#LeadingVBHC – We talked to Linda Russell, MD from HSS after her presentation, Fundamentals of pre-op optimization: Patient selection, reducing cost
Breanna Cunningham: Hi, Bre Cunningham. I’m here with Linda Russell from HSS. We heard a lot of great stories that came out of your organization. Several of your colleagues were here today. Then you gave two fantastic presentations here at this value-based conference.
I just would love to dive in more and talk about how your organization has become a center of excellence, and really where everyone’s looking to see what’s going on in value-based medicine. I think that first starts with being a catalyst for change. If you’re not changing, you’re not staying advanced in what’s going on. Can you tell me how you’ve been able to instill a culture of change within your organization?
Dr. Linda Russell: We’re always striving to be better. That is our motto right now. We want to be better, and we know to be better we have to continually try to assess what we’re doing and to look to see how we can make it better. We found that if we put interdisciplinary groups together that includes administration, operational excellence, clinicians we can really come together at the table and design future state.
Then, trying to get to future state is the goal, but usually, with operational excellence, they can help us get to that future state. We just have to have buy-in as an institution what we want that to be. Then we can slowly try to work towards that goal.
Cunningham: I’d love to have an example. I would love to hear about a technology or something that you were wanting to implement, and how these interdisciplinary teams came together and then approached the administration and got the buy-in.
Russell: Well, I think the biggest project we’ve done recently is last February we put Epic in place. It’s an electronic medical record, so for about 18 months before we actually put Epic in place we had teams that dealt with the outpatient world, the inpatient world, the operating rooms, and at that time we looked at the current state. We decided what was great about the current state, what was not great about the current state, and then slowly we designed future state knowing what Epic could help us with. We had Epic at the table with us and they were able to show us what the technology could do.
I think you don’t really understand it until you have it in place, so now we’re in phase two where we do have a new electronic medical record and we’re trying to build on that and make things better. I think, actually, this is the exciting time because we figured out that we could put Epic in place and everyone survived. Now we want to see how we can use it to make patient care better and more efficient, actually.
Cunningham: Right. Are you still using that interdisciplinary approach with that for optimization?
Russell: We do, we do. We found that works very well. Whenever we have a problem that we want to solve, we put together a team, and that’s been our best approach for getting problems solved, actually.
Cunningham: Another big theme of this conference was outcomes. We heard a lot about how important they are and what people are doing with them. What we haven’t heard a lot of is how people are collecting them. One of your colleagues had mentioned that you have a program in place for your orthopedic patients for outcome data. I’d love to hear what you’re doing, how you’re doing it, and what you’ve found successful about the program and what’s been challenging.
Russell: Over the years we’ve had registries. Registries for total joint replacement, for ACL repair, and basically …
Cunningham: Internal registries? Like, HSS has their …
Russell: HSS registries, yeah. Basically, we used research assistants to help collect that data. Some patients are very tech savvy and they can enter information on their own. Some people are older and not as comfortable with technology so the research assistants would help facilitate collecting that data.
Cunningham: In clinic was it being collected? On paper being sent to the patient?
Russell: Yes, often it was being collected on paper in the old days and then entered into some program that we had. Our goal now is, is to find one database that we can enter all registry data. What Cathy McClain is trying to do, is she’s trying to have each patient who has a surgical procedure fill out an outcome tool and ask questions about, basically, activities of daily living, how you’re doing. Then we want to follow that over time, especially if there’s a surgery in the middle, to see if a surgery or a procedure or a physical therapy session changes how the patient’s doing. It’ll be very objective and we’ll do it throughout the institution. We’re going to try to do it disease-specific. If someone has rheumatoid arthritis or lupus, we’ll try to have specific outcome measures for that group of patients.
Cunningham: You’re talking about building a global program, not just with your surgical population, but with all your patient population?
Russell: Yes, eventually we want it with all our patients. Right, exactly, that’s the goal.
Cunningham: Currently you’re doing it with your total joints?
Russell: Yes. Individually, like in the department of rheumatology we do collect, we have a lupus registry, so we do collect some information, but the goal is that it would be much broader and there’ll be hopefully one or two IT places where all the information is kept. All the information before Epic was in multiple different places, so we want to try to bring it into one place.
Cunningham: Do you use a red cap system for storing that data or an access database?
Russell: Yeah, we have used red caps, we have used lots and lots of things, but it’s not been coordinated. We have people in the research department that are thinking this through, trying to find out the best way to collect data and store it.
Cunningham: Just like you had done with Epic.
Russell:: Exactly, exactly.
Russell: It’s just that patient care came before collecting research data. Now we have the liberty of thinking about this a little bit more.
Cunningham: That’s exciting, I mean, you definitely ahead of the game, and I’m sure that people will be looking to see what HSS does and copying that. What about national data registries? Are there any national registries that HSS participates in or supports?
Russell: Yeah, there are a lot of national databases that, it’s required that you submit information to. We submit information, or information is collected on things like readmission rates, surgical site infection rates, rate of VTE which has to do with blood clots after surgery. In general, we participate in anything that we’re allowed to participate in. We don’t have an emergency room, we don’t take care of all types of patients, so we can’t always submit to some of the national programs. Whenever we can, we try to actually.
Cunningham: Nice. One final question for you. What was your favorite session of the conference and why?
Russell: I think one of my favorite sessions was the session that it kind of explained bundled payments in a very basic manner because I think many people are still grappling with what bundled payments are and trying to understand the different bundled payments we’ve had. I think that was very informing for everybody at the conference.
Cunningham: Is that Kelly Price?
Russell: Yes, exactly.
Cunningham: I agree, that was a very, very good presentation. Well, thank you so much, Linda Russell, from HSS, and we are signing off.