2015 iHT2 Health IT Beverly Hills Summit
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Sajid Ahmed presented on the implementation of an EHR system at Martin Luther King Jr Community Hospital on a limited budget and tight timeline. The hospital was established through a public-private partnership between LA County and UCLA. Key strategies for successful implementation included aligning the culture, processes and people; allowing the processes to drive the EHR design rather than the other way around; and focusing on the hospital's mission when facing challenges. Through extensive planning and vendor management, the EHR went live on time and on budget to support the hospital's opening.
2015 iHT2 Health IT Beverly Hills Summit
- 1. Sajid Ahmed, CHCIO Chief Information and Innovation Officer November 4 2015 Martin Luther King, Jr Hospital: Maximum Implementation with Limited Resources A Startup Hospital Goes All In on Time and on Budget
- 2. Martin Luther King, Jr. Community Hospital Page 2 Session Objectives • Learn to apply MLK-LA's implementation strategies and multi-factorial experience with limited resources and time to large scale implementations, new hospitals, and new services. • Learn the examples and issues of designing an EHR as a tool during an evolving and changing organization • Demonstrate how people, processes, and systems need to work together to succeed
- 3. Martin Luther King, Jr. Community Hospital Page 3
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- 5. Martin Luther King, Jr. Community Hospital Page 5 "Once we rid ourselves of traditional thinking we can get on with creating the Future." — James Bertrand
- 6. Martin Luther King, Jr. Community Hospital Page 6 Vision To be a leading model of innovative, collaborative community healthcare. Mission The mission of Martin Luther King, Jr. Community Hospital is to provide compassionate, collaborative, quality care and improve the health of our community. Values • Caring, Collaboration, Accountability, Respect, Excellence Mission, Vision, and Values
- 7. Martin Luther King, Jr. Community Hospital Page 7 A private, non-profit, safety net hospital providing high quality, collaborative care for South Los Angeles and surrounding communities in partnership with the County of Los Angeles, University of California and other community providers Identity Statement
- 8. Martin Luther King, Jr. Community Hospital Page 8 Hospital History Date Milestone August, 2007 MLK-Harbor, a 461-bed acute care hospital operated by Los Angeles County in South Los Angeles closes; the County maintains a commitment to re-establish hospital services on MLK campus October, 2007 South Los Angeles Preservation Fund signed into law; ensures funding for new Hospital Spring, 2008 County approaches Governor Schwarzenegger and the Regents of the University of California for assistance with re-opening Hospital November, 2009 UC approves plan to work with County and State to re-open the Hospital. Terms of re-opening: • County and UC would work together to form a wholly independent, nonprofit 501(c)(3) entity which would open and operate new Hospital • Hospital to focus on providing community-based medicine • Hospital to contract with UC for the provision of “key services”
- 9. Martin Luther King, Jr. Community Hospital Page 9 Hospital History Date Milestone April, 2010 County and UC jointly sponsor AB2599 to ensure long-term financial viability of the new Hospital; AB 2599 signed by Governor on September 23, 2010 July, 2010 County and UC sign Coordination Agreement . UC will assist with: • Hiring the Hospital’s Chief Medical Officer • Development of the Hospital’s Graduate Medical Education program • Development of hospital-based physician services • Development of the Hospital’s quality and performance improvement programs • Assistance with other pre-opening activities that require physician expertise July, 2010 MLK-LA formed as a new nonprofit entity; Board members are appointed by the County and UC April, 2014 Board of Supervisors approve lease and funding agreement
- 10. Martin Luther King, Jr. Community Hospital Page 10 The New MLK Community Hospital A Public/Private Partnership Governance: County Board of Supervisors Governance: Board of Regents MLKCH Foundation Coordination Agreement IGT and Indigent Care Funds MLK, Jr. Community Hospital Governance: Community Board Non-Profit 5013c Building Lease LA County UC, UCLA Fundraising
- 11. Martin Luther King, Jr. Community Hospital Page 11 MLKCH Clinical Services Licensed Bed Type Total Medical/Surgical 93 Intensive Care 20 Obstetrics 18 Total Licensed Beds 131 Other Licensed Services Total Nursery - Bassinets 11 Emergency Department 21 Fast Track Stations 8 Operating Rooms 4 C-Section Rooms 1 Post-Anesthesia Care Unit 12 Scope of Inpatient Services to be Provided by the Hospital Anesthesiology Cardiology Emergency Services Gastroenterology General Medicine General Surgery Infectious Diseases Neurology Obstetrics & Gynecology Ophthalmology Orthopedics Otolaryngology Pathology Radiology Pulmonary Medicine Urology
- 12. Martin Luther King, Jr. Community Hospital Page 12 Key Demographics • 1.35 million residents; 46.0% age 15-44 years • 70.4% Hispanic, 22.7% Black • 64.6% of household incomes less than $50,000 Large portions of the service area are Health Professional Shortage Areas (“HPSA”) and/or Medically Underserved Areas (“MUA”), indicating a deficit of primary care physicians. Physician shortages exist across most medical and surgical specialties. Service Area Overview
- 13. Martin Luther King, Jr. Community Hospital Page 13 Projected Payer Mix – 2015* Medicare 10% Medi-Cal FFS 24% Medi-Cal managed care 39% Medicare dual-eligible 2% Uninsured 23% Commercial 2% *Based on ADC
- 14. Martin Luther King, Jr. Community Hospital Page 14 The New MLKCH: An Innovative, Integrated Care Strategy Los Angeles County Ambulatory Clinics Shared Professional Staff MLK Medical Campus Innovation Hub/HealthCare Transformation Medical Groups/IPAs UCLA and community- based providers Community-based Providers, FQHCs Care Coordination Shared Data Partnering Hospitals Tele-ICU/TeleHealth Pre-Post Acute Providers Home Visits Prevention, Education, and Wellness Partners Learning Center, Wellness Center
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- 16. Martin Luther King, Jr. Community Hospital Page 16 Patient California Hospital Med Center St. Francis Hospital LAC DHS Rancho Harbor LAC USC UCLA Clinical Leadership Quality Telehealth Hospital Partners Community Partners Physician Partners Alta Med HCLA IPA Alta Med IPA Global IPA Home Health, DME, Rx Payor Partners Health- Net Medi- care Anthem Medical Groups SPA 6 MLK Campus Public Health Centinela Hospital LA County Molina Indep. Physicians DHS MLK OC Blue Shield Long-Term Care Other Community Partners Associ- ations CBOs Govn’t Agen- cies MLKCH Care Partners in Population Health Improvement SNF Applecare IPA Care First Omnicare IPA Social Services, Transport Gardena Memorial DHS MH Urgent Care MediCal LA Care CHLA Brand New Day Health Care Partners Angeles IPA EHS IPA Talbert Medical Group Preferred IPAMolina LBMMC DMH Hawkins CFC IPA MOB SSC 8 FQHCs
- 17. Martin Luther King, Jr. Community Hospital Page 17 MLKCH’s Collaborative Care System (EHR) and Portals for Patients, Providers and Health Plans/IPAs • Uses a fully integrated Cerner EHR designed with care management for every patient with real-time critical data into the clinician workflow • Patient’s health record will issue alerts to providers of possible health risks direct to MLK’s Care Phones (iPhones) Portals • Patient Portal: Provides secure messaging, lab results, eVisits, and appointment scheduling between your patients and providers with Cerner Patient Portal. • Physician/Provider Portal: Provides health information on the providers’ patient(s), view only into the MLKCH’s EHR System • Health Plan/IPA Portal: Provides daily real time census on a health plans’ members or IPA patients currently admitted at MLKCH and any relevant medical status notes
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- 20. Martin Luther King, Jr. Community Hospital Page 20 • Evaluated, selected, tested and integrated over 20 software packages • Negotiated, contracted and managed over 36 vendors • Integrated 57 unique medical device types into the our EHR (CCS), making this implementation the largest device integration ever in Cerner history • Designed and implemented over 55 EHR modules • Project Managed over 134 interfaces • Architected, engineered, installed, configured and tested over 1,000 unique hardware items in our Data Center and technical rooms, equipment closets and on the floors • Designed, configured, deployed and supported an IP-based phone system for over 500 users as well as the analog backup system • Defined, configured and deployed over 700 desktops, laptops and phones • Added cabling and 193 wireless access points to support a high density network connectivity throughout the hospital • Installed, tested and delivered Interactive Patient Care system in over 100 patient rooms • Held competitive bids for Health IT outsourcing. Reviewed, selected, negotiated and on- boarded CareTech. Hired key IT Director positions internally • Developed over 53 policies and procedures Continuing to project manage and operate the hospital command center for licensing, Joint Commission and a successful hospital opening! What We Accomplished to date….
- 21. Martin Luther King, Jr. Community Hospital Page 21 Design, Innovation and Culture…
- 22. Martin Luther King, Jr. Community Hospital Page 22 Getting the Gears of Change Aligned Culture Process People
- 23. Martin Luther King, Jr. Community Hospital Page 23 Getting the Gears of Change Aligned Culture Process People “Give us your current orders, processes, policies and procedures and we will build your EHR.” Problem: We didn’t have any (And, by the way, we have no department directors, managers, or physician staff to participate) (And we have an absolute no-can-fail deadline)
- 24. Martin Luther King, Jr. Community Hospital Page 24 Startup: • Consultants, Consultants, Consultants = $$$ • Extensive Roadmap and pre-planning • Subject matter experts (SME’s) = $$$ How do People Come Together…People
- 25. Martin Luther King, Jr. Community Hospital Page 25 Down the Roadmap: • Project management – Get the right people on the bus – Make the hard decisions on who is best for the job – There was no time to start over • On boarding the permanent hires – Balancing flexibility between the expertise they bring to the table and avoiding letting every new hire from changing everything to mirror their old way How do People Come Together…People
- 26. Martin Luther King, Jr. Community Hospital Page 26 Approaching the completion: • Down sizing the consultants – Varying the overlap (transition); do you have a competent hire in place? • Looking for your super users • Training new hires en mass • Onboarding all new physician staff (beyond the EHR) How do People Come Together…People
- 27. Martin Luther King, Jr. Community Hospital Page 27 The EHR could not drive policy and procedure • The paradox of building out the EHR before P&P • Continuous change management with checks and balances • Designated individuals with clinical and technical expertise communicating both sides of the processes The Process needs to drive the EHRProcess
- 28. Martin Luther King, Jr. Community Hospital Page 28 Rapid Design vs Method M • Synopsis of Rapid Design and Method M • “The best laid plans…” – You can’t be rigid • Endless effort to “break the silos” • Changing the roadmap on the fly – Examples (we were more than a Greenfield…) Process What were lessons learned in the Cerner Process
- 29. Martin Luther King, Jr. Community Hospital Page 29 • Re focusing on the mission and cause at hand – Dave Logan’s “Tribal Leadership” – Helping each other to a higher level • When stressed, people revert to what they knew first – The learning curve(s) • Understand different communication styles – “Crucial Conversations” Nurturing a Culture of Values and Leadership Culture
- 30. Martin Luther King, Jr. Community Hospital Page 30 • Creating buy in after-the-fact – 100% usage, no choice, no alternative • Moving forward: – “Refinement and enhancement” ( Not do-over and “fix”) – An EHR is an never ending story, never complete • Trust and Communication – Setting expectations to match reality Creating a Culture of Values and Leadership Culture
- 31. Martin Luther King, Jr. Community Hospital Page 31 Its not the technology’s ability to work, but the peoples ability to work the technology People, Processes, and Systems: Laurie Lipton On, 2008
- 32. Martin Luther King, Jr. Community Hospital Page 32 Lessons Learned
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- 35. Martin Luther King, Jr. Community Hospital Page 35 Questions and Answers
- 36. Martin Luther King, Jr. Community Hospital Page 36 Thank you! Sajid Ahmed, CIIO, [email protected]