pleasing patients through coordination of services

Pleasing Patients through Coordination of ServicesPresented by:

William Gillespie, VP-CTO WellSpan Health

Frank Poggio, President, The Kelzon Group

KELZON

GROUP

1) Learning - Objectives

2) Introduction: The Care Coordination Challenge

3) WellSpan Health - Background

4) WellSpan Coordinated Services-Scheduling

- Challenges, Accomplishments

- Success Factors, Benefits

- Future Plans

5) ROI Touch Points

6) Larger Challenges and Recap

7) YOUR TURN…...Q&A

Agenda

Learning Objectives

1. Discuss how to improve patient satisfaction by scheduling all medical

and non-medical services for inpatients

2. Identify why coordinating inpatient care has been a challenging task in

most hospitals

3. Discuss the difference between coordinated services and central

scheduling, and why the latter is fraught with organizational difficulties

4. Describe how to avoid the organizational and political battles that come

with improving care coordination, and address the hurdles of

unscheduled emergency services

5. Explain why most hospitals that tried to improve inpatient service flow

have failed, and how they could have succeeded

Introduction: The Care Coordination

Challenge

• Building a Better Delivery System

• Inter-Department Coordination

• Partial-Coordination via HIS/EMR

• Possible Solutions

• Full-Service Coordination

Building a Better Delivery Systemthrough Coordination of Services

Definition: Health care delivery, like other business enterprises, is a

complex socioeconomic system in which multiple agents, often with

very different agendas, interact. As in complex business enterprises,

decisions taken by one party can significantly affect the costs

incurred and the quality of service provided by other parties in the

system. In addition, different entities in the system, so-called agents,

often have different, sometimes conflicting, objectives. The history

of enterprise-management systems has shown that a thorough

understanding of how different agents in the system interact can

yield significant benefits for the entire system.

Building a Better Delivery System, Proctor P. Reid, W. Dale Compton, Jerome H. Grossman, and Gary Fanjiang, Editors, Committee on

Engineering and the Health Care System, Institute of Medicine and National Academy of Engineering, 2005, ISBN:978-0-309-65406-7

Finding 3-1. The health care delivery system functions not as a system, but as a

collection of entities that consider their performance in isolation. Even within a given

organization (e.g., a hospital), individual departments are often isolated and behave as

functional and operational “silos.”

Inter-Department Care Coordination

Discharge Process – Hip Replacement

Medical /Ancillary Support Services External Services

Therapy Status

Lab Values

Meds – Taper &

Take Home

Radiology Results

Social Services

Dietary

Financial

Nursing

Discharge Plan

Instructions

Patient Readiness

Assessment

Transportation

Referral to:

HH, Hospice, Rehab

Medical Equipment

Home Care Services

Return Clinic Visit

External Transportation

How communicated, work flows, hand-offs,

who’s responsible? One gets missed and ….

Via: HIS /EMREmail, Fax, Paper, Phone

Radio

logy

Surg

ery

Thera

pie

s

Fin

ance

Card

iolo

gy

Pharm

acy

Labora

tory

Housekeep

Tra

nspor-

tation

Nurs

ing-

Routine

• Focus is department system notification

• Ancillary orders / results / documentation focus

• Very little inter-departmental business / clinical logic

• Block timing, simple work lists by department

• Clinical logic – limited cross checking

• Conflict resolution – limited to linkage

• No inter-department workflow

• Many dropped hand-offs

Characteristics & Attributes

HIS / CPOE / EMR – Orders & Results

Socia

l S

erv

Partial-Coordination via HIS /EMR

Die

tary

Possible Solutions

If it’s a scheduling problem…

1) Replace all patient scheduling systems?

(issues – time, investment, does it exist?)

2) Short-term measures – electronic bed / status boards,

add case managers or care coordinators, use RFID, smart

pagers etc.

(issues – cost, dealing with symptom, integration of bolt-ons)

3) Overlay Coordination Scheduler on top of current systems.

(issues – organizational, perceived control, integration..)

How do we get to full Inpatient Care Coordination?

Required Attributes

Schedule Integrator – Workflow Engine - Conflict Resolution

Radio

logy

Surg

ery

Thera

pie

s

Fin

ance

Card

iolo

gy

Pharm

acy

Socia

l S

erv

Labora

tory

Housekeep

Tra

nspor-

tation

Nurs

ing-

Routine

• HIS & specialty vendor coordination, no replacements

• Many front-end checks

• Includes department custom criteria

• Brings together support services + ancillary+ auxiliary services

• Supports inter-department business / clinical logic

• Multi-discipline conflict logic with warnings, overrides, etc.

• User definable inter-department rules

• Coordination tool – NOT a central control tool

Full-Service Coordination

Example – Discharge Planning

WellSpan Health System –

Background

WellSpan Health System

• Geography

• Facilities

• Staff

• Patient Experience

http://www.verispan.com/products/product_details.php?id=8s6f6gf62k

http://www.verispan.com/products/product_details.php?id=8s6f6gf62k


Who are we?

● Integrated health system located in south-central PA

● Top 100 – Integrated Health Systems

● York Hospital – “Top 100” Hospital with Thomson Reuters – 7 years

● Gettysburg Hospital – “Top 100” Performance Improvement Leader

2 hospitals (630 beds)

65 sites in 3 counties; 2 states serving a population of 500,000, 60% overall market share

8,000 staff, physicians, volunteers

7 residency programs, 250 students and a research center

6 retail pharmacy sites

450-member multi-specialty medical group

1 home health organization

PPO serving 50,000+ covered lives


● 36,000 IN-PAT DISCHARGES

● 1.1 million OUT-PAT ENCOUNTERS

- 95,000+ ED visits

- 74,000 Clinic visits

- Lab-specimens and nursing home labs

● $1.2 billion annual gross revenue

● 1.2 annual medical group physician visits

Wellspan Health Statistics

Every week, a significant percentage of the Adams-York population experiences care from a WellSpan Service

14,133 patients visit a

WSH physician practice

8,708 patients fill a

prescription at a WSH

outpatient pharmacy

1,918 patients receive

a VNA home visit

685 patients are admitted

to a WSH hospital

17,575 patients undergo a

test, procedure or treatment

in a WSH ambulatory facility

1,678 patients visit a WSH

emergency department

Community Health

Improvement

Patient Experience

Health System Design

Financial Performance

Physician Partnerships

Human Resources

WellSpan Strategic Goals

WellSpan Health

Patient Experience - Goal

To provide an exceptional

care experience—safe,

timely, effective, equitable,

efficient and patient-

centered—to each and every

patient, each and every

time, every day.

1. A consistently great patient experience is a matter

of design

2. We are not Disney. Satisfaction is less about making

people happy and more about reducing anxiety

3. Caring and communicating caring are two different

things

4. Patients want care to feel personal. We can

standardize personalization

5. Ineffective accountability is evidence that we are not

serious.

WellSpan Health

Patient Experience - Guiding Principles

WellSpan Coordination of Services –

Scheduling

WellSpan Coordination of Services

Patient

Practice Appointment Scheduling

Verification

Authorization

Referrals

Hospital appointment scheduling

Hospital Registration

Hospitals

Physician

Practices Clinics

Patients

Electronic Medical Record

Enterprise Person Identifier

Goal: One System – One Patient – One Record

Right Patient – Right Record

The Big Picture

Provider PortalEnable referring physician offices

to schedule online

Patient PortalEmpower patients to schedule,

cancel, reschedule and

pre-register online

Pre-Registration –

interfaces to our Registration

and Clinical systems Pre-registration function and integration

Insurance Plan-specific rules and edits

Eligibility verification

ADT

2-way ADT interface

Pre-reg

interface

Surgical Schedules

Patient AgendaInstructions

Maps/DirectionsDate and Time

Patient/Resource SchedulingSchedule patients and resources faster, better,

easier Questions, rules, notes, ensure accurate

scheduling every time

First available slots across ALL locations

Medical necessity checks, referral and

authorization management

How busy are my

resources/clinics?

How many no-shows do

we really have?

Appointment

RemindersVia phone, email,

and/or letter

no-shows

Reports from USA

Will show us

statistics for

WellSpan

How many patients did Dr. Jones refer

last week or last month?

USA-RMS

WellSpan Coordinated Services

1.From the top – Executive Champion

2.Primary Objectives: Streamline services,

pursue patient itinerary

3.Project led by: Peter Ivers, Director of Product Knowledge Office, and

Amy Repman, Director of Patient Access

4.Start in Imaging

Director of Access

Manager of Access

Call Center

Manager of

Hospital Access

Access Call CenterSupervisor of

Central Registration

Supervisor of York

Emergency

Department

Registration

Supervisor of

Gettysburg Hospital

Registration

Supervisor of Nurse

Call Center

Emergency

Department shift

team leader

Sr. Vice President of

Finance

Dotted Line to

Medical Group

Administration

Hospital Call Centers Hospital Access

17.32 FTE’s

23 Staff

23.87 FTE’s

26 Staff

44.77 FTE’s

46 Staff

45.25 FTE’s

52 Staff

101.6 FTE’s

111 Staff

Dotted line to

Emergency

Department

Administration in

both hospitals

Organizational Chart of

Access Department

Supervisor of

Contact Center

Supervisor of

Insurance Specialty

Center

Medical Group Call Centers

VNA/HealthSource

Rehab Scheduling

and Pre-registration

18 FTE’s

22 staff


• Improving the patient experience with complete view of department and patient availability and appointment history

• Integrating pre-registration and registration information

• Providing preparatory instructions and details to reduce anxiety due to the “unknown”

• Integrating appointment location with driving directions and on-site directions and details

• Rehabilitation Medicine

• Imaging

• Cardiology

• Maternal Fetal Medicine

• Pulmonary and Sleep

• Specialty Clinics

WellSpan Coordinated Services -Scheduling

Initial project focus – All Imaging services

Started - March 2007

Go live at Gettysburg facility - December 2007

WellSpan Coordinated Services -Scheduling

WellSpan

Coordinated Services -SchedulingChallenges:1. Eleven different scheduling systems

across just all imaging services,

2. Different patient priorities for each,

3. Different clinical and operational rules,

4. Different code tables, mpi, little or no

communication between them,

5. Organizational issue;

centralization=loss of control?

WellSpan

Coordinated Services -Scheduling1.Specialized systems not replaced, eg. Radiation

Oncology, linked into new coordinated scheduling system.

2.New coordinated scheduler from outside firm.

3.Tied together all manual and automated existing

systems.

4.Service requests can originate in new system or

in any of the eleven systems and are

coordinated for conflicts.

WellSpan

Coordinated Services -Scheduling

Typical conflict /coordination problem:. A patient is scheduled for a series of radiology exams all of which could

conflict with each other if not done in the proper sequence.

Specifically, a physician places an order for a CT with contrast on

Monday, and on Tuesday orders a multi-day Nuclear Medicine exam that

can only be done 24 hours after the Monday contrast procedure. In this

example, we have to do a conflict check on a prior scheduled procedure,

then schedule the Nuclear Medicine exam with enough elapsed time for

the contrast to dissipate.

In the past this was done manually referencing a set of three inch binder

rule books. A time consuming and error prone process.


Imaging services hurdles:

• Standardizing terminology across all

locations

• Identify champions in each area

• Disparate coding systems in each area (insurance, payer, service codes, etc.)

• How to handle random ER requests?

• Link 7 different imaging systems

• Allow routine imaging requests to be made

real time in physician offices

WellSpan Coordinated ServicesAccomplishments:

Radiology procedures can be scheduled from any

site in less than 10 minutes

• Inpatient and outpatient services are coordinated,

conflicts resolved quickly

• Physicians can schedule Images from their

offices before the patient leaves,

• Critical demographic and insurance info is

captured long before the patient comes to the

ancillary department.

• Itineraries for multi service visits are available


Handling ER requests and interruptions:

In the past: Inpatient requests were back fill for

large ER unused open blocks.

Current: All IP requests scheduled, system

manages flexible smaller open block times for

ER cases.

Results: ED support can be accommodated

without using inpatients as back fill.

Future: Experienced based predictive models

could eliminate ER open blocks


Success Factors:1. Executive leadership needed to drive such an undertaking across

multiple departments

2. Keep the focus on patient satisfaction.

3. Openness and willingness of the Imaging staff to adopt standards

and coordination of schedules.

4. The technical integration ability of WellSpan’s IT staff in

implementing linkages across the multiple systems.

5. Software flexibility of purchased system, and vendor’s open

approach to work with other systems.


Benefits:1. Significantly improve patient satisfaction by eliminating or

greatly reducing wait times (for both IP and OP) at the

ancillary departments and quicker turnaround for service

schedule requests.

2. Increase revenue by increasing department capacity without

increases in capital investment.

3. Avoid financial losses due to longer than allowed stays under

DRG or managed care contracts.

4. Improve physician relations from remote office scheduling.

WellSpan Coordinated IP Services

Future Plans:

1) Expand Vendor system to more

ancillary areas

2) Create the complete patient

itinerary in Vendor system

Rest of the Pieces

Rarely done in Hospitals because:

- Requires Significant Department Coordination

- Rethink transportation management and other support services

- Complex inter-department process re-engineering (LEAN+)

- Requires sophisticated work flow tools

- Many political / organizational hurdles

- ‘Centralization’ not an accepted clinical approach…’coordination’

But can have significant benefits & ROI:

Inpatient Care Coordination

The 800 pound gorilla !

- MANDATORY: Active Executive Support !!

Today…

Coordinated IP Services

• Improve Patient Flow

• Start point for ACO

• Improve Patient Satisfaction – Patient Itinerary - P4P Impact

• Increase Revenues from Increases in Capacity

• Improve Physician Satisfaction = Increase Revenues

• Facilitate ‘Health Support Models’ = Improve Revenues

• Reduce DRG / Managed Care Losses for Extra Stays

• Reduce / eliminate/ avoid Capital Investments:

ED, Surgery, Beds, Ancillary service equipment, etc.

• Labor / Supply Reductions, Increase Department Efficiency

ROI Touch Points

YOUR TURN….

Have you identified this as a major issue?

How do you deal with it now?

Who in your organization is the lead?

Other suggestions / observations?

Questions?

Thank YouGroup

Kelzon

Improving Care Coordination

Frank L. Poggio

Frank L. Poggio has over thirty-five years of experience in health care systems. He has served as a

hospital administrator/CFO, software entrepreneur, and industry consultant. He has completed

consulting engagements for both large and small hospitals and clinics, and major vendors of health

information systems. He is President of The Kelzon Group, a firm that focuses on health systems

issues. Previously, he was General Manager of Mediware, Inc., a clinical software and publicly held

company. He served as President of Citation Computer Systems, Inc., a St. Louis based clinical

software company acquired by Cerner ,Inc. In 1980, Mr. Poggio founded Health Micro Data Systems

(HMDS), a firm specializing in client server based systems for health care organizations. HMDS’

clinical and financial software was installed in over 120 hospitals and other health facilities around the

country.

In 1971 he started his health care career as a project engineer for the Hospital Association of NY where

he completed many operational reviews for patient flow and operational efficiency. He was VP and

Associate Administrator, CFO and CIO at the University of Wisconsin Hospital and Clinics and was

Senior Consultant with KPMG for health information systems. He is a frequent invited speaker for the

Healthcare Financial Management Association, and the HIMSS. He served as a faculty member of the

University of Wisconsin Graduate School of Business, Health Care Fiscal Management Program for 13

years. Mr. Poggio has published over forty articles in various professional health journals on health

information systems, finance and related topics.

Mr. Poggio can be contacted at [email protected], or http://KelzonGroup.com

KELZON

GROUPGroup

Kelzon

mailto:[email protected]

William ‘Buddy’ Gillespie

Mr. Gillespie is Vice President, Chief Technology Officer and CIO

Emeritus at WellSpan Health, an integrated delivery system based in

York, Pennsylvania. WellSpan has been named a Top 100 Most Wired

and a Top 25 Best Connected health system four-years running.

Gillespie joined WellSpan Health in 1996 after serving as vice president

of information services at Allegheny General Hospital in Pittsburgh. As

WellSpan's CTO, he is responsible for the strategic planning and

implementation of information technology to support integrated

applications consisting of financial, clinical and administrative

systems. Mr. Gillespie holds degrees in physics and mathematics from

Athens University. He has been active in healthcare informatics for more

than 25 years in both the development and implementation of technology

solutions He also serves on the PAeHI Board where he is Chair of the

Health Information Exchange Committee.

Mr. Gillespie can be contacted at: [email protected]