Using Internet Technology To Improve The Preadmission Process

1. 2nd Annual Ellison Pierce Symposium Positioning Your ORs For The Future Using Internet Technology To Improve The Preadmission Process Stephen T. Punzak, MD Medical Web Technologies, Inc. Boston University School of Medicine May 20, 2006 8:00-8:30am

2. What percentage of the US population uses the internet at least once per week? QUESTION: • 0 – 20% • 21 – 50% • 51 – 70% • > 71% 0 / 10

3. Do you use the Internet for preoperative screening of patients scheduled for surgery? QUESTION: • Yes • No 0 / 10

4. Main Talking Points • The evolution of the preop screening process. • Are the factors that drove the creation of PATCs still valid? • An Internet-based model for streamlining the PATC process. • Advantages of an Internet-based PATC process. • The One Medical Passport System • The Technology Adoption Life Cycle and how it affects everything you do in healthcare.

5. The first step to getting help (realizing that you need help) is admitting (recognizing) that you have a problem…

6. Put another way, you never get a second chance to make a good first impression… • The PATC and the preadmission process are a patient’s first impression of your medical facility. • Make sure that you get it right. • If you get it wrong, i.e., if you make a patient miss another day of work to sit for hours in your PATC you will be “behind the 8 ball” for all subsequent interactions that patient has with your facility and staff.

7. The Birth and Evolution of PATCs & Surgical PreScreening • Created when patients began to be admitted the same day as their surgical procedure to reduce “surprises” and last minute cancellations. • Accelerated demand created by new surgical and anesthetic techniques & drugs that allowed for rapid recovery. • Same Day Surgery techniques made free-standing ambulatory surgery centers (ASCs) possible. • ASCs, most without a formal PATC, decreased prescreening requirements even further, i.e., the “telephone interview”.

8. Yes, PATCs get patient information and decrease cancellations, but: • Expensive to operate - at least $125.00 per patient not including testing • Non-reimbursable cost • Extremely inconvenient for patients • “Routine testing” doesn’t improve patient care

9. PreOp Clinic Approach ADVANTAGES: • Convenient for the facility DISADVANTAGES • Inconvenient for Patients • Expensive for the facility - $125.00 per patient (Stanford Univ. ) • Lots of repetitive work processes • Is the “assessment time” allocated correctly to the patients who need it most?

10. Telephone Interview Approach ADVANTAGES: • Somewhat more convenient for patients than having to go to the medical facility. • Somewhat less expensive than an in-person visit. DISADVANTAGES: • Calls often made at inconvenient times for the patients. • Multiple calls to reach a patient. • HIPAA concerns re: personal health information, e.g., calling a patient at work. • Patients may be reached at a location where they don’t have access to their medications, family with additional info, etc.

11. Why Change ????? • “If it ain’t broke, don’t fix it” • “Change is scary” • “Pioneers…those are the guys with the arrows in their backs…” • “A body at rest, remains at rest, unless acted upon by an outside force” Given the above, why change your current PATC process?

12. Catalysts For Change • $$$$$ - it costs, on average, $125.00 for a PATC visit not including diagnostic testing. This is usually not reimbursable. • Worsening nursing shortage that is likely to be a long term change, not a short term problem. • Patients are more sophisticated and realize that they have choices. They are increasingly intolerant of inefficiency and inconvenience. • Competition from “For Profit” medical facilities with a keen eye on streamlining processes and providing increased patient satisfaction.

13. PreOp Process Redesign • Start with a “clean sheet of paper”, i.e., free your thinking from all preconceived notions of what the process should entail. • Define “goals” of an ideal process. • Design a process that meets the goals. • Break down the process into the smallest component steps possible. • Decide “Who, what, where, when” for each step.

14. Attributes Of An Ideal PreOp Screening System • Information obtained in advance of seeing a patient allows “triaging”, i.e., best allocation of scarce resources. • Information presented in a legible, uniform fashion. • Duplicate work processes eliminated.

15. Current Information Flow Process In Most Facilities Patient Nursing Patient Anesthesia Patient Surgeon Patient Admitting Staff

16. Internet-based Process Information Flow Surgeon Patient Data Server Nursing Anesthesia Admitting

17. U.S. Internet Usage Statistics • 70% of U.S. population use the Internet at least once per week. • 50 M people in the U.S. use the Internet daily. • Last 12 months have shown an increase in “complex transactions” such as online shopping, travel reservations and banking/financial transactions.

18. The One Medical Passport System

19. The Technology Adoption Life Cycle • Initially described in the mid-1950’s to explain sales of improved hybrid corn seed. • Made famous, in business circles, by Geoffrey Moore in his book: “Crossing the Chasm”. • Central premise: All markets are divided into 5 distinct groups that “buy” based on markedly different criteria. • Whether selling ideas or goods, understanding these 5 distinct groups and what motivates each one to buy (or not buy) is critical.

20. The Technology Adoption Life Cycle • Innovators (Technology Enthusiasts) • Early Adopters (Visionaries) • Early Majority (Pragmatists) • Late Majority (Conservatives) • Laggards (Skeptics)

21. Innovators (Technology Enthusiasts) • A.K.A. “Techies” • Buy solely because something is new • Enthralled with technology for its own sake • Will put up with Beta versions, no documentation, etc. • Relate to other “techies” • They want the truth • They want to be the first to get “new stuff” • Only 1-2% of the total market

22. Early Adopters (Visionaries) • Match an emerging technology to a strategic opportunity • Typically recent entrants to the executive ranks • Have a dream that they want to pursue • Looking for breakthroughs, not incremental improvements • Often view their careers as a series of stepping stones.

23. Early Majority (Pragmatists) • They want evolution, not revolution • Slow, incremental progress is their goal • Very reference oriented • Want references from their “peers”, not from Innovators and Early Adopters. • Risk averse • Strong company loyalty

24. Late Majority (Conservatives) • They fear change a bit • Loyal to tradition: “That’s not the way we do it here…” • Want a fully developed, “bundled package” of goods • Expect heavily discounted prices

25. Laggards(Skeptics) • Do not participate in adopting new products, services or ideas except to block their introduction • Will continually point out discrepancies between what’s been promised and what’s been delivered. • Will continue to fight a “guerilla war” after a decision has been made • Goal is to neutralize their influence and the potential damage that they can do