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Using Enterprise IT and Process Improvement to Transform Patient Flow Mac McClurkan Vice President/CIO HealthEast Care System St. Paul, Minn.  Driving Our Patients Away HealthEast Care System was born from mergers of multiple hospitals and facilities. We're proud of our rich history of leading-edge care, but we faced lingering process variability across settings, sometimes resulting in communication silos and patient flow bottlenecks. With 925 beds and four hospitals, total capacity wasn't the issue. The problem was disconnected patient throughput processes at individual hospitals. Often, our hospitals would divert ambulance traffic to competitors, unaware that other nearby hospitals in our health system had plenty of capacity. We were literally driving our patients away. In 2008, we earned the dubious distinction of having the highest diversion hours statewide and suffered a serious ripple effect: longer ED wait times, denied admissions, physician dissatisfaction and the growing community perception that HealthEast was difficult to access. Our frustration mounted as we saw the percentage of uncompensated days for observation patients rising. And our lack of a standardized concurrent review process was leaving us vulnerable in the event of a Medicare Recovery Audit Contractor (RAC) audit. Our challenge: find ways to function as a coordinated system, rather than disjointed hospitals. What we needed was a big-picture view, with system-wide visibility into patient flow and related processes. Synchronizing the System Ultimately, we synchronized and transformed our system by: Choosing the right technology. We began by establishing a System Throughput Team that included executives, leaders and experts from each hospital. Our goals:  Optimize existing capacity Capture real-time capacity and throughput data Improve staff and physician productivity/satisfaction Enhance patient satisfactionWe had a real "ah-ha" moment when we saw how McKesson's Horizon Enterprise Visibility™ offers a bird's eye view of patient status, with color-coded, time-stamped icons. We envisioned that its large, electronic whiteboard would help us improve communication across hospital departments and help put everyone in the care process on the same page.  Its real-time patient status viewed against the image of our floor plan would help us uncover hidden beds and bottlenecks to better manage length of stay, reduce our diversions and claims denials, and mitigate compliance risk. We installed these monitors in patient care areas, physician lounges and select C-Suite offices at each hospital. The monitors linked everyone to speed patient flow, quickly spot process gaps and address them immediately.Establishing an Operations Center. After implementing the technology across hospitals, we established a centralized operations center with 24/7/365 RN staffing. Large wall-mounted monitors provide real-time, at-a-glance information about patient status and location across all four of our hospitals. Using these tools, our operations center places patients quickly and efficiently, levering our existing bed capacity to its fullest. Looking Beyond Bits and Bytes. Technology was the enabler of improvement, but it wasn't the total solution. To turn its promise into reality on the ground, we had to align people and processes — from administrative offices to the front lines. To help eliminate silos, we demonstrated the IT solution and shared the data it produced across our health system. When stakeholders saw the value of doing things differently, they embraced the needed changes. Leveraging our Solutions. In addition to Horizon Enterprise Visibility, our new operations center also uses other enterprise solutions from McKesson to concurrently review each admission for appropriate billing status and provide clinical backup for all claims. Achieving Significant Results Our results confirmed that combining enterprise technologies with major process re-engineering yielded substantial results: Average diversion hours decreased by 63% from 2008 to 2009 ED wait times dropped, as did the number of patients who left without being seen Number of denied admissions decreased, from approximately 80 a month to 10 Observation days decreased by 37%, month-over-month We now perform concurrent admission reviews for every patient, every time ED patient satisfaction scores jumped 36% Increased physician satisfaction — it now just takes one call to place a patientDriving Care in the Right Direction Today, we have more patients coming in our doors, and they're receiving more efficient, high-quality care. Our physicians are more satisfied because they're getting expedited patient placement. We're using the tool to help ensure regulatory compliance and have increased revenues. Transforming our system – through investment in technology, people and processes – has been a huge win for everyone at HealthEast. HealthEast Care System is a winner of McKesson's 2010 Distinguished Achievement Award. The annual awards program recognizes McKesson customers that demonstrate outstanding achievements with healthcare IT to enhance healthcare quality. Mac McClurkan, Vice President and CIO of HealthEast Care System in St. Paul, Minn., is a 27-year veteran of health information technology. His career includes a Malcolm Baldrige Award win, a prior McKesson VIP award and achievement of top-percentile IT physician satisfaction.   |
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