Women’s Health LeadershipBest Practices and Reducing Perinatal Variability:
Geisinger’s ProvenCare® Model
HealthLeaders Media LIVE fromGeisinger Health System
A live event on September 18, 2013
12:00 p.m.–3:00 p.m. EST
Geisinger Health System,
Danville, Pa.
Women’s Health LeadershipBest Practices and Reducing Perinatal Variability: Geisinger’s ProvenCare® Model
HealthLeaders Media LIVEfrom Geisinger Health System
A live event on September 18, 2013
12:00 p.m.–3:00 p.m. EST
Geisinger Health System,
Danville, Pa.
The HealthLeaders Media Live From Geisinger Health System: Women’s Health Leadership: Best Practices and
Reducing Perinatal Variability: Geisinger’s ProvenCare® Model Workbook is published by HCPro, Inc.
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FRONT OF THE BOOK BACK OF THE BOOK
Speaker 1Presentations
Resources 13
Who We Are iv
Faculty v
Agenda vii
For more information, please visit us at www.healthleadersmedia.com/live
CONTENTS
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WHO WE ARE
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HANS P. CASSAGNOL, MD Dr. Cassagnol, associate chief quality officer of Geisinger Health System and director of obstetrics and gynecology at Geisinger Medical Center Northeast, joined Geisinger in 2002 and also chairs the Performance Improvement Committee and cochairs the Ethics Committee. He is a member of the teaching staff for the Geisinger Obstetrics and Gynecology Residency Program and has served on the ProvenCare® Perinatal Initiative. Dr. Cassagnol earned a bachelor of biology degree from St. John’s University, a Master of Medical Management from the University of Southern California, an MD from the University of Connecticut School of Medicine, and completed his residen-cy at Flushing Hospital Medical Center.
HARRY O. MATEER JR., MD A physician lead for the ProvenCare® Perinatal Initiative and a member of the teaching staff for the Geisinger Obstetrics and Gynecology Residency Program, Dr. Mateer, director of obstetrics and gynecology, received the Quality Award in 2011 for patient safety initiatives recognizing his involvement in a postpartum hemorrhage protocol for the system. He holds a bachelor of biology degree from Washington & Jefferson College, a medical degree from Jefferson Medical College, and completed his residency at the Reading Hospital and Medical Center.
JOHN D. NASH, MDDr. Nash joined Geisinger in 2009 as chairman of the Women’s Health Service Line. Prior to Geisinger, he directed the Gynecology Oncology Program at the University of
Connecticut and conducted ovarian cancer research. He began his career in the U.S. Navy, eventually chairing the National Naval Medical Center’s Department of Obstetrics and Gynecology. He received his BS from the United States Naval Academy, served as an officer in the nuclear subma-rine force, and earned his MD from the Medical University of South Carolina. Dr. Nash completed his residency in obstetrics and gynecology at the National Naval Medical Center and his fellowship in gynecologic oncology at the National Naval Medical Center, Walter Reed Army Medical Center, and the National Cancer Institute.
KERRI POTSKO, RN, BSNA member of the Geisinger Health System for 21 years, Potsko began her career as an inpatient nurse in hematol-ogy/oncology at Geisinger Medical Center. She went on to hold several operations positions, including regional direc-tor of operations for cancer services. She received her BS in Nursing from Misericordia University and her Master of Health Administration from King’s College.
KIMBERLY A. SKELDING, MDDr. Skelding is a board-certified cardiologist who is widely published on heart-related topics. She earned her medical degree from Northwestern University School of Medicine and completed her residency at Geisinger Medical Center. She completed a fellowship in interventional cardiology at the Mayo Clinic.
FACULTY
vii©2013 HealthLeaders Media. All rights reserved. Women’s Health Leadership
11:30 AM–12:00 PM REGISTRATION AND NETWORKINGJoin us for a light meal and network with speakers and attendees before the event’s start
12:00 PM–1:15 PM Panel 1: Best Practices and Reducing Perinatal Variability: The ProvenCare® Model• Defining a set of best practices
• Tool for process consistency and accountability
Speakers:
• JohnD.Nash,MD,Chairman,Department of Obstetrics and Gynecology
• HarryO.MateerJr.,MD,Director of Obstetrics and Gynecology
• HansP.Cassagnol,MD, Associate Chief Quality Officer
• KerriPotsko,RN,BSN,Associate Vice President, Women’s Health
1:15 PM–1:30 PM BREAK
1:30 PM–2:15 PM Panel 2: Redefine Patient Engagement: Standardize Education and Empower Interaction
• Assessing the message from the patient’s perspective
• Using the patient portal for secure communication and enhanced education
Speakers:
• JohnD.Nash,MD,Chairman,Department of Obstetrics and Gynecology
• HarryO.MateerJr.,MD,Director of Obstetrics and Gynecology
• HansP.Cassagnol,MD, Associate Chief Quality Officer
• KerriPotsko,RN,BSN,Associate Vice President, Women’s Health
2:15 PM–3:00 PM Panel 3: Integration Techniques for Women’s Cardiovascular Care • Electronic health records, hardwired referrals, and enhanced patient communication
Speakers:
• KimberlyA.Skelding,MD,Interventional Cardiologist and Director of Women’s Heart & Vascular Health
Agenda subject to change.
AllagendatimeslistedbelowareEST.
AGENDA
1
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September 18, 2013 | Geisinger Health System
Women’s Health Leadership Best Practices and Reducing Perinatal
Variability: Geisinger’s ProvenCare® Model
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September 18, 2013 | Geisinger Health System
Copyright Information
Copyright © 2013 HealthLeaders Media
The HealthLeaders Media Rounds From Geisinger Health System: Women's Health Leadership: Best Practices and Reducing
Perinatal Variability: Geisinger’s ProvenCare® Model webcast materials package is published by HealthLeaders Media,
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Attendance at the webcast is restricted to employees, consultants, and members of the medical staff of the Licensee. The
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In our materials, we strive to provide our audience with useful and timely information. The live webcast will follow the
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ACGME trademark; or the Accreditation Association for Ambulatory Health Care (AAAHC).
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Today’s Interactive Session
• Our roundtable today is designed to be a discussion
involving you. For our virtual audience, please ask any
question of the presenters at any time by typing your
question into the chat box on your screen. Please
note that your questions will remain anonymous. We
will address as many questions as we can during each
of the four panels of today’s program.
2 Women’s Health Leadership
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PANEL 1
Best Practices and Reducing Perinatal Variability:
The ProvenCare® Model
Speakers: John D. Nash, MD Harry O. Mateer Jr., MD Hans P. Cassagnol, MD Kerri Potsko, RN, BSN
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September 18, 2013 | Geisinger Health System
Presented by:
John D. Nash, MD
Dr. Nash joined Geisinger in 2009 as Chairman, Women’s
Health Service Line. Prior to Geisinger, Dr. Nash directed the
Gynecology Oncology Program at University of Connecticut
and conducted ovarian cancer research. He began his
career in the US Navy, eventually chairing the National
Naval Medical Center’s Department of Obstetrics and
Gynecology. He received his BS from the United States Naval
Academy, served as an officer in the nuclear submarine
force, and earned his MD from the Medical University of
South Carolina. Dr. Nash completed his residency in
obstetrics and gynecology at the National Naval Medical
Center and his fellowship in gynecologic oncology at the
National Naval Medical Center, Walter Reed Army Medical
Center, and the National Cancer Institute.
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Presented by:
Harry O. Mateer Jr., MD
A physician lead for the ProvenCare® Perinatal initiative
and a member of the teaching staff for the Geisinger
Obstetrics and Gynecology Residency Program, Dr. Harry
O. Mateer, Jr. received the Quality Award in 2011 for
patient safety initiatives recognizing his involvement in a
Post-partum Hemorrhage Protocol for the System. He holds
a Bachelor of Biology degree from Washington & Jefferson
College, a medical degree from Jefferson Medical
College, and completed his residency at the Reading
Hospital and Medical Center.
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Presented by:
Hans P. Cassagnol, MD
Dr. Cassagnol joined Geisinger in 2002 and also chairs the
Performance Improvement Committee and co-chairs the
Ethics Committee. He is a member of the teaching staff
for the Geisinger Obstetrics and Gynecology Residency
program and has served on the ProvenCare® Perinatal
Initiative. Dr. Cassagnol earned a Bachelor of Biology degree
from St. John’s University, a Master of Medical Management
from the University of Southern California, an MD from
the University of Connecticut School of Medicine, and
completed his residency at Flushing Hospital Medical Center.
8
September 18, 2013 | Geisinger Health System
Presented by:
Kerri Potsko, RN, BSN
A member of the Geisinger Health System for 21 years,
Ms. Potsko began her career as an inpatient nurse in
Hematology/Oncology at Geisinger Medical Center. She
went on to hold several operations positions, including
Regional Director of Operations for Cancer Services.
Ms. Potsko received her BS in Nursing from Misericordia
University and her Masters of Health Administration from
King’s College.
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New Spaces, Same Issues
“The basis behind ProvenCare® is that we know that for
certain procedures, whether it’s a surgical procedure or
a complex nine-month ordeal such as pregnancy, that
there are certain aspects of care that should be offered
to all patients at various points during the procedure.”
—Harry O. Mateer Jr., MD, Director of Obstetrics and
Gynecology at Geisinger Medical Center
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“Most physicians know what they have to do. It’s just really making sure that it does get done.”
—Harry O. Mateer Jr., MD, Director of Obstetrics and Gynecology at Geisinger Medical Center
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September 18, 2013 | Geisinger Health System
Perinatal ProvenCare® Goals
• 103 discrete evidence-based elements of care were incorporated, measured, and tracked for compliance
• Redesign, from the ground up, all aspects of provider workflow
– Drive fundamental efficiency improvements
– Increase patient safety and process reliability
– Reduce/eliminate documentation redundancy
– Streamline patient education and cut costs
• Seek observable reductions in C-section rates and premature births
• Enhance management of comorbid conditions
• Improve fetal/child health and wellness
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Key Process Redesign Principles
• Eliminate any care steps that can be eliminated
• Automate any work that can be automated
• Delegate work to appropriately trained nonphysician staff when possible
• Innovate by creating tools to enhance the reliability or efficiency of the care provided
• Activate and engage the patient
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Create eForms
• eForms now enable nurses and providers to complete documents electronically
– Care Coordination Record
– Home Health Referral for Healthy Beginnings
– OBNA for MA insurance
– Cervical Ripening—Scheduled Induction
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September 18, 2013 | Geisinger Health System
Provider and Nursing Roles
Non Provider (Nurse) Work Flow
Initial Visit Return Visit Post Partum Visit
Best Practice
Episode Create Episode.
Confirm encounter is
linked to Episode
Confirm encounter is
linked to Episode
Encounter will not be
linked to Episode
Chief
Complaint
Enter Chief Complaint Enter Chief Complaint Enter Chief Complaint
Dx and Orders Enter single Urine Dip
order or enter Urine Dip
standing order.
Remember to Enter/Edit
the results.
Enter or release Urine
Dip order. Remember
to Enter/Edit the results.
Rooming Tool Complete Rooming
Tool
Complete Rooming
Tool
Complete Rooming
Tool
Allergies Review and update if
needed
Review and update if
needed
Review and update if
needed
Med List Review and update if
needed.
Review and update if
needed.
Review and update if
needed.
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Utilize All Appropriate Resources to Overcome Barriers • Challenge the team to think creatively
• Count steps, clicks, etc., and ask yourself if the team will follow the workflow
• Recognize problems and develop solutions—don’t pretend they will resolve on their own
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Standardization Across Women’s Health Service Line • Orders and vitals by gestational age with trending
• Joint Commission/DOH intake questions
• Smoking cessation
• Initial prenatal visit screening
– Positives requiring follow-up are presented to provider
• Provider exams (initial prenatal and postpartum)
• Standard new patient, return, and postpartum visit workflows
• Postpartum screening—Edinburgh Postnatal Depression Scale
• Patient education in each trimester—“Just in time”
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Best Practice Bundles
• Diabetes
• Preeclampsia/eclampsia/HELLP
• Preterm labor
• Primary cesarean section rate
• Maternal wellness
• Fetal/newborn wellness
• Maternal history, physical exam
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Current Status
• Process reliability
• C-section rates
• Harm scores
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September 18, 2013 | Geisinger Health System
Break
We will reconvene at:
1:30 p.m. (Eastern)
12:30 p.m. (Central)
11:30 a.m. (Mountain)
10:30 a.m. (Pacific)
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September 18, 2013 | Geisinger Health System
PANEL 2
Redefine Patient Engagement: Standardize Education and Empower Interaction
Speakers: John D. Nash, MD Harry O. Mateer Jr., MD Hans P. Cassagnol, MD Kerri Potsko, RN, BSN
21
September 18, 2013 | Geisinger Health System
“We found something like 120–130 different educational materials that different providers in different clinic sites
were giving either at different stages of pregnancy or all at once during the pregnancy.”
—Hans P. Cassagnol, MD, Associate Chief Quality Officer of Geisinger Health System,
Director of Obstetrics and Gynecology at Geisinger Medical Center Northeast
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Patient Education
Number of Prenatal Education Materials: Before & After Standardization
0
50
100
Num
ber o
f edu
. mat
eria
ls
Before 25 122 44
After 0 10 10
Material not appropriate for
antepartum periodMaterial applicable to all patients
Material applicable to specific
conditions
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September 18, 2013 | Geisinger Health System
Patient Education Savings
Cost Reduction in Education Packets
$11,574.86
$38,309.67
$26,734.81 $27,905.74
$4,340.57
$23,565.17
$0.00
$7,500.00
$15,000.00
$22,500.00
$30,000.00
$37,500.00
$45,000.00
Materials Labor Total Cost
Old PacketsNew Packets
*Annual projected cost reduction of $10,400
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September 18, 2013 | Geisinger Health System
Perinatal Education
• Specific education for each trimester
• Agreed upon by core team
• Implemented across the system
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September 18, 2013 | Geisinger Health System
Patient Engagement
MyGeisinger
• Provides direct access to providers
• Allows tracking of GDM glucose reporting/monitoring
• Appointment reminders
OpenNotes
• Better understanding of plan of care
• Transparency
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September 18, 2013 | Geisinger Health System
PANEL 3
Integration Techniques for Women’s
Cardiovascular Care
Speakers: Kimberly A. Skelding, MD
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September 18, 2013 | Geisinger Health System
Presented by:
Kimberly A. Skelding, MD
Dr. Skelding is a board-certified cardiologist who is widely
published on heart-related topics. She earned her medical
degree from Northwestern University School of Medicine
and completed her residency at Geisinger Medical Center.
She completed a fellowship in interventional cardiology at
the Mayo Clinic.
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September 18, 2013 | Geisinger Health System
“After her delivery, a patient’s pregnancy-related issues vanish and she goes on her way, not realizing that she’s
at risk in the next 20 years for heart disease.”
—Kimberly A. Skelding, MD, Interventional Cardiologist and
Director of Women's Heart & Vascular Health
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September 18, 2013 | Geisinger Health System
“Women may not see an internist for primary care until middle age. Early counseling regarding cardiovascular
risk and prevention may save lives.”
— Kimberly A. Skelding, MD, Interventional Cardiologist and Director of Women's Heart & Vascular Health
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September 18, 2013 | Geisinger Health System
“Obstetrical history (like any other aspect of a women’s past medical history) should be readily available to all
providers. Electronic health record links can make transitions of care seamless.”
— Kimberly A. Skelding, MD, Director, Women’s Heart and Vascular Health Program, Geisinger Health System
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September 18, 2013 | Geisinger Health System
All female patients—and each provider that cares for them—need education on the unique risks unmasked in pregnancy.
– MyGeisinger.org
– EHR
– Electronic media
– CMEs, grand rounds, health forums
— Kimberly A. Skelding, MD, Director, Women’s Heart and Vascular Health Program, Geisinger Health System
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Women’s Cardiovascular Services
• Dissemination of best practices throughout disciplines that connect to women’s health
• Electronic health record link for all providers
• Community and patient education
• Recognizing the unique needs of women in cardiovascular service
• Growth and strategic opportunity
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Thank You
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NOTES
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