Author: Heather Guild

Healthcare Purchasing News recently interviewed OPTIMIUM Health (OHI) founders Vicki Harrison and Mark Stega, MD to discuss the innovative way in which their company has brought workflow technology into the surgical setting. Specifically, the publication’s article focuses on improved OR scheduling and turnover while highlighting the benefits OPTIMI$ER Perioperative modules for pre-anesthesia testing, day of surgery pre-op, operating room management, and surgical office integration have brought to staff productivity, patient outcomes, and overall financial performance.

“Ready, Set, Go – Staying on Track with OR Scheduling” – Turnover The operating room (OR) is like a living center. It runs around the clock with several moving parts and people. Every detail matters at every point of service – from pre-operative procedures, surgery scheduling and supply planning to room set-up, equipment cleaning and patient discharges.

Despite its revolving activity and potential for errors, the OR is expected to perform and transition smoothly and expediently, in order to best meet the needs of patient care and hospital budgets.

“Studies show astronomical OR costs per minute. Any time you can shorten the turnover time turns that non-revenue generating time into revenue generating time; that adds value for everybody. Any product or service that supports the efficiency of the OR to meet the demand of scheduled starts has value directly to the bottom line of a hospital,” explains Suzanne Champion RN, BSN, MBA, CNOR, Director Clinical Operations, U.S. Acute Sales, Cardinal Health.

To read the entire article and to learn more about improved OR scheduling and turnover, please follow: https://www.hpnonline.com/surgical-critical-care/article/21121277/ready-set-go

On the afternoon of June 13th, a panel of healthcare professionals from Lifebridge Health, Anne Arundel Medical Center, and MedStar gathered at Turf Valley Conference Center to discuss “Life Beyond the EHR” and how emerging technologies can fill the gaps EHRs leave behind. Each panelist is on the front line of delivering the Triple Aim of lowering costs, delivering better care, and improving the patient experience. Below is a brief summary of their observations and suggestions to others in the provider health community. A two hour video of the discussion is available on request.

EHRs/EMRs ARE NOT THE HOLY GRAIL:
“The EHR we have (Cerner) did not support the clinical processes we have in surgical services. For example, data did not transfer electronically from the EHR to the forms we use in pre-anesthesia testing. This meant we needed to re-enter or cut and paste information which slowed everything down and compromised accuracy. And there are no dashboards or checklists to help keep track of where a patient is in the clearance process. We were wasting valuable clinical resources doing clerical tasks.”
Jerry Henderson – VP Perioperative Services, Sinai Hospital (Baltimore, MD)

“Our EMR (Epic) is a great repository for information but as an end-user it is not easy to input information. And it does not push or allow you to search for information in a meaningful way. Plus, reducing paperwork, rework, and error rates is something that EMRs don’t really address”
Brian Baker, MD – LEAN Process Lead, Anne Arundel Medical Center (Annapolis, MD)

PROBLEMS ENCOUNTERED BY MOST HOSPITALS & PHYSICIAN OFFICES:
“Before we implemented OPTIMI$ERTM there was a lot of frustration and finger pointing between surgical services at the hospital and the surgical offices. Requests for patient information would be sent multiple times, not at all, or the wrong information would be sent. So much RN time was being wasted chasing information that should have been easy to get.”
Sakinah Abdullah, Manager Patient Care Services, Sinai Hospital (Baltimore, MD)

“We have OR’s in the main building, an ASC across the street and surgical offices all over the county. Before OPTIMI$ER, there was no way for everyone to see the clearance status of patients in real time. This really hurt our delay and cancellation rates because we couldn’t act proactively to resolve issues before the day of surgery.”
Monique Holzer, AVP Surgical Services, Northwest Hospital (Baltimore, MD)

“We are always looking for ways to optimize patient throughput. I remember J.W.Marriott, Jr saying “a hotel room that is empty tonight is revenue lost forever”. I feel the same way about an empty slot on a doctor’s or nurse’s schedule or in the OR – you can never reclaim it.”
Pete Celano, Director MedStar Innovation Center, MedStar Health (DC Metro Area)

“A cancelled case still requires clearance rework even if it comes back on the schedule a few days, weeks or a month later – this wastes staff time. And our patients aren’t happy either if the cancellation is due to something we didn’t do ahead of time.”
Jerry Henderson – VP Perioperative Services, Sinai Hospital (Baltimore, MD)

“Cancellations and add-ons at 24 hours before the day of surgery were running nearly 20% – keeping track of what to work on to was chaotic. Schedule changes in Surginet were not communicated in real-time in a meaningful way to the clearance RN’s so they would be working to clear cancelled cases and not working on the add-ons.”
Sakinah Abdullah, Manager Patient Care Services, Sinai Hospital (Baltimore, MD)

“Sometimes you need to blow up the old process and look at things through fresh eyes – small change won’t necessarily make the big, positive impacts you need.”
Brian Baker, MD – LEAN Process Lead, Anne Arundel Medical Center (Annapolis, MD)

DEALING WITH RESISTENCE TO CHANGE:
“There was a general belief that our EHR (Cerner) did everything. So after months of roadblocks, our IT department set up a meeting with Cerner in Kansas City and was told face to face that Cerner’s EHR did not do what OPTIMI$ERTM does, nor did Cerner intend to do it in the future. That finally took down the barriers and we implemented within 6 months.”
Jerry Henderson – VP Perioperative Services, Sinai Hospital (Baltimore, MD)

“What we liked was people at Optimium Health came to observe our workflow, suggested “best practice”, listened to our concerns and then adapted OPTIMI$ER to meet our needs – it went a long way in making my nurses feel ownership. They moaned a little when we brought OPTIMI$ER on, now they would scream if we took it away.”
Sakinah Abdullah, Manager Patient Care Services, Sinai Hospital (Baltimore, MD)

“OPTIMI$ER, while based on “best practice”, is customizable, not off the shelf. It helps people embrace a new technology and new way of doing things when their ideas are listened to and put into action.”
Lori Vento, Clinical Manager, Rubin Institute for Advanced Orthopedics, LifeBridge Health (Baltimore, MD)

BENEFITS OF WORKFLOW OPTIMIZATION SOFTWARE:
“Simply said, OPTIMI$ER helped my surgical services department lower case cancellations from 9% to 6% and allowed us to open a new book pre-anesthesia services with the same level of staff. This resulted in over $2M of revenue we otherwise would have lost.”
Jerry Henderson – VP Perioperative Services, Sinai Hospital (Baltimore, MD)

“With OPTMI$ER’s checklist, task alert, and audit trail features, we can better manage the insurance pre-authorization process and reduce denials. We also cannot request a posting without a preauthorization, we can only request a “hold. This helps reduce same day cancellations that occur because there is no pre-authorization.”
Lori Vento, Clinical Manager, Rubin Institute for Advanced Orthopedics, LifeBridge Health (Baltimore, MD)

“OPTIMI$ER allows us to monitor staff productivity, to be transparent so everyone knows where we are in the game, and to improve patient satisfaction. For example, when a patient calls multiple times before a surgery and speaks with multiple people at the hospital or the surgical office, it’s nice when staff can pull up the workflow record and see who said what to the patient and when.”
Monique Holzer, AVP Surgical Services, Northwest Hospital (Baltimore, MD)

“In EMRs, discrete data points are not easy to pull out or identify as missing. From what I’ve seen with the OPTIMI$ER surgical services application, critical data is accessible and missing data is easily identified. This is what clinical staff needs – technology to get information to decision makers quicker, more accurately so wait times are reduced.
Brian Baker, MD, Anne Arundel Medical Center (Annapolis, MD)

WHAT LIES AHEAD:
“You cannot un-ring the bell on low consumer satisfaction – we have to delight the patients. We have to create mechanisms that are far more convenient. I think virtual visits are among the very top priorities health systems should be working on.”
Pete Celano, Director MedStar Innovation Center, MedStar Health (DC Metro Area)

“Technologies that we can put in place to pull information or bypass the impediments EHRs create – the ones that get in the way of efficiency – will be very helpful.”
Jerry Henderson – VP Perioperative Services, Sinai Hospital (Baltimore, MD)

“The key is getting standardized workflows. Create the standard work, create the process, and identify the process champion and core team so people in the organization own it. The technology needs to be aligned with that.”
Brian Baker, MD – LEAN Process Lead, Anne Arundel Medical Center (Annapolis, MD)

*** For a video download, please contact: heather@optimiumhealth.com ***

Two of the frequently heard buzz words in health care are “Connected Health”. Defined as the use of technology to facilitate the efficient and effective collection, flow and use of health information, the scope of “connected health” can cut across providers, payers, patients, and family and friend caregivers. A noble goal that can have significant impact on the quality and cost of care delivery. Especially if implemented in a purposeful and strategic manner.

No doubt about it, health care communication is complex. Multiple people, locations, and tasks are involved for each service provided, whether scheduling an annual check-up or a major surgery. This is where “connected health” can make a huge difference by eliminating communication and care coordination failures that cause delays, cancellations and, at worst, mistakes that put patients at risk.

What The Industry Experts Are Saying
A recent article published in Health Data Management and written by Greg Slabodkin, “Interoperable IT Critical to Improving Cancer Outcomes”, highlights many of the issues preventing a “connected health” environment. He focuses on the oncology setting, including chemotherapy and radiation treatments. But the same interoperability issues are found across the care spectrum of services.

“If the United States is going to improve cancer-related outcomes, it must overcome serious policy and technical barriers preventing the country from achieving a nationwide, interoperable health IT system. That’s among the findings of the President’s Cancer Panel, which issued its latest report to the Obama White House on Tuesday.
Although technologies have been widely adopted in healthcare settings as well as among the general population, health information often remains trapped in silos, according to the President’s Cancer Panel. Patients, caregivers, care teams, researchers and health agencies often lack the tools they need to access and optimally use these data.”

For the entire article click this link: https://www.healthdatamanagement.com/news/interoperable-health-it-critical-to-improving-cancer-outcomes

How We Can Help
Optimium Health applauds the findings of the President’s Cancer Panel. In fact, we are doing our part to make a difference to cancer patients and care teams early next year. We are developing an oncology workflow software with a prominent cancer center in Baltimore, MD. The newest addition to the OPTIMI$ER family of clinical workflow tools will address several of the issues Mr. Slabodkin cites in his article.

The oncology overlay will interface with existing systems like EHRs and scheduling to eliminate duplicate data entry and, importantly, add protocol checklists, task reminders, issue alerts, and real-time patient status dashboards to facilitate care coordination. The goal is two-fold: first, to enhance the patient experience by minimizing treatment delays and cancellations and second, to reduce the cost of care by improving productivity and eliminating “waste” in the system.

If you have an questions about the OPTIMI$ER Oncology or Perioperative Workflow technologies, please contact heather@optimiumhealth.com

Sometimes it’s easy to drink your own Kool-Aid®. In the case of Optimium Health, we believe problems with healthcare coordination inside hospitals are so bad that the pathway to corrective action and proven technology solutions must obvious to everyone. While many health systems recognize the problems they choose to believe EHR’s are the Holy Grail. EHR’s can solve everything that ails their organizations. After all, for northwards of $10 million dollars these EHR’s should fix the problems.

So when I read Closing the Technology Gaps Between the Clinical & Business Sides of Healthcare, by Tom Furr (Health Data Management, January 2016), I realized I was not drinking Kool-Aid®. There are others who believe what we believe.

In the article, Mr. Furr cites that a lot of what healthcare needs to do to bring its “business side” into the 21st century was developed by other industries and is available today. Industries like banking, travel, and manufacturing. However, up to now, the focus of technology advancements in healthcare are on the clinical side on the front lines of face-to-face patient care. They are not the business of back room where care-coordination lives.

Mr. Furr summarizes this belief in the following excerpt:

“Massive development activities and hefty investments in technology that advance the clinical side alone will not bring healthcare systems into the future. It may well further enhance the ability to diagnose, treat and prevent any number of medical maladies. But the industry will not move into the future if the other side of the healthcare house still operates with technology developed in the 1980s. The back office of healthcare, which the patient used to never see when insurance paid most, if not all of the bill, is becoming as important and prominent as the clinical side, and is just as important in the patient engagement equation.”

Follow this link for the entire article: https://www.healthdatamanagement.com/news/closing-technology-gaps-between-the-clinical-and-business-sides-of-healthcare

If you would like information on how Optimium Health can help your health organization make meaningful advancements in care coordination through proven and affordable technology solutions, please contact Heather Guild at heather@optimiumhealth.com

Boston Physician Atul Gawande wrote The Checklist Manifesto in 2009 stressing that medicine should adopt “pilot’s checklists” to ensure that operating room teams are “ready for takeoff” before a scalpel is ever opened. in other words, incorporate workflow into IT software. The manifesto was written just before the electronic health record (EHR) mandate came into being as a result of the Accountable Care Act passage in 2010. If Dr. Gawande had known about the EHR mandate, he might have suggested that EHR’s include checklists for key clinical areas to improve communication and reduce oversight and error.

In his blog, Life as a CIO, John D. Halamka MD and Chief Information Officer of Beth Israel Deaconess Medical Center (BIDMC), recently demonstrated how BIDMC implemented The Checklist Manifesto ideas in software to complement its EHR. Dr. Halamka is also Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the Health Information Technology (HIT) Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician.

Dr. Halamka observes that to this day many clinicians complain that EHR’s create burden without significant benefit. He goes on to state that incorporating workflow and checklist tools into EHRs, especially in the operating room, offers high value. It ensures good team communication, while also reducing errors. According to Halamka, it’s “a win/win for everyone!” For entire blog on this subject as well as others, please click the link:
https://geekdoctor.blogspot.com/2016/06/an-ehr-implementation-of-checklist.html

Optimium Health has long been a supporter of Dr. Gawande’s ideas and more recently, those of Dr. Halamka. The EHR is a powerful system, but without electronic workflow assistance and key process checklist features, the EHR’s potential is not fully realized as a way to improve productivity and deliver better patient care.

If you would like more information on how Optimium Health can help your organization improve IT integrated views for better communication across care teams, lower operational costs, and enhancing care delivery, please contact: heather@optimiumhealth.com

Unfortunately, hospital wait time woes are a common source of frustration for patients and their families. A recent article in Forbes Magazine by Sanjeev Agrawal, a health services specialist, draws an insightful comparison between healthcare in 2016 and air traffic control in the 1980’s.

The article’s premise is that while the service area (hospitals, airports & air space) is fixed without an expansion of infrastructure, the demand for services is increasing concurrently with pressure for lower costs. A conundrum ultimately resolved in the case of airports & air space with technology solutions that optimize the flow of air traffic to allow for an increased flow of passengers at lower costs. Mr. Agrawal argues the same transformation can, and should, take place in healthcare to reduce patient wait time.

Below is an excerpt from the article:
“The challenge healthcare providers face: increasing patient access while lowering costs and increasing quality of care has a direct parallel – airports like JFK have had had the same challenge in the last 30 years when the volume of aircraft, traffic and flights has increased 10 times while using the same air space, number of runways and gates. Process transformation through advanced data analytics delivered using scalable technology platforms has been the key.”

For the entire article, please click on the link: https://www.forbes.com/sites/sanjeevagrawal/2016/04/02/the-future-of-hospital-operations-resembles-air-traffic-control/#55b67d7788e6

Optimium Health could not agree more with the Forbes article’s assessment of the need for action to solve wait time and efficiency issues in healthcare. The analogy to advances in air traffic control is a reasonable one from which lessons can be learned. Everyday more hospitals are realizing that EHR implementations are not the Holy Grail to fix systemic clinical workflow inefficiencies that costs time and money and put patient safety and satisfaction at risk with long delays and preventable oversights.

If you would like more information on how Optimium Health can help your organization improve IT interoperability while lowering operational costs and enhancing care delivery, please contact:
heather@optimiumhealth.com

The American Hospital Association (AHA) recently issued an RFI focused on IT solutions for perioperative workflow. In the aftermath of EHR implementations, hospitals are facing the harsh realization that, following great expense and organizational pain, EHR’s actually add to the complexity of clinical workflow. This is evidenced by lower patient throughput and increased costs. Thus, hospital executives are starting to search for more robust “workflow” assistance, especially in areas, like surgical services, that can account for 40%-60% of hospital revenue.

The AHA request begins by stating:
“Clearing patients for a surgical procedure is a lengthy process that involves managing several logistics. It requires coordinating members of the care team, allocating the necessary staff and equipment, reserving a room/ space for the procedure, preparing the patient physically and mentally prior to the procedure and administering the necessary medication and drugs for the procedure. Hospitals that effectively manage these logistics can avoid delays and cancellations of the patient’s procedure, prevent clinical errors and reduce readmissions.”

The RFI goes on to say: “Perioperative care management solutions can improve care coordination and achieve greater efficiency in resource utilization and workflows. Therefore, AHA Solutions is engaged in the process of identifying a partner who will provide the AHA and its associated hospitals with a perioperative care management solution.”

Furthermore, in an article written for EHR Science, Jerome Carter writes: “According to Google, “clinical workflow analysis” is the most popular search term that brings visitors to EHR Science. I am not surprised. Workflow disruptions are increasingly being recognized as workarounds, usability issues, safety concerns, and CDS problems. The first step to solving any problem is recognizing that it exists.” Follow this link for the entire article: https://ehrscience.com/2014/12/15/a-place-for-everything-clinical-workflow/

Optimium Health applauds both EHR Science and the AHA decision to open an RFI and has submitted OPTIMI$ER as a candidate to fulfill its perioperative workflow solution goal. The time has come, now that the dust has settled on EHR implementations, for hospitals to see for themselves that EHR’s are not the Holy Grail to fix systemic clinical workflow inefficiency that costs time, money, and patient safety and satisfaction.

If you would like more information on how Optimium Health can help your organization improve IT interoperability while lowering operational costs and enhancing care delivery, please contact: heather@optimiumhealth.com

One of the elephants in the room regarding health technology is that in spite of all the talk, a meaningful level of interoperability has yet to be achieved in the 5700 hospitals across the country. A recent report to Congress from the Office of the National Coordinator (ONC) shows that provider efforts are being held up by reasons beyond just financial ones. Here are the five major roadblocks to more widespread data sharing among caregivers, according to the ONC:

1. Lack of universal standards-based EHR systems’ adoption
2. Impact on providers’ day-to-day workflow
3. Complex privacy and security challenges associated with widespread HIE
4. Need for synchronous collective action among multiple stakeholders
5. Weak or misaligned incentives

Point #2 is Optimium Health’s sweet spot. Providing clinical workflow technology that seamlessly interfaces with EHR, scheduling, and practice management systems is at the heart of what we do. So we want to highlight what the ONC goes on to say about the need to incorporate workflow technology into a hospital’s interoperability strategies.

“Technology has reached the capability of making interoperability possible, but process innovation has yet to catch up. Existing processes must be redesigned to incorporate new technologies – a more prominent problem in the healthcare arena, mostly due to a lack of standardization.”
Included in the same report are ONC recommendations for processes to establish over the next six months in order to foster better interoperability. And things to watch out for: 1)Hospitals can have hundreds of IT systems, vendors have built proprietary databases but not everyone follows the same standards and 2) health systems fear sharing data with competitors and policymakers have not focused on health information exchange or EHR usability.

Click on this link for the full article: https://www.healthcareitnews.com/news/onc-cites-security-incentive-woes-among-5-biggest-interoperability-roadblocks

If you would like more information on how Optimium Health can help your organization improve IT interoperability while lowering operational costs and enhancing care delivery, please contact: heather@optimiumhealth.com