Maximizing The Clinical Effect of a System Wide EMR 10/David...Becker’s Health IT + Clinical...
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Becker’s Health IT + Clinical Leadership 2018 1 Maximizing The Clinical Effect of a System Wide EMR David J. Adinaro MD, M.Eng., FACEP Vice President & Chief Medical Officer, SJUMC Chief Medical Information Officer, SJHS Director, Fellowship in Administration and Informatics Date: May 10, 2018
Transcript of Maximizing The Clinical Effect of a System Wide EMR 10/David...Becker’s Health IT + Clinical...
Becker’s Health IT + Clinical
Leadership 2018
1
Maximizing The Clinical Effect of a
System Wide EMR
David J. Adinaro MD, M.Eng., FACEP
Vice President & Chief Medical Officer, SJUMC
Chief Medical Information Officer, SJHS
Director, Fellowship in Administration and Informatics
Date: May 10, 2018
No financial relationships to declare
• Founded 151 years ago in Paterson, NJ by the Sisters of Charity of St. Elizabeth (still our Sponsors)
• Total budget of $810 Million
• Two hospitals, one nursing home, joint visiting health service, extensive behavioral health network and primarily clinic based ambulatory presence
• Flagship is St. Joseph’s University Medical Center
• Urban, academic medical center including Trauma, Cardiothoracic programs as well as a Children’s Hospital
• Average inpatient census of 480 patients
• 4th busiest ED in country (165,000 visits)
• 220+ residents and fellows
• Large proportion of aligned but not employed physicians
St. Joseph’s Health
St. Joseph’s Healthcare System: Who we are…
• Sponsored by the Sisters of Charity of Saint Elizabeth
• 150 years of service dedicated to the Mission
St. Joseph’s Healthcare System is a healing ministry of the Catholic Church sponsored
by the Sisters of Charity of Saint Elizabeth. We are committed to provide exceptional
quality care which sustains and improves both individual and community health, with
a special concern for those who are poor, vulnerable and underserved.
• Embracing Excellence
Value Driven Organization:
Dignity, Charity, Justice, Excellence, Stewardship
• One of New Jersey’s 12 regional safety net hospitals and 2nd largest provider of charity care services in New Jersey
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Source: State of New Jersey, Department of Labor and Workforce Development, Population & Labor Force Projections.
Service Area Population
Paterson• 2nd most densely populated city in the nation (146,199 people
residing in the City).• 26.6% of residents living below the poverty level, including 39%
of those under age 18.
Wayne• Between 2012 and 2017 the fastest growing demographic is 65+
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Total Population of Service Area = 1.2 million
SJHS Hospitals
Total Population by City
150,000
3,674
90
Top 10 Cities by Population
City Population
Paterson 145,920
Clifton 83,524
Passaic 70,215
Wayne 54,849
Bloomfield 47,442
West Orange 46,386
Hackensack 43,466
Montclair 38,340
Belleville 35,973
Fair Lawn 32,659
Strengths of the System
• Strong and loyal Medical Staff • 1,300 member medical staff of which 600+ are affiliated with the System
IPA. • 300 physicians are economically aligned with the System forming the
foundation for future clinically integrated network
• Four time designated Magnet Hospital with Regional Clinical Centers of Excellence in Cardiac, Children’s Hospital, Perinatal (High Risk OB), Orthopedics, Neuroscience, and Trauma
• Regional Employer of Choice – continue to draw the most highly qualified staff to care for our patients, completely non-union workforce
• 1 of 4 in the State of NJ designated as a University Academic Medical Centers. System affiliated with New York Medical College, Seton Hall University, St. George’s University
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Where we were
Resulting Trends Impacting Hospitals
Market consolidation
Tighter integration with
physicians
Increased provider
accountability through risk-
based reimbursement
Development of provider
capacity to manage
populations
Reduction in inpatient
admissions
Growth in ambulatory
services
Downward
Pressure on Price
and Cost
ACA: Insurance
Reforms, Coverage
Expansion, New
Funding
Federal Regulatory
Changes
Advances in
Medicine &
Disruptive
Technologies
Shift In
Responsibility For
Research Funding
to Private Sector
Factors Driving Healthcare Transformation
Health Care Delivery and Payment Models Undergoing Rapid Transformation
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• Allow maximal physician autonomy within a structured environment.
• Make it easiest to do the right thing.
• Foster collaboration and identity.
• Create a clinical environment that supports accountability and communication.
• Create sustainable governance/operational structures.
• Nurture and expand existing highly collaborative programs.
• Support Rev Cycle!
Goals …
• Halo- Enterprise EMR
• Collaborative Leadership (Clinical Leadership team, Sepsis project, PDIT, etc. )
• High Reliability Organizing (Philosophy, culture)
• TeamSTEPPs, LEAN (Operationalize philosophy)
• Engagement, Enforcement (CDMP, chairs, better reporting)
Tools…
• Halo- Enterprise EMR
• Collaborative Leadership (Clinical Leadership team, Sepsis project, PDIT, etc. )
• High Reliability Organizing (Philosophy, culture)
• TeamSTEPPs, LEAN (Operationalize philosophy)
• Engagement, Enforcement (CDMP, chairs, better reporting)
Tools…
Benefits of Enterprise Solution
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Business Clinical
Operational
One Patient
One Chart
One System
Analytics
Long Term Vendor
Viability
Simple visit coding
Single Patient Portal
Strategic Market Position
Integrated Charge Capture
Regional Integration
Clinical IntegrationPop Health
Streamlined Care
SJHS Future State Applications –Cerner Millennium
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Physician
Involvement
Key Dates
Post-Acute
July 2018
Clinics & Physician Practices
September 2018
Hospitals
July 2018
Community Behavioral Health
May 2018
Community Partners
TBD
Includes:
• Adult Clinic
• Peds Sub-Specialties
• Employee Health
• Practices
Includes:
• Community Physicians
• Passaic Coalition
• FQHC
• Community Resources
• Social Services
Via:
• Cerner HIE HUB
• Jersey HealthConnect
Includes:
• Paterson
• Wayne
• Hospital Outpatient
DepartmentsIncludes:
• LTC and Rehab
• Home Care Mgmt
Go Live Plan and Schedule
Success Metrics
We will measure the success of our halo initiative based on specific metrics within these categories:
• Better Clinical Care and Outcomes (across continuum)
• Increased Engagement (Patient, Community, Physicians, Clinicians and Staff)
• Support and enable our Financial Health
• Single Chart Adoption and Utilization across the organization
• 1. Standardization of orders
• 2. Standardization of documentation, “use right template” education/retraining
• 3. Transcription to Voice Recognition (with immediate OR reports)
• 4. Sepsis Care Standardization/Improvement
• 5. Ambulatory Defragmentation
• 6. Privacy of employee medical information
Better living through electrons…
• 7. Standardization of Academic Supervision
• 8. Single Source of Physician Documentation monitoring and compliance
• 9. Resolution of Shadow HIM, standardization of record handling
• 10. Standardization of cardiology reading work flows including standardized reporting structures
• 11. System-wide conversion to metric
Better living through electrons…
• If you are unsure or subject is new listen more, speak less, seek consensus.
• If you are sure then lead, state the goal or plan (ie blue dress).
• Be consistent and open to criticism, but lead.
• Physicians care about mission but focus on the two questions: “What do I have to do”? “How will this affect me?”.
• .
CMIO Philosophy…
• Always be an advocate for front line providers
• Leadership = ownership and advocacy.
• Set consistent expectations and expect consistent processes.
• Collaborate with everyone.
• Avoid one-offs. Always be building and moving forward.
• ABC (always be closing)
CMIO Philosophy…
• “Show them what they need not what they think they want”.
Full credit to Beth Kushner DO (Fellow, incoming CMIO)
Blue Dress Design…
• Design a workflow and orders/documentation that supports that.
• Lean hard on standardization and simplification
• Show it to them…and let them accessorize.
Blue Dress Design…
Systems Engineering though
an Enterprise System
• First priority is modify the EMR system to work better for the physicians\front line staff
• Customize
• Optimize
• Data based approach
Systems Engineering though
an Enterprise System
• .
Systems Engineering though
an Enterprise System
• .
Systems Engineering though
an Enterprise System
• Then flip a .
• Focus becomes modifying EMR to optimize our clinical systems.
Systems Engineering though
an Enterprise System
• Similar to design principles.
• Focus is on “Making right thing the easiest thing”.
• Highly collaborative.
• Must remain sensitive to the bedside providers
• Understand the power you have!
Finally….
•Understand your core values and joys
