Manager Solutions Manager Solutions Manager Service AMB System Production Process QA/Testing Compendium Project Integration Project Delivery Support Control Improvemen Manager Manager Managers Manager Managers Manager Manager Manager ManagerSERVICE SYSTEM ACQUISITION/ QUALITY COMPENDIUM ALLSCRIPTS DEVELOPMENTDESK SUPPORT EXPANSION TEAM TEAM TEAMTEAM TEAM TEAM ICD-10 PM SUPPORT OPTIMIZATION TEAM TEAM CLINIC IT PROJECTS 28
  • 29. “The first half of ourlives is ruined by ourparents, and the secondhalf by our children.“ - Clarence Darrow 29
  • 30. Measure Progress• Goal is to Improve: –Support Staff Competency –End-user Competency –Physician Satisfaction –Upgrade experience• Our ability to measure was and still is lacking 30
  • 31. Help Desk 31
  • 32. 32
  • 33. Help Desk Ticket 33
  • 34. Dashboard of Incidents 34
  • 35. New Workflow for handling Tickets 35
  • 36. Dashboard of Incidents 36
  • 37. Areas of Emphasis• Team Learning and • Implementation Growth • ICD-10• Service Delivery • Integration• Process • Budget Improvement Performance• Service Metrics• Optimization 37
  • 38. Direct Surveys Of Physician Satisfaction 38
  • 39. Better results 39
  • 40. Survey Rationale• Baseline analysis of MMG provider perceptions of the Allscripts EMR, quality reporting, training, and other issues.• Identify gaps in workflows, training, and reporting.• Support prioritization of efforts to fill identified gaps. 40
  • 41. Survey Background•Idea took shape on February 11, 2013•Development of instrument February 11-18, 2013•Published online to four different groups on February 19, 2013 – Primary Care – Medical Specialists – Surgical Specialists – Hospitalist•Survey closed March 4, 2013 41
  • 42. Example of actual survey 42
  • 43. Example of results as shown in SurveyMonkey 43
  • 44. Example of results to a Question 44
  • 45. Survey Response Total Responses Scratch Off %Primary Care 76 71.1%Medical Specialties 38 63.2%Surgical Specialties 29 65.5%Hospitalists 7 57.1%Total 150 67.3% 45
  • 46. “My Doctor gave me sixmonths to live, butwhen I couldn’t pay thebill he gave me six moremonths.“ - Walter Matthau 46
  • 47. Integration Detectives• 50+ interface requests outstanding a year ago• Business use case validation implemented• 22 unique requests survived that process – 6 needed EMPI, we could not create an interface – 3 were found in discussions with the orgs they were not needed – 4 put on hold per the organization• 9 unique interfaces remained – 6 are completed or in flight (represent large number of initial requests) – 3 are very low priority and impact very small number of providers 47
  • 48. Upgraded Upgrades• Allscripts v11.2.3 in June 2012 – Robust testing process – Smaller instance in So Cal used as “pilot” – Fewest errors seen by Allscripts for this version to date• 3 Successful Hotfix upgrades• Plan for upgrade to v11.4 for all instances by Calendar year end 48
  • 49. Other Technologies• MD Tracker• WebTop• Physician Portal 49
  • 50. MD Tracker Doctor List 50
  • 51. Doctor Profile 51
  • 52. Notes from Rounding 52
  • 53. WebTop – Single Sign-on – Physician Portal
  • 54. My Home My Clinic My Patients My Community My Support Avatar CHW Indicator Database CareConnect CareConnect Application (Remote Access) Event Reporting System MIDAS+ Live Application MIDAS+ Live Web Site Zynx
  • 55. My Home My Clinic My Patients My Community My SupportOncology Free EventsCancer Center Calendar (PDF): See a montly schedule of our freeclasses and support groups.Cancer Center Ongoing Events (PDF): See a list of cancer centerevents and programs.
  • 56. My Home My Clinic My Patients My Community My Support
  • 57. My Home My Clinic My Patients My Community My Support
  • 58. My Home My Clinic My Patients My Community My Support!
  • 59. “We must not ceasefrom exploration and theend of all our exploringwill be to arrive wherewe began and to knowthe place for the firsttime.” - T.S. Elliott 59
  • 60. Questions???
  • 61. The Choluteca Bridge in Honduras 61
  • 62. After Hurricane Mitch hit in 1998 62