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In South Los Angeles, a High-Tech Hospital Delivers Healthcare to an Underserved Community

September 11, 2018
by Heather Landi, Associate Editor
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A culture of innovation has spurred progress at one California hospital
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When Martin Luther King, Jr. Community Hospital (MLKCH) opened in South Los Angeles in July 2015, it marked the opening of a hospital built from the ground up while incorporating the latest technology into its design. It also marked the closing of a one chapter of South Los Angeles’ health history and the beginning of a new one, as MLKCH shares the same site in the Willowbrook neighborhood as the area’s previous hospital, Martin Luther King Jr./Drew Medical Center, which closed in 2007.

South Los Angeles continues to be a community facing significant socioeconomic and health challenges. According to MLKCH officials, the area is federally designated as Medically Underserved and a Healthcare Professional Shortage Area. Residents rank lowest in life expectancy and worse than L.A. County in nearly every healthcare indicator, and the poverty rate is two times that of the rest of California. The average U.S. community has 10 times the number of doctors as found in South Los Angeles, hospital officials say.

“It’s a community that is reflective of the challenges of delivering healthcare in an urban, low-income, medically underserved community. We have very significant health disparities among our population. We have inadequate outpatient healthcare. We have a 1,200-physician deficit in this community. We have fewer hospital beds than in other communities. We have a lot of social conditions that contribute to poor health, and all of those add up to the challenges that we’re addressing here,” Elaine Batchlor, M.D., CEO of MLKCH, says.

According to a 2015 article in the Los Angeles Times, when King/Drew hospital opened in South Los Angeles in 1972 it was viewed as a victory of the civil rights era and a source of pride for black Los Angeles, as the hospital served one of the neediest parts of Los Angeles. However, the county-run hospital was plagued in later years by poor medical care, staff errors and a series of controversial patient deaths, according to the Los Angeles Times, and the facility shuttered in 2007.

The new private, nonprofit MLKCH is smaller than the previous hospital, with 131 beds, has a new management structure and was built as a state-of-the-art, “all-digital” hospital that serves as a safety net for the local community, according to MLKCH officials. While MLKCH shares the same ground as its predecessor, the new hospital is operating in a different healthcare landscape, one in which hospital leadership can leverage technology and digital tools to provide high-quality care to an urban, underserved community of about 1.3 million people. The hospital operates in partnership with Los Angeles County and the University of California.

“One of the benefits and opportunities of creating a brand-new hospital and a brand-new healthcare organization is that we were able to look for best practices from every area and incorporate those best practices. And, we could build an infrastructure that could support future healthcare delivery,” Batchlor says.

“We were fully unencumbered by technology and the systems that you would have in a hospital that had been opened for many years,” says Tracy Donegan, MLKCH chief information and innovation officer. “We were able to implement a fully integrated electronic health record (EHR) from the get-go.”

Donegan is slated to be the keynote speaker at Healthcare Informatics’ Beverly Hills Health IT Summit at the Sofitel Los Angeles at Beverly Hills November 8-9, where she will share her organization’s journey to developing a world class IT infrastructure.

Built from the ground up, MLKCH incorporates technology into every aspect of its design—from the facility itself to service delivery to post-discharge care, according to Batchlor. “We deliberately sought the technology and used the technology as we designed our policies, procedures and approaches to care delivery from the beginning,” she says.

Elaine Batchlor, M.D.

The hospital was recognized by HIMSS Analytics, the analytics arm of the Healthcare Information and Management Systems Society (HIMSS), as Stage 6 on the EMR (electronic medical record) Adoption Model in its first year of operation. This year, the hospital was recognized as HIMSS Stage 7 for EHR best practices—a status achieved by only 6.4 percent of hospitals nationwide by the end of 2017.

The inpatient facility was constructed to integrate technology into care delivery. All inpatient beds are “smart beds” that weigh each patient automatically each day and record the findings in the patient's EHR. The “smart beds” also detect when a patient is getting out of bed and can alert the attending nurse if the patient is deemed a fall risk, Donegan says. Inpatient rooms also are wired with MyStation technology for patient interaction. “By using the TV in the patient’s room, we can engage the patient in health education when he or she first arrives at the hospital. They take a fall risk assessment on their TVs, and that’s integrated with the EHR so that clinicians are notified of patients with a fall risk,” she says.

The hospital’s clinical staff carry secure smartphones that interface with the EHR system and inpatient biomedical devices. Donegan also notes, “We also have over three dozen unique medical devices integrated with the EHR, and that was unique and progressive at the time we opened the hospital.” The hospital opened with clinical protocols programmed into the EHR system, she says. “That helps clinicians practice in a manner that’s consistent with best practices and evidence.”

“Technology is really about supporting high-quality patient care and patient safety,” Donegan says. “One area that we are really proud of is our ability to leverage technology to support medication safety. We use smart bar coding and scanning for dispensing medications in the hospital and for use of blood products. That is a huge patient safety boost.”

Hospital leadership also deployed technology tools to compensate for a shortage of physicians in the community. The entire hospital is wired for telemedicine, and telemedicine services are provided by physicians at UCLA Medical Center. “One of the areas where we use [telemedicine] is in our labor and delivery area, where we use tele-neonatology. We also use tele-radiology, tele-neurology and tele-psychiatry. In an area that has a severe shortage of physicians, telemedicine is a huge benefit to link residents to premier healthcare centers and to give them access to high-quality care,” Batchlor says.

MLKCH leaders note that the hospital is filling a need in the community for quality patient care. The hospital is on track to see 90,000 patients in the ED this year, and MLKCH’s patient satisfaction scores are in the top 20 percent of all hospitals nationwide, hospital leaders say.

A Culture of Innovation

Opening a new hospital has certain advantages, such as the ability to deploy the latest technologies without having to address older legacy systems. However, MLKCH leadership faced the unique challenge of designing and planning the IT infrastructure without having a full clinical staff in place.

“One of the huge challenges we had was that we had very little staff when we made decisions about what to purchase, what to implement, how to set it up, or the design of systems, and we used a lot of expert consultants and a pretty small group of staff members to make those decisions,” Batchlor acknowledges, “One the challenges we had after we opened was that we had to make a lot of adjustments for the permanent staff, and for the actual patient population that we were serving.”

Donegan initially began working with MLKCH as a consultant and then moved into the permanent CIO position. “With regard to technology, we had a very clear vision from the start that we wanted to use the technology to promote high-quality patient care, but we also wanted to use it to differentiate the hospital and attract high-quality talent. That helped us guide our technology portfolio because we understood, at the end of the day, what was really needed to be done to achieve these goals.”

Tracy Donegan

And she notes that the complexity of the project was one reason she wanted to be involved in the design and opening of MLKCH. “What also attracted me was the mission of the hospital. It was very exciting. I’ve been in healthcare 20 years, and I felt that this would be the opportunity of a lifetime to have a direct impact on a community.”

Batchlor credits the hospital’s culture of innovation for the successful implementation of an advanced IT infrastructure.

“Some of the decisions we made were not obvious decisions,” Batchlor admits. “I often hear our IT team say that we implemented more Cerner modules than any other hospital has ever implemented. Some of that was risky and did require a willingness to work through problems, as we’re using technology that’s fairly new,” she says, adding, “It’s not always a slam dunk.”

She points to the deployment of the clinical staff smartphones as one challenging project. “The clinicians had some concerns and we listened to them. And, because of their concerns, we made a change to a different platform. It’s that kind of responsiveness that helps to make an IT initiative successful,” she says. “You have to be willing to struggle through those challenges, persist and solve problems. And, I think that’s something that is different about us compared to other places; a culture of supporting that kind of innovation.”

While MLKCH leadership faced a unique situation as a brand-new hospital, there were important lessons learned about technology adoption, Donegan says. “You have to involve the clinicians and any other stakeholders every step of the way in the choices and in the design; that is critical. It’s also extremely important to be very responsive to their concerns and their needs.”

Approaching Care Delivery Beyond the Hospital Walls

Beyond hardwiring technology into the inpatient facility, MLKCH executive and IT leaders also integrated technology into patient care plans. Each patient in the hospital, even those in the ED, is assigned a care coordinator, with the goal of reducing readmissions and providing targeted care to each patient. The EHR is integrated with dashboards and population health management tools for disease management and patient tracking.

“One of the things that’s important to us is continuous quality improvement and because we have such a great health information system, we also have access to real-time information about what’s happening with our patients, what’s happening with care that we’re providing, and it fuels our ability to monitor performance and improve that performance over time,” Batchlor says.

What’s more, MLKCH leadership are focused upstream from hospital care to prevention, disease management and community health.

“We are able to collect information about our population and approach our care delivery from a population health management perspective. We’re not just focused on what we are doing when our patients are within the four walls of our organization, but we’re thinking about what they need before they get here, what they need after they leave and we’re able to invest in building out other parts of the delivery system and just managing that whole continuum of care,” Batchlor says.

To this end, in December 2016, MLKCH launched its first outpatient medical practice, Advanced Care Clinic, with a post-discharge clinic and specialty care, and launched a nonprofit medical group, with five providers.

“One of the things that we quickly recognized after we opened was that many patients were coming to the emergency department with medical conditions that were not adequately treated in the outpatient setting,” Batchlor says, adding, “We are growing that medical group, it’s a multispecialty medical group. We have plans to build out a medical office building on campus, and that started with the recognition of the needs of the patients that we were seeing.”

The organization plans to break ground on the medical office building, the Wellness Center, later this year, offering space to accommodate specialty care physicians, along with services such as outpatient surgery, a dialysis center, an infusion center, a wound clinic and a retail pharmacy.

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Survey: Healthcare Orgs Ramping up Investment in AI, Confident about ROI

November 16, 2018
by Heather Landi, Associate Editor
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The majority of health care executives (91 percent) are confident they will see a return on investment (ROI) on artificial intelligence investments, although not immediately, and foresee the greatest impact of AI will be on improving health care, according to an OptumIQ survey.

Most (94 percent) health care leaders responded that their organizations continue to invest in and make progress in implementing AI, with 75 percent of healthcare organizations say they are implementing AI or have plans to execute an AI strategy, based on OptumIQ’s survey of 500 senior U.S. healthcare industry executives, primarily from hospitals clinics and health systems, life sciences organizations, health plans and employers. OptumIQ is the intelligence arm of data and analytics of Optum, an information and technology-enabled health services business that is part of UnitedHealth Group.

While many healthcare organizations have plans, progress is mixed across sectors. Of the 75 percent who are implementing AI or have plans to execute an AI strategy, 42 percent of those organizations have a strategy but have not yet implemented it. Employers are furthest along, with 22 percent reporting their AI implementations are at a late stage, with nearly full deployment.

The average AI implementation is estimated to cost $32.4 million over five years. The majority of respondents (65 percent) do not expect to see a ROI before four years with the average expected period being five years. However, employers (38 percent) and health plans (20 percent) expect ROI sooner, in three years or less, according to the survey.

The survey found that health care leaders universally agree the greatest impact of AI investment will be on improving health care. Thirty-six percent expect AI will improve the patient experience; 33 percent anticipate AI will decrease per-capita cost of care; and 31 percent believe AI will improve health outcomes.

Most health care leaders believe AI can make care more affordable and accessible. Ninety-four percent of respondents agree that AI technology is the most reliable path toward equitable, accessible and affordable health care.

AI will make care more precise and faster, according to respondents. The top two benefits respondents expect to see from incorporating AI into their organizations are more accurate diagnosis and increased efficiency.

The survey found that respondents are looking to AI to solve immediate data challenges – from routine tasks to truly understanding consumers’ health needs. Of those health organizations that are already investing in and implementing AI: 

  • 43 percent are automating business processes, such as administrative operations or customer service;
  • 36 percent are using AI to detect patterns in health care fraud, waste and abuse; and
  • 31 percent are using AI to monitor users with Internet of Things (IoT) devices, such as a wearable technology

With more organizations seeing the benefit of adopting an AI strategy, 92 percent agree that hiring candidates who have experience working with AI technology is a priority for their organization. To meet this need, nearly half (45 percent) of health care leaders estimate that more than 30 percent of new hires will be in positions requiring engagement with or implementation of AI in the next 12 months. However, health organizations seeking to hire experienced staff will likely face talent shortages.

“Artificial intelligence has the potential to transform health care by helping predict disease and putting the right insights into the hands of clinicians as they treat patients, which can reduce the total cost of care,” Eric Murphy, CEO of OptumInsight, said.

“Analytics isn't the end, it's the beginning – it's what you do with the insights to drive care improvement and reduce administrative waste,” Steve Griffiths, senior vice president and chief operating officer of Optum Enterprise Analytics, said. “For AI to successfully solve health care’s biggest challenges, organizations need to employ a unique combination of curated data, analytics and health care expertise... We are already seeing a race for AI talent in the industry that will grow as adoption continues to increase.”






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Breaking: The 2019 Healthcare Informatics Innovator Awards Program is Open

November 15, 2018
by the Editors of Healthcare Informatics
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Providers and vendors can now submit their entries to the Healthcare Informatics Innovator Awards Program

The 2019 Healthcare Informatics Innovator Awards Program is now open for submissions. As always, it’s a great privilege and pleasure for us to sponsor this program.

And as many readers know, the concept of team-base recognition, which began with the 2009 edition of the program, has encompassed numerous sets of multiple winning teams that our publication has recognized for their achievements across a very broad range of areas.

As it always does, the Healthcare Informatics Innovator Awards Program recognizes leadership teams from patient care organizations—hospitals, physician groups, clinics, integrated health systems, payers, HIEs, ACOs, and other healthcare organizations—that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance.

The Innovators Program, as it has in the last few years, also recognizes vendor solution providers who are asked to describe their core products or services in five categories. We are asking vendors to submit their innovation in one of five critical health IT areas: Data Security; Value-Based Care; Revenue Cycle Management; Data Analytics; and Patient Engagement.

Indeed, again this year, the Innovator Awards program will again include two tracks for innovation recognition—one for healthcare provider organizations and one for technology solution providers.

The submission form link for both tracks is right here. The deadline for submissions is January 4, 2019.

What’s more, the winning teams will be featured in an upcoming issue of Healthcare Informatics, and winning vendor teams will be awarded free digital distribution of whitepapers to all HIT Summit Series attendees.

At Healthcare Informatics, we are honored to be able to showcase these kinds of case studies from both providers and vendors, which we believe embodies the spirit of innovation around adaptive change that will light the way for their colleagues from across the industry.

At a time of extraordinary change in healthcare, now is as great a time as ever to showcase your innovations. Please consider submitting an entry to our program, and good luck in your entry!

--The Editors of Healthcare Informatics


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New Blockchain Project Sets to Tackle Provider Credentialing

November 12, 2018
by Rajiv Leventhal, Managing Editor
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A group of five healthcare enterprises—National Government Services, Spectrum Health, WellCare Health Plans, Inc., Accenture, and The Hardenbergh Group—are linking up to participate in a distributed ledger program aimed at resolving administrative inefficiencies related to professional credentialing.

The project, Professional Credentials Exchange, is being developed by ProCredEx and Hashed Health, a blockchain innovation consortium. The exchange leverages “advanced data science, artificial intelligence, and blockchain technologies to greatly simplify the acquisition and verification of information related to professional credentialing and identity,” according to officials.

In an announcement, officials noted that credentialing healthcare professionals “is a universally problematic process for any industry member that delivers or pays for patient care.  The process often requires four to six months to complete and directly impedes the ability for a healthcare professional to deliver care and be reimbursed for their work.”

They added, “Hospitals alone forfeit an average of $7,500 in daily net revenues waiting for credentialing and payer enrollment processes to complete.  Further, nearly every organization required to perform this work does so independently—creating a significant administrative burden for practitioners.”

As such, the groups, via the exchange, will aim to address the time, cost, and complexity associated with these processes by facilitating the secure, trusted exchange of verified credentials information between exchange members.

Included in the collaboration are WellCare Health Plans, which serves about 5.5 million members, and Spectrum Health, a 12-hospital health system in western Michigan. National Government Services is a Medicare contractor for the Centers for Medicare & Medicaid Services (CMS), and processes more than 230 million Medicare claims annually.

"A fundamental component of developing the exchange lays in building a network of members that bring significant verified credential datasets to the marketplace," Anthony Begando, ProCredEx's co-founder and CEO, said in a statement.  "These are the leading participants in a growing group of collaborators who bring data and implementation capabilities to accelerate the deployment and scaling of the exchange."

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