Health 2.0 Provider SymposiumLowell General Hospital CollaborationSeptember 25, 2016

2™

Managing patients across the transitions of care increasing in importance with the advent of episode of care payments

Source: Stead, Stan. How Do I Get Paid for the Perioperative Surgical Home, Perioperative Surgical Home Summit, June 2016.

3™

Procedure cancellations remain a significant clinical and financial challenge

Cancelled Case

Workup 20%

No RealCancellation

11.1%

Capacity 13.4%

26.7%

4.4%

13.3% Did not want operation

Preoperative instruction not followed

Intercurrent disease after schedule finalized

11.1%Instantaneous

lack of key specialized personnel

Surgery no longer indicated

Insufficient workup

Co-morbidities found after schedule finalized

Key patient information not reviewed

4.4%

6.7%

6.7%

2.2%

Scheduling error

IT system error

6.7%

4.4%

9.0%

4.4%

Overbooked – transferred to waitlist

Overbooked – rescheduled next day

Patient 44.4%

Specialized Personnel 11.1%

Source: Seim, A, Causes of Cancellations on the Day of Surgery at Two Major University Hospitals, Surgical Innovation, 2009.

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Financial pressures from payment reform require real changes to care coordination and patient engagement

Source: Stead, Stan. How Do I Get Paid for the Perioperative Surgical Home, Perioperative Surgical Home Summit, June 2016.

Surgical Home ChallengeSurgery day Joan recovers at

homeJoan needs an

operation

ReadmissionsCancellations

She has questions, is frustrated, apprehensive and isn’t prepared for the procedure

She doesn’t complete Critical pre-op tasks in time

Discharge instructions are not communicated clearly, resulting in innocent errors in care by all

Complications not caught because follow-up visit not scheduled, and patients don’t know what to look for

88

8

8

8

Procedure is delayed or cancelled the day of surgery

Poor Patient Experience Burnout

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Goals of the pilot

Activate patients

Engage family members

Identify high risk patients

Coordinate providers

Measure cost/quality

88% of patients in the U.S. do not have proficient health literacy

80% of the care provided to the sickest 1% of patients that use 20% of healthcare expenditures is provided by family membersRisk prediction models only 55% accurate 9% of models include social support60% of readmitted patients had no foll0w-up visit

Costs, patient engagement, coordination, difficult to measure

7™

Perioperative Surgical Home

Diagram Source: American Society of Anesthesiologists – Perioperative Surgical Home (PSH)

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ClinicalBox powers care coordination & patient engagement for complex episodes of care

EHR

View the Episode of Care and Pathway for Each Patient with Tasks, Communication & Education Embedded by Stage

Tasks are Specific To Each Surgical Procedure and Tailored by Patient

Connections are Clear to the Coordinator for Follow-up Questions with Family and Healthcare Providers

Ron: Surgical Coordinator (Staff)“I coordinate with doctors and patients to make sure everything runs smoothly” Employer: HospitalBackground: BA Hospital Administration

Quick take on SallyQuick take on Ron

Computer skills Intermediate

Job situation Employee

Computer type DesktopSmartphone

Tools ExcelEMRReportingInternetPhone

Background AdministrationBusiness

Key goals:• Educate patients. • Make sure patients are prepared for

all surgeries and appointments• Ensure medical records are correct

and up to date• Ensure all external dependencies are

taken care of.• Ensure doctors know when and

where they need to be• Understand which patients need the

most time and effort• Minimize mistakes• Make sure patients are happy.• Be able to quickly and easily identify

a patient and their next steps.

Time:• 65%: Admin Duties (Phone. Scheduling,

Typing)• 20% Dr. Sally Personal Tasks/Errands• 15% Miscellaneous personal tasks

A day in the life:• 8am: Arrives at work

• First priority: Checks e-mails. ~10 from Dr. Sally & 20 from patients

• 930am-12pm: Makes calls to patients for upcoming surgeries

• Educates patients, provides direction, comfort and support

• 12pm: Too busy to eat lunch. Has to attend front desk/administrative staff meeting

• 2pm: Picks Dr. Sally’s children up from school and brings them to babysitter

• 3pm: Back at office• Has Dr. Sally waiting for her to

schedule new surgical consults• 4pm-6pm: Admin Duties

• Falls behind on sending out new patient packets

• Has 11 voicemails to answer• Unanswered e-mails and follow-

ups• 630pm: Leaves work later than

scheduled, tasks left until next day

How staff are different:They are power users. They will be using the application all day long to coordinate care

EXAMPLE OF USER PROFILE TEMPLATE USED TO INFORM UI/UX DESIGN

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Thoughtfully staging implementation is critical to success of pilot and further deployment

1-3

4-6

7-9

10-12

13-15

16-18

19-21

22-24

25-27

28-30

v01 v02 v03 v04Functionality Groupings

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Practices

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Key Figures and Results from Pilot

• Data on 13,134 patients processed• 2,310 high risk patients seen at

pre-screening coordinated• 761 patients with cardiologists• 1,770 patients speak a language

other than English• 1,877 pre-screening date/time

changes• 6,063 surgery date/time changes• 431 unique primary care

physicians• 25 unique cardiologists• 12,585 family members

• Examples of ClinicalBox impact• 94,118 pre-op tasks tracked (Main

OR only)• 747 consents signed and

exchanged • 289 phone calls avoided

• Demonstrated high scalability

• Ability to work and collaborate with existing IT systems and IT team

• High satisfaction and demand among key stakeholders:

• Surgeons• Surgeon staff• Nurses• Pre-screening staff• Major centers of

excellence• Critical tasks caught in time

to prevent cancellation or delay

• Higher efficiency achieved through process and workflow optimization.

Key Pilot Figures (of of 6/1/16) Results I never had visibility into the surgical pipeline I needed to manage until now.

ClinicalBox provided me with an effective channel of communication with the surgeon offices

ClinicalBox was able to turn around changes in days and weeks vs. months and years

The ClinicalBox team really took the time to clearly understand the patient experience

Surgeon Staff

Pre-screening staff

Nurse Liaison

Anesthesiologist

15™

Lessons Learned

Start small and build momentum with early adopters1

2

3

4

5

6

7

8

9

10

Need to do one of three things: cut costs, increase revenue or make life easier

Generate enough value, for the right stakeholder, in the right amount, at the right time

Ensure that innovator and health system business models and incentives are aligned

Novelty creates excitement but it doesn’t necessarily generate adoption

Reduce the bureaucracy: no standing meetings, no steering committee, keep it fluid

At first do things that do not scale: not everything has to be fully automated

High-tech and high-touch are not mutually exclusive: help people to do their jobs better

Helicopter constantly between the health system leadership and front-line staff and clinicians

Persevere: pivot until you get traction. Healthcare is a tough industry, keep going!