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Anatomy of a Pilot at Health 2.0 Provider Symposium - Clinical Box and Lowell General Hospital


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

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Anatomy of a Pilot at Health 2.0 Provider Symposium - Clinical Box and Lowell General Hospital

  1. 1. Health 2.0 Provider Symposium Lowell General Hospital Collaboration September 25, 2016
  2. 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. 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. 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. 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. 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. 7. 6 ™ Perioperative Surgical Home Diagram Source: American Society of Anesthesiologists – Perioperative Surgical Home (PSH)
  8. 8. 7 ClinicalBox powers care coordination & patient engagement for complex episodes of care EHR
  9. 9. View the Episode of Care and Pathway for Each Patient with Tasks, Communication & Education Embedded by Stage
  10. 10. Tasks are Specific To Each Surgical Procedure and Tailored by Patient
  11. 11. Connections are Clear to the Coordinator for Follow-up Questions with Family and Healthcare Providers
  12. 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. 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. 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. 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!