Healthcare System Improvement
Through HIT: Case Study at
VNSNY
Carol Raphael, President and CEO
Visiting Nurse Service of New York
June 24, 2006
Overview
• Drivers of HIT
Investment
• HIT Solutions
• Lessons Learned
Drivers of HIT Investments
1. Highly decentralized service
system
– Large scale / scope of services
– Dispersed multi-disciplinary field
staff
– Communication often not “face to
face”
2. Shifts in Payment & Regulatory
Requirements
• In 2000, Medicare moved
to PPS
– Tied to OASIS assessment
• Increased managed care
admissions & reporting
3. External Measures of Quality
• Required to submit OASIS scores
on functional improvements &
adverse events
• CMS Æ Public Disclosures
– “Home Care Compare”
– Benchmark Æ National averages
• Movement to Pay for Performance
4. Labor Market Pressures
• How to increase capacity of
current staff?
• What tools do staff need to
facilitate their jobs?
• How does an organization
continually educate staff?
HIT Solutions &
Systems at VNSNY
1. Electronic Health Records
• Mobile Pen Tablets Components:
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–
–
–
–
–
–
Assessments
Progress notes
Plan of Care
Monitoring of outcomes
Problem lists
Medication management
Standardized best-practice “decision tree”
VNSNY Mobile Pen Tablets
2. Quality Measurement System
• Measures in 4 domains collected for
clinical teams quarterly.
– Process, outcomes, cost/utilization,
satisfaction
• Targets set annually in different areas
– “Improvement” & “Priority” indicators
• Easy access by front-line staff
– Measures how team is doing compared to
other teams & targets
– Outcomes website
Reduction in Emergent Care of Wound Patients:
2001-YTD 2005
36
26% Reduction
35
34
33
32
31
30
29
28
27
26
2001
2002
2003
2004
Y TD 2 0 0 5
3. Tele-monitoring
• Speech Tele-health
– Target people w/ strokes &
Parkinson’s
– 206% improvement in staff
productivity
– 98% patient satisfaction
Tele-health Pilot
• 284 patients
• Equipment guides patients to
collect vital signs in 8
languages
• Data transmitted to central RN
station Æ info triaged
4. e-Exchange Partnerships
• MD Web-Based Portal
– Shares patient medical information
– Improves communication between
nursing staff & MDs
– Stakeholder Benefits:
• Promotes self-care management
• Increases efficiency, communication,
patient outcomes, & MD satisfaction
• NY Community Home Health
Interoperability Project
– Goal Æ Electronic exchange of
patient’s clinical information
• VNSNY key lead with
– 4 MD Practices
– 2 Community Health Centers
– 3 Labs, SNF, & Adult Day Center
• Participant in 4 Regional Health
Information Organizations
5. E-Learning
• Goals
•
•
Improve field staff access to best practices
Reduce training time & costs
• Piloting Diabetes Self-Management
Module
•
•
•
Planned roll-out to 1,700 RNs
53% of RNs think “learning is easier”
75% of RNs believe course strengthened ability
to teach patients about self-care management
“Lessons Learned”
1. The way technology & info is
used produces advantages
– Before adapting technology,
tackle core processes that cross
silos:
• Job design
• Incentives
2. Implementation takes
considerable resources
& support
3. Difficult to project &
achieve ROI
4. Clear governance structure needed to
facilitate decision making & establish
accountability
VNSNY I.S. Steering Committee key functions:
• Develops priorities tied to strategies
• Determines allocation of I.T. expenditures
• Monitors projects, timelines, costs, &
budget
• Quarterly status presented to Board
Technology Committee
5. Strong project management
systems vital to success
• Provide early warnings
• Measure total-multi-year costs,
resource utilization, deliverables
• VNSNY Model Æ Moved to 2 phases
– Phase I: Early estimates, strategic
rationale, cost/benefit analysis
– Phase II: More precise, detailed plan
VNSNY
Quality
Capacity
Efficiency
Picture: Southwest Missouri State University, Hammons Field opening: April 2004
Conclusions & Reactions
1. Investment in IT solutions can
enable deliverables in three
key areas:
– Improving quality
– Gaining efficiencies
– Enhancing capacity
2. Technology can enable
virtual systems &
interconnectivity with other
parts of health care
– Relies on the building of
partnerships & flexibility
3. Technology needs to be
part of a long term,
broader strategy both
within the organization
& in public policy arena
• Technology as a vehicle to
promote independent living
– Key factors:
• Ease of use
• Affordable
• Shift from a provider-driven
orientation
• Privacy issues are paramount
• Support of research