Lakota Health System: eICU Pilot for Pine Ridge Indian Health Services Hospital

MMI 404 Health Enterprise Operations

Group 1 Rhona Banayat Ralph Garcia Nicole Hawkins Mik N Mike Nowak k November 19, 2011

Presentation Summary y
Introduction Lakota Health System Mission Pine Ridge Indian Reservation and Health Service Hospital Proposal Rationale and Return on Investment Clinical Approach Implementation I l t ti Technical Solution Plan and Schedule Cost Estimate Conclusion

Lakota Health System y

Lakota Health System y Mission
Our Mission... to deliver compassionate, high-quality health care services that improve the quality of life of Lakota Indians Our Goal... to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to Lakota Indians

Pilot Program Request Approval to implement a satellite eICU tele-monitoring system t Pi it l at Pine Rid Ridge H Hospital. The request includes temporarily reassigning PA & Nurse Personnel

Pine Ridge g Indian Reservation

Demographics Approximately 40,000 persons and 35% are under the age of 18 Largest town on the reservation is Pine Ridge, pop. 5,720 people Employment Information Median income is approximately $2,600 to $3,500 per year 97% of the population lives below Federal poverty levels Living Li i Conditions C diti Most families live in rural areas, w/average 17 people per home Over 33% of the Reservation homes lack basic water and sewage systems and electricity Life Expectancy/Health Conditions Life expectancy p y is 48 y years old for men and 52 for women Diabetes and TB rate approximately 800% higher than the U.S. average

Pine Ridge Indian Health Service Hospital

Pine Ridge Indian Health Service Network 9 small reservation medical satellite facilities aligned with the Sanford Hospital in Sioux Fall S.D. Pine Ridge g Hospital p is the largest g satellite facility y 38-bed inpatient ward, including small ICU, OB/labor and delivery, emergency department, and surgery department 5 full-time full time physicians with a severe intensivist shortage Serves over 17,000 patients Sanford Hospital is the Hub Facility (Command Center) 545 licensed li d beds b d Over 24,000 annual admissions Over 32,000 ER responses each year Owns one helicopter and two fixed-wing aircraft

Map p of Pine Ridge g Indian Reservation

Sanford Regional Hospital Sioux Falls, SD 540 miles il

The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

There is no public transportation available on the Reservation Predominant form of transportation is hitchhiking Weather is extreme ranging from 110 F to 50 F Pine Ridge Hospital

Proposal

Proposal - Rationale and Return on Investment

Rationale
- Enhance collaboration between intensivists at the main hospital (Sanford) and staff at the satellite hospital (Pine Ridge) - Provide continuous monitoring of patient data - Minimize complications and improve patient safety

Return on Investment (ROI)

- Save $30,000 per ICU bed (~$1 million/year) - Can generate additional revenue from decreased length of stay: ~$100,000/month - Reduce p patient transfer costs to main hospital p by y$ $1 million/year y

Proposal p Clinical Approach pp

Clinical Background
Role of the Intensivist Central Monitoring Station at Sanford Command Center Pine Ridge Hospital ICU

Proposal p - Clinical Approach pp

Role of the Intensivist
Physician who specializes in the treatment of critical care patients Typically work in the Intensive Care Unit setting Current national shortage of intensivists Most hospitals cannot afford an intensivist; only 10 to 15% of hospitals have a trained intensivist

Proposal p Clinical Approach pp

Central Monitoring Station At Sanford Command Center
24 hour staffing by intensivists Critical Care nurses assist intensivists with patient monitoring Patients monitored through a remote video camera Use advanced software for continuous, real time view of the patient Use electronic monitoring for vital signs; alarms activate if there are any changes in patient condition Use rule-based decision system

Proposal p - Clinical Approach pp

Pine Ridge Hospital Intensive Care Unit
Nurse provides hands-on care at the patient bedside Nurse administers medication Nurses communicate by voice w/intensivist at main hospital Use house officers or ED physician to complete procedures such as intubation

eICU Implementation

Implementation p
Technical Implementation p Goals & Objectives j
Implement iMDsofts MetaVision Central solution for ICU t l telemonitoring it i at t Pine Pi Ridge Rid H Hospital it l Partner a e with iMDsoft so a and d Sa Sanford o d Health ea IT resources esou ces to o complete implementation l t i l t ti i th C Complete implementation in 4 months 12-month p pilot study y

Implementation p Technical Solution

The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

High Level Technical Architecture High-Level

Media Server MVCentral Server

Pine Ridge Hospital

The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

Sanford Health System

The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

Internet VPN
The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

Video and Telemetry y Feeds

eICU Command Center

Media Server MVCentral Server

Implementation p Technical Solution

Detailed Technical Architecture

The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

Pine Ridge Hospital

/ VPN
The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again.

VPN eICU Command Center

Implementation p Cost Estimate

Capital and One-Time Costs for eICU Implementation
Capital and One-Time Costs for eICU Implementation (Year 1)
Item# 1 2 3 4 5 Expense Item Description Software License and Implementation Fees ICU E Equipment i tI Including l di C Computers t Network and Infrastructure Costs Non-Licensing and Implementation Software Costs Project Management and Consultant Costs Total Implementation Costs $ $ $ $ $ $ Cost 100,000 65 000 65,000 38,000 25,000 20,200 248,200

Ongoing System Maintenance Costs (Year 2 moving forward)

Item# Expense Item Description 1 Annual Software Maintenance Support Fees* 2 Annual Hardware Maintenance Annual Maintenance Costs (for 5-ICU beds) * 5% increase per year $ $ $ Cost 42,000 6,000 48,000

Implementation p Plan & Timeline

High Level Implementation Plan & Timeline
Phase / Task 1 2 3 4 5 16-Week Implementation 6 7 8 9 10 11 12 13 14 15 16

Initiate
Develop Workplan Identify fy & Obtain Resources Project Kick-off Install Hardware & Software Establish Network Connection

Design
Design g eICU Workflow f Design Application

Execute
Application Build / Config Equipment Install / g Testing g Functional/Integrated End-User Training

Deploy
Activation Plan Go-Live Activation Activation Support pp

Project Management

Conclusion
In support of the Lakota Health System y mission, the pilot program g will provide continuous monitoring of critical care patients at the Pine Ridge satellite hospital. The pilot program will also improve patient outcomes and provide substantial cost savings for the Lakota Health System. We request approval to implement and conduct the eICU pilot program p g at Pine Ridge g Hospital p to p provide high g q quality y critical care services for the Lakota Indian community.

Thank a You! ou Rhona, Ralph, Nicole and Mike

Appendix

Appendix pp A: Project j Assumptions p

Lakota Health System y investment in new EMR application: iMDsofts MetaVision software Lakota Health System investment in ICU tele-monitoring application: MVCentral software The pilot program will be conducted first at Pine Ridge Hospital to determine if eICUs can be used at other satellite hospitals in the future Cost of staff intensivist, nurse practitioner and physican assistant will be paid by Sanford Regional Hospital

Appendix pp B Detailed Cost Estimates

eICU Cost Estimates - Detail

Detailed Cost Breakdown

Item# Expense Item Description 1 Software License and Implementation Fees - S/W License - Implementation Fees 2 ICU Equipment Including Computers - Computer Hardware - Video Equipment - Media & Telemetry Servers 3 Network and Infrastructure Costs - Network Hardware (Switches & Appliances) - Internet Connection 4 Non-Licensing N Li i and dI Implementation l t ti S Software ft C Costs t 5 Project Management and Consultant Costs - 1 Project Manager (20 hrs at $185/hr) - 1 Technical Consultant (35 hrs at $165/hr) - 1 Integration Consultant (65 hrs at $165/hr) Total Implementation Costs $ $ $ $ $ $ $ $ 40,000 40 000 60,000 $ 20,000 10,000 35,000 $ 30,000 8,000 $ $ $ $ $ 3,700 5,775 10,725 $ 248,200 25,000 25 000 20,200 38,000 65,000 Total Cost 100,000

Appendix C Additional ROI Information

eICU ROI from Other Health Care Organizations g Avera Health System, Sioux Falls, SD - Saved $6.4 million over 3 years - Continues C ti t to save $1,000 $1 000 per patient ti t d day St Marys Hospital, Jefferson City, MO c eased revenue e e ue by $ $1.2 million o in first s 2 yea years-reduced s educed LOS OS - Increased University of MA Memorial Health Center, Worcester, MA - Saved $5,000/case due to early detection of patient problems Resurrection Health Care, Chicago, IL - Over 2 years, saved 9200 ICU days (~$11.5 million)

Appendix pp D eICU Quality y Measures

eICU Pilot Project: j Health Care Quality y Measures Length of Stay Rate of ventilator associated pneumonia R t of Rate f central t l line li associated i t d bloodstream bl d t infection i f ti Deep vein thrombosis prophylaxis u be o of pa patients e s with pressure p essu e u ulcers ce s Number Patient mortality

Appendix pp E Questions and Answers

Question 1: Who will run the 12 month pilot study? y Answer: A nurse manager from Sanford Hospital will act as the pilot study coordinator. Question 2: Who is responsible for data collection and reporting pilot study information to the board? Answer: The nurse manager will work with Sanford IT to mine d data f from eICU ICU patient i fil files; the h b board d will ill receive i quarterly l reports (refer to Appendix D for quality measures).

References
California HealthCare Foundation. (2011). Shortage of Specialists Prompting Hospitals to Adopt eICU Technology Retrieved from I Health Beat website: Technology. http://www.ihealthbeat.org/articles/2011/7/5/shortage-of-specialists-prompting-hospitals-to-adopt-eicutechnology.aspx Cummings, J., Krsek, C., Vermoch, K. & Matuszewski, K. (2007). Intensive care unit telemedicine: review and consensus recommendations. American Journal of Medical Quality, y, 22, 239-249 Hoffman, Leslie PhD. (2009). Special Feature: Telemedicine in the ICU: Views of Adopters and Nonadopters. Retrieved from High Beam Research website: http://www.highbeam.com/doc/1G1208104966.html Landro, L. (2009). The Picture of Health. Retrieved from the Wall Street Journal website: http://online.wsj.com/article/SB10001424052970204488304574428960127233136.html Lilly, Craig, Cody, Shawn, Zhao, Huifang, et al. (2011). Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes. Journal of the American Medical Association, 305 (21), 2175-2183 New England Healthcare Institute & Massachusetts Technology Collaborative. (2010). Critical Care, Critical Choices: the Case for Tele-ICUs in Intensive Care. Retrieved from Massachusetts Technology Collaborative website: http://www.masstech.org/teleICU.pdf New England Healthcare Institute & Massachusetts Technology Collaborative. (2010).Telemonitoring Can Make ICUs Safer for Patients. Patients Retrieved from Patient Safety and Quality Healthcare website: http://www.psqh.com/news/current-news/702-tele-monitoring-can-make-icus-safer-for-patients.html

References
Nguyen, Yen-Lan, Kahn, Jeremy, & Angus, Derek. (2010). Critical Care Perspective: Reorganizing Adult Critical Care Delivery The Role of Regionalization, Regionalization Telemedicine, Telemedicine and Community Outreach. Outreach Retrieved from American Journal of Respiratory and Critical Care Medicine website: http://ajrccm.atsjournals.org/cgi/content/abstract/181/11/1164 Philips eICU Info Center. (2011). Clinical Transformation Case Study: Building a Sustainable Rural eICU Model. Retrieved from Philips p website: http://www.healthcare.philips.com/main/products/patient_monitoring/products/eicu/eicu_program/eicu_c ase_studies.wpd Philips eICU Info Center. (2011). Clinical Transformation Case Study: Critical Care Outreach to Rural and Community Hospitals. Retrieved from Philips website: htt // http://www.healthcare.philips.com/main/products/patient_monitoring/products/eicu/eicu_program/eicu_c h lth hili / i / d t / ti t it i / d t / i / i / i ase_studies.wpd Philips eICU Info Center. (2011). Clinical Transformation Case Study: Improving Critical Care Quality and Cost. Retrieved from Philips website: http://www healthcare philips com/main/products/patient monitoring/products/eicu/eicu program/eicu c http://www.healthcare.philips.com/main/products/patient_monitoring/products/eicu/eicu_program/eicu_c ase_studies.wpd Philips eICU Info Center. (2011). Scientific Articles: Clinical & Financial Evidence for Improving Quality and Efficiency in the ICU. Retrieved from Philips website: http://www.healthcare.philips.com/main/products/patient_monitoring/products/eicu/eicu_program/eicu_s cientific_articles.wpd

References
Robert Wood Johnson Foundation. (2011). Study Evaluates Effectiveness of Telemonitoring in ICU, Other Settings. Settings Retrieved from Robert Wood Johnson Foundation website: http://www.rwjf.org/childhoodobesity/digest.jsp?id=21545 Shaw. G. (2009). Virtual ICUs: Big Investment, Bigger Returns. Retrieved from Healthleaders Media Council website: http://www.healthleadersmedia.com/page-3/MAG-256507/Virtual-ICUs-BigInvestment-Bigger-Returns## gg