August 21, 2007
It’s a Challenge of Scale* 1.A Commercial 2.Motivation, dilemmas 3.Community HC Perspective - complex & large, and getting harder & bigger 4.With systems & structures that are already not intuitive enough *We’re an end user of technology. A systems integrator.
Virtua Health Today
Virtua Health Today 4 South NJ Acute Care Hospitals Berlin, Marlton, Mount Holly, Voorhees Outpatient Center, inc. ED Camden 2 Long-Term Care Facilities Berlin, Mount Holly 2 Home Health Services Camden & Burlington Counties 2 Ambulatory Surgery Centers Voorhees, Mount Holly
Virtua – Mid-Size Integrated Delivery Network 7,200 Employees 2,100 Physicians 56,000 Annual Admissions 270,000 Outpatient Visits 7,600+ deliveries (2006) 176,865 ED visits 1,200 Beds
What Makes Virtua Different? Relentless measurement Rigor and accountability Our Tool Box Programs of Excellence Partnerships with Industry Our people Our results
The Virtua STAR: The Backbone of Our Organization Excellent Service Resource Clinical Stewardship Quality & Safety Outstanding Patient Experience Caring Best People Culture
It’s a Challenge of Scale 1.A Commercial 2.Motivation, dilemmas 3.It’s complex & large, and getting harder & bigger 4.With systems & structures that are already not intuitive enough
Burning Platform: Medicare Should Keep Pushing US in Quality, Safety Patients receive recommended care 55% of the time… All care 55% Acute 54% Pat ient s Report ing Any Error by Num ber 5 Chronic 56% of Doc t ors Seen in Past Tw o Years, Sic k er Adult s, 2005 Perc ent Preventive 55% 75 1 doc t or 4 or m ore doc t ors 48 0% 25% 50% 75% 100% 50 40 37 35 31 28 22 25 15 14 14 12 12 0 UK GER NZ AUS CAN US 2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Burning Platform: We’re Mediocre at Quality Reduce Medical Injuries (Intermountain) Account for 44,000 - 98,000 deaths per year in the United States More people die from medical errors than from breast cancer or AIDS or motor vehicle accidents Brennan et al. New Engl J Med 1991 Thomas et al. 1999 Direct health care costs totaling $9 - 15 billion per year- Thomas et al. 1999 Johnson et al. 1992
Dilemma: Spending Stifling Our International Competitiveness Hospit al Spending US HC $ as % OF GDP Health Spending as a Percent of GDP, 2002 per Inpat ient Ac ut e Care Day in 2004 25% Adjust ed for Differenc es in Cost of Living $2,500 $2,337 United Kingdom 7.7% 20% Japan 7.8% $2,000 Australia 9.1% 15% $1,500 Canada 9.6% $1,069 $1,015 CMS National Health France 9.7% $862 $1,000 $793 Expenditures: “Health Spending 10% Projections Through 2015: Germany 10.9% $549 $419 Changes on the Horizon,” $500 Switzerland 11.2% Health Affairs, February 22, 5% 2006 and “National Health OECD median 8.5% $0 Spending In 2004,” Health b a a a Unit ed Franc e Aust ralia Canada OECD Germ any J apan United States 14.6% Affairs January/February 2006. St at es Median 0% a 2003 b 2002 0% 2% 4% 6% 8% 10% 12% 14% 16% J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007). 0 5 0 5 0 p p p 8 8 9 9 0 5 0 5 9 9 9 9 0 0 1 1 1 1 1 1 2 0 0 0 2 2 2 In Summary : we’re the best at treating chronic, acute care, but still die younger. •US healthcare is called-in after the fact: Americans (esp. NJ) do not take responsibility for their own health. •It’s not just a value-chain length or an acute care problem. •It is very difficult to see the whole person, anticipate, prevent or treat a health issue holistically. • US Healthcare remains specialized compendium of silos and compartments with distinct care processes and protocols.
Germans Live Longer and for Less Better outcomes and costs thru longitudinal patient care: > 80 million electronic health cards All phases of care Access to medical data (opt in) Gov’t and private health insurance > 750 million prescriptions every year Annual savings > 1 billion euros www.euser-eu.org
No Sunk Costs, No Baggage Slovenia’s 2 nd generation Web-based system 2007 launch
We Cost Too Much (2X healthier countries). Healthy Patients are Leaving the US. OFFSHORE Is less than 1/3 our costs
Burning Platform: countries). Healthy Patients are Leaving the US. The Clincher..…
Exacerbated by Staffing Shortage Med School Grads US Nursing Workforce Senior Metro North America Population Solution - productivity •Less in-patient, acute care •In-home •Ambulatory •Productivity thru process, technology •Process optimization •Automate what you can •Flat world…
Solution: New Model of Care Systems FROM - Reactive Cottage Industry & Individual Craft: •Americans do not take responsibility for their own health •Healthcare is called-in after the fact in generally isolated forms •Result: we’re the best in the world at treating chronic, acute conditions TO – Proactive, Connected Healthcare: •Expand scope of care to cover all phases of life, prior to conception until after death •Shift the industry culture from reactive to proactive, crisis to prevention • Result: Unified, preventative, holistic care processes & teams enabled by technology
It’s a Challenge of Scale 1.A Commercial 2.Motivation, dilemmas 3.Community HC Perspective - complex & large, and getting harder & bigger 4.With systems & structures that are already not intuitive enough
Example: 75 YOM Diabetic, > 10,000 Transactions Day 1 Day 3 Day 5 Day 7 PACS RAD Update Update ??? EMR EMR Primary Care Lab EMR Payer Rx PACS Echo, Stress Specialist 1 Lab ??? EMR (Cardio) Payer Rx 3 rd Party Telemetry Specialist 2 Lab (Endo) ??? EMR Payer Rx Virtua EMR EMSChart Paramedic Payer PACS Echo, Stress Telemetry Virtua ED Ibex Lab EMR Payer Rx 3 rd Party Telemetry Virtua Home Misys EMR Health Payer Observation Cath Lab ICU Med Surg
Personalized Med-Mania Solution – Larger scale systems: •Decision support systems •Realtime, on-line I’s and O’s •As if medication & therapy •Automated H&Ps, notes, etc. management was not hard enough… •Medication management •Add genetically tailored meds •Proactive diagnosis, therapy assist •Add ten times the codes, protocols •Realtime coding (charging) with ICD-10 in 2010
One Simple Transaction Paper Processes Invite Errors, Make for a Clerical Day Daily Report LAB Old Charts FLOWSHEET MONITOR Dangerous IMAGE PUMP CHART Chart Ancillary MAR Results Review Documentation Documentation Flow Sheet Update > 60% of the time Communication Device Monitoring > 55% of the time Orders Communication Billing • Leaving less than half for our time real patient care • Patients move faster than charts
Community Healthcare Under the Hood • 4M Transactions per day, across • Over 220 Applications, Servers but dropping • CCW: logical messaging, physical messaging, WAN
Digital Transformation Increases Computing Infrastructure Server Growth •Net new functionality - create new operating system, database, etc. licenses •In house only •Some services and servers get retired Client Growth •Each project creates new applications… some get retired •Creates new mobile, portable and/or desktop license requirements •Net new employees
Traditional Inpatient-Focused Architecture
Typical Architecture – 315 Best-of-Breed Services and Growing CORE IT SYSTEMS •Clinical Applications: •Order processing •Nursing Documentation •Electronic Medication HORIZONTAL HORIZONTAL Administration Record (eMAR) •Patient Management & Accounting •Administrative, Financial Applications •Human Resources, Staff Mngt.
Virtua Health – Current Timeline 2006 2007 2008 2009 2010 2011 2012 Non-Clinical Clinical R7.0 Electronic Record Phase 4 Electronic Record Phase 3 R6.0 Electronic Record Phase 2 R5.0 Electronic Record Phase 1 R4.0 Pharmacy IS R2.5 Document Management R1.9 HC Exchange R1.5 LIS R1.4 Cardiology R1.3 OR Digitization R1.0 IBEX/PICIS ED EMR R0.5 Misys: Home Care EMR; MICU: EMSChart R0.3 R0.4
Virtua Health – Current Timeline 2006 2007 2008 2009 2010 2011 2012 Non-Clinical Clinical R7.0 Electronic Record Phase 4 : y e Electronic Record Phase 3 R6.0 n r u o J l a n o Electronic Record Phase 2 i R5.0 t a m r o f s n a r Electronic Record Phase 1 T R4.0 r a l e a s y t e i p 5 s a n c e p n Pharmacy IS R2.5 x i e M g 0 0 n i 1 t a $ r e > p Document Management R1.9 o • n i M M 0 0 1 HC Exchange R1.5 $ > • LIS R1.4 Cardiology R1.3 OR Digitization R1.0 IBEX/PICIS ED EMR R0.5 Misys: Home Care EMR; MICU: EMSChart R0.3 R0.4
Recent Launch Successes • Team efforts working: – Home Health EMRs, remote sensing – Paramedics with EMRs – Material management automation – Integrated hemodynamics, cardiology – ED automation, tagging, tracking
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