11From Patient to Population: Technology’sRole in Providing Optimal CareRonald A. Paulus, MDPresident and CEOMission Healt...
22Managing Both Individual andPopulation HealthMy Geisinger Transformation Experience
3Geisinger Health SystemCareworks Convenient HealthcareNon‐Geisinger Physicians With EHRLast updated 08/18/09Geisinger Pro...
44GeisingerTransformation Infrastructure
5AlertsPrompts/RemindersOrder SetsAutomated care plansPatient portal messagesInformation Rx…Effectors…EBM GuidelinesPatien...
66Population Health OptimizationThe Patient: Diabetes
7Diabetes BundleMeasures FY07HgbA1C measurement XHgbA1C control XLDL measurement XLDL control XBlood pressure control XRet...
8DM Best Practice Alert/Order Set
9Patient Reminder ViewCDIS
10Diabetes Bundle ResultsPrimary Care Average (n=23,404)
11CAD Bundle Primary Care Results Average(n=14,714)
1212Population Health OptimizationThe Patient: CABG
13Research Ties
14
15GHS Receives One “All In” Global Fee• One fee for the ENTIRE 90-day period including allsurgery-related care:– ALL surge...
16Process Redesign: Work Flow
17Process Redesign: Hardwiring
18Clinical OutcomesBefore With ChangeProvenCare ProvenCare (% Reduction)(n=132) (n=181)In-hospital mortality 1.5% 0%Patien...
19Financial Outcomes• Hospital:– Net revenue +12.3% (with expenses only +5.6%)– Contribution margin +17.6%– Total inpatien...
2020Population Health OptimizationThe Population
21
22
23
24
25
2626Mission Health Overview
27Service Area
28Mission Health: 127 Years of ExceptionalService to WNC• Created, governed and owned by WNC for the exclusivebenefit of W...
29Our BIG(GER) Aim• Achieving the DESIRED OUTCOME for each patient:– WITHOUT harm– WITHOUT waste– WITH an exceptional expe...
3030Core Focus: Service Excellence,Patient Safety and Quality
31Leadership Rounds
32Our Journey Towards an ExceptionalExperience: Our Tools• Communication in Healthcare• Relationship Centered Leadership• ...
33Result: Overall Patient Experience657480766875807689.484.388.590.18491.289.26065707580859095Apr‐Jun 09Jul‐Sep 09Oct‐Dec ...
3434System RedesignSafety
35Chief PatientSafety Officer(MD)-----------------ExecutiveDirectorQuality &Safety (RN)MD/RNPSO pair(EmergencyServices)MD/...
362 3 4 5 6 7 8 9 10 11 12 1 2 32012 2013ESE 2 2 1 2 2 6 4 5 8 2 4PSE 2 16 30 39 62 63 69 77 68 77 86 94 73 69SE 1 1 1 2 4...
37Top Patient Safety Events (PSEs)Categories• System Priorities:– Specimen Labeling– Bar Code Med Administration– Missed O...
38Causal Tree Analysis: Chemotherapy AdminMITOX DoseAdministered EarlyORRN believed it wastime to administerMed available ...
39Aggregate PSEs/ESEs – System Teams’ Progress% Complete
4040System RedesignWorkflow
41Mission re:DesignEDMed/Surg2012 2013 2014Aug –SeptOct –DecJan –MarApr –JuneJuly –SeptOct –DecJan –MarApr –JuneJuly –SepO...
42CultureNursing Documentation - iView Redesign• Workflows are standardizedand nurses are satisfied withtheir documentatio...
43iView Redesign: What Nurses Said
4444Results
45Left Without Being Seen: Single MobilePoint of Discharge0.00%1.00%2.00%3.00%4.00%5.00%6.00%Weekly LWBS % 9/2/2012 ‐ 3/16...
46Low Acuity Throughput PatientSatisfaction– Preliminary Outcomes
47Reduced Urinary Tract InfectionsStatistically significant improvement from Before to After
48Reduced Respiratory InfectionsJa n2 0 1 2O ct 20 11Jul 2 0 11A pr2 0 11Ja n2 0 11Oc t 2 0 1 0Jul 2 0 1 0Apr2 0 1 0Ja n2 ...
49Peri-Operative Glucose ControlBEFORERed: value far out of rangeAFTERAFTERGreen: value in range
50DateDaysDec-12Aug-12Apr-12Dec-11Aug-11Apr-11Dec-10Aug-10Apr-10Dec-09Aug-095.04.54.03.53.02.52.01.5_X=2.777UCL=3.781LCL=1...
51Reduced the use of ICU Propofol0100200300400500600Oct‐10Nov‐10Dec‐10Jan‐11Feb‐11Mar‐11Apr‐11May‐11Jun‐11Jul‐11Aug‐11Sep‐...
52
53Improved Medication Reconciliation onAdmission
54
55Improved Communication at Handoffs inCardiac Catheterization Lab
5656The Bottom Line
57Reduced Risk‐Adjusted Mortality (Top 16% of US Comparison)
5858Future Steps…
59
60
61Summary: Technology and CareOptimization• Direct patient care• Population/sub-population analytics• Predictive modeling•...
Upcoming SlideShare
Loading in …5
×

iHT2 Health IT Summit Atlanta - Ronald Paulus, President & CEO, Mission Health, Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"

1,720 views

Published on

Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"

Ronald Paulus, MD, MBA
President & CEO
Mission Health System

Published in: Education, Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,720
On SlideShare
0
From Embeds
0
Number of Embeds
1,046
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

iHT2 Health IT Summit Atlanta - Ronald Paulus, President & CEO, Mission Health, Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"

  1. 1. 11From Patient to Population: Technology’sRole in Providing Optimal CareRonald A. Paulus, MDPresident and CEOMission HealthApril 13, 2013
  2. 2. 22Managing Both Individual andPopulation HealthMy Geisinger Transformation Experience
  3. 3. 3Geisinger Health SystemCareworks Convenient HealthcareNon‐Geisinger Physicians With EHRLast updated 08/18/09Geisinger ProvenHealth Navigator SitesContracted ProvenHealth Navigator SitesGeisinger Medical GroupsGeisinger Specialty ClinicsGeisinger Inpatient FacilitiesAmbulatory Care Facility Geisinger Health System Hub and Spoke Market AreaGeisinger Health Plan Service Area
  4. 4. 44GeisingerTransformation Infrastructure
  5. 5. 5AlertsPrompts/RemindersOrder SetsAutomated care plansPatient portal messagesInformation Rx…Effectors…EBM GuidelinesPatient PreferencesFormulary/EconomicsOther InputsEHRClinical,Schedule…Real-time Clinical StatusDecisionSupportCDISNormalization, Transformation,Analytic ApplicationFinanceClaims Ops…Clinical Decision Intelligence System (CDIS)ConsumerPortal
  6. 6. 66Population Health OptimizationThe Patient: Diabetes
  7. 7. 7Diabetes BundleMeasures FY07HgbA1C measurement XHgbA1C control XLDL measurement XLDL control XBlood pressure control XRetinal examUrine (protein) exam XFoot examInfluenza immunization XPneumococcal immunization XSmoking status XUse of ACE/ARB for microalbuminuria/DM nephropathyUse of ACE/ARB for hypertensionPatients who receive/achieve ALL of the above XYearlyYearlyOnceNon-smokerYearlyYearlyYearlyYesYes< 100< 130/80Quality StandardEvery 6 monthsYearly< 7Measures FY07HgbA1C measurement XHgbA1C control XLDL measurement XLDL control XBlood pressure control XRetinal examUrine (protein) exam XFoot examInfluenza immunization XPneumococcal immunization XSmoking status XUse of ACE/ARB for microalbuminuria/DM nephropathyUse of ACE/ARB for hypertensionPatients who receive/achieve ALL of the above XYearlyYearlyOnceNon-smokerYearlyYearlyYearlyYesYes< 100< 130/80Quality StandardEvery 6 monthsYearly< 7
  8. 8. 8DM Best Practice Alert/Order Set
  9. 9. 9Patient Reminder ViewCDIS
  10. 10. 10Diabetes Bundle ResultsPrimary Care Average (n=23,404)
  11. 11. 11CAD Bundle Primary Care Results Average(n=14,714)
  12. 12. 1212Population Health OptimizationThe Patient: CABG
  13. 13. 13Research Ties
  14. 14. 14
  15. 15. 15GHS Receives One “All In” Global Fee• One fee for the ENTIRE 90-day period including allsurgery-related care:– ALL surgery-related pre-admission care– ALL inpatient physician and hospital services, includingcardiologists, cardiac surgeons, anesthesia, consultants, etc– ALL surgery-related post-operative care– ALL care for any related complications or readmissions• Eliminates perverse incentives
  16. 16. 16Process Redesign: Work Flow
  17. 17. 17Process Redesign: Hardwiring
  18. 18. 18Clinical OutcomesBefore With ChangeProvenCare ProvenCare (% Reduction)(n=132) (n=181)In-hospital mortality 1.5% 0%Patients with any complication (STS) 38% 30% 21%Patients with >1 complication 7.6% 5.5% 28%Atrial fibrillation 23% 19% 17%Neurologic complication 1.5% 0.6% 60%Any pulmonary comp 7.3% 4.0% 46%Blood products used 23% 18% 22%Re-operation for bleeding 3.8% 1.7% 55%Deep sternal wound infection 0.8% 0.6% 25%Readmission within 30 days 6.9% 3.8% 45%
  19. 19. 19Financial Outcomes• Hospital:– Net revenue +12.3% (with expenses only +5.6%)– Contribution margin +17.6%– Total inpatient profit per case improved +$1,946• Health Plan:– Paid out 4.8% less/case for CAB locally– Paid out 28-36% less for CAB at locally vs. other providers
  20. 20. 2020Population Health OptimizationThe Population
  21. 21. 21
  22. 22. 22
  23. 23. 23
  24. 24. 24
  25. 25. 25
  26. 26. 2626Mission Health Overview
  27. 27. 27Service Area
  28. 28. 28Mission Health: 127 Years of ExceptionalService to WNC• Created, governed and owned by WNC for the exclusivebenefit of WNC– We are the only such health system remaining…• Unwavering commitment to not-for-profit healthcare,quality and community service• A Thomson Reuters/Truven Analytics “Top 100 Hospital”and “Top 15 Health System”
  29. 29. 29Our BIG(GER) Aim• Achieving the DESIRED OUTCOME for each patient:– WITHOUT harm– WITHOUT waste– WITH an exceptional experience
  30. 30. 3030Core Focus: Service Excellence,Patient Safety and Quality
  31. 31. 31Leadership Rounds
  32. 32. 32Our Journey Towards an ExceptionalExperience: Our Tools• Communication in Healthcare• Relationship Centered Leadership• Meetings with Departments with Next Step Action Plans• Quality Leadership Rounds• Redesign Work
  33. 33. 33Result: Overall Patient Experience657480766875807689.484.388.590.18491.289.26065707580859095Apr‐Jun 09Jul‐Sep 09Oct‐Dec 09Jan‐Mar 10Apr‐Jun 10Jul‐Sep 10Oct‐Dec 10Jan‐Mar 11Apr‐Jun 11Jul‐Sep 11Oct‐Dec 11Jan‐Mar 12Apr‐Jun 12Jul‐Sep 12Oct‐Dec 12Patient Satisfaction Scores“Overall Quality of Care”Percentile RankingNational Percentile Ranking
  34. 34. 3434System RedesignSafety
  35. 35. 35Chief PatientSafety Officer(MD)-----------------ExecutiveDirectorQuality &Safety (RN)MD/RNPSO pair(EmergencyServices)MD/RNPSO pair(CriticalCareServices)MD/RNPSO pair(AcuteCareServices)MD/RNPSO pair(TBD)MD/RNPSO pair(AnesthesiaServices)MD/RNPSO pair(Surgical/proceduralServices)Physician:NursePartners
  36. 36. 362 3 4 5 6 7 8 9 10 11 12 1 2 32012 2013ESE 2 2 1 2 2 6 4 5 8 2 4PSE 2 16 30 39 62 63 69 77 68 77 86 94 73 69SE 1 1 1 2 4 3 1 1 10102030405060708090100Count PSE/SE/ESE Count by Month: End of Feb 2012 ‐ Mar 2013
  37. 37. 37Top Patient Safety Events (PSEs)Categories• System Priorities:– Specimen Labeling– Bar Code Med Administration– Missed Orders• Other Top Categories:– Delay in Diagnosis / Treatment– Med Errors– Critical Equipment– Patient Identification– Handoff
  38. 38. 38Causal Tree Analysis: Chemotherapy AdminMITOX DoseAdministered EarlyORRN believed it wastime to administerMed available in Pyxis –Interpreted as time toadministerConversation w/Dr.was mis-interpretedto mean ok toadministerPretest resultsOKTiming info in eMARis usually wrong forChemoDidn’t see timing inwritten orderDidn’t see timing inroadmapSecond checkdidn’t catchtiming2ndRN new toChemo2ndRN assumedmore experienceRN was rightANDUrgency toadminister medbefore PM shiftHandwrittenorders androadmap can behard to readFirst dose commonlynot on time (but w/inacceptable tolerance)Practice for RNsto not re-timechemo on eMARANDCan either dropor add doses ifeMAR isadjustedUse of “days”can beconfusing w/12hr dosesRN trying toalleviateworkload frompm shiftStaffing andretention – toofew chemocertified nurseson pmSystem mayinterpret timechange asrequest for add’ldoseRN notaccustomedto meds beingso earlyChemodelivered muchearlier thantime for whichdose scheduledANDANDDr. assumed RNquestion wasregarding results ofuncommon 2ndEcho2nd EchorecentlycompletedRN didn’texplicitly askabout timingANDPatient can belatePrework timingcan varyMissedshorteningfraction ininitial EchoevaluationUnusual to useshorteningfraction in theprotocolEarly delivery iscommon for eveningchemo dosesChemopharmacistevening coveragenot alwaysavailableRN used eMARfor timing insteadof paper MARPaper MAR isn’talways createdLack ofunderstanding ofhow to use paperMAR inconjunction witheMARR1.1SBAR notfollowed1.01.11.1.11.1.21.1.31.2.11.2.22.02.0.12.0.22.0.32.1.12.1.22.1.2.1 2.1.2.23.0 4.04.1.14.1.24.1.34.2.14.2.24.2.35.0 6.05.1.15.1.25.1.35.2.15.2.25.2.35.35.40.00.1R1.1R1.2R5.1R1.2R1.2R1.2 R2.1R4.1RNs not callingPharmacy toadjust eMARtimes4.5RNs unawarethey should dothis4.5.1Lack of formalprocedure4.5.2R1.2SBAR notyet rolled-outin Peds1.2.3R3.1R1.1R2.2R1.1
  39. 39. 39Aggregate PSEs/ESEs – System Teams’ Progress% Complete
  40. 40. 4040System RedesignWorkflow
  41. 41. 41Mission re:DesignEDMed/Surg2012 2013 2014Aug –SeptOct –DecJan –MarApr –JuneJuly –SeptOct –DecJan –MarApr –JuneJuly –SepOct –DecSurgeryVSMVSMVSMRealize outcomes/returns Realize outcomes/returns Realize outcomes/returns PharmacyVSM Realize outcomes/returns SupplyVSM Realize outcomes/returns 
  42. 42. 42CultureNursing Documentation - iView Redesign• Workflows are standardizedand nurses are satisfied withtheir documentation andworkflow.• Improved Nurse Satisfactionwith Documentation: 31% to90%.• Improved Nurse Satisfactionwith Workflow: 32% to 69%PeoplePatient
  43. 43. 43iView Redesign: What Nurses Said
  44. 44. 4444Results
  45. 45. 45Left Without Being Seen: Single MobilePoint of Discharge0.00%1.00%2.00%3.00%4.00%5.00%6.00%Weekly LWBS % 9/2/2012 ‐ 3/16/2013• Increase in Hospital Census• Increased LOS• Influx of New Hires• InfluenzaFlu Epidemic
  46. 46. 46Low Acuity Throughput PatientSatisfaction– Preliminary Outcomes
  47. 47. 47Reduced Urinary Tract InfectionsStatistically significant improvement from Before to After
  48. 48. 48Reduced Respiratory InfectionsJa n2 0 1 2O ct 20 11Jul 2 0 11A pr2 0 11Ja n2 0 11Oc t 2 0 1 0Jul 2 0 1 0Apr2 0 1 0Ja n2 01 0Oct 2 00 90 .1 00 .0 80 .0 60 .0 40 .0 20 .0 0M o n t hRateofRespNIMs-MSICU_A v g = 1 .8 9 %U C L= 5 .5 1 %LB = 0B e fo r e P r o je c t D u r in g A fte r P r o je c tC o n tr o l C h a r t o f R e s p i r a to r y N I M s - M S I C UA v g = 3 .7 4 %A vg = 1 .8 7 %U C L= ~ 9 .2 5 %U C L = ~ 5 .6 5 %
  49. 49. 49Peri-Operative Glucose ControlBEFORERed: value far out of rangeAFTERAFTERGreen: value in range
  50. 50. 50DateDaysDec-12Aug-12Apr-12Dec-11Aug-11Apr-11Dec-10Aug-10Apr-10Dec-09Aug-095.04.54.03.53.02.52.01.5_X=2.777UCL=3.781LCL=1.773Before After1COLI - ALOSP‐Value – 0.016
  51. 51. 51Reduced the use of ICU Propofol0100200300400500600Oct‐10Nov‐10Dec‐10Jan‐11Feb‐11Mar‐11Apr‐11May‐11Jun‐11Jul‐11Aug‐11Sep‐11Oct‐11Nov‐11Dec‐11Jan‐12Feb‐12Mar‐12Apr‐12May‐12Jun‐12Jul‐12Aug‐12Sep‐12Oct‐12Nov‐12Dec‐12Jan‐13Feb‐13Mar‐13Apr‐13Propofol Bottles Removed ‐ ColiBottles Removed, ColiLinear (Bottles Removed, Coli)
  52. 52. 52
  53. 53. 53Improved Medication Reconciliation onAdmission
  54. 54. 54
  55. 55. 55Improved Communication at Handoffs inCardiac Catheterization Lab
  56. 56. 5656The Bottom Line
  57. 57. 57Reduced Risk‐Adjusted Mortality (Top 16% of US Comparison)
  58. 58. 5858Future Steps…
  59. 59. 59
  60. 60. 60
  61. 61. 61Summary: Technology and CareOptimization• Direct patient care• Population/sub-population analytics• Predictive modeling• Trend analysis, local norm development• Decision Support• Hard-wiring of core care process changes• Care process automation• The list goes on…it’s really everywhere

×