The long reach of IT

Kini ex­tends ser­vices far be­yond the com­mu­nity

Modern Healthcare - - CEO IT ACHIEVEMENT AWARDS -

“I tell peo­ple that the rea­son I have cal­luses on my hands is be­cause I have to hold the reins back,” says Gary Gre­gory, board chair­man at Mi­ami Chil­dren’s Hos­pi­tal, re­fer­ring to the hos­pi­tal CEO’s ex­u­ber­ance when it comes to health in­for­ma­tion tech­nol­ogy. Since Dr. Naren­dra Kini joined 272-bed Mi­ami Chil­dren’s as pres­i­dent and CEO in 2008, it has been full speed ahead with IT im­ple­men­ta­tion, as Kini has driven a dig­i­tal­iza­tion strat­egy that in­cludes ini­tia­tives in telemedicine, mo­bile tech­nol­ogy, “big data,” pa­tient en­gage­ment and rev­enue-cy­cle man­age­ment. They’re the re­sults of Kini’s goal to cre­ate an en­vi­ron­ment for pa­tients and their fam­i­lies sim­i­lar to what they ex­pe­ri­ence in other seg­ments of the econ­omy.

“Peo­ple ex­pect con­ve­nience, ef­fi­ciency and most ac­tiv­ity to be on the Web,” says Kini, 50. “So how do you trans­late health­care func­tions? How do you get all of that ac­tiv­ity in the same man­ner or for­mat as (an air­line) board­ing pass or mak­ing a pur­chase on the Web?”

That has been the chal­lenge and the phi­los­o­phy that Kini, his board and the staff at Mi­ami Chil­dren’s have been fac­ing for the past five years. And it’s why Kini is one of two re­cip­i­ents of this year’s CEO IT Achieve­ment Awards, pre­sented by Mod­ern Health­care and co-spon­sored by the Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety.

The recog­ni­tion comes more than a year af­ter one of Kini’s crown­ing achieve­ments at Mi­ami Chil­dren’s—the im­ple­men­ta­tion of a $67 mil­lion health-record sys­tem (par­tially off­set with fed­eral stim­u­lus funds) that re­placed a 42-year-old pa­per process. The sys­tem went live in April 2012. Though the hos­pi­tal would be in jeop­ardy of los­ing a por­tion of its Medi­care and Med­i­caid fund­ing be­gin­ning in 2015 if it didn’t have an EHR sys­tem in place meet­ing the “mean­ing­ful-use” cri­te­ria, the ex­ten­sive list of other IT ini­tia­tives at Mi­ami Chil­dren’s pro­vides ev­i­dence that gov­ern­men­tal pres­sure was not the sole mo­ti­vat­ing fac­tor be­hind the IT push.

Be­fore then, other hos­pi­tal stake­hold­ers—start­ing with board mem­bers—had al­ready be­gun to see ev­i­dence of a dig­i­tal evo­lu­tion of sorts.

“Three years ago, Kini came to me and said that we’re go­ing to get rid of all pa­per for the board. We’re go­ing to give them iPads,” Gre­gory says. To­day, the board op­er­ates with­out pa­per, al­low­ing them to ac­cess and share data any­time and any­where.

“It pushes IT and its ben­e­fits,” Gre­gory says, point­ing to the in­creased ef­fi­cien­cies that have trick­led down from the hos­pi­tal board and ex­ec­u­tives to the en­tire staff.

Tablets are now used through­out the hos­pi­tal in both busi­ness and clin­i­cal set­tings— to col­lect in­sur­ance in­for­ma­tion and co­pay­ments, al­low pa­tients to read and sign elec­tronic con­sent forms, and pro­vide bed­side ac­cess to med­i­cal his­to­ries and other clin­i­cal in­for­ma­tion.

The hos­pi­tal has re­ported that in its emer­gency depart­ment, self-ser­vice tablets and kiosk-based pa­tient man­age­ment sys­tems have de­creased the aver­age time from triage to regis­tra­tion from al­most an hour in July 2012 to just two min­utes by De­cem­ber 2012.

But it isn’t just a mat­ter of mov­ing away from pa­per, Kini says. “We re­al­ized that a lot of the data that comes from med­i­cal equip­ment is part of de­ci­sion­mak­ing and needs to in­ter­act with the elec­tronic med­i­cal records, so we’re bring­ing other de­vices into that en­vi­ron­ment.”

That has meant an ef­fort to bring on­line con­tent—ed­u­ca­tional in­for­ma­tion, clin­i­cal ma­te­ri­als, forms and tem­plates—into a por­tal for­mat that pa­tients and their fam­i­lies can ac­cess. There’s a se­cure e-mail/con­tact method for physi­cian and pa­tient com­mu­ni­ca­tion, as well as a tech­nol­ogy in­fra­struc­ture that mon­i­tors the se­cu­rity of pa­tient data. And the hos­pi­tal is also im­ple­ment­ing an en­ter­prise data ware­house that in­cor­po­rates clin­i­cal, fi­nan­cial and op­er­a­tional data for im­proved and per­son­al­ized clin­i­cal so­lu­tions; tracks op­er­a­tional met­rics; and cor­re­lates fi­nan­cial mea­sures with clin­i­cal and op­er­a­tional mea­sures.

Thanks to those data-min­ing and busi­ness in­tel­li­gence tools that han­dle vo­lu­mi­nous data col­lected through the EHR sys­tem, the hos­pi­tal’s ex­ec­u­tives and clin­i­cians are pro­vided with ac­tion­able in­for­ma­tion that they can use to im­prove the ef­fec­tive­ness and ef­fi­ciency of pa­tient care. For ex­am­ple, be­tween 2006 and 2010, asthma hos­pi­tal­iza­tions at Mi­ami Chil­dren’s dropped from 350 ex­cess days to 50. It saved money for pa­tients and third-party pay­ers and also im­proved the qual­ity of care.

Gre­gory says the trans­for­ma­tion hasn’t ben­e­fit­ted just kids in the com­mu­nity. “Now, be­cause of our IT prow­ess, we’re serv­ing West Palm Beach, which is 90 miles away. Never would we have thought in our wildest dreams we’d be serv­ing West Palm Beach.”

In 2010, Mi­ami Chil­dren’s Hos­pi­tal formed an af­fil­i­a­tion with 166-bed Palms West Hos­pi­tal in Lox­a­hatchee, Fla., to pro­vide pe­di­atric emer­gency care to Palm Beach County. And last fall, the Mi­ami Chil­dren’s Hos­pi­tal Nick­laus Out­pa­tient Cen­ter opened in Palm Beach Gar­dens, Fla., to of­fer pe­di­atric re­ha­bil­i­ta­tion ser­vices, imag­ing ser­vices and ur­gent care to the com­mu­nity. Tech­nol­ogy is what has en­abled the af­fil­i­a­tions.

But ex­pan­sion of ser­vices hasn’t been limited to South Florida. Through its tech­no­log­i­cal in­vest­ments, the hos­pi­tal is now able to treat chil­dren in South Amer­ica, Rus­sia and many other na­tions. Last year, Mi­ami Chil­dren’s signed tele­health part­ner­ship agree­ments with pe­di­atric health­care providers in Colom­bia, Peru and Ecuador. The global telemedicine ef­fort is one com­po­nent of Kini’s three­p­ronged Pe­di­atric Dig­i­tal Out­reach Pro­ject that in­te­grates a tele­health cen­ter, mo­bile health ap­pli­ca­tions, and in­ter­ac­tive mo­bile equip­ment and de­vices.

The telemedicine com­mand cen­ter is a 2,400-square-foot fa­cil­ity on the hos­pi­tal’s main cam­pus that al­lows for global ac­cess to pe­di­atric spe­cial­ists and re­mote in­ter­pre­ta­tion of high-res­o­lu­tion vis­ual im­ages, ra­diol-

ogy re­ports, lab­o­ra­tory tests and other di­ag­nos­tic in­for­ma­tion.

“We em­barked on bring­ing our ex­per­tise to any pa­tient, any­time, any­where, through a tele­health ca­pac­ity,” Kini says.

An­other way Mi­ami Chil­dren’s is do­ing that is through pro­pri­etary mo­bile health apps, such as its own “ScripteRx,” which helps im­prove pa­tient ad­her­ence to pre­scribed med­i­ca­tions and doc­tors’ or­ders. For ex­am­ple, it sends a weekly re­port on com­pli­ance, in­clud­ing in­for­ma­tion as to what times or doses were skipped most of­ten.

Fur­ther from home, the hos­pi­tal is be­gin­ning its de­ploy­ment of tele­health pe­riph­er­als that are part kiosk, part cart, part mo­bile ap­pli­ca­tion, part ro­bot. Those kiosks, or “pods,” can be placed any­where in the world to af­ford chil­dren and fam­i­lies 24/7 care from a Mi­ami Chil­dren’s physi­cian. Though Gre­gory says “the ro­bots are in their in­fancy,” Kini ex­pects to have them placed in var­i­ous lo­ca­tions world­wide and be up and run­ning by year-end.

“Th­ese are de­vices we can place in any en­vi­ron­ment where peo­ple can come and seek care,” Kini says. “The in­ter­ac­tion is much more than an au­dio/video con­sult. A doc­tor or nurse can take your vi­tal signs, do some blood- work, see your skin.”

Gre­gory notes that IT in­vest­ments can be chal­leng­ing for what he calls a rel­a­tively small and in­de­pen­dent hos­pi­tal that, as a pe­di­atrics fa­cil­ity, doesn’t have the base that adult hos­pi­tals do. Its an­nual IT bud­get is less than $50 mil­lion. But since the start of Kini’s ten­ure, the once small IT depart­ment of 10 to 15 peo­ple has grown to 165 em­ploy­ees.

“We had to do it. We had to make the in­vest­ment,” Gre­gory says.

“Kini con­vinced the board to give him $1 mil­lion to build the telemedicine cen­ter. It’s kind of our show­piece,” he says. “Now we’re ne­go­ti­at­ing li­censes with other hos­pi­tals with­out them hav­ing to make cap­i­tal in­vest­ments be­cause we made the in­vest­ment al­ready.”

And with the li­cens­ing of that show­piece and the ad­di­tion of new global mar­kets, Gre­gory ex­pects to see some boost to the hos­pi­tal’s bot­tom line. Mi­ami Chil­dren’s an­tic­i­pates its mo­bile tech­nol­ogy ini­tia­tives alone will gen­er­ate about $1 mil­lion in ad­di­tional rev­enue by 2015.

Kini ac­knowl­edges that it’s not the tech­nolo­gies alone that drive im­prove­ment. “There needs to be a lot of pre­work done in two spe­cific ar­eas—cul­ture man­age­ment and process im­prove­ment. You can­not take pa­per­based pro­cesses and dig­i­tize them. And you have to pre­pare or­ga­ni­za­tions well in ad­vance for change,” he says, re­fer­ring to the Lean busi­ness im­prove­ment model that he in­tro­duced soon af­ter join­ing the or­ga­ni­za­tion.

Some of that cul­tural ac­cep­tance is also cer­tainly tied to the fact that Kini is a prac­tic­ing pe­di­atric emer­gency physi­cian him­self. “I’ve never seen the doc­tors buy­ing into the ad­min­is­tra­tion’s ideas like this,” Gre­gory says. “He man­ages through data and ev­i­dence-based medicine, and peo­ple are start­ing to see the ben­e­fits.”

And al­though it’s been a busy and pro­duc­tive five years al­ready, Kini’s phi­los­o­phy for the next five sug­gests that Gre­gory prob­a­bly shouldn’t ex­pect the cal­luses to heal any­time soon.

“The era is chang­ing be­cause of the con­sumer,” Kini says. “We’ve got­ten so used to the con­ve­nience of on­line and Web-based ca­pa­bil­i­ties. Our opin­ion is that we have to catch up.”

Mi­ami Chil­dren’s Dr. Naren­dra Kini led de­vel­op­ment of the hos­pi­tal’s telemedicine pro­gram, which has helped ex­tend ser­vices around the globe.

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