#23 - Meg Rivera, Tamas Fixler, Patient Manager at AdventHealth

Jeff Terry

Hello and welcome. I'm Jeff Terry. Today we're going to talk about Patient Manager version three. I'm so excited to show you the evolution of this tile, which is our most popular tile. We're going to focus today on how it's used at AdventHealth. AdventHealth, of course, is a national health system, one of the leading health systems in the United States, with 31 hospitals in five different states, including a density in Florida. Patient Manager is used at the seven hospital campuses in and around Orlando.

Jeff Terry

Before we show you the tool, I want to hear some from some users. So we're going to hear from Devry Aldaz and Michele Freeman, who are the Chief Nursing Officer and Director of Nursing respectively, at one of the AdventHealth hospitals. Devry and Michele, please go ahead.

Devry Aldaz

Patient Manager has had a really positive impact on performance at Kissimmee. We started our MDR process at the end of last year without this tool. We had paper that we were using to go through everything, and so there's sometimes a lot of misinformation that can happen. Once we started using this tool, we were able to see everything live time. You can see everything you need to see about all the patients in the hospital in one quick place. And you can keep up with where that patient is on their stay with us because we know exactly what they need, and we can have that live-time communication with our physicians. This has been an essential tool to keep us organized on that journey.

Michele Freeman

I do believe probably the biggest impact that Patient Manager has had is it has brought our entire team together of healthcare providers. And it has opened the doors to communication, to problem solving, based on the real time accurate information. There's no guessing.

Jeff Terry

I love this word live time. Maybe we should say that instead of real time. You heard puts all the information in one place, you heard fast, and I think those are great aspects of Patient Manager. So let's take a look. On the screen here, you see Patient Manager, which of course, we access through Tile Viewer, where we can get to a number of tiles.

Jeff Terry

Let me quickly remind you of what's here and show you some of the different profiles that are representative of how it's used. So we've landed on a rounding view. This is used in multidisciplinary rounds across AdventHealth. We've landed on, for example, how it would look for unit 4 South. And you can see it's sorted by bed number, and each row there gives us information about the patient. You see on the right, I have a summary of tasks, some that are completed, some that are open. Moving to the left, we see the dispositions that we're following, and we'd see a disposition if it's confirmed. To the left of that, we see the dates, the admitted date, the GMLOS, the anticipated day of transition. If there's a discharge order, we would see it there. And to the left of that, we see some key information about the patient.

Jeff Terry

There's also a collection of flags there. You see those small icons that can be very useful, like that red icon tells us this patient has a fall risk. All sorts of things. Is the patient COVID positive? Are they on dialysis? Are they on telemetry? Who's their PCP? All sorts of flags will appear there.

Jeff Terry

I'm going to highlight two other aspects of this rounding view. The first is this assist button, which is if we need help, and every now and then, five, 10 times a day, one of the care teams will be unsure of how to handle a situation. And so what they can do is hit the assist button and then escalate any of those tasks, either to mission control or to the relevant department, to say, hey, we don't know what to do with that. And that'll show up in an escalation view that each of the departments have access to.

Jeff Terry

I also want to show you how we can just interact with the patient in general. So during rounds, we can click and we can update the EDD, we can add dispositions, we can add tasks. Many of these tasks are derived from the EMR. We see the order, we see the progress and the risks of the radiology scan, and so we represent the status of that patient's progress on their image. All the flags that we showed are derived in real time from the EMR, but not everything's in the EMR. So sometimes we add a task or add a note here.

Jeff Terry

If I cancel out of that... Also, I want to show you how quickly we can filter. So there's a couple ways to work through the tile. Let's say a physician walks into the room, and let's say, it's Dr. Hinton, H-I-N-T-O-N. If I click on the search button, I can search by location or patient name or physician. And you can see when I type in Hinton, once I get a few letters, I get any patients that have that name or any physician. When I click on Dr. Hinton, it shows me all of her patients with this little box. Each rectangle is a patient with a little summary information. And now you can say, "Doctor, you want to talk about patient Kelly? Let's talk about patient Hoover." And if I click on any of those patients, I see that information that you're starting to get used to. So easy and so fast, as you heard from the nursing leaders. And hopefully, you start to see how that works.

Jeff Terry

Other thing I want to show you is some of the profiles. So that's a very common and important use case, is MDRs. You see on that dropdown some other use cases where people have filtered, and these are examples. The first one you see there, let's say I'm a care navigator and I want to see all the COVID-19 positive patients, or PUIs, who are discharging within today or tomorrow, whatever we want to set it to, to a post-acute facility. That's obviously a transition that needs to be handled very carefully, and that's what this profile has been set up to do.

Jeff Terry

And you'll notice this view up in the upper right, that little CC button is depressed, where we were on the R button before. When things are in the CC view, the font's a little bigger, the rows are a little tighter, and they're for these focused use cases like finding and managing my five patients who met the criteria I mentioned that need special attention. And that's five out of 2,200. Dynamically updating that, finding that in reports in traditional ways, is very difficult. This is a great example of the type of lists someone will create. It's the reasons why they say they love this tile so much.

Jeff Terry

Another profile you see on the list is neuro-ICU downgrade. So let's say we're looking for an ICU bed in the neuro-ICU. Well, if we need that, obviously we need that urgently, and this profile has been built to help us find that. In this case, what it's doing is it's sorting all the patients in the neuro-ICU by their readiness to downgrade. You can see the first patient has an order to go to GT9. So if we need one neuro-ICU bed, well clearly, we would just see if we can expedite that movement of that patient who already has an order and a bed assigned. The second patient has an order to downgrade, but they don't yet have a bed assigned. So if we need two, maybe we can expedite that.

Jeff Terry

And then the third patient says ready for downgrade. That's an algorithm that we've developed with the clinical team. It's not a GE algorithm, but it's derived in real time based on the factors that they tell us are important so that they can decide when to downgrade. If we need that third or fourth bed, we can huddle the team and consider these patients first. Obviously, humans are going to make those decisions, the intensivist, but this focuses us on the patients who are most likely to be ready.

Jeff Terry

Other thing I'll call out in this view, you see the boxes over to the right with the rounded corners? So the rectangles are tasks, more or less. The things with the rounded corners, those are the criterion that are keeping that patient in the ICU. And in this case, abnormal SAO2. And if I click, I get the value and the result. And I think at advent, we're monitoring about 25 different criteria that the clinical staff has asked us to give them visibility to that may keep the patient in the ICU.

Jeff Terry

So that's a view focused on downgrades. We also saw a view on that list that's just, hey, I'm the neuro-ICU nurse manager and this is my MDR list. It's a little bit different than 4 South MDR view because patients mostly downgrade rather than discharge from the ICU. And so you can see similar structure, but we've got that downgrade column. And now instead of sorting by downgrade readiness, the patients are sorted by bed number.

Jeff Terry

Couple last profiles to show you. And hopefully, you start to get the idea. You see the one PT priority discharge. That's going to be for the PT supervisor to look at and say, hey, what patients have a discharge order and they have an outstanding physical therapy task? We want to make sure we're not the bottleneck. Boom, there's that list. And you saw a similar list for MR. So show me all the patients who have a discharge order today or tomorrow or whatever you want. And by the way, this is all fake data and that's what makes the dates a little goofy, why you see discharge order five days ago. But whatever you want. I want to see discharges today or anticipated for tomorrow where they have an open MR. I've immediately found the two out of the 2,200 inpatients.

Jeff Terry

I want to connect a dot here, though, because this is looking at the open MRs for discharges from one lens. But if you're the modality, you have a different lens. You want to think about, okay, I have patients waiting for an MR for discharge. I also have patients waiting for an MR for downgrade, waiting for an MR in the ED, all over the place. Of course, as you know, the modalities are constantly prioritizing and sequencing those cases, and that can be stressful.

Jeff Terry

This is the imaging tile. And you see at the top of that list, that same patient that we saw that had a discharge order who is prioritized, but this algorithm is prioritizing all the patients dynamically based on an algorithm that we have created with the medical staff. And it's a little different in how we work, which is, okay, how does an OBS patient compare to a discharge compare to a downgrade compare to an ED? And by codifying that, we make sure we sequence scans the way we want. And we destress a lot of the advocating that can go on behind the scenes for people to be fighting for their patient to get scanned because they don't have confidence in how the prioritization is happening.

Jeff Terry

Hopefully, you start to get an idea of how the tile works. So with that, I want to bring in Meg Rivera, who's a GE team member. She's served AdventHealth for the last 18 months helping to activate this tile, or in other words, to put it into practice. So good morning, Meg. Thanks for being with us.

Meg Rivera

Thanks for having me, Jeff.

Jeff Terry

So please describe the process that you undertake to deploy this out to the various teams.

Meg Rivera

Absolutely. So the process that we've taken, or that Advent's chosen, is we are rolling this out to each of their campuses across one of their largest divisions in Florida. And when we talk about rolling it out to each campus, it really is an entire multi-disciplinary care team rollout. So the decision was made this isn't just a nursing tool, it's not just a care management tool. The real benefit that we've found is when the entire care team is involved in participating and updating the tool and using it for their reports. So that includes training and activation as well. So everyone from the nursing team, care management, rehab imaging, as you talked about, we bring all those teams on board to make sure it's the most successful rollout as possible.

Meg Rivera

And really, what it boils down to is about an hour and a half of training for each of the care team members. So we start off with just a 30 minute online training session. What that is, is we put the training session on Advent Learning Network so the care team can access it at their leisure, whenever they're available. And it walks them through a lot of what you went through in the podcast so far. So what information is available to me on Patient Manager? How do I know that information is pulled in from the EMR versus what's been manually added? What are some of the different views that are available to me? Just gets them comfortable with this is what Patient Manager looks like and this is how you might integrate it into your daily process.

Meg Rivera

We follow that up the following week with a one hour in-person training session. And really, the goal of the one hour session is having the care team members bring their computers, log into Patient Manager, get their hands dirty, if you will, on how to set up their profiles, how they can click and edit patients within Patient Manager. So that when they leave that training session, they have their profiles set up and they're ready to go for go live date when their unit rolls out this tile.

Jeff Terry

That's wonderful. What feedback do you get? These are super busy people, they have a lot going on. So what feedback do you hear from those sessions?

Meg Rivera

I think the biggest feedback we get is honest excitement from the teams. A lot of times and what we found is that work was previously being done in silos. So everyone was taking notes during rounds or shift handoff, but it was done on paper. So while maybe myself as the charge nurse had my set of notes, no one else was privy to that information. And so the teams are really just excited that now they're not just documenting information for their own personal benefit or for their knowledge to follow up on later, but the whole care team gets brought into the equation. And I know we heard two of the Kissimmee team members talking about it before, but really the accountability. So they're excited that when they enter in that a patient is pending an ultrasound or they need lab results and that's the final thing for their discharge, that someone out there is looking at it, listening, and helping them to take action to be able to deliver more proactive patient care.

Jeff Terry

That's wonderful. What about a lesson learned, Meg? What's your reflection what have you learned from this?

Meg Rivera

So many lessons. I could probably name a ton. But I think the biggest one has got to be setting up profiles for care team members as soon as possible. There's a basic one of what's your unit profile, but making sure that we set those up in advance before they go live, all the nuanced ones as well. So really talking to them, figuring out what reports they're currently manually generating, and how do we make those reports smarter? They're already entering information into this tool. How do we replace morning huddle reports and things like that with Patient Manager? One, I think it increases buy-in from the care team drastically when you can tell them we're not duplicating work, we're streamlining it all to make them work smarter and not harder by using Patient Manager. But two, it makes them realize the power of Patient Manager, the filterability, and really the benefit they can gain from the different profiles and reports they can run from this tool.

Jeff Terry

And it's really the profiles that's personalized. Is that fair to say?

Meg Rivera

Exactly. I would 100% agree.

Jeff Terry

Awesome. Meg, thank you very much. With that, I want to bring in Thomas Fixler, who is the product leader who implemented this at AdventHealth. Good morning, Thomas.

Thomas Fixler

Good morning. Great to be here, Jeff.

Jeff Terry

So you heard Meg talk about the criticality of profiles for each different caregiver type to get their dynamic list so they can action it. Could you walk us through how a profile is created?

Thomas Fixler

Yeah, absolutely, Jeff. So all the tiles have a little gear button in the top right. And if you click on that, you get all sorts of settings. But the top one that you'll see is this profile setting over here. If you click on new, it'll ask you to create a profile name. So let's say that I'm a care manager and I want to create a profile that shows me all of the discharging patients that have a priority care management task that I need to be aware of. And I can choose to copy that from an existing profile, or in this case, I'll create it from an empty profile.

Thomas Fixler

So I'll create that profile, and now I can apply all sorts of sorts and filters to the profile. So for example, under filters, because it's a discharged profile, I might focus specifically on patients who have a discharge order. And let's say, for example, that I am the care management leader representing facility one, and I'm interested in the MT/MS units at that facility. And of course, in terms of the tasks, I really only care about the care management tasks, so let's highlight those as well. And then I hit save profile. And you'll quickly notice that of the 2,287 patients in the health system, using those filters, I have now narrowed down the list to the 43 patients on my units who are discharging have pending care management tasks.

Jeff Terry

Perfect. Thank you. And obviously, we could tune that further to certain types of care management tasks or certain discharge dispositions, all sorts of things. Now, that's creating a profile. The other thing that Patient Manager version three does for the first time is enable users to choose their own adventure, actually create their own summary views, or what are called CC views. Could you create a view for us so we can see how that works?

Thomas Fixler

Absolutely. So with the profile, what I've done is I've narrowed down the patient list using filters to the list of patients that I want. Now, what the view will allow me to do, and I can do that by scrolling, again, back into settings, scrolling all the way down to this feature called view editor. And what the view editor will do is it will allow me to tailor the content in my view to the specific content that I want to see for those patients. So you can see on the left here, it's already going to pre-populate all the patient information for me. I can add specific flags. So as a care manager, maybe I'm only interested in... I certainly want to know if the patient is COVID positive, I might be interested in 30 day readmissions. So I can apply this and then look at those flags only.

Thomas Fixler

I can add the specific dates that I'm interested in. So for example, because I'm looking at discharging patients, I'll want to know the discharge order date as well as the GMLOS would be of interest to me. I can add dispositions. Typically as a care manager, I'd be interested in all of them, so I'm not going to apply any filter there.

Thomas Fixler

And then of course, I can add alerts. And what I'm going to do here is I'm going to add a filter on these alerts, not to filter patients, but rather, to filter the specific alerts that I see. So you can see that my alerts are conveniently organized by department. And I hit care management, and I will now only see all of the care management tasks or alerts. And of course, I can select specific tasks or alerts as well. But in this case, I'll look at all of the ones that apply to my department. I'll hit apply. And then I can actually resize this so that I get more space in the screen to view more tasks or alerts.

Thomas Fixler

And then all I have to do is hit save profile and close, switch over to the CC view. And you can see that my tailored view has quickly loaded. And again, what I've done here is I've tailored the specific content that I want to see to what is of interest to me.

Jeff Terry

So same 43 patients, but in a summary view set up the way that I want it. And then one last thing I want to make sure our users see. So we're in facility one. You've got this profile. But there's another way to navigate we haven't shown. Can you click on that caret and show how you can navigate unit by unit?

Thomas Fixler

Absolutely. So there's a caret up here on the right. If I click on that, you can see all of the units in the health system are organized first by facility or hospital, and then within that by level of care. So if I wanted to quickly jump to the MT/MS unit facility three, all I got to do is click on that, and my view will quickly reconfigure to that facility. So it's a convenient way to navigate between the-

Jeff Terry

So same filters other than location. So now we can see this particular care management discharging today, et cetera. And again, ignore the dates where it says three days ago. The data's fake, so the dates can get a little goofy. But yeah, it makes a lot of sense. Thomas, thank you very much. Congratulations to you and to Meg for the work on this. And also, thanks very much to our guests from AdventHealth who shared their views today. I think with that, we'll say thank you to our audience and close the podcast.