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Technology Replacement
Goal:
To design and implement the Hospital-Wide Conversion from the current intermittent intravenous (IV) delivery system to a syringe platform using microinfusion and multidose technology.
Description:
The Brigham and Women's Hospital and Massachusetts General Hospital decided to implement a new syringe platform to deliver IV therapy to their inpatients. In order to achieve a standardized approach to an intermittent drug delivery system, each hospital chose to change its platform for quality and cost savings.
The role as project manager was to facilitate a Conversion Working Team responsible for the new platform conversion in each hospital. Team Membership included representatives from Pharmacy, Nursing, Nursing Education, Materials Management, Biomedical Engineering and supporting vendors of each hospital.
It was essential that each hospital's issues be regarded as separate as each culture was different even though they are within the same healthcare network. A standardized approach and methodology included the following initiatives: estimating syringe volume projections for hospital-wide conversion; provide nursing competencies and procedural templates for the Nursing Clinical Procedure and Practice Committee; implemented process change by identifying issues and solutions related to IV pharmaceuticals, disposables and device flow on each unit as well as hospital-wide; and updated and refined operations procedures.
The inservice script and schedule was designed and coordinated while working closely with the Vendors' Inservice Team. Finally, we provided and coordinated logistical details of the actual platform conversion. During the "go-live" phase, we provided expedient issue resolution to each unit using the new platform.
Procedure
Booking Process
Goals:
To
identify information needs along the continuum of orthopedic
pre-operative planning and incorporate these needs into an efficient
and accurate operative planning system thereby reducing delays
related to equipment, patient preparation and miscommunication.
Description:
The entire surgical booking process for the
Orthopedic Surgical Service
at the Brigham and Women's Hospital, Boston MA, was redesigned. Automated surgeon specific procedure preference cards were reviewed
and updated to reflect actual case needs.
A series of five
Surgical Booking Request Forms were created to identify specialized
equipment and prosthetic needs for orthopedic cases. Preparation for
pre-admission testing was enhanced to minimize the patient’s
pre-op visit time. Intradepartmental responsibilities related
to the booking process (surgeons, schedulers, materials
management, and OR nursing staff were redesigned.
Booking information was
then further automated to augment the live
operative schedule to enhance materials management and
scheduling needs of the operating room.
Creation
& Implementation of an
Operating Room Database
Goals:
 | To create an accurate and dynamic
Operating Room Database used for tracking utilization of
services, procedures, procedure times and billing information
for 44 Operating Rooms and 13 Surgical Services. |
| Convert 20 years of historical data
stored on a VAX system |
| Create easy access to utilization data |
| Create an automated billing interface to
the hospital billing mainframe VAX for Part A charges |
| Provide an interface with the Scheduling
Database |
Description:
We worked with the
Massachusetts General Hospital, Boston MA which was using two separate databases
to track all activity related to operating room services.
One stand-alone system was used for scheduling and block time
allocations, while a VAX system tracked operating room service
utilization and provided information feeds to PATCOM for Part A
Hospital Billing. It
was difficult to combine information from both systems as imports
and exports were not possible without code modifications.
Hospital Administration desired ad hoc queries that
individual surgical services could conduct within their own offices
and maintain the billing interface.
Operating
Room Services
Staff Role Enhancements
Goal:
To shift non-professional anesthesia and patient care
duties to indirect care staff within a specified surgical area to
decrease room turn over time and patient preparation time. This
process was applied at the Brigham and Women's and Massachusetts
General Hospitals.
Description:
After several hours of observation and interviewing
all levels of the surgical
team, the roles of the Patient Care Assistant (PCA’s), Anesthesia Technician (AT) and Circulating RN, were
redesigned to maximize hands on time and proactive assistance to
the professional staff. Performance
expectations were developed and training conducted with all involved staff. Floor plans were
also developed for individual rooms to reduce equipment
maneuvering between cases. Additional
FTE’s were justified
and later approved to
augment the shift of duties from the circulating RN’s to the PCA
and reduce turnover time.
Program
Development
- Workers' Compensation
Goals:
| To design a streamline claims management program for workers'
compensation claims for Partners HealthCare System, a
Harvard-Affiliated Healthcare Network in the Boston Area |
| To identify a Workers' Compensation Management software system
compliant with the network's information technology platform |
| To create an implementation plan for internalization and
program development; dovetail systems and implement operations |
| To provide a smooth transition of claim payments and customer
service to employees at the time internalization occurs |
| To provide documentation if the implementation process and
knowledge transfer when the internal learning curve is at 100%
and the client is willing and able to provide project management |
Description:
Partners HealthCare
System asked HealthSystems
Redesign, Inc (HSR) to create a workers’ compensation program that
would manage claims for their employees at the Brigham and Women's
Hospital and the Massachusetts General Hospital.
Our client had identified opportunities related to moving
claims management from the TPA to within its own network. They had
two main objectives: 1)
Timely payment of claims to its employees and 2) Access to
information regarding all aspects of payment and injury information. There
were two main phases that needed to dovetail for successful
implementation of this program: system installation and operational
development. In
partnership with the Information Systems Department, Human Resources
Administration, and Occupation Health Services, and after careful
functional and cost analyses of available software packages, the
software program, ENVISION, was purchased.
HSR negotiated the lowest purchase price that included a
module for 32 users, data mapping, historical data conversion, and
implementation services support with a reduced annual maintenance
fee. The Workers’
Compensation Division needed to be created from ground zero, staffed
and integrated into the healthcare network.
This division needed to absorb the total functionality of the
TPA on a “go live” date and be familiar with 100% of all open
claims. A payment
process, which included cutting checks and reconciliation, needed to
be implemented as well.
Clinical
Registry
Goals:
To operationalize a newly
developed, burn registry information system to support internal
performance improvement activities as well as the clinical and
research information needs of a specialty teaching hospital. To
identify internal and external user needs, custom data fields, data
collection systems and report writing capabilities extracted from an
accurate, clinically based, information system.
Description:
Several
opportunities were realized to reengineer, improve and integrate
registry data into the hospital’s performance improvement and
medical staff risk
management activities. Data
collection tools specific to the hospital’s population,
systems for retrospective and concurrent data collection and
validation, as well as an internal process for ICD-9 and E-coding
(injury code) were
developed.
Database Management and
Creation of ACCESS Reports
For Hospital Infection Control
Goals:
| To provide the Infection Control Unit access to confidential intra-operative information maintained on the Operating Room Database |
| To update and maintain the Infection Control OR Database and provide automated scheduled reports predetermined by the Infection Control Unit and other regulatory agencies. |
| To provide database management documentation and report finalization |
| To train the Infection Control staff how to manage the database and create/run queries |
Description:
HSR worked with the Infection Control Unit of the Massachusetts General Hospital in Boston. Our clients required confidential data from the hospital's operating room database (SYBASE) to perform their surveillance programs. The problem was how to access the specific information they required to support their surveillance program, and communicate, in a timely fashion, to each surgeon their own statistics regarding their infection rates.
HSR created a download from SYBASE for a predetermined subset of case-data related to patient, procedure, procedure length, service, surgeon, and intra-operative antibiotic delivery and prepared a batched download that could be extracted on demand and transferred to the Infection Control database that we built in ACCESS. We integrated the download with the Infection Control Surveillance Database. A monthly download and management of the Infection Control OR Database was created.
Reports were created in ACCESS 7.0 to meet surveillance needs. Monthly and Quarterly Reports per Infection Control's Schedule was created to provide compliance with regulatory agencies.
Implementation
of HR/PR US and
Canada Application Systems
Goals:
To
trouble shoot and resolve new application development
problems and systems issues between the programmers and
the client, thereby reducing the client’s
in-house interruptions of regular daily business operations in medium to large
organizations. To
provide the resources to prepare and test payment, deduction and tax formulas of client selected applications. To manage
all phases of the
project life cycle.
Description:
As
the implementation consultants for several client - selected
systems, several payment and deduction formulas needed to be
created and tested. Conversion specifications were
developed and distributed to the programmers.
As the software required
fine tuning for client specific needs, requirements would
be gathered, specifications developed and outcomes tested. In
the cases where
production was scheduled for mid-year, conversions were often required for tax reporting purposes.
Cross mapping between
the clients existing system to the new product was
performed.
Medical
Staff Risk Management
Program Development
Goals:
To develop a system for
identifying, reporting, timely review, and trending of medical staff complications, patient care events
and outliers. To reconcile peer review activities into the
individual physician profiles for consideration in the
credentialing
process. To develop a
credible and functional medical staff risk management program
Description:
A complete revamping of service
specific complications, identification process and monthly peer review/morbidity and mortality
meeting format was
necessary. Color-coded
tracking sheets were created to capture events and subsequent
documentation. Activity was tracked, critical discussions held, opportunities for improvement identified and loop
closure achieved.
Credentialing
Goals:
To develop a system for tracking
medical and research staff information
for purposes of hospital and academic appointment and re-appointment incorporating internal, external and regulatory
requirements.
Description:
A computerized method for
tracking professional, narcotic, visa and other licensure requirements was developed.
Individual specialty
profiles (Anesthesia, Plastic Surgery, Pediatrics, etc.) were also
created to identify service specific and hospital quality
performance indicators.
Delineation of privileges (DOP) for each
specialty were also revised and in some instances reorganized
into core privileges. |
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