Center For Innovation
Unique Vision and Untiring Effort What really counts as innovation in healthcare? At Mission Health, our goal has been to deliver the latest innovations through the collaboration of a dedicated team of healthcare professionals. While it is important to reach for the proverbial stars in integrating the latest, cutting-edge technologies in healthcare, it is equally important to consider the feasibility, practicality, cost, and our patients’ needs when implementing any new healthcare solutions. This is exactly what Mission Health’s Center For Innovation (CFI) does. CFI is our healthcare think tank, that pilots, refines, and rolls out programs to better serve the community. The Center’s priority is enhancing the patient experience, and often focuses on how staff protocol and hospital systems can change in order to improve care. Center For Innovation Manager Randy Burkert notes the crucial aspect of innovation mentioned above: “While innovation starts with ideas and trying something new, the long-term goal must be a proven solution that is scalable and sustainable for the Health System.” In other words, feasibility and practicality are key to the Center’s work.
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Burkert adds that for the CFI to perform best, the size and scope of work must not become too expansive. “The Center for Innovation is small by design – we have a staff of four, which allows us to be flexible, resourceful, and adaptable,” says Burkert. “This also means t hat there must be intent focus, relentless prioritization, and collaborative support from external, dedicated sources within and external t o Mission Health, as well as financial support.” Supporters of CFI initiatives, however, are open to new ideas, and can visualize possibilities for products, programs, and services that will enhance the experience of the patient, clinician or any member of Mission’s healthcare team. The department is unlike many others in that supporters will need to take a metaphoric leap of faith. For instance, Patient Observer™ is a new-to-market technology, jointly developed with Cerner that has demonstrated a measurable reduction on inpatient falls. The data of the program’s success justify its funding now and into the future. CFI seeks support for projects such as these that are still in their pilot phase. Due to our unique goals, we are currently unable to provide Pro Formas, as is standard for most other departments seeking specialized funding for projects, but we plan to provide them in the future. Generally, Pro Formas will be created as projects progress from the trial to the roll-out stage.
The Center also provides support for, as they explain, “introducing, developing, and deploying innovative ideas” through education, connection facilitation with partners, business planning and feasibility analyses, case-by-case funding, and a partnership project with Western Carolina University. The Mission Health Center for Innovation seeks vital funding for a host of progressive programs.
Virtual Care is focused on the future of healthcare delivery. Innovation is focused on disrupting and transforming the future of healthcare delivery. - Marc B. Westle, DO Senior Vice President, Center for Innovation
Mission Health’s Center is tasked with a daunting assignment. The Center, according to their mission, “view[s] change as an exciting, positive opportunity for transformation, and exist[s] to encourage, support and develop ideas for innovative improvements in healthcare within the Mission Health System and beyond. From the way care is delivered, to the technology used to treat patients, the Mission Center for Innovation is here to link departments and accelerate product and process development.” The CFI exists to spark novel ideas, test them, refine and perfect them, and then introduce patientcentered technologies, processes, and systems to Mission Health. Initial belief in and support of the pilot process, however, are vital for the investment “buy-in”—the requisite financial needs—t hat makes such programs possible.
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The Cerner Patient Observer™ Those hospital patients at risk of falling, along with their families and loved ones, live with a constant worry: What if a fall occurs when the patient is alone? Falls occur as a result of patients becoming agitated and attempting to move independently. Currently, patients with fall risks far outnumber the “sitters” available to monitor them. The cost of an average injury resulting from a fall comes with the hefty price tag of $14,000 per fall. The Cerner Patient Observer (CPO) is a tool whose key component is similar to a video gaming system camera that captures players’ movements in order to make the game more interactive. The CPO system offers live streaming, which eliminates the worry that patients might have about whether their actions are being recorded. Technicians, with the help of the CPO 3D camera, can watch twelve patients from one location, and if a patient’s movements are sensed by the system, the technician can communicate with the patient via in-room audio to address the patient needs. Often, all it takes is a prompt to help a patient reconsider risky movement and request help from hospital staff. For more urgent patient needs, the monitor tech can contact the care team directly and dispatch them to the patient room. During the three month CPO pilot program, the patients monitored with CPO experienced zero falls. These results prompted a pilot extension to collect more data, which ultimately demonstrated a unit fall reduction of almost 40% with the use of only six CPO cameras on a 34 bed unit. This pilot study was submitted to the New England Journal of Medicine and published in their online NEJM Catalyst series for practical innovations in healthcare delivery. Randy Burkert, Center for Innovation Manager, is excited about the idea of using this technology at every regional hospital at Mission Health. All of the monitoring could be done from Mission Hospital, keeping the task centralized. Mission Health piloted the CPO program for three months with six cameras. 8,615 patient hours were monitored by staff, which is equivalent to $103,380 in one-on-one sitter costs. Mission Hospital has committed to deploying 60 additional cameras over the next six to nine months, which will allow for the monitoring of 84 additional patients. The implementation services, aside from Cerner’s optimal placing of cameras in the hospital, include a comprehensive, real-time communication system for fall notification, provision of sample forms and signage, a hardware list, training, camera data log provision, and ongoing support for after the Patient Observation program goes live. The time line for this project includes a six to nine month window for placement of the 84 cameras. As it concerns patient privacy, during the time the CPO pilot was being tested, nurses made sure to provide an educational explanatory component when talking to their patients about CP. Thus far, there have been no patient complaints.
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Using Technology to Solve a Recurrent Problem The CPO tool has been embraced by hospital staff, and other departments have requested the technology. Currently the specific cost is undetermined. Seven monitoring technicians will also be part of the funding requirements if CPO is to be successfully implemented. Cerner is working with Mission Health to offer the best system price possible, but even at a discount, acquisition of the CPO tool is a significant expense. There are many more possible uses for the CPO system including the monitoring of epilepsy patients, virtual visits, and intravenous drug abuse monitoring. The deployment of innovation in numerous and different contexts is what makes this project, and the work of Center for Innovation more broadly, exciting and unique. In terms of figures, the tentative sales agreement we have with Cerner includes the following costs: Licensed software (paid quarterly) Software support (monthly fees) Professional services for kickoff
$132,000 $1,320 $60,000
(20% of implementation fees, interface/integration testing completion) Successful completion of pilot testing First productive use Formal acceptance of product Equipment and sublicensed software (one-time fee) Shipping Installation (one-time fee)
$135,794.07 $1,913 (max) $5,400
TOTAL ONE-TIME FEES TOTAL MONTHLY FEES
$333,194.07 $1,320
(Please note: Cerner fees may increase if a third-party supplier increases fees to Cerner.)
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Tele-Wound Care Wound care is a ubiquitous and necessary service provided by certified Wound Ostomy Nurses (WOCN’s) in healthcare settings, who receive highlyspecialized training and certifications. In fact, the need for these services far outstrips the reserve of clinicians who are available to perform them. The tele-wound pilot project, under the auspices of the CFI, would allow certified WOCN’s to provide real-time consults via the use of a smart device (a smart phone, tablet, or Smart Glasses) in conjunction with bedside nurses. This is another example in which live-stream video and audio would be utilized to improve health outcomes. The benefits of this project’s implementation include: •We could exponentially increase the ability for more patients to receive care, which would increase the number of positive patient outcomes. •Complex wounds often necessitate patient transfers to Mission Hospital; tele-wound consult capability would significantly reduce the need for t ransfers. •Patients who live in remote areas could remain i n their community and care setting, yet still r eceive top-notch, WOCN-certified care. •In the future, patients who benefit from certified W OCN treatment include those under the care of institutions not within the Mission Health system. •Patients would be guaranteed time with a certified W OCN nurse within 24 hours.
Certified WOCN Staffing by the Numbers The Mission Health System now employs seven certified WOCN’s: six are stationed in Asheville, while another serves at Angel Medical Center. Unfortunately, there are no certified WOCN staff members that serve Mission Health’s other member hospitals. This shortage of certified WOCNs poses inconvenience and risk for patients, as well as increased cost for both patients and Mission Health. No solid statistical data yet exist on numbers of patients identified as needing certified WOCN services across Mission Health’s system. However, anecdotal information per nursing leaders puts the patient percentage—those who either already have wounds upon hospital admittance or develop them during hospitalization—at 10-15 percent, a significant percentage.
Trials at Mission Member Hospitals in Tele-Care Wound Treatment Currently McDowell Hospital and Blue Ridge Regional Hospital are participating in a tele-wound care pilot program. Certified WOCN’s working at the Mission St. Joseph campus use high definition video conferencing technology to connect through iPads with bedside caregivers at the participating hospitals. Though this pilot serves as our Proof of Concept (POC), potential implementation improvements have already been identified. One such improvement includes the need for nurses to work completely “hands free,” a current obstacle, as nurses must manually manipulate the iPad during consults. An ideal solution to this problem would be the use of Smart Glasses, which are wearable computers that allow nurses to record the same data as iPad technology. In addition, a higherdefinition video feed has been identified as a necessary improvement in the existing pilot program.
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Mission Health has been fortunate to receive a $20,000 grant from the American Nurses Credentialing Center and Sigma Theta Tau International Honor Society for Nursing for this project. This funding will prove pivotal in allowing us to test new Smart Glasses technology and collect data for development of an evidence-based practice implementation. While these funds will allow us to explore new care delivery model, we do not have the requisite funds to expand it beyond a single pilot location. The future of the tele-wound program is truly dependent upon its supporters, especially regarding the speed at which we might enhance the program’s tools and how soon it might be implemented in every Mission Health member hospital. Tele-wound care presents an opportunity to address the topographical challenges our region poses—in terms of the distance between our member hospitals. The vision for tele-wound is to expand beyond the Mission regional facilities and be able to provide care to patients in their immediate community, neighborhood or home. The tele-wound care project provides remarkably better patient outcomes through increasing access to care for patients and expanding the resources of the certified WOCN staff at Mission Health.
Virtual Visitation Mission Vision Central’s goal is to virtually connect patients, via secure, HIPAA-compliant video technology, to their families, friends, and physicians. The tools and applications utilized for this connection are the same ones currently used daily: smart phones, tablets, Skype capability, and others. The ramifications are profound when one considers the need for parents, spouses, and others to be involved in the care experience. Some specific examples of patients and support networks this technology will address are: • Parents who have a baby in the NICU; patient stays are typically weeks-long and parents could participate in a morning “check-in” with the multidisciplinary neonatal care team. • All supporters of a patient, from family members to caring coworkers, could visit the hospital room virtually. • Often it behooves a patient to have a companion at doctor’s appointments to take notes and ask questions. This technology would enable that support to continue, even when the “support person” is remote. • Since Asheville is a tourism center and retirement destination, there is the potential for patient visits from distant locations. This would ease a great deal of familial and patient tension that accompanies hospitalization. Additionally, the CFI is investigating how this technology may benefit other cohorts of patients: namely, female inpatients hospitalized as a result of domestic violence or assault, who would benefit from the ability to remotely connect with courthouse staff/judges to obtain an emergency protective order. This technology would enable behavioral health staff members to communicate via secure video conferencing, and thus integrate a key component in our goal of providing holistic patient care.
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Financial Needs At this point, the CFI has very few resources available to pursue this project, especially if they were to research purchasing an all-inclusive system that would provide for service, training, technology, and other needs. They are, however, working with Cisco, an inhouse vendor partner, on designing a system that would work within the current infrastructure. Because of this constraint, generous donor support would make a very measurable difference in the following ways: • A new prototype needs to be designed. • The prototype program should be built with attendant technology and staff needs in mind. • Trial the prototype (The CFI philosophy involves trying new concepts, failing at some, and redesigning and refining t he priorities that truly define innovation.) • Though the CFI is still in the pre-POC stage, the most significant anticipated costs for the program will be the required technology, including computers, cameras and mobile carts, and software and security program costs. • The CFI’s most immediate project-related research must focus on how technology fits within current infrastructure and gap analysis. • A very important investment will be thorough and failsafe cybersecurity for the program, as hackers attack hospitals regularly.
The Virtual Visitation program will be a “win-win” for all involved—patients, those in their support networks, clinicians, and project supporters. The Center for Innovation intends for this service to be free of charge to patients, ensuring that access to this major quality of care enhancement will be available to all.
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Versabadge Real Time Location Systems (RTLS) is a technology with myriad potential uses in healthcare settings. It is a tool for monitoring data which aids hospitals as they study efficiency within their institutions. Versabadge is a RTLS that develops and implements medical instrument, electronic and staff tracking systems. Hospitals environments aren’t static and work priorities are constantly changing. Thus, RTLS tools such as Versabadge, have the capability to track movements as they happen, as well as quantify movement and use in a manner that has previously proved impossible. Since specialized medical equipment is so costly, and physicians must often share a limited number of tools, it is important the items stay in the building. Versabadge ensures that they do, and also monitors how much of said tools are used. From the smallest surgical tool to a machine that performs scans, Versabadge ensures that hospitals instruments are tracked, receive regular maintenance and are available for clinicians.
Versabadge allows hospitals to assign one person to manage a hospital’s vast materials assets electronically. For example, with Versabadge technology, a hospital staff person could identify how many recalled beds are in the hospital, and pinpoint their whereabouts for expedited relocation. Versabadge also functions as a computing mechanism for observing the time an Emergency Department provider spends on patient care as opposed to tasks that do not fall under patient care. We know that at critical access hospitals, time not devoted to patient care is reimbursable and can add up to as much as $100,000 (or more) annually at each hospital. We hope to install Versabadge technology quickly in all Critical Access Hospitals. Versabadge is adaptable and can be used for the following functions: • Condition monitoring (lab specimens, blood bank units, etc.) • Compliance assurance for time-based reporting • Asset management, as mentioned above • Patient flow • Staff tracking • Smartphone proximity applications • Smartphone sign-on and proximity sign-off • Hospital way-finding
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In late June, the CFI piloted a program that analyzed ED provider tracking for CMS cost reporting reimbursement. The trial was performed at Transylvania Regional Hospital. The pilot was quite successful and the data collected will help to quantify Versabadge’s value. Fortunately, during said pilot, we worked closely with the developer of Versabadge, who has taken care of the bulk of the up-front cost. Our primary objective now is to prove how well Versabadge works in diverse applications, and to illustrate its consistent accuracy. Mission Health aspires to adopt the tool and institute it in many places within the health system; it would be at this juncture that Mission Health would assume financial responsibility for Versabadge. Some notable advantages of Versabadge technology include: • Versabadge requires significantly less infrastructure and staffing changes for successful implementation than other similar solutions. • Versabadge is currently leveraging Bluetooth Low Energy technology which makes installation easy, offers superior technical accuracy, and is extremely cost effective – no other commercial vendor is offer ing Bluetooth Low Energy technology at this time. • The product, as its name implies, is versatile—it is easily adaptable to the diverse needs of the many different departments that constitute the Mission Health system. • The Versabadge vendor is creating software that will be not only user-friendly, but customized for various departmental needs.
Financial Needs There is no Pro Forma for this plan yet, because we do not possess the requisite information—a familiar byproduct of innovation. Charting new territory automatically implies that some of the financial pieces take more time to assess than more conventional projects. A preliminary list of needs and their costs (per Critical Access Hospital ED), if we were to adopt Versabadge, is as follows: Equipment and hardware: $15,000 (one-time fee) Software and professional service fee: $12,000 (one-time fee) Hardware and software maintenance: $4,000 (annual cost) *Please note: It is too early to provide an accurate cost estimate for installing and supporting an entire Critical Access Hospital.
Final validation testing to complete the Proof of Concept is ready as of November 1, 2016, with a goal of sharing quantifiable information for each example of use by April, 2017. The system-wide adoption and use of Versabadge by many Mission Health departments will drastically increase efficiency and produce significant cost saving. In turn, more efficient hospital processes and cost savings translate to higher quality patient care. When clinician and staff performance improves as a result of these enhanced systems, patients are the direct and immediate beneficiaries.
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The Center for Innovation: If at First You Don’t Succeed… The Center for Innovation’s mission is, at its most basic, to evaluate and trial new and transformational ideas and adapt them to Mission Health’s needs. As with all experiments, some will work, but many won’t succeed their first time around. It takes persistence and a unique vision to understand how a system or tool contributes to better healthcare. An investment in the Center for Innovation shows a strong commitment to out-of-the-box thinking and imaginative problem solving. As the inventor Thomas Edison famously quipped, “I have not failed. I’ve just found 10,000 ways that don’t work.” This spirit of the thinker-tinker, a uniquely American quality of willing to try and try again, informs both the work of Center for Innovation and Mission Health. Innovation in any field requires imagination, dedication and a certain fortitude—a belief that better, perhaps even revolutionary, solutions are out there if we have the patience, diligence and aspiration to find them.
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