Davin Lundquist, MD CMIO Dignity Health Medical Foundation Case Study: "Leveraging technology to build an organizational strategy fostering staff competency & physician satisfaction" Health IT systems will never please all users however providers are employing strategies that can significantly improve user satisfaction. Staff re-education and continually measuring the effectiveness of initiatives can make a positive impact on an organization’s ability to realize gains with IT. This presentation will explore Dignity Health’s lessons learned and organizational strategy to ensure staff competency levels and physician satisfaction. Dignity Health is a family of more than 60,000 caregivers and staff delivering excellent care to diverse communities across 17 states. Founded in 1986 and headquartered in San Francisco Dignity Health is the fifth largest hospital provider in the nation and the largest hospital system in California.

1. Organizational Strategy to
Address Staff Competency
and Physician Satisfaction
Davin Lundquist, M.D.
Chief Medical Information Officer
Dignity Health Medical Foundation
1

2. “Better to remain
silent and be thought a
fool than to speak and
remove all doubt.”
- Abraham Lincoln
2

3. Dignity Health (formerly Catholic Healthcare West)
• 5th Largest Hospital Provider
in the Nation
• 60,000 caregivers and staff
across 17 states
• Founded in 1986 and
headquartered in San
Francisco
• 1200 Employed Physicians
• 10-12,000 Affiliated
Physicians
3

4. Outline
• My Informatics Journey
• DH Medical Foundation Story
• New Organizational Strategy
• Technologies Deployed and/or Envisioned
• Lessons Learned
4

5. 5

6. Family Medicine Residency
Naval Hospital in Bremerton, Washington
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7. Microsoft Access Database
“EMR Lite”
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8. Microsoft Access Database
8

9. Microsoft Access Database
9

10. Naval Ambulatory Care Clinic
Ventura, California
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11. Navy EMR
11

12. Navy EMR
12

13. Ranks #1 in Obesity
Mississippi
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14. Magee General Hospital
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15. Centers for Family Health
Ventura, California
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16. “Cut the Cord” to Paper Charts
16

17. On day 1, there were No Charts
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18. • 550+ Physicians
• 10 Medical Groups
• Multi-specialty
18

19. 19

20. • Upgrade from v10 to v11 in Summer 2011
• Felt more like a downgrade
20

21. “I had some eyeglasses.
I was walking down the
street when suddenly
the prescription ran
out.“
- Stephen Wright
21

22. Root Cause Analysis
• Following the v10 – v11 upgrade, all sites participated in a Root
Cause Analysis (RCA) exercise to understand what went wrong
and take those ‘lessons learned’ and apply them to ensure the
current environment, future releases and upgrades are
successful.
• The ultimate goal of this exercise was to provide better patient
care, provider and staff satisfaction.
• One of the causes that was identified was our Organizational
structure was not equipped to meet the demands of the
upgrade process
22

23. Diginty Health Dignity Health
Medical Foundation IT Connectivity
IT
Manager
Help
Desk Software
Learning
& Analysts
And
Clinical &
Development
Application Implementation
(Training)
Support Support
Team
Dell Field Service
Team
(Hardware)
23

24. Took a trip to Sharp
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25. President & CEO
Chief Medical
Information Officer
EHR Operations
Director Director
Physician Clinical Informatics Physician Clinic IT
Practice Health
Integration Information
Executive Executive
Executive Executive Executive Director, Executive Director Executive
Director
Director, Director, Greater Bay Director, Stockton, Grass Director,
Bakersfield,
Sacramento Woodland Area Ventura Valley North State
Merced
Clinical Clinical Clinical Clinical Clinical
Informatics Informatics Informatics Informatics Informatics
Manager Manager Manager Manager Manager
Clinical Clinical Clinical Clinical Clinical
Support Suppor Support Support Support
Specialist Specialist Specialist Specialist Specialist
Clinical Clinical Clinical Clinical Clinical
Support Support Support Support Support
Specialist Specialist Specialist Specialist Specialist
Clinical Clinical Clinical
Support Support Support
Specialist Specialist Specialist
Clinical Clinical
Support Support
Specialist Specialist
25

26. Clinical Informatics Managers
Clinical Support Specialists
• First line of defense
• At the elbow
• Single source of truth
26

27. Chief Information Chief Medical
Officer (EVP) Officer (EVP)
Chief Medical
Vice President
Information Officer
IT Connectivity
(VP)
Director Director Director
Director
Community HIE & Data Patient Engagement
Physician Clinic IT
Physician IT Management & Telehealth
27

28. Vice President
IT Connectivity
Director Director Finance
Clinical Informatics Physician Clinic IT
Customer
Physician Implementation Integration
Informaticist Experience Solutions Manager
Solutions Manager
Solutions Manager
Service AMB System Production Process
QA/Testing Compendium Project Integration Project
Delivery Support Control Improvemen
Manager Manager Managers Manager Managers
Manager Manager Manager Manager
SERVICE SYSTEM ACQUISITION/ QUALITY COMPENDIUM ALLSCRIPTS DEVELOPMENT
DESK SUPPORT EXPANSION TEAM TEAM TEAM
TEAM TEAM TEAM
ICD-10 PM SUPPORT
OPTIMIZATION
TEAM
TEAM
CLINIC IT
PROJECTS
28

29. “The first half of our
lives is ruined by our
parents, and the second
half by our children.“
- Clarence Darrow
29

30. Measure Progress
• Goal is to Improve:
–Support Staff Competency
–End-user Competency
–Physician Satisfaction
–Upgrade experience
• Our ability to measure was and still is lacking
30

31. Help Desk
31

32. 32

33. Help Desk Ticket
33

34. Dashboard of Incidents
34

35. New Workflow for handling Tickets
35

36. Dashboard of Incidents
36

37. Areas of Emphasis
• Team Learning and • Implementation
Growth • ICD-10
• Service Delivery • Integration
• Process • Budget
Improvement Performance
• Service Metrics
• Optimization
37

38. Direct Surveys Of
Physician
Satisfaction
38

39. Better results
39

40. Survey Rationale
• Baseline analysis of MMG provider perceptions
of the Allscripts EMR, quality
reporting, training, and other issues.
• Identify gaps in workflows, training, and
reporting.
• Support prioritization of efforts to fill identified
gaps.
40

41. Survey Background
•Idea took shape on February 11, 2013
•Development of instrument February 11-18, 2013
•Published online to four different groups on February 19, 2013
– Primary Care
– Medical Specialists
– Surgical Specialists
– Hospitalist
•Survey closed March 4, 2013
41

42. Example of actual survey
42

43. Example of results as shown in SurveyMonkey
43

44. Example of results to a Question
44

45. Survey Response
Total Responses Scratch Off %
Primary Care 76 71.1%
Medical Specialties 38 63.2%
Surgical Specialties 29 65.5%
Hospitalists 7 57.1%
Total 150 67.3%
45

46. “My Doctor gave me six
months to live, but
when I couldn’t pay the
bill he gave me six more
months.“
- Walter Matthau
46

47. Integration Detectives
• 50+ interface requests outstanding a year ago
• Business use case validation implemented
• 22 unique requests survived that process
– 6 needed EMPI, we could not create an interface
– 3 were found in discussions with the orgs they were not needed
– 4 put on hold per the organization
• 9 unique interfaces remained
– 6 are completed or in flight (represent large number of initial requests)
– 3 are very low priority and impact very small number of providers
47

48. Upgraded Upgrades
• Allscripts v11.2.3 in June 2012
– Robust testing process
– Smaller instance in So Cal used as “pilot”
– Fewest errors seen by Allscripts for this version to
date
• 3 Successful Hotfix upgrades
• Plan for upgrade to v11.4 for all instances by Calendar
year end
48

49. Other Technologies
• MD Tracker
• WebTop
• Physician Portal
49

50. MD Tracker Doctor List
50

51. Doctor Profile
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52. Notes from Rounding
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53. WebTop – Single Sign-on – Physician Portal

54. My Home My Clinic My Patients My Community My Support
Avatar
CHW Indicator Database
CareConnect
CareConnect Application (Remote Access)
Event Reporting System
MIDAS+ Live Application
MIDAS+ Live Web Site
Zynx

55. My Home My Clinic My Patients My Community My Support
Oncology Free Events
Cancer Center Calendar (PDF): See a montly schedule of our free
classes and support groups.
Cancer Center Ongoing Events (PDF): See a list of cancer center
events and programs.

56. My Home My Clinic My Patients My Community My Support

57. My Home My Clinic My Patients My Community My Support

58. My Home My Clinic My Patients My Community My Support
!

59. “We must not cease
from exploration and the
end of all our exploring
will be to arrive where
we began and to know
the place for the first
time.”
- T.S. Elliott
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60. Questions???

61. The Choluteca Bridge in Honduras
61

62. After Hurricane Mitch hit in 1998
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