Physician Engagement - Building a Long Lasting Relationship

Physician EngagementBuilding a Long Lasting Relationship

John Kontor, MD – Bon Secours Health SystemTrenor Williams, MD - ClinovationsOctober 17th, 2008

2

Agenda

1 Introduction

2 Dating

3 Getting Married

4 Making it Last

6 Closing Thoughts

7 Q & A

3

Our

Hopeful

Journey …

Hopefully

Not

This One

4

Dating

5

Activities

Gaining Initial Interest

Structure

Scope of Work

Lessons

ChangeManagement & Adoption


ClinicalContent

Development

ClinicalContent

Development

Physician Workflow

Design

Physician Workflow

Design

6

Bon Secours Health System

Established 1983 with 14 Acute Care Hospitals

Number of Licensed Beds 4,820

Employees 16,500 FTEs

Physicians 8000 (only 200 employed)

State of the System at Project Outset

• Variable order set use

• No impatient electronic medical record

• Some ancillary system use and some electronic results review

• Variable inclusion of evidence-based practices

7

Like every relationship there were obstacles

Geography

Limited EMR Experience

Multi-Year Rollout

Private Physicians

8

ConnectCare seeks to:

Make patient care safer

Continuously-increase quality patient outcomes

Connect clinicians to one another and to their patients

Provide an immediate and integrated single point of access to information

Design a patient care delivery system that allows BSHSI to determine where there is innovation and where BSHSI needs to innovate

ConnectCare seeks to:

Make patient care safer

Continuously-increase quality patient outcomes

Connect clinicians to one another and to their patients

Provide an immediate and integrated single point of access to information

Design a patient care delivery system that allows BSHSI to determine where there is innovation and where BSHSI needs to innovate

Appealed their best interest…

9

Explained our IT goal…

10

Arriving at stage 6

“Stage 6 hospitals appear to have a significant advantage over competitors for patient safety, clinician support, clinician recruitment, and competitive marketing for both consumers and nurse recruitment. “

- HIMMS Analytics 2007

11

Outcomes (p<0.0001)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Death RespiratoryFailure

ProlongedLength of Stay

Elevated TotalCharges

Blood Cultures AppropriateAntibiotics

Pathway non Pathway

Ann. Epidemiol. 2004:14:669-675

Presented a Logical Argument based on Quality.

12

We Created a New Physician Structure

BSHSI Physician Design Team (PDT)

Clinical Content / Order Set Teams

Local Physician Engagement Team

Workflow Team

Informatics Team

13

Physician Design Team

Oversee physician engagement in ConnectCare design, implementation and proficient use of ConnectCare

Workflow Team

PDT members along with other system physicians who will be advisors at design sessions and who develop a deep knowledge of the system design to provide continuity, integration and leadership.

Clinical Content Team

Responsible for development of order sets, best practice alerts, clinical protocols and pre-configured text

14

Design Sessions System

Workflow

Initial Content

Bon Secours

02/19/07 02/26/07 03/05/07 03/12/07 03/19/07 03/26/07 04/02/07 04/09/07 04/16/07M T W R F M T W R F M T W R F M T W R F M T W R F M T W R F M T W R F M T W R F M T W R F

N/A N/A N/A Model System Val Easter DBV 1 N/A

Enterprise Team - Richmond


DBV 2 Memorial Day DBV 3 N/A DBV 4


N/A 4th of July DBV 5 N/A DBV 6 N/A N/A Validation 1 N/A


UGM U U U U

DBV 7 Labor Day N/A User's Group Meeting DBV 8 N/A N/A DBV 9 N/A


DBV 10 N/A DBV 11 Thanksgiving N/A DBV 12 N/A DBV 13 Christmas


New Years N/A Final Validation N/A N/A TBD

PDT Meetings DBV Session Build time Holiday OR Team Session

PDT Virtual PDT Face to Face PDT Virtual

PDT @ Validation

PDT Virtual PDT Face to Face

PDT Virtual PDT Face to Face PDT @ Validation

N/A

All-RichmondClinical Ldrshp Team - BWI Hilton

Clinical Leadership Model System Validation N/A

N/A Clinical Summit - BWI

BWI Hilton Enterprise Team - Richmond

TBD TBD TBD

All - TBD

Verona, WI

PDT Virtual PDT Face to Face

TBD

All-Richmond

All-Richmond All-Richmond

All-Richmond

TBD

TBD TBD TBD

Application Testing Begins

15

Order Set Story

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Goals Develop a sufficient number of order sets for the pilot go-live –

approximately 70% of admissions

Create intranet or paper-based order sets for all other facilities

Develop a process for building, updating, and maintaining content on an ongoing basis

2 Pilot sites – electronic order sets

Other 12 sites – implement paper order sets

100% CPOE Goal

Prioritized order set development based upon admissions, clinical initiatives, CMS and other regulatory requirements

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Content Governance

Physician Design Team (PDT)

Clinical Content / Order Set Teams

Local Physician Engagement

Team

Workflow Design Team

Informatics Team

Order Set ManagerOrder Set

Manager

Clinical Doc.

Manager

Clinical Doc.

Manager

MD DirectorMD

Director

Clinical Doc.

Analyst

Clinical Doc.

Analyst

Order Set AnalystOrder Set

Analyst

Admin AssistantAdmin

Assistant

RN Analyst(AuthorSpace)RN Analyst

(AuthorSpace)

PharmacyPharmacy

Physician Participation

• Practicing Physicians

• Executive participation at system and local site

• Clinical Leadership Group

• 8000 physicians able to review

• All 14 hospitals despite their sequence in the EMR rollout

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Content Development Cycle Using Zynx

Enterprise Order Set & Care Plan creators use Zynx evidence to

draft order sets

Enterprise Order Set & Care Plan creators use Zynx evidence to

draft order sets

Implementation of Order Sets by Local

Facilities

Implementation of Order Sets by Local

Facilities

Drafts are pushed to ViewSpace where they

can be reviewed and critiqued

Drafts are pushed to ViewSpace where they

can be reviewed and critiqued

PDTEndorse and approve

initial order sets


initial order sets

Enterprise Order Set & Care Plan creators

update order sets based upon local

comments

Enterprise Order Set & Care Plan creators

update order sets based upon local

comments


final order sets


final order sets

Order Set Team

PDT

Local Facilities

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Phase I

GENERALMEDICINE

Phase II Phase III

OB GYN

CRITICAL CARE

ORTHO

NEURO -SURGERY

BEHAVIORALHEALTH

NEUROLOGY

SURGERY

CARDIOLOGY

PEDIATRICS

Development Timeline MonthsApril May June July August September October November December January February

PALLIATIVECARE

CV SURGERY

Nephrology

Urology

Interventional Radiology

Vascular Surgery

GI

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ZynxHealth: Order Set Review

• Review by specialty – all 8000 employed and community physicians were invited to participate

• Central clinical content team created workplan and infrastructure and then each local system worked off that plan to engage their physicians

• Physicians log in whenever and from wherever they like to asynchronously provide comments

• We used this process to engage the physician community in the process

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Where are we today?

As of October 2008, Bon Secours has built 275 standardized order sets in a little more than one year

Order Set Completion

01020

3040506070

8090

100

Phase 1 Phase 2 Phase 3 ED

Phase of Work

Number of Order Sets

% of Admissions / Visits

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Lessons

Early Involvement

Local Leadership Support

Finances – helps to pay the providers

Workflow Review

Revisiting workflows

Gather Local Content and workflows

Difficulty keeping sites involved if their go-live was not imminent

Sustaining energy is challenging

23

Getting Married

24

Activities

Local System Engagement Physician Workgroup

Go-Live

Physician Documentation

25

Local ConnectCare Project Framework20 specialtiesLocal CMO and CMIOSystem Leadership12 Administrators

Credentialing Physician Services EVP Communications HIM Compliance PMO IT

StaffingWork Group

StaffingWork Group

CommunicationWork Group

CommunicationWork Group

TrainingWork Group

TrainingWork Group

Workflow Work Group

Workflow Work Group

ConnectCare Workgroup Executive Leads

ConnectCare Workgroup Executive Leads

BudgetWork Group

BudgetWork Group

I.T. Work Group

I.T. Work Group

PhysiciansWork Group

PhysiciansWork Group

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Local Physician Workgroup Provide guidance on:

Physician Training Physician Support Content (order sets, alerts, rules) for St. Francis-specific

situations Workflows Devices

Participate in engagement and adoption activities: Lead the actions that ensure St. Francis’ physicians are

ready and willing to use the system Engage their colleagues in the process, including adoption of

new workflows Perform demonstrations on the system at St. Francis

ConnectCare events Help achieve 100% adoption

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Tools For…

Who They Are

Where They Work

What They Do

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Physicians and Locations June 2008 Go-Live

ED Physicians

Review patient's demographic, lab, rad information

Complete all documentation in Epic

Complete all orders in Epic - order sets and individual orders

Non-ED Docs

Review patient lists, patient's demographic, lab, rad information in Epic

Complete orders using paper order sets

Complete documentation (H&P) using current process

On the Floor Floor docs will review ED information on the patient's that have been admitted in Epic and have a printed copy.

In the Clinic

Review the patient’s ED visit in Epic if desired

Still receive patient’s information using current process

Physician Documentation Process

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ProgressH&P

DischargeConsultOp Note

Procedure

35 SpecialtiesWho

What

Build Build

MDReview

MDReview

Over 300 Notes

Every Specialty Engaged

Foundation forthe System

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Lessons

Dedicated roles for local physicians

Go-Live Support

Post Go-Live Support

We thought we had it right

Balance of Local Needs vs. Enterprise Build

Training

The challenges of sustaining energy and interest

31

Making it Last

32

Activities

Post Go-Live / Optimization Site 1

Next Go-Live in Site 1

Rollout

Clinical Transformation

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Next Site Activities

Paper Order Sets

Documentation Review

Local Infrastructure

Workflow Review



ClinicalContent

Development

ClinicalContent

Development

Physician WorkflowsPhysician Workflows

Post Go-Live Optimization

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Support Resources

Adherence to workflows

Fixes vs. Training

Vendor Updates

35

Integrating Clinicians and Initiatives

Enterprise Team Local Team

Specialty Teams

Focus on both EMR and Clinical Transformation Initiatives Pulling in Quality and Benefits Realization resources Regular meetings – some face to face and some virtual Multidisciplinary Teams

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This doesn’t look easy …

Closing Thoughts

Relationships are tough

They evolve

Membership will / should change

Leadership Opportunities

EMR can be for catalyst new structures

Marathon not a sprint

37

Contact Information

John Kontor, MD

[email protected]

(443) 841-2753

Trenor Williams, MD

[email protected]

(202) 270-4553

38

Thank You

Documents

Physician Engagement - Building a Long Lasting Relationship