A Month At A Glance - October 2002.
Center For Senior Health - Pursuing Perfection
A Month at a Glance- October 2002
Accomplishments to date:
1. Wiring/hardware installation for touch screen patient satisfaction survey -done.
2. Training for clinical staff for CHF Registry-done . Thanks Jean Marie!
2. Clinical snap-shot for 94 patients complete for CHF Registry- Thanks Liz!
3. Basic Data Collection -done.
4. Team Development Survey -done.

Upcoming Meetings/Events:
1. Wednesday 10/09/02 Implementation Team Meeting 7-9 am Erin ;
Jean Marie and Terry to observe CSH-CHF Registry process 9-11 am.
2. Friday 10/18/02 @ 3-4 pm meeting set to discuss process for patient satisfaction touch screen survey. ( Matt, Terry )
3. Monday 10/21/02 meeting - Terry, Jean Marie, Dr.Cummins, Dr.Vanderbilt, Dr. Jones, Dr. Roberts to discuss Pursuing Perfection Project and CHF Registry.
4. Wednesday 10/23/02 Next Implementation Team Meeting 7-10 am @ FHA Erin or ??
4. Friday 10/25/02 date for Terry to pilot the touch screen survey all day.
5. Wednesday 10/30/02 Terry to observe CSH for day.

Future Meeting:
Monday November 4, 2002 Next Guidance Team meeting 12:30-1:30 pm
( Mary, Terry, Cindy, Matt, Erin, Penny)
I hope this is helpful to all, please let me know if I missed anyone. Thanks!

North Cascade Cardiology - Pursuing Perfection Project
A Month At A Glance - October 2002
Accomplishments to date:
1. Wiring/hardware installation for computer touch screen patient satisfaction survey -done.
2. Basic Data Collection -done.
3. Team Development Survey -done.

Upcoming Meetings/Events:
1. Wednesday 10/9/02 Implementation Team meeting 7-9 am @ FHA ( Andrew , Dr. Trenouth);
11- 12 noon Terry, Stacey, Andrew, Cheryl meeting to discuss process for patient flow for touch screen survey.
2. Monday 10/21/02 5 pm meeting with Terry, Stacey, and NCC staff to go over process for touch screen survey.
3. Tuesday 10/22/02 Terry and Stacey to pilot touch screen survey all day.
4. Wednesday 10/23/02 Next Implementation Team meeting 7- 10 am * @ FHA (Andrew, Dr. Trenouth) . * Note time change*
5. System Dynamics Presentations 10/28/02 3- 7 pm @ SJH Conference room 5/6
( Dr. Trenouth - 2 hrs ) Open to ALL interested ; Wednesday 10/30/02 7-9 am @ CSH Conference room ( Dr. Trenouth , Dr. Lombardi) .

SeaMar - Pursuing Perfection Project
A Month At A Glance- October 2002
Accomplishments to date:
1. Wiring/hardware installation for computer touch screen patient satisfaction survey -done.
2. Basic Metric Data Collection - done.
3. Team Development Survey - done .
4. Training for Clinical staff for Diabetes Registry - done.
5. 273 diabetic patients have been identified and accounts set-up in Last Word for implementation of the Diabetes Registry. Thanks Tracey!
6. Spanish translation for patient satisfaction touch screen survey -done. Thanks Wendy and Norma!

Upcoming Meetings/ Events:
1. Monday 10/7/02 Terry, Stacey, Lyly and staff meeting to discuss process for computer touch screen survey implementation.
2. Wednesday 10/9/02 Implementation Meeting 7-9 am @ FHA. ( Dr. Adams , George Minor).
3. Thursday 10/10/02 Terry, Stacey, Lyly meeting to discuss process for computer touch screen survey implementation.
4. Wednesday 10/16/02 First Guidance Team Meeting 10 am-12 noon @ SeaMar ( Dr. Adams, George Miner, Jackie Coggins, Mary Bartolo, Shanon Daws, Terry, Mary, Cindy ).
5. Friday 10/18/02 8:30 - 9:15 am Cindy Manning to meet with Clinical staff on Change /Transition.
6. Wednesday 10/23/02 Terry to pilot computer touch screen survey all day ;
Implementation Team Meeting 7- 10 am @ FHA ( Dr. Adams, George Minor).
7. System Dynamics Presentations 10/28/02 3- 7 pm @ SJH Conference room 5/6
( Dr. Adams - 2 hrs ) Open to ALL interested.
8. There is on-going work being done for the Diabetes Registry in gathering data for a Clinical Snap-shot as to a patients current status regarding there last A1c value , B/P , foot exam etc.
Thanks Jean Marie for all of your help in facilitating this!

Future Meetings:
1.Next Guidance Team meeting on Wednesday 11/13/02 12 noon - 3 pm @ SeaMar
( Dr. Adams,Jackie Coggins, Lyly Cummins, Terry, Mary, Cindy, Mary Bartolo ( via phone) ).


Terry Wagner RN BSN
Process Facilitator
Whatcom County Pursuing Perfection Project
twagner@peacehealth.org
Cell # 360 319-9786

Week of October 21-25th. th-Oct

Oct.21-22, 2002 At school Oct. 23-27th

Oct.22- Met with Judy Pratt -process facilator for the P2 project-and discussed the planning for the hospital kick-off meeting for Nov. 4th. Outline the presentation about the grant for foundational information Discussed role of the management guidance team vs the team members and who should be on it. á Should we break out in smaller work groups under the team member category? Discussed what are the key deliverables that we might do and timeline considerations around interfacing with the electronic shared care plan, medication list, & registry. Drafting a timeline and action steps to prepare for the implementation of the project. Judy and Mary will meet with Marla Sanger, the new Asst. VP tomorrow to brief her more about the P2 project. It is understood that I will co-facilitate the change project with Judy, still focusing on the team development interventions.

Week in Review: November 1st.

Deliverable/Project: Shared Care Plan (SCP)

Update Summary:
> SCP database created.
> Coding of the SCP interface well underway, including linking fields to the SCP DB.
> Most security/access issues for v. 1.0 addressed, including proof of identity, security classes, use of LastWord accounts, and how to alert LastWord users of SCPs.
> Confidentiality and privacy statements being written; first drafts available for review by November 8th.
> Best data source and method for medication lookups identified.
> Reference tables filled in
> Interim URL identified for patient portal: www.patientpowered.org/com

Tasks Scheduled Next 2 Weeks:
> Finish building interfaces 
> More work need on registration work flow
> Putting together the big pieces: SCP interface, security/access piece, medication lookups, process and workflow considerations
> Polish look with graphic designer
> Thorough testing and troubleshooting of the application

Deliverable/Project: Shared Care Plan

Update Summary:

Wire frames nearly finished; shown to patients and P2 staff with good response and feedback. Some more polishing needed (especially with Medications portion), but parts will be ready to build.

Security/access modelpresented on Friday (Oct. 18^th) at meeting with all the right people in attendance. Good progress made - group will meet again next week to continue work.

Tasks Scheduled Next 2 Weeks:

• Finish wireframes
• Begin building the SCP
• User interviews, focus groups and usability testing to inform the above tasks
• Finalize security/access model
• Meet with graphic designer
• Work on integrating Medication lookup tables

Note: URL selection on hold until overall website strategy is addressed.

This is a "week in review" I completed for another audience, but will probably be useful here as well:

Deliverable/Project: Shared Care Plan

Update Summary:

SCP Requirements Document approved by the Implementation Team on September 25^th.

Task analysis underway with SCP workgroup.

Tasks Scheduled Next 2 Weeks:

• Finish task analysis
• Build wireframes
• User interviews, focus groups and usability testing to inform the above tasks

Prioritized list of Deliverable/Other Issues

Priority	Issue	Status
Medium	URL selection will be made and finalized at the Communication Team meeting on October 8th.	Good
Low	Pilot test of the English version of the touch screen patient satisfaction survey at North Cascade Cardiology has been moved to October 10th. SeaMar still on track to pilot on October 8th.	Good

This is a "week in review" I completed for another audience, but will probably be useful here as well:

Deliverable/Project: Shared Care Plan  

Update Summary:

á         Favorable reactions to the SCP Requirements Document from customers whoâve seen it (IT Technical Team, P2 Staff, Clinicians; very recently circulated to Directors, Team Leaders, and the Guidance Team). Iâll have a chance to discuss the contents of this document with the Implementation Team on September 25^th.

á         Reporting needs of the SCP are being clarified with the assistance of Sarah Donelson and the addition of a Data Analyst (Christine Kelley) to the SCP Work Group. The Work Group will meet Friday morning to finalize these needs for inclusion in the requirements.

á         Some initial implementation planning has occurred around the best scope for the release of SCP v.1.0. Due to persistent process and security/access issues, the recommendation is that only patients at one clinic and with a Clinical Care Specialist use the SCP. Additionally, only patients and healthcare professionals will be given passwords and electronic access, excluding for now ãout-of-systemä care team members such as pharmacists, family, and friends (who could possibly be given ãpaper accessä in the meantime). Will make another attempt to discuss implementation planning at next P2 Staff Meeting (Monday).

Tasks Scheduled Next 2 Weeks:

• Task analysis
• Begin process modeling (could possibly wait until SCP v.2.0 with a limited initial release?)
• Begin building wireframes
• User interviews, focus groups and usability testing to inform the above tasks
• Initiate formalized implementation planning

Tasks Falling Behind/Obstacles: Security/Access Issues

Prioritized list of Deliverable/Other Issues

Priority	Issue	Status
Medium	Weâve had a lot of input regarding the URL naming of the portal and have a process to make a decision. Nailing one down by October 1st still on track.	Good
Low	Pilot test of the English version of the touch screen patient satisfaction survey will take place at North Cascade Cardiology on Tuesday October 1st.  The English version will also pilot at SeaMar on October 8th.	Good

I called one of my diabetic patients this week to see how she was doing. She said she was better after her fall and trip to the ER. She elaborated: She'd gone for a walk with her dog. She has severe neuropathy in her feet and so tries to use a trail near her home because it has an even surface. Anyway, in spite of her efforts, she took a fall and landed onto her shoulder. She was in extreme pain and feared she'd broken something. Somehow she managed to get up and get back to home where a kind neighbor took her to the ER. She said she knew they would ask her about what medicines she takes so she remembered to take her copy of the Shared Care Plan(SCP) with her. She said it was wonderful! All the nurses and doctors were so excited and pleased to have a clear, up-to-date copy of her meds. She was glad she remembered the SCP because it made it much easier for her while she was in pain. She did not want to take the time to find all her medicines and take them to the ER.

Yes, I'd call that a success! However, the situation highlights many problems as well.

1. I had no idea she'd had the fall and gone to the ER. Her primary care provider will no doubt get the summary via the hospital. However, as Clinical Care Specialists, we are not yet in the communication loop. I am not sure how to address this problem.

2. Since she received new medications to deal with her shoulder injury, her meds list is no longer accurate.I will need to revise her SCP and then get a copy to her. Logistically this can be a challenge especially as our case loads increase.

3. So far, there is no electronic method of up-dating patient information.

I am so very much looking forward to the electronic Shared Care Plan. It seems like such an obvious necessity and will improve patient safety and multi-provider communication. The logistics are challenging because it will require that the entire medical community embrace and implement this for it to work. The vision is compelling!

Last week we did not have the Thursday staff meeting because so many were out of town. Nancy is currently on leave as well so I'm covering her patients as well as mine. There were three patients who got admitted, a major case conference to deal with a particularly challenging patient of mine, and just lots of stuff to deal with.

We are in the trenches; it feels like we're hitting the ground running from morning to night.

I'd have to say that the "keyword' for this week is TEAM. Frequently through the week, I was impressed by the sense of team and focus I've encountered everywhere. We had a lengthy and challenging Implementation Core Team meeting on Wednesday, starting at 0700. There we were around a large table: an amazing gathering of physicians, nurse practitioners,  IT specialists, hospital quality staff, and our own project staff wrestling with the realities of implementing parts of the project. Something as simple as installing a computer in each clinic has become a formidable task. This isn't a complaint, it's merely a reality. Sheer logistics, budgets, timelines and tons of real work all become barriers to completion of a task. And it's only one task of many. But here we have a determined group of people willing to take on their part whenever and wherever they can.

Our TEAM was suffused with support by Mary Minniti, our Project Manager. I wonder how many who read this can remember starting a staff meeting with a comment of appreciation for each individual staff member. It is so affirming! I do not believe I have ever encountered this level of team building in any other work setting in my entire professional life!

This positive energy flows forward and out into the pilot sites. It seems like I always receive a positive welcome from clinic staff, in spite of the usual hectic pace in all our sites.

So, it's a bright crisp autumn day in northwestern Washington. Think I'll enjoy the weekend!

information from meetings with systems dynamics people. Diabetes model explained.

3) Updated queries and macros with new provider info for new care providers at clinics.

4) Researching CHF community statistics through the CDC to attain a percentage of CHF patients in this community.

5) Systems dynamics meeting with consultants to discuss CHF measures and data to use for model.

6) Starting month end IHI and clinic reports.

Learned SPSS and process from Sarah Jane Satre on MOMS team. Distributed report to Marc P. and Mary M. via email.

2) Installed SPSS and started tutorials for processing of info for both frequency reports and upcoming initial RASCH analysis data for clinic PSAT reports.

3) Created Macros in Statit to improve efficiency of monthly reporting needs.

4) Added new CHF queries for additional CHF reporting needs brought up in Implementaion meeting for info relating to patients taking beta blockers, ACE inhibitors or both. Integrated these measures into the IHI-CHF report.

5) Working on P2 storyboard for upcoming HID university.

6) Continued to assist in adjusting the clinic PSAT survey.

created.

4) Further adjustments and tweaking of Clinic Pt Satisfaction Survey.
     -Bolded some text to provide more emphasis to key words
     -Changed the response categories for the following questions: Can I email my provider· and There are group visits at my clinic· to Yes, No, I donât know.  This change was approved by Bill.
     -Discovered some errors in the Spanish translation.  Working through those now and should have them fixed shortly.

5) Contact made with the Bellingham Fire Dept for gaining access to their data.  Need to report to IHI: # of pts with known CHF that called 911.  Will hope to set up a meeting with them and the necessary members of the P2 team as soon as possible.

6) Agreed on an initial reporting template for the PSAT reports as well as identified the process to create those reports.  Will look for continued support from the MOMS Team, specifically Sara Jane and Aaron Ignac, to get Brian and I up and running.

as is, without the financial numbers and when Dan Philpot is able to complete the financial portion of the pull we will then fwd on to Gary.

2)     Clinic specific IHI reports completed and presented at Implementation meeting.
Gathered some great feedback and clarification on the CHF and Diabetes measures.  Clinics seemed please to be able to receive clinic specific reporting.

3)     CHF registry and scratch pad retreat with MOMS team members for design and implementation of new CHF scratch pad.  CHF scratch pad area almost complete.
This ãscratch padä will mimic the DWAP scratch pad and allow us to report CHF clinical measures over time.  Further more, we feel that it eventually should be usable for other regions that implement the CHF registry.

4)     Meeting with Erez Gordon and Adam Miller to discuss survey input and processing.
Plan to touch base every other week for review of needs and update on any barriers around survey data storage.

5)     Meeting set up with MOMS team members to coordinate survey data reporting.
Will hope to produce a draft proposal that will cover all of the P2 Survey related reporting needs.  Looking forward to working with and learning from Aaron and Sarah Jane!

Included additional measure: Rate of CHF readmits.

2) Meeting with a team of analysts tomorrow to work on structure of data storage from CHF registry. Hope to mimic and improve on process used for the DWAP registry, ie DWAP Scratch Pad, that Josh Dorsey built.

3) Fully implemented an Excel based form that sits on the CSS desktop that allows them to update specific fields on those pts that they have admitted. This is then linked to our Access dB which enabled us to create a report that will notify the CCS if a pt is overdue to completed a specific survey. This dB is also used for compiling the data for the monthly report to IHI.

4) Finalized the Spanish Version of the PSAT. Both the Spanish and English versions are now ready and available to be taken by patients.

5) Starting on Clinic specific reports based on the IHI report format.

e tracked:
 
Diabetic patients clinical and lab measures to be tracked over time from the DWAP Registry.
 
Diabetic and CHF ED visits over time
 
Labeling Pilot site patient status of each visit (yes/no)
 
Labeling whether each patient is a Clinical Care Specialist patient at the time of their visit
 
This information is essential for the promise to patients that all unnecessary ED visits will be eliminated.
 
2)  Analyzed the response categories for the Patient Satisfaction survey to be implemented on the touch screens at the clinics soon.  Rasch analysis proved the categories of Poor, Good, Excellent and Absolutely Perfect to be better than the alternate response categories of Poor, Very Good, Excellent and Absolutely Perfect.
 
3)  Revised the Systems Dynamics reports of hospital patient info. File submitted Thursday afternoon.  Once Gary signs off on the format and content of file we will renew our work with the CSH data pull.
 
4)  Gearing up for the IHI reports due at the end of the month, including gathering the operational definition of CHF readmits.  Will also attempt to include the PSAT test survey data that used the new response categories into a baseline measure to be reported to IHI.  Will need to check with Bill M. on this one.

This week I had the pleasure of interviewing six leaders of organizations supporting Pursuing Perfection: Marcy Hipskind (Family Care Network), Mark Donaldson (Group Health Cooperative), Roland Trenouth (North Cascade Cardiology), Melicent Whinston (Community Health Plans of Washington), Mary Bartolo (Sea Mar Clinic), and Mark Rattree (Regence Blue Shield). Cindy Manning is interviewing the other members of the Pursuing Perfection Leadership Board.

Their stories are inspiring and their depth of experience will support us. After their retreat October 14th. Cindy Manning and I will begin sharing the stories with you. It is going to be a mad dash to organize their stories and insights during this coming week. Their stories and their insights are the basis for the retreat. As this group becomes a strong and committed team, we can expect the support we need to be successful in our work toward our visions.

Once again I am reminded how much everyone wants to make the experience better for patients AND how capable we all are of doing just that along side of patients.

I cannot overstate how honored I feel to be working with all of you.

Deliverable/Project: Shared Care Plan (SCP)

Update Summary:
> SCP database created.
> Coding of the SCP interface well underway, including linking fields to the SCP DB.
> Most security/access issues for v. 1.0 addressed, including proof of identity, security classes, use of LastWord accounts, and how to alert LastWord users of SCPs.
> Confidentiality and privacy statements being written; first drafts available for review by November 8th.
> Best data source and method for medication lookups identified.
> Reference tables filled in
> Interim URL identified for patient portal: www.patientpowered.org/com

Tasks Scheduled Next 2 Weeks:
> Finish building interfaces 
> More work need on registration work flow
> Putting together the big pieces: SCP interface, security/access piece, medication lookups, process and workflow considerations
> Polish look with graphic designer
> Thorough testing and troubleshooting of the application