We detailed our method for effectively implementing our cardiovascular information system

1. The Power of Data Integration Friday, March 5, 2003 Speakers: Pam Goepfarth, RN, CCRN, RCIS, MEd Director, Information Technology Saint Vincent Heart Center, Erie, PA Mark Kresse, MHS, PT Vice President Saint Vincent Heart Center, Erie, PA Executive Director Regional Heart Network

2. Mark Kresse, MHS, PT Mark earned his Bachelor of Science degree from Ithaca College, and Master of Health Science degree from the University of Indianapolis. A physical therapist by training, his 24 year healthcare career includes both clinical and administrative positions that span hospital, private practice, consulting, and physician practice management settings. As Heart Center Vice President, he is responsible for all inpatient and outpatient Heart Center operations, and serves as Executive Director of the Regional Heart Network. Pamela Goepfarth, RN, CCRN, RCIS, MEd Pamela Goepfarth is the Director of Heart Center Information Systems for Saint Vincent Health Center. She has a Associate degree in Nursing, a Bachelor’s degree in Science and a Master of Education degree in Speech Pathology and Audiology. Pam is a Registered Nurse with clinical background in cardiovascular services and has studied database management. Pamela has spoken publicly in numerous seminars about the power of data integration and has published multiple articles on the same topic. Saint Vincent Heart Center, ©2004

3. The Power of Data Integration 1 Saint Vincent Heart Center, ©2004 A “Defining Moment” “ Getting Acquainted with Your Data” “ Process Improvement” “ Driving the Work Process”

4. 2 A Logical Framework CHARACTERISTICS Saint Vincent Heart Center, ©2004 Driving the Work Process and Decision Support Process Improvement Getting Acquainted with Your Data Report Analyze Collect

12. Entry Getting Acquainted REPORT 1. Quality 10 A nice graph showing averages Saint Vincent Heart Center, ©2004

13. Level with Your Data EXAMPLES Operational Volumes 11 Executive Summary Saint Vincent Heart Center, ©2004

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15. The Power of Data Integration 13 Saint Vincent Heart Center, ©2004 A “Defining Moment” “ Getting Acquainted with Your Data” “ Process Improvement” “ Driving the Work Process”

18. 16 REPORT Intermediate Process 1. Costs Wasted M & S Supplies: Simple Bare Metal Stent Cases M & S Supplies: Cost per case for Simple Bare Metal Stent Cases Measuring Outcomes 8% 24% Saint Vincent Heart Center, ©2004

19. Simple Bare Metal Stent Cost / Case (CY 2002) (CY 2003) Providing blinded physician data is a very effective way to impact process improvement 1. Costs (cont’d) Level Improvement EXAMPLES 17 $37 $1,900 1.2 1.4 0.9 1.6 370 Phys E $30 $1,910 1.5 1.6 1.1 1.5 315 Phys D $31 $1,475 1.2 1.4 0.75 1.4 220 Phys C $38 $1,510 1.1 1.3 0.7 1.4 280 Phys B $36 $1,790 1.2 1.4 0.8 1.3 266 Phys A Waste Cost Guide Wire Balloon Stent N $37 $1,900 1.2 1.4 0.9 1.6 350 Phys E $75 $2,115 1.5 1.6 1.1 1.8 281 Phys D $31 $1,475 1.2 1.4 0.75 1.2 199 Phys C $38 $1,510 1.1 1.3 0.7 1.3 270 Phys B $46 $1,818 1.2 1.4 0.8 1.6 259 Phys A Waste Cost Guide Wire Balloon Stent N Saint Vincent Heart Center, ©2004

20. Minutes Intermediate Process REPORT 2. Revenue 18 Physician response data proved otherwise Cath Lab staff claimed ongoing turn-around time delays due to physician response times Saint Vincent Heart Center, ©2004

21. Relative value analysis Pattern analysis with relative values 2. Revenue Level Improvement EXAMPLES 19 Saint Vincent Heart Center, ©2004

22. “ If You Can’t Measure it, You Can’t Manage it” -Peter Drucker Automation provided sustainability and drove billing errors to near zero Intermediate Process REPORT 2. Revenue (cont’d) 20 Began looking at charges, validating w/ Finance Department, & recovering revenue Saint Vincent Heart Center, ©2004

23. Cath: Billed Procedures in Apollo Name Description Stent Charge? # Stents 5/19/2003 Patient Yes 2 Stent PTCA Simple (5331015) ACT Levels (4010135) LHC LV-Gram Cors Perc (5331003) 5/19/2003 Patient 2 LHC LV-Gram Cors Perc (5331003) 5/19/2003 Patient 3 Yes 1 ACT Levels (4010135) Drug Eluting Stent Simple (5331090) 5/19/2003 Patient Yes 1 LHC LV-Gram Cors Perc (5331003) ACT Levels (4010135) Stent PTCA Simple (5331015) Automated charge validation in real-time 2. Revenue (cont’d) Level Improvement EXAMPLES 21 Saint Vincent Heart Center, ©2004

25. 3. ROI Level Improvement EXAMPLES 23 DES technology Monthly monitoring of costs enables us to react quickly to unexpected fluctuations Saint Vincent Heart Center, ©2004

26. Intermediate Process REPORT 4. Market 24 Know your referral market to build & maintain your business Saint Vincent Heart Center, ©2004

27. 4. Market Level Improvement EXAMPLES 25 Referring physician detail enables prompt action when trends are spotted Saint Vincent Heart Center, ©2004

28. Intermediate Process REPORT 5. Quality 26 Vascular comp 1 SD above & below mean Case volume High risk, high volume procedures are monitored closely. Automated analysis : PV techs perform non-inv arterial studies on any suspicious access site. Data entered into CV information system. Automated reports created to scan for complications in real-time. Saint Vincent Heart Center, ©2004

30. Intermediate Process REPORT 5. Quality 28 “ Customers feel variations, not averages.” - Dave Schulenberg Focused on holding the gain Saint Vincent Heart Center, ©2004

33. SAINT VINCENT GAP Target Populations: Myocardial Infarction Congestive Heart Failure Atrial Fibrillation Tool Kit: Pocket Guidelines Standard Order Set Clinical Path for Caregivers Reminder Stickers for Charts Patient Education Binder MI Teaching Team Discharge Contract Hospital Report Card & Physician Report Card Go Live: March 2003 with MI, September 2003 with CHF, March 2004 with Atrial Fib Level Improvement EXAMPLES 31 Saint Vincent Heart Center, ©2004

34. The Evidence Scientific rationale validates practice choices Challenge - Physicians resist someone telling them “..how to practice medicine”. Example: initial ACLS implementation. Intermediate Process REPORT 5. Quality (cont’) GAP - AMI 32 1 Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, Weaver WD, “ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee on Management of Acute Myocardial Infarction)”. Saint Vincent Heart Center, ©2004

35. 5. Quality (cont’) GAP - AMI Level Improvement EXAMPLES 33 Performance measures Reducing variability in care Saint Vincent Heart Center, ©2004

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39. The Power of Data Integration 36 Saint Vincent Heart Center, ©2004 A “Defining Moment” “ Getting Acquainted with Your Data” “ Process Improvement” “ Driving the Work Process”

40. Advanced Driving the Work GAP Population Identification Interfaces 37 Patient Registration Laboratory Central Data Mgmt tm Tom Allen 87498 John Smith 46165 Sally Jones 98994 Alan Riley 99849 Ann Smiley 10564 GAP Patients Bi-directional interface of qualifying patient info and patient treatment data drives Case Manager work process Saint Vincent Heart Center, ©2004 Pharmacy

45. Level Process EXAMPLES* 42 Saint Vincent Heart Center - Drug Eluting Stent Impact Analysis *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. Saint Vincent Heart Center, ©2004 A “what if?” analysis to project the impact of multiple variables

46. Advanced Driving the Work REPORT 2. Cost Reduction 43 Model based on The Advisory Board Company, 2002 In Year 1, expect 51 cases to convert from CABG to PCI w/ DES *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. Saint Vincent Heart Center, ©2004

47. Level Process EXAMPLES* 44 5-year volume projections make budgeting easier and defensible DES use monitored by on-line, updatable query report Saint Vincent Heart Center, ©2004

48. Advanced Driving the Work REPORT 3. Revenue Enhancement 45 Saint Vincent Heart Center, ©2004

49. Level Process EXAMPLES 46 ACS Saint Vincent Heart Center, ©2004

50. Advanced Driving the Work 4. Market Share Knowledge 47 Saint Vincent Heart Center, ©2004

51. Level Process 48 Saint Vincent Heart Center, ©2004

52. Advanced Driving the Work REPORT 2. Market Share Knowledge* 49 *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. In-house DRG data provides current market share information Per capita data provides perspective on total market size External database provides DRG-based by-hospital admission data Saint Vincent Heart Center, ©2004

53. Level Process EXAMPLES* 50 *SVHC data which is considered competitive, confidential and/or proprietary has been modified for this document. Knowledge of “out-migration” provides opportunity for volume growth Saint Vincent Heart Center, ©2004

54. Advanced Driving the Work REPORT 5. Return on Investment 51 Surgical patients discharged to home Monthly surgical case data review suggested increased incidence of re-admission for pleural effusion Saint Vincent Heart Center, ©2004

55. Level Process EXAMPLES 52 Saint Vincent Heart Center, ©2004 Moving P.O. Visit #1 to Day 10 reduced pleural effusion rates by 75% 75%

56. Advanced Driving the Work HEART CENTER 5. Return on Investment 53 Data is routinely updated by multiple sources across the network, avoiding an overload on individuals, and providing data accountability Saint Vincent Heart Center, ©2004

59. EXAMPLES 56 $525,000 “ Automatic Electronic transfer of procedural information to offices expedites billing & lowers accounts receivable. Our cardiology group saw A/R Days drop from 47 to 39 days, improving cash flow by $525,000.” -Cardiology group President Level Process Saint Vincent Heart Center, ©2004

63. Mark Kresse, MHS, PT [email_address] 814/452-7888 Pamela Goepfarth, RN, CCRN, RCIS, MEd [email_address] 814/452-7263 Saint Vincent Health Center 232 West 25 th Street Erie, Pennsylvania 16544 814/452-5000 Saint Vincent Heart Center, ©2004