“Life Beyond EHRs” – Roundtable Discussion Summary

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@www.optimiumhealth.com ***

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