Healthcare leaders attending the Health IT Summit in San Diego, sponsored by Healthcare Informatics, had the opportunity to hear about some of the elements fueling the tremendous advances taking place these days at the Danville, Pa.-based Geisinger Health System, straight from that organization’s senior vice president and CIO, John Kravitz. Speaking on Jan. 25 at the Summit, being held at the Omni San Diego, Kravitz told attendees that all the healthcare IT advances taking place at Geisinger are tied very tightly to the organization’s overall strategic plan, a strategic plan that has evolved forward under the leadership of David T. Feinberg, M.D., who arrived in May 2015, succeeding Glenn Steele, Jr., M.D., who had already made Geisinger’s name famous for innovation in clinical performance and care quality improvement and advancement.
As Kravitz told Health IT Summit attendees on Wednesday, Geisinger’s top strategic objectives include the following: “redefine our patient experience and clinical excellence”; “create an engaging and empowering work environment”; “enhance and scale distinctive ProvenCare Portfolio capabilities; “deepen our participation in post-acute care”; “develop a sustainable and competitive go-to-market strategy” for south central Pennsylvania; achieve and sustain a successful operating margin; achieve same-day access for primary and specialty care appointments, and eliminate ER waits; and “dramatically improve patient outcomes, consistent with the highest CMS [Centers for Medicare and Medicaid Services] criteria.” With regard to its ProvenCare portfolio, Geisinger Health System has become justly renowned for its ProvenCare program, which combines evidence- and consensus-based care pathways with, in some cases, pricing guarantees for certain procedures.
Related to those priorities, Kravitz told his audience that senior leaders at Geisinger Health are determined to improve patient, family, and community satisfaction and experience. Among other elements in that push, they are studying the Ritz-Carlton Hotels organization’s Talent Plus Program; are refocusing new employee orientation on the patient experience; are incorporating individual staff into members’ performance goals, goals oriented around the patient experience; and are working with the Net Promoter Network’s “Net Promoter scores” system to improve overall satisfaction and experience for stakeholder consumers of the health system’s services.
Within the area of patient and family satisfaction, Kravitz said, “We focus on quality and outcomes, but we were logging poor patient experience 18 months ago. We get about 50,000 phone calls a week for primary care appointments, in 216 clinics. And we found that 40 percent of calls were being dropped. People couldn’t get in to make appointments, so people would call back over frustration for waiting. So we have begun the migration to Enterprise Contact Centers with an omni-channel approach. Or videoconferencing to that appointment.”
He went on to say that “Our goal was to pick up every call on the first ring, every time.; get a same-day or next-day appointment for primary care services, and get a specialty care appointment within 10 days of request; care for our patients as if they were our family members. We’re trying to keep appointment blocs as open as possible,” he noted.
Shifting to the IT area, Kravitz told his audience that, very importantly, the overall organizational focus on service, satisfaction, and experience has shifted how the IT area of Geisinger is run, too. “We’re very performance goal-oriented,” Kravitz said. “We’ve really transformed IT to be a very metrics-driven organization. Adjust metrics over time to align to the business. IT doesn’t exist for IT; it exists to promote the business.”
Indeed, the unified data architecture initiative that Kravitz and his colleagues in IT leadership have undertaken, an effort that will make a shift towards end-user self-service around data analytics more practicable at Geisinger, has moved forward with alacrity. And that initiative has been so important that Kravitz and his IT team at Geisinger were named one of the semi-finalist teams in the Healthcare Informatics Innovator Awards program. A brief summary of the initiative can be found here, in the article on the nine semi-finalist teams. As mentioned in that article, the Geisinger IT leadership team “has been moving ahead to facilitate further work to improve outcomes and curb costs, through its project to create a Unified Data Architecture (UDA), in order to integrate all of the organization’s analytic platforms. After concepting the initiative, Geisinger leaders decided to create a big data (Hadoop) platform, as the foundation for the UDA, and as the first phase of the project. Within a year, the team established a big-data platform, based on Hadoop and other open-source components. Within that time, Geisinger project team members developed code for a source ingestion pipeline to pull in source data, perform necessary transformations, and load data into various views; and having done so, pulled in all of the source data currently populating the data warehouse (EDW), plus additional sources not in the EDW.”
What’s more, as our article noted, “A key element in all this is that Geisinger’s data and IT leaders ‘plan to deviate from industry standard and the common opinion that big data should augment the EDW, not replace it. We are on our way to proving that we can replace the EDW,’ they stated in their submission to the Innovator Awards Program. ‘By running analytics from our Hadoop infrastructure, we have all of the benefits of distributed computing, plus the additional benefits of late binding and the ability to deal with non-discrete data, such as we find in clinic notes.’” An interview with Joseph Scopelliti, IT director in Data Management at Geisinger, in which Scopelliti goes into considerable detail on the unified data architecture initiative, will be published soon here online.
With regard to the unified data architecture initiative, Kravitz told his audience that “We’ve established a Hadoop-based big data platform, and, using Hortonworks internally, we take our physician notes and move them into a semi-structured format.” And, with regard to the service experience issues he had described earlier, he noted that “With Cisco Call Manager, we dump that data into the data warehouse. We actually do heat maps of the data to determine appointment availability. We’re turning things around quickly, making certain that appointments are filled timely, and we can do outreach to patients. And how do we allow patients to self-serve? We are an Epic shop and now also Cerner, we’re keeping two different EHRs [electronic health records] running. But the MyGeisinger portal is very heavily used, with 650,000 patients using MyChart/MyGeisinger.” Indeed, he said, “Over 350,000 are on it daily, and we do 90,000 transactions a month with it. We want to open up more appointments with our Cadence appointment system, and we’ve taken a lot of calls off the call center.” So the shift to a unified data architecture is supporting service improvements on all levels, both internal and external.
One example of that is that, as Kravitz noted, “Tableau dashboard tools connect to our big data platform to provide timely data on contact center calls, appointment availability from Epic cadence system, identification of root cause, where patient calls not answered timely.”
Meanwhile, Kravitz shared with his audience at the Health IT Summit some of the advances that have been made in care delivery at Geisinger that relate both to improving patient outcomes and patient satisfaction. For example, he noted, Geisinger’s leaders and clinicians have been working hard to improve what is known as “door-to-balloon time” for cardiac angioplasty—the amount of time it takes to get a patient experiencing symptoms of a heart attack from their home to the emergency department, for percutaneous coronary intervention (PCI), or angioplasty, to treat that emergent heart attack. “We’ve been running at 42 minutes, and the 95th percentile for that measure is 49 minutes. And we have hospitals that are two hours away” from Geisinger’s main medical center campus.
Another area is anti-coagulation, in which Geisinger Health has an anti-coagulation clinic in rural Benton, Pennsylvania. “We went from being the best in the country to the best in the world” for anti-coagulation work, he said, “By using pharmacists in the process of anti-coagulation work.”
On a broader scale, Kravitz reported, “We do a lot of work with the Walmart Corporation. We have 22 states where we cover spine surgery for Walmart employees. They will fly the employee injured on the job to Geisinger, along with that employee’s significant other, put them up with us, cover meal expenses, and travel expenses, because our outcomes are so good. And 40 percent of patients don’t even need surgery; it turns out that they can be treated in other ways.” There have been “great outcomes” in that program, he noted.
ProvenCare continues to evolve forward
Meanwhile, Geisinger’s groundbreaking ProvenCare Program continues to evolve forward. As the program’s website explains, “Designed to deliver the right care at the right time, ProvenCare® is Geisinger's roadmap of safety and consistency for certain medical procedures and services. Following national guidelines, clinical trials and studies, Geisinger physicians along with members of the healthcare team work together to discover what kinds of care work-and don't work. Then they develop reliable healthcare methods to improve quality, maximize safety and get you feeling better faster.”
The ProvenCare Program began with coronary artery bypass graft (CABG) surgery a decade ago, and since has expanded to include the following other care delivery areas: bariatric surgery; chest pain; chronic obstructive pulmonary disease (COPD); developmental medicine; fragility hip fracture; heart failure; lumbar spine surgery; newborn protocols NIV (non-Invasive ventilation) management percutaneous coronary intervention (PCI), or angioplasty; perinatal care; rectal cancer; surgical management of lung cancer; and total hip replacement / total knee replacement. All the early learnings in the early years of ProvenCare are continuing to provide Geisinger leaders with insights for continual expansion and refinement of the program, he said.
In the end, Kravitz told the Health IT Summit audience in San Diego, all of the work that he and his IT team are engaged in is supporting the Geisinger Health System’s overall strategic goals of constantly improving clinical performance and patient outcomes, constantly improving patient, family, and community satisfaction and experience, and constantly improving cost-effectiveness and efficiency, Geisinger Health System-wide. Whenever IT initiatives are as closely linked to those overall organizational objectives, he emphasized to his audience, the chances of success are proportionally higher.