Using Multi-Hospital Laboratory Integration to Improve Lab ...Hub & Spoke Design HF-MWAR HF-WH HF-KG...
Transcript of Using Multi-Hospital Laboratory Integration to Improve Lab ...Hub & Spoke Design HF-MWAR HF-WH HF-KG...
Using Multi-Hospital Laboratory Integration to Improve Lab
Outreach SuccessJohn Waugh
Henry Ford Health System, DetroitExecutive War College, New Orleans 4/28/09
Henry Ford Health System
Integrated HealthcareDelivery System
Integrated HealthcareDelivery System
Financing of Health CareFinancing of Health CareHealth, Lifestyle & Alternative Med ServicesHealth, Lifestyle & Alternative Med Services
Home Health ServicesHome Health ServicesPrimary & Preventive CarePrimary & Preventive Care
Ambulatory CareSpecialty, Multi-specialty
High Technology
Ambulatory CareSpecialty, Multi-specialty
High Technology
Long-Term CareLong-Term CareSpecialized HospitalsSpecialized Hospitals
Acute CareHospitalization
Acute CareHospitalization
TertiaryCare
Hospitalization
TertiaryCare
Hospitalization
Research & Education
Now: Henry Ford Health SystemNow: Henry Ford Health System• Southeast Michigan• 22,000 employees• 7 hospitals, 40 ambulatory cntrs • 11 million billed lab tests (2008)
• Beds: 2,495 Admissions: 88,984 • 3 million clinic visits• 1100 physicians, 3rd largest multi-specialty group in US• >1500 partner community docs• HAP insurance, 540,000 members• $62M research funding, 3rd largest NIH $ in Michigan• Leap Frog Group- ‘Top 41 safest hospitals’• Thompson Reuters ‘100 Top Hospitals- Performance Improvement• 101 ‘Best & Brightest Places to Work’• Crain’s Detroit Business- ‘Coolest Place to Work’
HFHS Alignment - LEAP 2008Henry Ford Health System is a unified, integrated organization bringing
value to its patients, communities, members, physicians, employees and business units through:
Delivery of the highest quality of clinical care and personal service with aligned goals and standards of performanceA focus on coordination of services across the continuum of care to achieve a patient care experience that is appropriate, aligned and seamlessA culture of innovation and learningCoordinated growth strategies and brandingInformation technology that enhances patient care, increases theefficiency of administrative processes and supports clinical integration across the SystemProviding a world-class environment for employees and physiciansto practice their professions, expand their skills and talents and develop their careersMarket strength with a unified contracting strategy
HF-WBH
24/7
24/7
HF-COT
HF-MWARHF-KG
HF-MAC
24/7
HFH
HF-WH
Current Service Locations
Hospital24 Hr. Med CenterMedical Clinic
24/7
Integration NO
• Advertising• Signage• Annual Report• Insurance Products
Integration YES
It takes systems to integrate Systems
Pathology Billed Test vs Labor Equivalents
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400000
600000
800000
1000000
1200000
1400000
1600000
1800000
Mar-02
Jun-0
2Sep
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n-03
Sep-0
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7Dec
-07
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Jun-0
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Bille
d Te
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by Q
uarte
r
0.0
20.0
40.0
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80.0
100.0
120.0
Labo
r Equ
ival
ents
billed test LEQ
2002 2008
HFHS Pathology Financials75 CLIA Certificates, 663 FTEs
(millions) ServiceLine
HFH HFMG COT WBLM WAR WYAN CL TWP
Gross Rev $575 $346 $24 $6.8 $0 $32 $75 $55
Net Rev $207 $125 $8.4 $2.4 $0 $12 $27 $20
Sal/Beni $49 $28 $6 $1.0 $0 $3 $4.4 $4
Non-Labor $46 $22 $3 $1.5 $0 $3 $5.8 $5.5
Tot Exp $93 $48 $9 $2.5 $0 $6.1 $10.3 $9.3
Net Inc/GC $114 $77 ($0.5) ($0.1) $0 $5.4 $17 $11
HFH/HFMG Lab Retirements & HFWBH Hires - 2002 to 2049
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5
10
15
20
2520
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2004
2006
2008
2010
2012
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2016
2018
2020
2022
2024
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2034
2036
2038
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Year
Num
ber o
f FTE
sW. Blm Hosp Hires
HFH / HFMG RetirementsIncremental Certified Technical Staff Only
NOW
Pathology & Laboratory MedicineService Line (PALM)
Pathology & Laboratory MedicineService Line (PALM)
• All hospital Lab Service Line created 2001• Extension across system- 2008• “Accelerate one lab enterprise across system”• Corporate entity, CEO Liaison• Under leadership R. Zarbo, Senior VP• “Centralize to every extent possible”• Single capital pool• Cascading approach as LIS permits, on a timeline• New Hospital Lab now a ‘Stat Lab’ concept, space,
capital costs
Hail Augustus
HF-WBH
24/7
24/7
HF-COT
HF-MWARHF-KG
HF-MAC
24/7
HFH
HF-WH
Current Service Locations
Hospital24 Hr. Med CenterMedical Clinic
24/7
HF-WBH
24/7
24/7
HF-COT
HF-MAC
24/7
HFH
Hospital24 Hr. Med CenterMedical Clinic
24/7
Hub & Spoke Design
HF-MWAR
HF-WH
HF-KG
Molecular Pathology and Genomic MedicineMolecular Pathology and Genomic Medicine
Laboratory Director , PhD
Division Head,, MD
Advisory Members-Division heads and section chiefs
TransplantationInfectious Diseases Hematopathology Oncology IdentityPharmacogenomics
GonorrheaChlamydiaHIV quantHCV quantHCV qualMyco TB
Myco Av IntMyco
GordoniCMV
HSV 1 & 2MRSA
HLA class I & II
genotyping
Warfarin*CYP2C9-2CYP2C9-3VKORC1
NeoplasticJAK2
BCR-ABL major &
minor brkptsPML-RARA
CBFb-MYH11AML-1ETO
FLT3B cell IGH
TCR-gammaBCL2-JH
CoagulationFactor V (Leiden)Factor II
(Prothrombin)MTHFR
BrainMGMT
1p19q LOHLungEGFR
Ob/GynGestational
disease Colorectal
MSIMLH1
Tumor AssocEBV
Tissue &Patient Identity
HFWBH
24/7
24/724/7
HFCOT
HFMWARHFKG
HFMAC
HFHS LABTri-County
OUTREACH RING
P.A.L.M.SYSTEMCORE
&ESOTERIC
LAB MODEL24/7
CORE
HFWH
Laboratory Outreach Brand
Pathology & Laboratory MedicineService Line (PALM)
• PALM Principles
• Business Plan,
• Timeline & Schedule
Value Drivers
Focus on 20% of actions that will drive 80% of the economic value for the organization.
- With highest probability of success- In shortest period of time
Value Drivers• Requests for new tests should be reviewed for clinical value
and economic impact.
• Compare all hospital test menus with W. Bloomfield Hosp Menu
• Align proficiency testing orders with test menus
• Realign position management to PALM Service Line
• Review consumable contracts for aggregation and price protection.
• Catalogue all existing Lab Outreach testing
Value Drivers• Review and approve Capital needs as a Service Line
• Develop and trend internal Quality Management Metrics
• Review and understand professional staff duties by site
• Roll-up financial reporting and craft fair transfer pricing
• Create targeted communication to stakeholder groups
• Consider recommendations from Wellspring Partners
Value Drivers• Review and approve personnel requisitions at the PALM level
• Reassign professional staff contracts to PALM
• Unify all Laboratory Outreach under one brand….HFML
• Build-out Lab Portal to support Lab Outreach
• Review all service contracts for effectiveness and savings
• Redefine best practices in the new conditions
Value Drivers• Repatriate revenue from reference laboratory testing
• Repatriate revenue from prof Pathology contracts: Part A
• Repatriate revenue from prof Pathology contracts: Part B
• Migrate Clinton Twp to enterprise-wide LIS systems
• Tie LIS to Macomb choice of Careplus or Powerchart
• LEAN management to all PALM Service Line
Valu
e Driv
ers
1 CETAC review for new test services
2 Test Menu Review HF-WB as baseline
3 Realign position management to PALM Service Line
4 Consumable contracts PALM review & approval
5 Catalog all existing Lab Outreach
6 Capital PALM review & approval
7 Quality management metrics
8 Professional Staff Duties
9 Financial roll-up corporate with transfer pricing
10 Communication to Stakeholders
11 Wellspring Partners report
12 Personnel requisition approval
13 Professional staff contracts, reassign to PALM
14 Unified Lab Outreach to HFML
15 Service contract review
16 Best Practices redefined for New Conditions
17 Build-out Lab Portal
18 Repatriate $$ Revenue from Reference Lab Tests
19 Repatriate $$ Revenue from Professional Referrals
20 Align Proficiency Testing orders with test menus
21 Repatriate $$ Revenue from Part B to HFHS
22 LEAN management to ALL PALM Service Line
23 Macomb Clinton to Shared LIS
24 Clinton Lab results to CarePlus or Cerner Powerchart
SvcLine
IT $$$
• Value Drivers (24): Quality, Cost, Service– Economic Impact vs. Probability of Success
• Timeline– 20% of activities that drive 80% of Value
• 90 days• 180 days• 365+ days
• Implementation Drivers– No items require new $$ in 1st 150 days
Value Drivers
$
Probability of Success
Economic Impact vs. Success Probability
$ $ $
probability probability probability
90 days 180 days 365+ days
12
34 7
5 8 9
6
10
11
1215
14
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1617 19
24
18 20 22
21
23
Establish 3 fast moving teams
257
Test menu reviewCatalog existing OutreachQuality management metrics
Establish 2 teams
14 Unified Lab OutreachBest Practices16
Establish 1 team
22 LEANManagement
Pathology Service Line Launch
• Communication to Stakeholders– Internal
• Staff, physicians, leadership– External
• Physicians, vendors
• Savings Strategies & Growth Strategies
• Quality Management
Customers
• If Customers are not on the top of your priority list, re-do the list.– We can’t grow new customers and discard
old customers – Every customer is unique– Emphasizing customer satisfaction is a
common concern for all of us and a way to align us
Service Commitment• On-site pathologists• 24X7 pathologist and supervisor on-call• Sub-specialty coverage and consultation
– Surgical pathology• double read breast & prostate, 2nd opinions
– Clinical pathology• microbiology, chemistry, blood bank, hematopathology
• Common trended quality metrics• Centralize esoteric tests & autopsies• Implement LEAN management• Expand Outreach
HF-WBH
24/7
24/7
HF-COT
HF-MAC
24/7
HFH
Hospital24 Hr. Med CenterMedical Clinic
24/7
Centurions, Legion Commanders & Legionaries
HF-MWAR
HF-WH
HF-KG
Centurions
Fixed & Mobile Army
ALL ROADS LEAD TO ROME
TURN-AROUND TIME (TAT)
CAP ACCREDITATIONREQUIRED
Emergency Room TATCBC, Troponin, BMP, PT, PTT
STAT TEST TATChem, Heme, Coag, Urinalysis
Frozen Section TAT
Biopsy TAT (Small or Simple)Resection TAT (Large or Complex)
Cytology Non-Gyn TAT
Cytology PAP Smear TAT
Cytology ASCUS/HG PAP + HPVBlood Culture Contamination
Critical Value Reporting
Customer & Staff Satisfaction
Quality Management Metrics
Growing Outreach
• Start with Large In-Reach Base
• Lower Unit Cost for All
Mass ProductionMass Production
•Continuous Production
•Conveyor belt assembly line
•Division of labor
•Simple repetitive tasks
•Integrated supply chain
•Standardized parts
•Reducing waste
Lab Outreach
• Market Opportunity Assessment• Gap Analysis (fresh set of eyes)• Web Portal• Legal Structure• Add New Talent to lead Outreach
You can train a dog to climb a tree, or you can hire a squirrel
Sr. VP & Chair,
Pathology & Lab Medicine
EVP & COO HFHS
Office of PALM
Med & Admin Directors
System DirectorAnatomic Pathology
System DirectorClinical Pathology
Vice Chair, HFH
EVP & CEO HFMG
System Director Laboratory
Operations / COO
PATHOLOGY AND LABORATORY MEDICINE
HF CottageManager
HF Macomb Clinton Twp
Med. Dir.HF Macomb
Clinton Admin Director
HF W. Bloomfield
Admin Director
HFMG Regional
LaboratoriesMed. Dir.
HFMG Regional Labs
Manager
HF Macomb Warren
Med. Dir.HF Macomb
Warren Admin Director
CEO Liaison
HFH Admin
DirectorHFML
Manager
HF WyandotteMed. Dir.
HF WyandotteAdmin
Director
System Director Lab Operations / COO
Lab OutreachHenry Ford
Medical Laboratories
Med. Dir.
HF HospitalMed. Dir.
HF Cottage Hosp
Med Dir
HF W. Bloomfield Med. Director
Lab System Org StructureLab System Org Structure
Advisory Groups: Strategic Planning, Leadership, Quality Mgt, New Technology, Informatics,CLIA Lab Directors, New Test Services (CETAC), Accreditation
Administrative Leads Focus On: Human Resources Finance/Budget Purchasing, Info Technology
Sunquest / CoPath Histotrak
MASAqueduct
Middleware
LAB PORTAL Atlas
APOLLO Pathpacs
Scantron
LAB USER’S GUIDE
pathology.hfhs.org/lug
TELEPATHOLOGYLeica
− Store AP Req Scans− Store Clin Path Req Scans− Integrate External AP Results− Telepath Integration− Associate Imaging to Reports− Interface to acquisition devices
Cameras (1-2 M records/yr)- Gels- Microbiology
− Surg Path Reqs− Cytopath Reqs− Clin Path Reqs− Outreach Documents
− HFWBH
PathInformatics 032309
SCANNING
TISSUE BIOREPOSITORY
DOCUMENT CONTROL
Master Control
HEALTHSTREAMTraining
Competency
Wired
Seamlessness Seamlessness Pathology Service Line
Attributes
COT HFH HFMG HFMacomb
HFMacombWarren
WYH
Common Trended Quality Metrics X X X X X X
Enterprise-wide Lab Info System X X X X X
Lab Courier Shared X X X X X X
Esoterics to HFH Core Lab X X X x AP X X
Reporting to Common EMR X X X X X
Common Reference Lab – MCL X X X X X X
Centralized Blood Sourcing X X X X X X
Lab OutreachHenry Ford Medical Labs
X X X X X X
Pathology Consult In-Source X X X X X X
LEAN Management X X X X X X
Electronic Document Control X X X
Common Web Presence X X X
On-Line Lab Test Catalog X X X X X
Capital and Consumable Contracts X X X X X X
Key Changes 2004-2008Key Changes 2004-2008Organized visual, workflow, priority specimen workstreams
Key Changes 2004-2008Key Changes 2004-2008Laboratory structural redesign, work cell design & standardization
•Linear flow•U-shapedindividualworkcells
2
1
4
3
Requisition
Specimen container
Tissue cassette
Glass slide
Current Gross Lab Process Map
PC PC
PCPC
CassettePrinter
Scanner
Table
1
2 3
4
Microscope
BucketsProblem
Specimens
PCPC
PCCassettePrinter
To Histology
Storage
Storage
Transcription
1 4
2 3
StorageCutting Station 2ComputersSpecimen BucketsCassette PrintersCutting Station 4
Delays
Cutting Station 3Cutting Station 1
To Gross Lab
To Gross Lab
Tags
Cutting Stations
Tag Entry
Accession
SMART
Scanner
Accession #1Scanner Cassette
PrinterCassettePrinter
Accession #2
Specimen Rehab
Specimen Tracking
Cutting StationsSort Station
Color CodedBuckets
Histology
Storage
Accession & Gross Lab Process Flow Map“following the work”
Next Steps
• What we need from you as leaders– Your behavior is a role model, your shadow– Embrace & champion the change, THINK BIGGER– Communicate extra positive messages
• To your staff• To your clients
– Rid rumors & fear…Communicate– Contribute to transition teams– Be patient, we will get there together, playing well
on a larger team
Lessons Learned• It takes systems to integrate Systems• Value Drivers, move quickly• Align incentives, follow the money• Economy: We’re all running at redline
• Challenges: – Traditional Return to Silo response– Couriers, IT, Capital availability
Q & AHenry Ford Hospital Detroit Campus