Innovator Case Studies: Innovator Case Studies: Community Hospitals - - PDF document

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Innovator Case Studies: Innovator Case Studies: Community Hospitals - - PDF document

Feb 25, 2023 926 likes •1.15k views

Innovator Case Studies: Innovator Case Studies: Community Hospitals Community Hospitals Paul R. ODea Angela Blackburn Executive Director Vice President, Clinical Operations, Mary Cedars-Sinai Outpatient Cancer Center Crowley Cancer

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Innovator Case Studies: Innovator Case Studies: Community Hospitals Community Hospitals

Paul R. O’Dea Executive Director Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute Vice President, Aptium Oncology, Inc. Angela Blackburn Vice President, Clinical Operations, Mary Crowley Cancer Research Centers

Cedars Cedars-

  • Sinai Outpatient

Sinai Outpatient Cancer Center Cancer Center

Paul R. O’Dea Executive Director, Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute Vice President, Aptium Oncology, Inc. Los Angeles, California

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The Aptium Oncology Network The Aptium Oncology Network

  • Alta Bates Summit Medical Center

Berkeley, CA

  • Cedars-Sinai Medical Center

Los Angeles, CA

  • Desert Regional Medical Center

Palm Springs, CA

  • Mount Sinai Medical Center

Miami Beach, FL; Aventura, FL

  • Boca Raton Community Hospital,

Lynn Cancer Institute West Campus Boca Raton, FL

  • NYU Cancer Institute

New York, NY

  • St. Vincent’s Hospital Manhattan

New York, NY

  • Trinitas Hospital

Elizabeth, NJ 4

Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

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Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

  • Community/Teaching Hospital

– 952 licensed beds; 26 operating rooms – 2.5 million square feet – Inpatient units in two adjacent towers – ICU beds in separate newly constructed tower – Outpatient services in multiple buildings – Dedicated research building

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Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

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Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

  • Outpatient Cancer Center

– Contract with Aptium to build and manage – 1984 – Completed – 1988 – 53,000 Square feet

  • Lower Level of the North Tower
  • Open 24/7

– Expansion to 74,000 Square feet

  • Faculty/Private Attending in contiguous office space – 2005
  • Lab, MD Office, Exam Room, Infusion Center expansion
  • Phased Construction – beginning in 2007

– Addition of Gamma Knife in nearby location - 2006

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Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

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Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

  • Cancer Center Capabilities

– Exam Area 15 rooms - expanding to 25 – Dedicated Laboratory (70% of tests) – Dedicated Pharmacy – Dedicated Radiology

  • CT
  • Digital X-Ray

– Infusion Center

  • 17 Private rooms
  • 5 Chair infusion room
  • 18 Central Chairs
  • Expanding to add 13 infusion chairs

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Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

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Cedars Cedars-

  • Sinai Medical Center

Sinai Medical Center

  • Cancer Center Capabilities

– Radiation Oncology

  • In/Outpatient (5%/95%)
  • 3 Linear Accelerators (one being replaced)
  • HDR Brachytherapy Afterloader
  • Superficial X-Ray
  • Gamma Knife
  • Trilogy (12/2007)

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Physicians Physicians

  • Radiation Oncologists – offices in the Cancer Center - 3

– exclusive professional services contract

  • Faculty – offices in the Cancer Center - 10

– Employed by CSMC

  • Division Chief – 1
  • BMT/SCT/Hematology – 3
  • Pediatric Oncology – 2
  • Gynecologic Oncology - 4
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Physicians Physicians

  • Private attending – offices in the Cancer Center - 18

– Pay rent for administrative office

  • Surgical Oncologists – 4
  • Gynecologic Oncologist – 1
  • General Surgeon – 1
  • Plastic Surgeon (Breast Reconstruction) – 1
  • Medical Oncologists – 10
  • Psychiatrist – 1
  • Nurse Practitioners – space in the Cancer Center - 2

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Physicians Physicians

  • Medical Group – offices off site - 2

– Employed by Cedars-Sinai Medical Group

  • Medical Oncologists – 2
  • Prostate Cancer Center – located in adjacent building - 2

– Faculty – employed by the Medical Center

  • Medical Oncologists – 2
  • Members of the Hematology Oncology Division – 29

– Private attending

  • Offices located in various off campus locations
  • Medical Oncologists - 29
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Organizational Chart Organizational Chart

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Medical and Executive Director Duties Medical and Executive Director Duties

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Competitive Analysis Competitive Analysis

  • Surrounded by three NCI-designated comprehensive

cancer centers:

– UCLA

  • 4.5 driving miles

– USC Norris

  • 14.5 driving miles

– City of Hope

  • 34 driving miles
  • Saint John’s - John Wayne Cancer Center

– 9 driving miles

  • Private attending physicians’ “Cancer Centers”

– two within one mile

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Innovations Innovations

  • Open twenty four hours a day

– Prolonged chemotherapy (outpatient stays up to 24 hours) – Initiation/titration of pain management modalities – Emergent (not emergency) cancer care

  • For example:

– Intractable nausea and vomiting – Febrile neutropenia – Dehydration – Sudden onset of pain – Etc.

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Innovations Innovations

  • Most services located on one floor

– Physician/nurse/supportive care office visits – Laboratory – Pharmacy – Infusion therapy – Radiation Therapy – Dedicated cancer patient imaging (CT and X-Ray) – Other imaging (e.g., PET/CT, MRI, Ultrasound, etc.)

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Innovations Innovations

  • In-house cancer supportive care

– Pain management – Psychosocial (Psychiatry, Social Work, Child Life) – Nutrition – Complementary medicine

  • Maintain highly competent nursing staff

– Incentives for receiving Oncology Certified Nursing (OCN) designation

  • 92% of the full time RN staff is OCN certified
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Innovations Innovations

  • Gamma Knife Capabilities – late 2006

– Support a growing neurosurgical program – Only unit located on the “westside” of Los Angeles

  • Cancer Institute Director – late 2007

– Build cancer service line as a unified program

  • Dedicated Cancer Phase I Trial Unit

– Coming in 2008

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Innovations Innovations

  • Others:

– Commenced collaboration with Health Care Design to create a "healing environment" in 2003 – Partnered with architectural, interior design and art firms whose focus is healing environments – Created new position to optimize flow and patient satisfaction – Launched niche programs for Sarcoma and Carcinoid – Surveyed cancer center physicians for satisfaction – Hired way-finding consultants – CARE program

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Mission Critical Mission Critical

  • Maintain referrals – generate new patients

– Innovations – Differentiation from competitors – Early adopter of technology – Program evaluation – Kaizen-like process evaluations

  • Maintain a favorable payor mix and

contracting

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100 150 200 250 300 350 DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV FY05 FY06 FY07

DEC JAN FEB MAR APR MAY JUN JUL AUG COMPARE FY05 267 282 259 300 213 275 288 228 280 2,392 FY06 237 254 258 319 245 319 299 270 323 2,524 FY07 272 280 292 309 308 316 317 311 287 2,692

  • New Patients

New Patients

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Payor Mix Payor Mix

44% 45%

42%

32%

31%

34%

9%

9% 10%

9% 11% 9% 4%

4%

4%

1%

1%

1%

0%

0%

0%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% PPO Medicare Medi-Cal HMO CSMC IP Commercial Private Pay

Payor Mix

FY05 FY06 FY07

  • A

A “ “Clinical Operating System Clinical Operating System” ” for Today for Today’ ’s Cancer Center s Cancer Center

Angela Blackburn Vice President, Clinical Operations Mary Crowley Cancer Research Centers

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Agenda Agenda

  • About the center
  • Needs & challenges
  • Solution
  • The road ahead
  • Lessons learnt

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About Mary Crowley About Mary Crowley

Non-profit, founded in 1992 Mary Crowley Network

includes Central Clinic and 8

  • ther affiliate sites around

the country

3,000+ patients treated to-

date

200+ investigative drugs,

140+ FDA approved studies

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Expanding Patient Treatments Expanding Patient Treatments

  • The Mary Crowley Difference

– Patient Experience – Innovative Research – Non-toxic Targeted Therapies – Personalized Treatment – Expanded Community Access – Partnership with Patients’ Existing Oncologists

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SMO

(Site Management Organization)

Clinic Mary Crowley Cancer Research Centers

TOPA Baylor Hospital Tyler, TX Greenville, SC Albany, NY Dayton, OH Billings, MT Dallas, TX Transc- ription Service Billing

Lab

Pharmacy

Affiliate Sites

External Labs Sponsor-1

Business Partners

Sponsor-2 Sponsor-3 Sponsor-4 Sponsor-5 Sponsor-n

Sponsors

The Network The Network

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Unique Requirements Unique Requirements

  • Centralized clinical trial management

– Secure yet “connected” to all affiliate sites – Direct sponsor interaction for billing and case report forms

  • Specialty cancer EMR for clinic

– Support rapid conversion of paper records from PCPs, Labs and Referring Physicians to electronic scans – Combine traditional treatment plans with clinical trial and translational treatment protocols – Connect to labs, pharmacy, sponsor systems, scheduling

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Challenges Faced Before New Challenges Faced Before New System System

  • Long patient wait times due to reliance on

physician’s ability to match incoming patient to

  • ne of 50 open protocols
  • Large number of data discrepancies and

costly “queries” due to disparate systems – EMR, Labs, Patient Scheduling and CTMS

  • Significant missed/late revenue due to

manual sponsor billing

  • “Paper” everywhere!
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33 Practice Management System Financial Systems EMR Labs and Pharmacy Clinical Trial Mgmt System

Disconnected silos of information made it impossible for doctors to get a single picture of patient record, let alone manage a comprehensive treatment plan

IT System Challenges IT System Challenges

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Implementation Methodology Implementation Methodology

  • Independent assessment by Net.Orange

to prioritize projects based on:

– Projected benefits – Estimated cost/effort

  • Slotted projects into incremental 3 month

releases

  • 1-2 month test cycle with limited

sites/users

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Solution: Clinical Operating System Solution: Clinical Operating System

Microsoft (Great Plains) CTMS Lab EMR Rx Finance Pract. Mgmt Net.Orange (cOS Trials) Antek (LabDaq) Net.Orange (cOS TheraSystem) Misys (Vision) PCS (Rx/3000)

Clinical Operating System

Partner systems

Referring Physicians, Patients Affiliate Sites Clinic Physicians, Nurses Sponsors Finance

CDMS Net.Orange (cOS TheraSystem)

Role-based Portals

Translational Medicine warehouse

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Benefits of a cOS for Mary Crowley Benefits of a cOS for Mary Crowley

  • Built for growth (new systems don’t need to be interfaced to

each system)

  • Better patient-study matching

– Reduced wait times – Better fit studies

  • Ability to track genomic profiles of patients
  • Faster sponsor billing, cash cycles
  • Support for adaptive trials and eCRF needs

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Roadmap Ahead for Mary Crowley Roadmap Ahead for Mary Crowley

  • Expanding the network with 5 more new

sites

  • Rollout of the Oncology EMR
  • Interfacing devices to the cOS

– Varidex CellSearch (circulating tumor cells) – Affymetrix GeneChip – Proteomics tool – Translational pathways tool

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Contact Us Contact Us

Paul R. O'Dea Executive Director Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute 8700 Beverly Blvd. Los Angeles, CA 90048 Tel: 310.423.0600 paul.odea@cshs.org podea@aptiumoncology.com Angela Blackburn Vice President, Clinical Operations Mary Crowley Medical Research Center 3535 Worth St. Collins Bldg, Suite 302 Dallas, TX 75246 Tel: 214.6581967 ablackburn@marycrowley.org