From our islands patients must obtain ....

Picking up on Marc's marcpp posting on chasms...if we don't build bridges or otherwise supply and coordinate safe passage between our islands, some will drown...We need to know how they can or should travel, for reasons of patient choice, efficacy, safety, timeliness and equitability.

Some may safely travel by ferry, benefiting from the company and sharing with fellow travelers, others may need airlift or speedboat transfer, some may wish to bike across a bridge.  In any event, we healthcare 'travel agents' need to ensure, proper documentation (medical passport?), guaranteed passage passage for all and confirmation of arrival at their destination.

(posting in this fashion because the discussion link didn't work for me, do I need to join and log in to discuss?)

This is a high level view of our project plan. Details will be forthcoming in various media and arenas. The project officially begins June 1 though much work has been going on at many levels in the participating organizations.

• Leadership Board Oversight
• Use of Simulation Model to advocate for reimbursement changes
• Complete Initial Staffing for Project
• Staff Training
• Creation of Curriculum and Documentation of Training provided all staff
• Measurement
• Information Technology Work on Infrastructure
• Medication Hand-offs Work
• Communication and Transparency (extraordinary openness) Infrastructure Complete
• Diabetes Pilot Work Plan
• Integrate Care Managers into the Clinics and Virtual Care Team
• Congestive Heart Failure Pilot Work Plan
• Hospital Related Changes to Support Chronic Care Model
• Living With Chronic Illness Program Expansion
• Idealized Design of Clinical Office Practice Completed for Pilots
• Develop Evidence Based Medicine strategy and approach
• Develop an approach for early adopters outside the grant

The Pursuing Perfection grant encourages, develops and requires Transparency. Extraordinary openness. In order to accomplish this level of openness we have the following project goals in front of us. Several are underway, even before the grant begins, June 1.

• Communication Plan Developed
• Establish Communication Team
• Identify current technology to support internal/external communication on Project Activities
• Test Technology with this Workplan
• Attempt to connect all sites participating across the country and in Europe with simple userfriendly web tools for communication. More later.
• Quarterly Community Forums Planned
• Extranet Web Site for Pursuing Perfection Started. More soon.
• Videos Developed
• Speakers Bureau Developed
• Experiment with RadioLand as long term communication solution
• Quarterly Community Forums

For this project to truly be succefful, these typse of staff positions will need sustainable funding. A daunting thought for a cottege industry. It's a system. The only question is whether the stakeholders can create infrastructure to support a system.

• Recruitment and Hiring of Project Staff (Data Analyst, Project Manager, Project Coordinator)
• Hire Grant Writer
• Recruitment and Hiring of information technology staff (Web Content/patient Education; Programmers)
• Recruitment and Hiring of Team and Process Improvement Facilitator and Organizational Development (OD)
• Recruitment and Hiring of Care Managers
• Consultants and Contractors may be hired

Leadership to Change Healthcare. Pursing Perfection (PP) Leadership Board Oversight

• Recruitment of Additional Members
  • We started with the leaders of the provider groups, added the leaders of the payer groups (Group Health and Regence. CHPW (Community Healht Plans of Washington) plans to join soon.
  • We plan to invite WA State Medicare (DSHS) and Medicare (CMS) to join in the ldiscussions and modeling for alignment of payment with improved care processes. This work begins in July and shold conclude by January.
• Ongoing Measurement of Team work
  • The Institute of Health Care Improvement is leading all of the grantees to find measures that are common between the participants across the nation. The goal is for us to benchmark ourselves and raise the bar on quality of healht care we deliver.
  • Locally we have experience in measuing patient-centered satisfaction with healthcare, healthcare functional status outcomes, and "teamness", a proxy for cooperation. We will share that knowledge and experience with the others.
• Assessment of development needs
  • We are hiring staff with skills in organizational development, education, and human relations. These folks will help us determine where we will want to increase our knowledge and skills, to make patient-centered care a reality by the end of this pilot project in less than two years.
• Develop Strategy to engage CMS and Medicaid
  • As noted above, we have a plan and strategy to collaboratively develop a deep understanding of the local health care situation including the patients' and payers' concerns. We plan to get all the key skakeholders at the table late summer and fall to model ideal health care for thoses with diabetes and congestive heart failure in Whatcom County. We sincerely hope that a coherent demonstration project can be crafted between the providers, patients, and payers; especially Medicare--since much of the cost of chronic care is paid by Medicare.
• Initial Training of Board
  • The existance of a board of professional leaders working together to create a system of care that supports the Institute of Medicine's (IOM) CHROSSING THE QUALITY CHASM report is exciting and represents a paradigm shift in focus and system building.
  • We will try to support this group so that they are the most effective team with the best ideas and models to support such dramatic change in and amoung their organizations. More later.
• We have engaged Kristin Crosby to orient us to Medicare realities
  • Kristen Crosby is the medical director of Olympic Healthcare, a division of Sterling Insurance. Olympic is the largest provider of Medicare supplemental insurance in the country. Kristen is helping us understand the workings and relationships needed for collaboration with Medicare.
• Development of strategic community-wide plan
  • For this pilot to meet its aims, it must begin to engage the entire community and provide a sustainable vehicle for the full development of the Six Aims of the IOM report Crossing the Quality Chasm: safe, effective, patient-centered, efficient, timely, equitable care. This level and direction of change will require ongoing system building. This is one of the key responsibilities of this PP Board.

Outline posting to weblog.

You all probably already know this, but I just discovered seriously cool functionality, from the outliner, click at the level desired to select, right mouse, and post to weblog.  Poof and voila, it appears.  See my previous post.

Patient information contributions. What information do patients have that they could contribute online to the healthcare community?

• Clinical
  • Shared Care plan updates
  • History & Physical information
  • reports of medication reactions
  • other allergies
  • need for appointments
  • need for RX refills
• Non-Clinical
• Demographic (PHI under HIPAA)
  • Health care improvement team participation
    • Posting documents
    • Commenting on draft policies

Testing a post, for aggregator functionality.  I had updated my outline two days ago, not sure if the aggregator picked (or is supposed to) that up.  Let me know what other testing you would like me to do. 

Pursuing Perfection Evaluation site visits From: Irene.Cramer@med.va.gov [mailto:Irene.Cramer@med.va.gov] Sent: Friday, May 17, 2002 11:57 AM Subject: Pursuing Perfection Evaluation site visits We are looking forward to having the opportunity to meet each of you and the members of your staff involved in the Pursuing Perfection effort. As RWJF's John Fiorillo and Linda Bilheimer described in their memo this week, we will be present at the May 29 IHI meeting to introduce the evaluation aspect of this project. We will also provide you with more specific information next week. The evaluation of the Pursuing Perfection effort has several aspects to it with the first being a visit to each of your facilities, hopefully in June. We will be on site for two full days and would like to meet individually with senior and line staff knowledgeable and involved in the Pursuing Perfection effort. In addition, we will want to become familiar with your system for performance based data collection. Because each site varies, we will need to identify the appropriate people site by site and will look to your counsel as well to help us identify the people and set up the appointment times prior to our visit. At this time we are asking you to choose from the times listed below, the three best time slots for a site visit. Please indicate your first, second and third choices. If possible, we would like to complete the site visits in June. We have three teams available, each with three people. 1st choice 2nd choice 3rd choice June 3 and 4 ________ ________ ________ June 4 and 5 ________ ________ ________ June 5 and 6 ________ ________ ________ June 6 and 7 ________ ________ ________ June 10 and 11 ________ ________ ________ June 11 and 12 ________ ________ ________ June 12 and 13 ________ ________ ________ June 13 and 14 ________ ________ ________ June 17 and 18 ________ ________ ________ June 19 and 20 ________ ________ ________ June 20 and 21 ________ ________ ________ June 26 and 27 ________ ________ ________ If you cannot choose three dates in June, please indicate from among the July dates as well. 1st choice 2nd choice 3rd choice July 9 and 10 ________ ________ ________ July 10 and 11 ________ ________ ________ July 11 and 12 ________ ________ ________ July 15 and 16 ________ ________ ________ July 16 and 17 ________ ________ ________ July 18 and 19 ________ ________ ________ If you have questions, please give me a call or e-mail me. Thank you for your assistance. Irene E. Cramer, Ph.D., Pursuing Perfection Evaluation Project Manager Management Decision and Research Center VA Boston Healthcare System (152-M) 150 South Huntington Avenue Boston, MA 02130 Telephone: (617) 232-9500 ext. 5758 Fax: (617) 278-4438 e-mail: irene.cramer@med.va.gov

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