Sentara Healthcare EMR: Our Journey. Bert Reese, CIO and Senior Vice President

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1 Sentara Healthcare EMR: Our Journey Bert Reese, CIO and Senior Vice President

2 Sentara Healthcare 123-year not-for-profit mission 10 hospitals; 2,349 beds; 3,700 physicians on staff 10 long term care/assisted living centers Extended stay hospital 3 Medical Groups (600+ Providers) 432,600-member health plan Sentara College of Health Sciences $3.9B total operating revenues $5.0B total assets 24,000 employees Virginia North Carolina 2

3 Recent National Recognition #1 Integrated Healthcare System 2009 # 1 Integrated Healthcare System 2010 HIMSS Analytics Stage 7 Certification 2010 HIMSS Davies Award 2010 CEO IT Achievement Award

4 Sentara and Epic Sentara s Care Transformation: ecare ecare What is it? Epic Implementation A shared medical record for patients across the continuum of care Opportunity for Process Redesign Re-evaluate and optimize 18 major processes ecare is bigger than Epic 4

5 Project Overview Timelines: Sep 2005: Epic contract signed Nov 2005 April 2006: Process redesigns May 2006 June 2007: Design, Build, Validate August 2007: First MD office implemented (150 MDs/Year) February 2008: First hospital implemented all but CPOM May 2008: First hospital implemented CPOM Sep 2008 Oct 2008: 2 nd & 3 rd hospital go lives Mar 2009 Nov 2009: Three more hospitals implemented 2010: Epic 2009 release upgrade; 7 th hospital go live 2011: 8 th hospital go live; community focus 5

6 Total Cost of Ownership 10 Year Overview Capital Operating Expenses Hardware Maintenance $ 15 M Software Maintenance $ 50 M Disaster Recovery $ 3 M Work Redesign $ 36 M Training $ 16 M Implementation $ 22 M Ongoing Support $ 22 M Other Non-Salary Support $ 6 M Total Cost of Ownership over 10 years $ 67 M $ 170 M $ 237 M 6

7 2011 ROI Business Case Benefits $38.7 M Expected; $53.7 M Achieved ecare Benefit Category Benefit (Millions)* - Reduce Length of Stay/ Reduced ADEs $ Increase Outpatient Procedures $7.5 - Increase Unit Efficiency/Retention of RNs $9.4 - Reduce Transcription Expense $3.2 - Reduce Med Records Supply Costs $2.0 - Reduce Medical Records Positions $2.4 - Reduce Optima (health plan) costs $1.9 - Reduce IT Maintenance Expense $5.0 - Reduce other costs $6.8 Total $53.7 *2011 for 7 Hospitals, Home Health and Health Plan 7

8 ecare Costs and Benefits by Year $60,000.0 $50,000.0 $40,000.0 $30,000.0 $20,000.0 $10,000.0 $- $(10,000.0) $(20,000.0) $(30,000.0) $(40,000.0) Expected Benefits Achieved Benefits Expenses Net Impact (vs. Achieved) Net Impact(vs. Expected) 8

9 Process Redesign Methodology Identify and map current processes Analyze current processes (Lean: Value Stream Mapping ) Handoffs Hunting & Gathering Communication disconnects Assess issues/problems/opportunities Develop solutions: Epic; Exploit Epic; Non-Epic; Future Map future processes Validate business case/identify success measures Create action plans for next steps: Epic Exploit Epic and Non-Epic actions 9

10 ecare Process Innovations Redesigned18 major processes covering entire continuum of care Lean Six Sigma Methodology Define Measure 1. Arrival Management 2. Bed Management 3. Case Management 4. Charge Capture 5. Claims Processing 6. Clinical Communications 7. Disease Management 8. Emergency Department 9. Home Health 10. MD Processes 11. Medical Records 12. Meds Management 13. Monitoring/ Recording 14. Order Sets 15. Patient Care Transformation 16. Patient/ Member Satisfaction 17. Physician Practice 18. Scheduling Complementary Technology: Bar-coding; Document Management; Device Integration Validate Design Analyze 10

11 # 15 Patient Care Transformation Team Identify Major Processes 1. Chart management 2. Clinician communication* 3. Order entry 4. Patient care prep procedures 5. Clinical admission process 6. Shift-to-shift hand-offs 7. Bedside Positive Patient Identification (PPID) 8. Documentation 9. Patient transfer 10. Lab specimen collection and delivery *these are the primary responsibility of other teams, we own the gaps 11

12 # 15 Patient Care Transformation Team Identify Major Processes (cont) 11. Management of safety 12. Work planning for the Novice vs. Expert 13. Hunting and gathering information 14. Clinical patient care procedures 15. Staff assignments 16. Nursing annual mandatory requirements 17. Entry of charges 18. People to technology interface 19. Medication administration* 20. Business processes *these are the primary responsibility of other teams, we own the gaps 12

13 # 3 Order Entry Current Process eicu orders entered by eicu MD Order prints in ICU eicu MD calls RN to notify of new order ORDER ENTRY PROCESS MD handwrites order MD flags order or gives to AA STAT orders are communicated to nurse and/or provider Nurse finds order Nurse or AA calls department for STAT order followup Nurse/AA calls consults to appropriate offices (Only some units) Nurse gives to AA/ NCP Nurse enters orders in TDS Person entering orders signs order sheet New Medical Order prints on unit AA/NCP/Nurse/No one picks up NMO Nurse corrects hand-written order Distributes to sorting boxes Order prints in pharmacy Pharmacy enters medication orders Medication orders are faxed to pharmacy OR Yellow caron is handed to rounding pharmacist Orders for tests that don't match TDS require phone call to clarify Nurse carries out order Nurse checks NMO against handwritten order NMO Put in order section of the chart Unclear orders require a phone call to clarify Call MD to re-write the order Notify Charge RN if needed Orders are checked Q2h OR When time permits OR Before acting on new order 13

14 #3 Order Entry Lean Analysis (non-value added work) eicu orders entered by eicu MD Order prints in ICU eicu MD calls RN to notify of new order ORDER ENTRY PROCESS MD handwrites order MD flags order or gives to AA STAT orders are communicated to nurse and/or provider Nurse finds order Nurse or AA calls department for STAT order followup Nurse/AA calls consults to appropriate offices (Only some units) Nurse gives to AA/ NCP Nurse enters orders in TDS Person entering orders signs order sheet New Medical Order prints on unit AA/NCP/Nurse/No one picks up NMO Nurse corrects hand-written order Distributes to sorting boxes Order prints in pharmacy Pharmacy enters medication orders Medication orders are faxed to pharmacy OR Yellow carbon is handed to rounding pharmacist Orders for tests that don't match TDS require phone call to clarify Nurse carries out order Nurse checks NMO against handwritten order NMO Put in order section of the chart Unclear orders require a phone call to clarify Call MD to re-write the order Notify Charge RN if needed Orders are checked Q2h OR When time permits OR Before acting on new order 14

15 #3 Order Entry Future Process ORDER ENTRY PROCESS eicu orders entered by eicu MD MD enters order New orders are flagged for nurse and others Med orders are reviewed by a pharmacist Unclear orders require a phone call or inbasket message to clarify New order written/ order adjusted Nurse acknowledges new order Nurse carries out order 15

16 Solution Categories Epic Optimize Epic Non-Epic Future ( Parking Lot ) 16

17 Clinical Improvements Provide one chart for patients with real-time information for all points of care (hospitals, MD offices, home care ) Provide accessible electronic charts, anytime, anywhere Streamline medication processes Reduce illegible orders and time spent deciphering Provide evidence based medicine alerts and reminders Reduce duplicate tests Enhance communications among and between providers 17

18 Select Throughput Improvements 2011 YTD versus 2008 Patient Flow Performance Median % Improvement Admit Request to IP Bed Assign Cycle 57% Total ED Boarder Cycle 21% IP Transfer Cycle 36% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 18

19 Post ecare Nursing Unit Study Consultants conducted time/motion studies pre & post go-live: Measure direct versus indirect patient care activities Assess impact of implementing a Stage 7 EMR with computerized physician order management (CPOM), Barcoding & Scanning Identify work flow changes and/or other opportunities for enhancement Four units selected at tertiary care facility Surgical, Med Surg/Stepdown, Medicine, Cardiac Collected over 31,000 data points All skill mix roles; 24/7 Included in room activities to capture work moved to the bedside Significant findings: 19

20 Quality Improvements Expected Ratio Ratio is Actual Mortalities over Expected Mortalities; 1.0 is National Avg. Source: Thomson Reuters Care Discovery 20

21 Red Light Green Light: Percent Green vs. Percent Red CMS Quality Measures: Cardiac; Pneumonia; Surgical Care; Infections, Patient Safety 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent Green Metrics Percent Red Metrics 21

22 Risk Management Hospital Claims Reduction 22

23 Pre and Post ecare Medications Management Improvements Avoided 117,400 potential medication errors due to medications barcoding Reduced meds administration time Baseline Post-eCare Average time from order written to order available to act on Average time from order written to med administration (NOW orders) 59.0 minutes 4.5 minutes minutes 38.4 minutes 23

24 Pre-Epic SNGH Medical Records Department 24

25 Post-Epic SNGH Medical Records Department 25

26 Sentara ecare ecare Today EMR at 8 Sentara hospitals 87% CPOE (Computerized Physician Order Entry) Realized benefits ($53.7M) exceed plan ($38.7M) 124 SMG MD practices and 2 Community MD practices 90,000 MyChart patients (patient portal) ecare Innovations Smart Room emedsurg Vital Sign Alerts Inpatient Scheduling 26

27 Welcome to the Starting Line Patient Centered Care 27

28 28

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