Role of Innovation at Sharp

Role of Innovation at Sharp

August 15, 2011

Bill Spooner

REFLECTION

"Some men see things as they are and say ‗Why?‘.

I dream things that never were and say ‗Why not.?‘"

Agenda

• Sharp Background

• Perspective on Innovation

• Examples of IT role in Innovations

• Other Areas we are Exploring

• Largest health care system in San Diego – 7 hospitals, 2000+- beds

• 4 Acute Care and 3 Specialty – 2 Affiliated Medical Groups

– Health Plan

– 5 Urgent Care Centers – 2 Skilled Nursing Facilities – Home Health and Hospice

• Largest private employer in San Diego – 15,000 Employees

– 2,600 Affiliated Physicians – 2,000 Volunteers

– $2+ Billion Operating revenue

Brief Organization History

• Early 1950‘s: Key hospitals opened

• Mid-1980‘s: Mergers forming Integrated Network • 1980‘s: Embraced managed care model

• 1985-1995: Tight reimbursement • Mid-1990‘s: Financial distress

• 1995-1997: Columbia/HCA option explored • 1997: Emerged independent and stronger • 1997 -2000: ―Just say No‖ campaign

• 2001-2011: Sharp Experience • 2007: Baldrige Award

John Glaser on Innovation

Practical innovation—the kind of innovation that genuinely improves

patient care or workflow and can be implemented by an organization today—is based on four cornerstones:

• The Right Culture

– Organizational fabric, directed at business or clinical value

• The Right Questions

– Vision, strategy, process, technology

• The Right Processes

– Portfolio, idea input, evaluation, pilots, impact assessment

• The Right Tools in support of innovation

Technology has no inherent ability to ―cause‖ innovation. Its innovation value is determined by the context of its potential use.

Sharp Translation

• The Right Culture

– Creativity encouraged

– Healthy risk appetite, tolerance for failure – Strongly motivated leaders, seldom fail

• The Right Questions

– Strategy alignment?

– Business or clinical value?

• Quality, Service, Finance

– Replicable across organization?

• The Right Processes

– Open door policy – Lean Sigma

– Strategic Planning Committee, IT Executive Committee

• The Right Tools

History of IT Innovations

• 1970s - Lab system

• 1985 - Clinical documentation alpha site (Clinicomp) • 1993 - Hospital Patient Accounting alpha site (IDX) • 1995 - EDI enrollment, claims and encounters

• 1998 - Sharp.com ―Internet baby"

• 1999 - First of eleven ‗Most Wired‖ awards • 2000 - Hospital EMR and PACS (Fuji) begins • 2003 - OnBase live with managed care claims • 2004 - Medical Group EMR begins (Allscripts) • 2006 - New Hospital EMR strategy (Cerner) • 2007 - EMR for Sharp‘s IPA begins (Allscripts) • 2010 - mySharp patient portal

Innovation Example

Collaborative Care Evolution

• 1980: Pacificare partnership

• 1985: Delivery Network integration

• Late 1980‘s: Capitation, Contract management

• 1991: Master Patient Index

• Mid-1990‘s: Data warehouse analytics

• Mid-1990‘s: EDI

• 1999 - CFO: “We have to have an EMR!”

• 2000+-: Clinical analytics, preventive health • 2003: Claims scanning

• 2004: Town Hall with David Brailer, MD • 2005+-: Online alerts eg Diabetes

October 2004

Value Proposition

• Steady market share gains • Profit improvement

• Pay-for-performance dollars

• High quality and patient satisfaction scores

– Press Gainey

– Pacific Business Group

– Malcolm Baldrige National Quality Award

• Strong employee satisfaction scores

– Low turnover

• San Diego leader on the Web • IT recognized in Baldrige Award

Identify, develop, and implement IT solutions to support effective care management from both an operational and patient-care focus.

Health Reform:

Full Continuum of Care IT Strategy

Wellness Illness

Prevention and Wellness

Outpatient Acute Post Acute Home Care Disease Management Hospice/ Palliative Care

Sharp’s Information Technology

• Master Patient Index (MPI) • Hospital EMR • Medical Group EHR • Health Information Exchange • MEDai • Data Warehouse • mySharp Evidence-Based Care Operational Excellence Quality Reporting External Care Coordination

•Government Quality Programs

•Pay for Performance

•Meaningful Use

•Providers

•Patients

•Financial & Practice Mgt

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mySharp Portal

Innovation Example

Sharp Data Warehouse

Supports Real-time

Compliance

Drill Down Report on

Non-Compliance

Diabetes

Action

0% 2% 4% 6% 8% 10% 12% Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08

Percent of Patients HbA1c Greater than 9

Sharp Rees-Stealy

Start DM-9

HCC/Quality

Button

Innovation Example

Paperless Admitting

2007+-Palm Vein Scanning

Improving Patient Identification at Registration

• Hospitals and SRS medical group

• Reduces unintentional duplicates and overlaps

• Protects patients from medical fraud and identity theft • Non-intrusive and highly accurate

• Currently 40,000+ patients are enrolled

Innovation Example

Out of Network Repatriation

• Bringing Sharp patients into Sharp hospitals • Coordinating quality care

• Decreasing OON hospital expenses – Saved about $8 million in 2010 • Workflow automation

– Notification of OON patients, logging, tracking – Bed availability

– Physicians and case managers – Patient transfer

OONWA

(Out of Network Web Application)

Integrated IT Toolset

Web Application Reporting

Innovation Example

Clinician Convenience

Patient Safety

Way2Care

• Allows users to login/logout quickly with their employee badge. • Complements single sign-on, context management

• Positive user response.

Virtual

Integration

Innovation Example

On Watch

Event Triggers

• Specific events that prompt investigation

– Reversal agents

– Critical lab values

– Sequential events/ trends

– Linked events such as meds and lab values

• Derived from research literature, clinical

expertise

• Designed to identify events where harm has

the potential to occur

Patient-centered Workflow

EMR Medical Devices Medical ImagingConsumer Devices Communications Entertainment Environment Internet

Physician Office Maternity Surgery Bed Hemodynamic Rx Station Auto Chem IV Pump Fetal Monitor Pathology Ultrasound PACs C-PACs ECG Photo Activity Sensors Vocera Scale Digital Camera BP Heart Rate Glucometer Proximity RFID Messaging Cell Phone Video Conf Gaming MyStation Sat Radio Movies Lighting Security Thermostat Monitoring Plumbing Education Research Reference

iAware Patient Perspectives Gadget Library Facility Perspectives

Discovere

Healthe IQHEALTH

EMR Medical Devices Medical Imaging Consumer Devices Communications Entertainment Environment Internet

Physician Office Maternity Surgery Bed Hemodynamic Rx Station Auto Chem IV Pump Fetal Monitor Pathology Ultrasound PACs C-PACs ECG Photo Activity Sensors Vocera Scale Digital Camera BP Heart Rate Glucometer Presence \ Location Unified Messaging Cell Phone Video Conf Gaming MyStation Sat Radio Movies Lighting Security Thermostat Monitoring Plumbing Education Research Reference RFID Proximity

Information and resources located at local level

EMR, Device, Environmental, Communication, etc Cerner & non-Cerner systems

Various Forms and Formats

Elements to support a contextually aware experience

Unified Communications

Apps and Communications Merge on Wireless Devices

Cellular WiFi Tablet _WiFi

Mobile Station To Deliver Approvals & Orders Portals & Dashboards Clinical Results Schedule & Patient Info Early Stages

Enterprise Logistics via Positioning Technology

Patients =ƒ(Patient Progression, Fixed Assets)

Fixed Assets

Staff & Mobile Assets =ƒ(Patients, Fixed Assets)

3D Queuing: Predict and Position EPS Visibility Capacity Management Patient Acuity Care Level Index Staff Assignment Case Management

Staff Scheduling Labor Analytics

Asset & Materials Management iBus

Conclusions

• Practical Innovation is key to our success

– It must have a purpose!

• Clinical and/or business drivers

– Six Pillars at Sharp

• Anyone can be the innovator

– (There are no bad ideas!)

Thank you!

Questions?