Organizational Strategy toAddress Staff Competencyand Physician SatisfactionDavin Lundquist, M.D.Chief Medical Information...
“Better to remainsilent and be thought afool than to speak andremove all doubt.”                   - Abraham Lincoln      ...
Dignity Health (formerly Catholic Healthcare West)                             • 5th Largest Hospital Provider            ...
Outline•   My Informatics Journey•   DH Medical Foundation Story•   New Organizational Strategy•   Technologies Deployed a...
5
Family Medicine ResidencyNaval Hospital in Bremerton, Washington                                          6
Microsoft Access Database       “EMR Lite”                            7
Microsoft Access Database                            8
Microsoft Access Database                            9
Naval Ambulatory Care Clinic    Ventura, California                               10
Navy EMR           11
Navy EMR           12
Ranks #1 in Obesity    Mississippi                      13
Magee General Hospital                         14
Centers for Family Health   Ventura, California                            15
“Cut the Cord” to Paper Charts                                 16
On day 1, there were No Charts                                 17
• 550+ Physicians• 10 Medical Groups• Multi-specialty                      18
19
• Upgrade from v10 to v11 in Summer 2011• Felt more like a downgrade                                           20
“I had some eyeglasses.I was walking down thestreet when suddenlythe prescription ranout.“                   - Stephen Wri...
Root Cause Analysis• Following the v10 – v11 upgrade, all sites participated in a Root  Cause Analysis (RCA) exercise to u...
Diginty Health                               Dignity Health        Medical Foundation                             IT Conne...
Took a trip to Sharp                       24
President & CEO                                                    Chief Medical                                          ...
Clinical Informatics ManagersClinical Support Specialists• First line of defense• At the elbow• Single source of truth    ...
Chief Information                   Chief Medical                          Officer (EVP)                     Officer (EVP)...
Vice President                                                            IT Connectivity      Director                   ...
“The first half of ourlives is ruined by ourparents, and the secondhalf by our children.“                   - Clarence Dar...
Measure Progress• Goal is to Improve: –Support Staff Competency –End-user Competency –Physician Satisfaction –Upgrade expe...
Help Desk            31
32
Help Desk Ticket                   33
Dashboard of Incidents                         34
New Workflow for handling Tickets                                    35
Dashboard of Incidents                         36
Areas of Emphasis• Team Learning and   •   Implementation  Growth              •   ICD-10• Service Delivery    •   Integra...
Direct Surveys Of    Physician   Satisfaction                    38
Better results                 39
Survey Rationale• Baseline analysis of MMG provider perceptions  of the Allscripts EMR, quality  reporting, training, and ...
Survey Background•Idea took shape on February 11, 2013•Development of instrument February 11-18, 2013•Published online to ...
Example of actual survey                           42
Example of results as shown in SurveyMonkey                                              43
Example of results to a Question                                   44
Survey Response                             Total Responses   Scratch Off %Primary Care                       76          ...
“My Doctor gave me sixmonths to live, butwhen I couldn’t pay thebill he gave me six moremonths.“                    - Walt...
Integration Detectives• 50+ interface requests outstanding a year ago• Business use case validation implemented• 22 unique...
Upgraded Upgrades• Allscripts v11.2.3 in June 2012 – Robust testing process – Smaller instance in So Cal used as “pilot” –...
Other Technologies• MD Tracker• WebTop• Physician Portal                     49
MD Tracker Doctor List                         50
Doctor Profile                 51
Notes from Rounding                      52
WebTop – Single Sign-on – Physician Portal
My Home   My Clinic   My Patients                 My Community        My Support                            Avatar        ...
My Home                             My Clinic              My Patients   My Community   My SupportOncology Free EventsCanc...
My Home   My Clinic   My Patients   My Community   My Support
My Home   My Clinic   My Patients   My Community   My Support
My Home   My Clinic   My Patients   My Community   My Support!
“We must not ceasefrom exploration and theend of all our exploringwill be to arrive wherewe began and to knowthe place for...
Questions???
The Choluteca Bridge in Honduras                                   61
After Hurricane Mitch hit in 1998                                    62
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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"

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Davin Lundquist, MD
CMIO
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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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"

  1. 1. Organizational Strategy toAddress Staff Competencyand Physician SatisfactionDavin Lundquist, M.D.Chief Medical Information OfficerDignity Health Medical Foundation 1
  2. 2. “Better to remainsilent and be thought afool than to speak andremove all doubt.” - Abraham Lincoln 2
  3. 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. 4. Outline• My Informatics Journey• DH Medical Foundation Story• New Organizational Strategy• Technologies Deployed and/or Envisioned• Lessons Learned 4
  5. 5. 5
  6. 6. Family Medicine ResidencyNaval Hospital in Bremerton, Washington 6
  7. 7. Microsoft Access Database “EMR Lite” 7
  8. 8. Microsoft Access Database 8
  9. 9. Microsoft Access Database 9
  10. 10. Naval Ambulatory Care Clinic Ventura, California 10
  11. 11. Navy EMR 11
  12. 12. Navy EMR 12
  13. 13. Ranks #1 in Obesity Mississippi 13
  14. 14. Magee General Hospital 14
  15. 15. Centers for Family Health Ventura, California 15
  16. 16. “Cut the Cord” to Paper Charts 16
  17. 17. On day 1, there were No Charts 17
  18. 18. • 550+ Physicians• 10 Medical Groups• Multi-specialty 18
  19. 19. 19
  20. 20. • Upgrade from v10 to v11 in Summer 2011• Felt more like a downgrade 20
  21. 21. “I had some eyeglasses.I was walking down thestreet when suddenlythe prescription ranout.“ - Stephen Wright 21
  22. 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. 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. 24. Took a trip to Sharp 24
  25. 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. 26. Clinical Informatics ManagersClinical Support Specialists• First line of defense• At the elbow• Single source of truth 26
  27. 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. 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. 29. “The first half of ourlives is ruined by ourparents, and the secondhalf by our children.“ - Clarence Darrow 29
  30. 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. 31. Help Desk 31
  32. 32. 32
  33. 33. Help Desk Ticket 33
  34. 34. Dashboard of Incidents 34
  35. 35. New Workflow for handling Tickets 35
  36. 36. Dashboard of Incidents 36
  37. 37. Areas of Emphasis• Team Learning and • Implementation Growth • ICD-10• Service Delivery • Integration• Process • Budget Improvement Performance• Service Metrics• Optimization 37
  38. 38. Direct Surveys Of Physician Satisfaction 38
  39. 39. Better results 39
  40. 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. 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. 42. Example of actual survey 42
  43. 43. Example of results as shown in SurveyMonkey 43
  44. 44. Example of results to a Question 44
  45. 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. 46. “My Doctor gave me sixmonths to live, butwhen I couldn’t pay thebill he gave me six moremonths.“ - Walter Matthau 46
  47. 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. 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. 49. Other Technologies• MD Tracker• WebTop• Physician Portal 49
  50. 50. MD Tracker Doctor List 50
  51. 51. Doctor Profile 51
  52. 52. Notes from Rounding 52
  53. 53. WebTop – Single Sign-on – Physician Portal
  54. 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. 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. 56. My Home My Clinic My Patients My Community My Support
  57. 57. My Home My Clinic My Patients My Community My Support
  58. 58. My Home My Clinic My Patients My Community My Support!
  59. 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. 60. Questions???
  61. 61. The Choluteca Bridge in Honduras 61
  62. 62. After Hurricane Mitch hit in 1998 62

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