Physician Engagement - Building a Long Lasting Relationship ...

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  • Prenup stated it was an enterprise build, by the time you get into the issues, you have forgotten the prenup details
  • Physicians need to develop comfort with the keyboard and mouse to truly enjoy the rewards of the system Epic has many tools that save time; mastery of those tools takes time Users need ongoing experience, training and support to achieve optimal efficiencies Integration with Ambulatory medical record improves overall physician satisfaction Living in a hybrid environment (paper & electronic) The Change Management of EMR is significant Workflow changes are major and it takes time to adjust Requires medical staff leadership, commitment and flexibility Ramp up period requires training and on-site support Expect initial productivity hit as you learn the system. The IT challenges are significant Resource intensive, expensive project This is not an IT project: it requires an Integrated Team approach of Professional, Business/Operations and IT partners Many small and mid-size groups don’t have the infrastructure or the integrated Team to approach such an ambitious implementation… You do have that opportunity and the challenges can be managed Keys are strong partnership, strong vendor, solid build, committed leadership, excellent training and effective communication
  • Physician Engagement - Building a Long Lasting Relationship ...

    1. 1. Physician Engagement Building a Long Lasting Relationship John Kontor, MD – Bon Secours Health System Trenor Williams, MD - Clinovations October 17 th , 2008
    2. 2. Agenda 1 Introduction 2 Dating 3 Getting Married 4 Making it Last 6 Closing Thoughts 7 Q & A
    3. 3. <ul><li>Our </li></ul><ul><li>Hopeful </li></ul><ul><li>Journey … </li></ul>Hopefully Not This One
    4. 4. Dating
    5. 5. Activities <ul><li>Gaining Initial Interest </li></ul><ul><li>Structure </li></ul><ul><li>Scope of Work </li></ul><ul><li>Lessons </li></ul>Change Management & Adoption Clinical Content Development Physician Workflow Design
    6. 6. Bon Secours Health System <ul><li>Established 1983  with 14 Acute Care Hospitals </li></ul><ul><li>Number of Licensed Beds 4,820   </li></ul><ul><li>Employees 16,500 FTEs </li></ul><ul><li>Physicians 8000 (only 200 employed) </li></ul><ul><li>State of the System at Project Outset </li></ul><ul><li>Variable order set use </li></ul><ul><li>No impatient electronic medical record </li></ul><ul><li>Some ancillary system use and some electronic results review </li></ul><ul><li>Variable inclusion of evidence-based practices </li></ul>
    7. 7. Like every relationship there were obstacles <ul><li>Geography </li></ul><ul><li>Limited EMR Experience </li></ul><ul><li>Multi-Year Rollout </li></ul><ul><li>Private Physicians </li></ul>
    8. 8. Appealed their best interest… <ul><li>ConnectCare seeks to: </li></ul><ul><li>Make patient care safer </li></ul><ul><li>Continuously-increase quality patient outcomes </li></ul><ul><li>Connect clinicians to one another and to their patients </li></ul><ul><li>Provide an immediate and integrated single point of access to information </li></ul><ul><li>Design a patient care delivery system that allows BSHSI to determine where there is innovation and where BSHSI needs to innovate </li></ul>
    9. 9. Explained our IT goal…
    10. 10. Arriving at stage 6 <ul><li>“ Stage 6 hospitals appear to have a significant advantage over competitors for patient safety, clinician support, clinician recruitment, and competitive marketing for both consumers and nurse recruitment. “ </li></ul><ul><li>- HIMMS Analytics 2007 </li></ul>
    11. 11. Ann. Epidemiol. 2004:14:669-675 Presented a Logical Argument based on Quality.
    12. 12. We Created a New Physician Structure BSHSI Physician Design Team (PDT) Clinical Content / Order Set Teams Local Physician Engagement Team Workflow Team Informatics Team
    13. 13. <ul><li>Physician Design Team </li></ul><ul><li>Oversee physician engagement in ConnectCare design, implementation and proficient use of ConnectCare </li></ul><ul><li>Workflow Team </li></ul><ul><li>PDT members along with other system physicians who will be advisors at design sessions and who develop a deep knowledge of the system design to provide continuity, integration and leadership. </li></ul><ul><li>Clinical Content Team </li></ul><ul><li>Responsible for development of order sets, best practice alerts, clinical protocols and pre-configured text </li></ul>
    14. 14. <ul><li>Design Sessions </li></ul><ul><ul><li>System </li></ul></ul><ul><ul><li>Workflow </li></ul></ul><ul><ul><li>Initial Content </li></ul></ul>
    15. 15. Order Set Story
    16. 16. <ul><li>Goals </li></ul><ul><li>Develop a sufficient number of order sets for the pilot go-live – approximately 70% of admissions </li></ul><ul><li>Create intranet or paper-based order sets for all other facilities </li></ul><ul><li>Develop a process for building, updating, and maintaining content on an ongoing basis </li></ul><ul><li>2 Pilot sites – electronic order sets </li></ul><ul><li>Other 12 sites – implement paper order sets </li></ul><ul><li>100% CPOE Goal </li></ul><ul><li>Prioritized order set development based upon admissions, clinical initiatives, CMS and other regulatory requirements </li></ul>
    17. 17. Content Governance Physician Design Team (PDT) Clinical Content / Order Set Teams Local Physician Engagement Team Workflow Design Team Informatics Team <ul><li>Physician Participation </li></ul><ul><li>Practicing Physicians </li></ul><ul><li>Executive participation at system and local site </li></ul><ul><li>Clinical Leadership Group </li></ul><ul><li>8000 physicians able to review </li></ul><ul><li>All 14 hospitals despite their sequence in the EMR rollout </li></ul>Order Set Manager Clinical Doc. Manager MD Director Clinical Doc. Analyst Order Set Analyst Admin Assistant RN Analyst (AuthorSpace) Pharmacy
    18. 18. Content Development Cycle Using Zynx Enterprise Order Set & Care Plan creators use Zynx evidence to draft order sets Implementation of Order Sets by Local Facilities Drafts are pushed to ViewSpace where they can be reviewed and critiqued PDT Endorse and approve initial order sets Enterprise Order Set & Care Plan creators update order sets based upon local comments PDT Endorse and approve final order sets Order Set Team PDT Local Facilities
    19. 19. Development Timeline Phase I GENERAL MEDICINE Phase II Phase III OB GYN CRITICAL CARE ORTHO NEURO -SURGERY BEHAVIORAL HEALTH NEUROLOGY SURGERY CARDIOLOGY PEDIATRICS Months April May June July August September October November December January February PALLIATIVE CARE CV SURGERY Nephrology Urology Interventional Radiology Vascular Surgery GI
    20. 20. ZynxHealth: Order Set Review <ul><li>Review by specialty – all 8000 employed and community physicians were invited to participate </li></ul><ul><li>Central clinical content team created workplan and infrastructure and then each local system worked off that plan to engage their physicians </li></ul><ul><li>Physicians log in whenever and from wherever they like to asynchronously provide comments </li></ul><ul><li>We used this process to engage the physician community in the process </li></ul>
    21. 21. Where are we today? <ul><li>As of October 2008, Bon Secours has built 275 standardized order sets in a little more than one year </li></ul>
    22. 22. Lessons <ul><li>Early Involvement </li></ul><ul><li>Local Leadership Support </li></ul><ul><li>Finances – helps to pay the providers </li></ul><ul><li>Workflow Review </li></ul><ul><li>Revisiting workflows </li></ul><ul><li>Gather Local Content and workflows </li></ul><ul><li>Difficulty keeping sites involved if their go-live was not imminent </li></ul><ul><li>Sustaining energy is challenging </li></ul>
    23. 23. Getting Married
    24. 24. Activities <ul><li>Local System Engagement </li></ul><ul><ul><li>Physician Workgroup </li></ul></ul><ul><li>Go-Live </li></ul><ul><li>Physician Documentation </li></ul>
    25. 25. Local ConnectCare Project Framework <ul><li>20 specialties </li></ul><ul><li>Local CMO and CMIO </li></ul><ul><li>System Leadership </li></ul><ul><li>12 Administrators </li></ul><ul><ul><li>Credentialing </li></ul></ul><ul><ul><li>Physician Services </li></ul></ul><ul><ul><li>EVP </li></ul></ul><ul><ul><li>Communications </li></ul></ul><ul><ul><li>HIM </li></ul></ul><ul><ul><li>Compliance </li></ul></ul><ul><ul><li>PMO </li></ul></ul><ul><ul><li>IT </li></ul></ul>Staffing Work Group Communication Work Group Training Work Group Workflow Work Group ConnectCare Workgroup Executive Leads Budget Work Group I.T. Work Group Physicians Work Group
    26. 26. Local Physician Workgroup <ul><li>Provide guidance on: </li></ul><ul><ul><li>Physician Training </li></ul></ul><ul><ul><li>Physician Support </li></ul></ul><ul><ul><li>Content (order sets, alerts, rules) for St. Francis-specific situations </li></ul></ul><ul><ul><li>Workflows </li></ul></ul><ul><ul><li>Devices </li></ul></ul><ul><li>Participate in engagement and adoption activities: </li></ul><ul><ul><li>Lead the actions that ensure St. Francis’ physicians are ready and willing to use the system </li></ul></ul><ul><ul><li>Engage their colleagues in the process, including adoption of new workflows </li></ul></ul><ul><ul><li>Perform demonstrations on the system at St. Francis ConnectCare events </li></ul></ul><ul><ul><li>Help achieve 100% adoption </li></ul></ul>
    27. 27. Tools For… <ul><li>Who They Are </li></ul><ul><li>Where They Work </li></ul><ul><li>What They Do </li></ul>
    28. 28. Physicians and Locations June 2008 Go-Live ED Physicians <ul><li>Review patient's demographic, lab, rad information </li></ul><ul><li>Complete all documentation in Epic </li></ul><ul><li>Complete all orders in Epic - order sets and individual orders </li></ul>Non-ED Docs <ul><li>Review patient lists, patient's demographic, lab, rad information in Epic </li></ul><ul><li>Complete orders using paper order sets </li></ul><ul><li>Complete documentation (H&P) using current process </li></ul>On the Floor <ul><li>Floor docs will review ED information on the patient's that have been admitted in Epic and have a printed copy. </li></ul>In the Clinic <ul><li>Review the patient’s ED visit in Epic if desired </li></ul><ul><li>Still receive patient’s information using current process </li></ul>
    29. 29. Physician Documentation Process Progress H&P Discharge Consult Op Note Procedure 35 Specialties Who What Build Build MD Review MD Review Over 300 Notes Every Specialty Engaged Foundation for the System
    30. 30. Lessons <ul><li>Dedicated roles for local physicians </li></ul><ul><li>Go-Live Support </li></ul><ul><li>Post Go-Live Support </li></ul><ul><li>We thought we had it right </li></ul><ul><li>Balance of Local Needs vs. Enterprise Build </li></ul><ul><li>Training </li></ul><ul><li>The challenges of sustaining energy and interest </li></ul>
    31. 31. Making it Last
    32. 32. Activities <ul><li>Post Go-Live / Optimization Site 1 </li></ul><ul><li>Next Go-Live in Site 1 </li></ul><ul><li>Rollout </li></ul><ul><li>Clinical Transformation </li></ul>
    33. 33. Next Site Activities <ul><li>Paper Order Sets </li></ul><ul><li>Documentation Review </li></ul><ul><li>Local Infrastructure </li></ul><ul><li>Workflow Review </li></ul>Change Management & Adoption Clinical Content Development Physician Workflows
    34. 34. Post Go-Live Optimization <ul><li>Support Resources </li></ul><ul><li>Adherence to workflows </li></ul><ul><li>Fixes vs. Training </li></ul><ul><li>Vendor Updates </li></ul>
    35. 35. Integrating Clinicians and Initiatives Enterprise Team Local Team Specialty Teams <ul><ul><li>Focus on both EMR and Clinical Transformation Initiatives </li></ul></ul><ul><ul><li>Pulling in Quality and Benefits Realization resources </li></ul></ul><ul><ul><li>Regular meetings – some face to face and some virtual </li></ul></ul><ul><ul><li>Multidisciplinary Teams </li></ul></ul>
    36. 36. This doesn’t look easy …
    37. 37. Closing Thoughts <ul><li>Relationships are tough </li></ul><ul><li>They evolve </li></ul><ul><li>Membership will / should change </li></ul><ul><li>Leadership Opportunities </li></ul><ul><li>EMR can be for catalyst new structures </li></ul><ul><li>Marathon not a sprint </li></ul>
    38. 38. Contact Information <ul><li>John Kontor, MD </li></ul><ul><li>[email_address] </li></ul><ul><li>(443) 841-2753 </li></ul><ul><li>Trenor Williams, MD </li></ul><ul><li>[email_address] </li></ul><ul><li>(202) 270-4553 </li></ul>Thank You

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