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Thought Leadership
Case Studies
Engaging Physicians as Implementation Leaders
Sentara Healthcare IT leadership attributes the fact that many EMR projects are not adopted by physicians to a failure to engage physicians at the initiation of the project. Focused on ensuring vested interest, support and adoption of eCare, Sentara Healthcare IT leadership established structured partnerships with physicians and employees from across the organization. The leadership credits the active involvement of physicians in the development and implementation of eCare with its quick and successful adoption. Following implementation, Sentara hospitals achieved nearly 90% computerized physician order management (CPOM) within two weeks. This rapid adoption rate significantly exceeds national rates of 25-50%.
David Levin, MD, Sentara Healthcare Chief Medical Information Officer, and Colin B. Konschak, MBA, FACHE, Managing Partner, DIVURGENT, summarized the eCare physician implementation structure in their white paper “Electronic Medical Records: What If We Build It and They Don’t Come?”
http://www.aha.org/aha/member-center/constituency-sections/Health-Care-Systems/sentara.html
BayCare Health System - Clearwater, FL
Revenue Management During a Clinical System Implementation
DIVURGENT was engaged by BayCare Health System (BayCare), a large healthcare integrated delivery system, to support the Revenue Management and Charge Services teams during Phase II of a three phase clinical transformation project using Cerner Millennium® as the electronic medical record (EMR).
BayCare is comprised of 11 not-for-profit hospitals in Hillsborough, Pasco and Pinellas counties. With 17,000 employees and a wide array of healthcare services, BayCare is the largest community-based healthcare system in the Tampa Bay region.
Phase II of the project replaced Siemen’s Invision® clinical applications with Cerner PowerChart®. All hospital clinical personnel, including nurses, patient care technicians and ancillary support, documented patient care in the EMR. The paper chart was virtually eliminated. Charges are no longer entered directly into a system or batched for data entry; they are a by-product of clinical documentation and virtually invisible to the clinical provider. As a result, there was a need for monitoring tools that had not been used previously by BayCare to ensure minimal impact on the revenue stream during activation and beyond.
DIVURGENT was responsible for developing reports and monitoring mechanisms to be used to identify potential revenue issues that included:
- A report for nurse managers and department directors to run at the end of each shift that identifies incomplete or unsigned charts that drive charging in the background.
- A report of incomplete tasks that have built-in charges on discharged patients to identify potential late charges.
- Daily detailed interfaced charge reports to help nurse managers and department directors balance patient load against charges.
- Charges that did not qualify for the financial system interface (suspended) to identify issues with unprocessed charges or revenue mapping by department.
Activation Metrics
The following metrics were used during clinical systems activation to monitor revenue and identify issues:
- Gross inpatient revenue per patient day compared to budget and similar day of the week revenue from the previous month.
- Gross outpatient revenue per encounter compared to budget and similar day of the week revenue from the previous month.
- Number of unsigned clinical documents per day.
- Number of overdue clinical tasks per day.
- % of total charges that were suspended.
400-bed academic acute-care hospital client located in the Northeast
Three years ago, this organization decided to take advantage of
cost savings and the open source benefits offered by Medsphere,
a company that created an EMR product from the VA's VISTA code.
DIVURGENT began working with this client in June 2009 in a process
redesign role. Today, DIVURGENT team members hold key roles in leading
overall clinical transformation initiatives, including:
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Project Manager: Responsible for coordination of the project
plan and working closely with the client's ancillary areas (i.e.,
Radiology, Pharmacy, HIM, and Nutrition) to prepare for the
replacement of legacy systems. |
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Clinical Transformation Lead: Responsible for working closely
with nursing and ancillary clinical leadership, is addressing
the process redesign and system adoption needs. |
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Project Executive: Responsible for overall project reporting
to the client's Executive Committee, order set validation,
communication planning, change management, and physician adoption. |
This three-phase implementation will begin with CPOE and basic
clinical documentation implementation. Phase 2 will address bedside
bar-code medication administration. The third, and final, phase
will result in a nearly paperless environment with the implementation
of clinical documentation for all clinicians and physicians. Metrics
for Success in Phase 3 will include compliance with the ARRA meaningful
use requirements.
New business development strategy
Our team led the development of a business strategy for a large
integrated delivery network interested in commercializing intellectual
property developed in the areas of technology implementation, clinician
integration, project management and vendor selection.
Total Cost of Ownership
Our consultant led the development of a Cerner Total Cost of Ownership
(TCO) model for a nine hospital IDN in the Southeast. DIVURGENT
partnered with all major client and vendor stakeholders in order
to outline a six year total cost of ownership for a suite of applications
to be implemented throughout the IDN.
PMO Development
DIVURGENT was engaged to develop a project culture that was built
on PMI principles that would improve project outcomes, provide timely
project information and the necessary guidance, support that would
frame projects to be completed within scope, on time and within
budget. In this engagement, our client recognized that a disciplined
change agent was required to carry their Information Technology
initiatives forward.
DIVURGENT provided various roles in the organization including:
Senior Project Manager, Project Managers and the Project Management
Office Director. During the engagement DIVURGENT guidance to the
organization in the following areas:
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