Executive Summary                                                 

Based in St. Louis, Missouri, SSM Health Care (SSMHC) is one of the largest Catholic systems in the country. It has 21 acute care hospitals and two nursing homes in four states (see Figure 1). A long time champion in health care continuous quality improvement (CQI), SSM Health Care was the first health care organization in the nation to receive the Malcolm Baldrige National Quality Award (2002).

Recognizing that an effective orders process would be critical to the success of the network’s access management, SSMHC-St. Louis worked with CareReady Solutions to implement the Orders Collaboration Service in its member hospitals in 2005. The performance improvement initiative and portal-based technology has enabled SSMHC-St. Louis to build a world-class patient access process that is customer focused and cost effective.

Figure 1.

 

Situation

Facing persistent physician complaints due to the chronic problems of missing physician orders, and the paralyzing scope of managing a paper-based workflow, SSM Health Care – St. Louis set out to find the best available solutions starting in Fall 2004.

Background

Loud and widespread physician dissatisfaction, caused by problems with orders processing in the member hospital’s Registration Departments, strained the relationship between physicians and the hospital. Service departments (e.g., Radiology, Surgery) often were not getting what they needed to proceed with care delivery on the day of service.

All access management departments were receiving thousands of orders using one or multiple physical fax machines. It's a paper-based workflow with a large degree of variation in consistency, timeliness and complexity. Having multiple fax numbers for orders meant physicians and their office staff had to juggle "correct" fax numbers with procedures/departments. Confusion and errors were frequently made, resulting in lost orders and “finger-pointing” between physicians and the department.

Assessment

The paper-based workflow meant access department staff spent a large amount of time to search, locate, and copy orders and corresponding to crises caused by misplacement or missing orders. Incomplete and illegible orders were not proactively followed up, resulting in service delays and interruptions, coding and billing delays and payment denials.

To the access department, “do nothing” to the status quo was not an option. Moving away from the paper-based process into electronic workflow was clearly the way to go. However, how to get there wasn't an easy decision - it took them a considerable amount of time to research the available solutions:

• “Piggy Back” on SSM’s e-mail system (Lotus Notes) was not feasible due to the scope, and technical complexity. To “Piggy Back” on online content management solutions (e.g., eFile) wouldn't give necessary customization and functionalities.
• A “Fax Server” solution, to either build or purchase, was an expensive route. It requires the user to purchase, install and customize hardware (e.g., servers), software (e.g., server and client software), and requires on-going support and maintenance. The time to implement would be lengthy, and risky due to the large capital outlay.

After extensive evaluation, SSM Health Care – St. Louis chose CareReady Solutions to pilot its turn-key, on-demand, web-based Orders Collaboration Service at SSM St. Joseph Health Center due to its strong and innovative technical capacity, cost-effectiveness and least time to implement. Among many other value points:

• Instantly convert fax machine-based faxing to an industrial strength server-based faxing and immediately improve order storage, access and retrieval, without purchasing hardware or software.

• Digitized orders can be indexed, searched and are accessible instantly via a web browser by anyone, anywhere, and at anytime with appropriate authorization.

• Easy to use, easy to learn. The customization, self-configuration and user management are done by patient access staff, not IT specialists.

• Interfaces with HBOC STAR and Scheduling through existing HL7 data streams.

• Total transparency to physicians - unlike typical CPOE or eOrder solutions, CareReady enables physicians to continue using their low cost fax machines to communicate orders, pre-certs, lab results, etc.. That means physician participation and buy-in are 100%.

• Improvement Roadmap brings best-in-class physician orders process to the access management.

Results

The implementation of the pilot program at SSM St. Joseph Health Center was seamless and simple, literarily at the flick of a switch. The result was an immediate 99% reduction in missing orders during the first week of going live. Physicians and their office staff applauded with overwhelmingly positive feedback and support.

Gone are the stacks of paper orders. And each registrar now has the orders at their fingertips electronically, resulting in significantly higher degree of operational efficiency. 100%  of the incomplete and illegible orders are now followed up immediately and downstream surprises are eliminated.

Figure 2.

The real-time Key Performance Indicators (a.k.a. Scorecard) (e.g., Figure 2.) enables access department to use real-time analytics to continue improving its service quality, effectiveness and resource allocations.

The success in the pilot program convinced the organization to replicate that success in other member hospitals since 2006.