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Collaboration-enabled healthcare enterprises – Part 4

By Dr. Dennis Schmuland, Chief Health Strategy Officer, Microsoft on February 24, 2016

Filed under Health

How Adventist Health System democratized innovation


In the last post, Collaboration-enabled healthcare enterprises. Part 3  How Advocate Health democratized innovation, I talked about the urgency for health systems to find and rapidly implement high leverage innovations across the organization to gain share and reduce waste to mitigate their contracting margins.  I also talked about how the conventional knee-jerk boardroom strategy to accelerate innovation is to fund the creation of a new innovation department.  But the time and scale limitations that those innovation departments suffer from limits them from generating the volume of process innovations necessary to expand their margins.

Collaboration-enabled healthcare enterprises
4-part series

Part 1 – The new value currency of healthcare in a post-EHR world: Conversation
Part 2 – Texas Health Resources: The socially savvy enterprise
Part 3 – How Advocate Health democratized innovation
Part 4 – How Adventist Health democratized innovation

I also stated that I’ve found several leading health systems that have overcome the limitations of the innovation department and found a way to democratize innovation across their enterprise.   These leading health systems had three things in common.  First, they’ve empowered their frontline teams to reinvent both clinical and non-clinical processes by challenging them to leverage the content, communication, collaboration, and analytics platforms within Office 365 to reinvent productivity and reimagine teamwork.  Second, they’ve deployed Office 365 across the entire enterprise to empower both clinical and non-clinical teams.   And third, these health systems think differently about their EHRs.  While most health systems look to their EHR vendor to support team communication, coordination, and team-based care, these leaders look beyond their EHR for higher leverage innovations.  As a result, the frontline teams of these health systems are not only generating the volume of innovations to improve quality and remove waste and inefficiencies, but they’re also proving the impact of those innovations within their live work environments. 

In the last blog I showcased Advocate Health Care as an example of a health system that’s liberated innovation from the confines of the innovation department and democratized innovation across the enterprise.  This blog spotlights Adventist Health System as another market leader that’s achieving surprising results by democratizing innovation.  I recently had the privilege of sitting down with Herb Keller, CIO for AHS-IS, Adventist Health System’s IT department, to find out how they were leveraging Office 365 to drive organic innovation across the enterprise and what innovations from their frontline teams may have come as a total surprise.  Below is a transcript of my conversation.

Schmuland: Could you briefly describe Adventist Health as an organization, your footprint and your journey to becoming a collaboration-enabled healthcare enterprise?

Keller:  Adventist Health System is a faith-based health care organization headquartered in Altamonte Springs, Florida, with 44 hospital campuses across 10 states.  Our 78,000 employees maintain a tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.  To-date, we’ve now empowered 60,000 employees with Office 365 in every one of our 44 hospitals across those 10 states.

Schmuland:  While most of your colleagues and competitors seem to be dragging their feet on their journey to the cloud, it appears that Adventist Health is fully embracing the cloud and leveraging Office 365 in ways that other health systems haven’t yet begun to imagine.  You’ve managed to exploit the advantages of Office 365 as a platform to support team communication, coordination, and team-based care alongside and in conjunction with your EHR.  And, unlike many of your competitors, you’ve aggressively rolled Office 365 out to both non-clinical as well as clinical associates.  Since your enterprise-wide roll-out, have you seen any innovations come from the frontline that surprised you?

Keller:  Yes, we have seen quite a few innovations from the frontline that we’d characterize as pleasant surprises—in three areas:  the speed and efficiency of patient flow, elimination of duplicate technology, and real improvements in the productivity and coordination of clinical teams.

Schmuland:  I’m interested to hear what you’ve done to improve the speed and efficiency of patient flow.  When most health systems think about improving patient flow, the first thing they turn to is what’s often referred to as “EHR optimization”.  What has your approach been?

Keller:  Our outpatient teams quickly picked up on the value of using IM to improve patient flow.  For example, IM and presence now enable them to have ad hoc conversations throughout the day from wherever they are– so they work in sync better as a team and depend far less on the phone or overhead page–which reduces the number of times in a day they’re interrupted.  When physicians need a test, assistance, or are finished seeing a patient they IM their assistants rather than stepping out of the room to find them.   Patient flow is faster because team members can now find each other more quickly and make handoffs to each other within seconds instead of minutes.

Another area we saw flow improvement was in inpatient imaging.  In the past, if a physician ordered an MRI scan, the patient would automatically be scheduled, only to find out when the patient arrived in the imaging suite that they weren’t even eligible for the scan because that had a contraindication like clips or metal implants.  Now a nurse brings an iPad or a cart with Skype for Business in the patient room to allow the imaging team to remotely interview the patient for contraindications using videoconferencing without needing to leave the imaging suite.  As a result, the imaging department has reduced the cost of late cancellations and patients are discharged sooner because the right alternative test is now ordered instead.  This makes the entire process much faster and more comfortable for the patient.

Schmuland:  You mentioned that your Office 365 deployment has enabled you to eliminate duplicate technology in surprising ways.  Could you expound more on that?

Keller:  Sure.  We’ve eliminated duplicate audio, webconferencing and 1-800 long distance costs by standardizing on Skype for Business as a single enterprise-wide platform for audio and webconferencing.   Plus we’ve reduced some of the hidden costs of video conferencing because we no longer have to use a central scheduling desk to reserve rooms.  We’ve also been able to eliminate the need for a technician in the room when videoconferencing is needed.  It just works.

And I can’t overemphasize the unexpected value of making the most current capabilities of Office 365 available to every end user.  Because of our large and varied environment, we’ve traditionally found it challenging to keep our Office products current.  But once we moved to Office 365 it gave us the ability to roll out the most up-to-date features and security protections to our 44 campuses across 10 states.

Another example is in the realm of virtual health. Several of our facilities are now using Skype for Business for psychiatric evaluations, which allows the evaluations to hit the chart sooner and the patient to receive the care they need more quickly.  In the Chicago area our behavioral health teams are using Skype for Business for telepsychology sessions to avoid the delays in scheduling and travel—for both the patient and psychologist.  And in Kansas City, they’re now conducting behavioral health consultations within the hospital from the remote offices of our psychologists.

Telestroke is another area where we’ve eliminated duplication.  For remote neurologist consultations for possible strokes in the ED and even stroke observation, we used to roll in a customized telemedicine cart.  Now we just use an iPad or a laptop with a front facing camera on a cart and our centrally located neurologists and neurosurgeons use Skype for Business for their consultations.  Because we’re already licensed for Skype for Business, we can now offer telestroke and telepsych services to more of our rural hospitals without incurring the high costs of custom telemedicine cart solutions.  Patients really appreciate getting specialist care without needing to schedule another appointment or needing to go to another facility.

Schmuland:  Health professionals today must know more, do more, and manage more patients, cases, and complexity.  This means that, to do their job efficiently, safely, and effectively, health professionals have to quickly and easily find and tap the expertise of others, often while they’re on the move in a fast-paced work environment.  How have your clinical teams improved their efficiency and ability coordinate care with Office 365?

Keller:  As I mentioned earlier, we’ve standardized on Skype for Business for all of our IM, presence, audio, and video conferencing across our 10 states.  This means that our employees and teams can easily schedule recurring and ad-hoc meetings and share their desktops anytime they want.  Presence and instant messaging has now been adopted by every business division including clinical, finance, and operations—so everyone can now find each other faster and almost effortlessly and get the messages out or the help they need within seconds.  We’re also seeing a rapid uptake in web conferencing by physicians reaching out to other physicians all over the country.

Another productivity consideration for our clinical staff has been the growing volume of administrative meetings, training sessions, job candidate interviews, and calls they have to attend.  For clinicians, every meeting potentially takes away from patient care time—and clinician time is costly.  With Skype for Business we’ve been able to convert many of those in person meetings and trainings into virtual meetings and reclaim a lot of that administrative time for patient care.  Instead of getting in their cars and driving—and then parking and walking–to these meetings, our clinicians can attend or start a meeting with a single click from their phone while in their car or laptop if they’re at work or home.

You mentioned that clinicians have to know more and do more than ever.  That’s definitely true.  And to know more and do more they need to be able to tap the expertise of others, in real time when possible.   Many of our physicians are reaching out to and tapping the expertise of their physician colleagues all over country using audio and videoconferencing in Skype for Business.  And we have a group of cancer researchers that are collaborating with each other by using OneDrive for Business with rights management to securely access and share files across their various devices.  OneDrive for Business has saved them the time, frustration, and compliance risk of using unauthorized consumer cloud file shares.

We’ve also improved the productivity of our patient sitters.  In the area of simple patient observation, Skype for Business is enabling our patient sitters to observe more high risk patients at a time from a central location, eliminating the need to locate physically in the room with each patient. We’ve also improved the productivity of our IT help desk teams by using desktop sharing to troubleshoot issues or assist with application navigation or feature issues that our clinical and non-clinical staff have across our 44 campuses

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