All posts by CHOC Children's

CHOC Children’s Specialists Strengthens Partnerships

One of CHOC Children’s key strategic initiatives was accomplished in November 2011 with the implementation of a medical foundation, CHOC Children’s Specialists. Created in response to physicians seeking closer alignment with the hospital, CHOC Children’s Specialists will help both CHOC Children’s and contracted physicians address future healthcare delivery and payment reform more effectively.

“As accountable care organizations (ACOs) become more prevalent in Southern California, CHOC Children’s Specialists will give our hospitals and contracted physicians a better position from which to respond,” said CHOC Children’s Chief Strategy Offificer Elaine Bauer. Late last year, she added, CHOC received a notice of intent from California Children’s Services to award a demonstration pilot project for the care of chronically ill children.

Additionally, the medical foundation’s ability to provide market-rate compensation is expected to increase CHOC’s ability to attract and retain the next generation of pediatric subspecialists who prefer a foundation model with less risk.

CHOC Children’s Specialists is operated as a division of CHOC. Planning, operations and fifinance are overseen by a Joint Governance Committee. At this time, CHOC Children’s Specialists has a professional services agreement with the Pediatric Subspecialty Faculty.

CHOC continues to have an open medical staff and physicians do not have to join CHOC Children’s Specialists in order to practice at CHOC or refer to CHOC physicians. For more information, please contact Elaine Bauer at (714) 532-7672.

Teaching Your Patients About The Medical Internet

Patients often have a difficult time understanding their medical problems or the recommended treatment. Many tend to tune out medical words, making it seem like what you say to them goes “in one ear and out the other”.  I have been astonished multiple times when people call asking a question that I have explained to them at great length previously.

In attempting to always be “The-Most-Excellent-Doctor-Ever,” I found myself distressed when patients looked at me with blank confused faces as I tried to draw their surgery for them, or write them a large list of post-operative things to expect.

This has changed for the better ever since I began showing patients how to look up their problems on the Internet. Even educated and computer-savvy patients do not realize how much information they can find about their medical problem on the right Internet sites. This answers a lot of their questions, calms down the anxious ones, and prepares them for participating in care decisions.

Our office has a computer in each exam room (EMR), so I show them the sites right there during the post-exam discussion.  I start with Google-Images, which will show them 4,000 images of their problem or surgery.  Patients just need you to write out the correct medical term or terms. For example, “ankle bimalleolar fracture,” “ankle fracture treatment,” and “ankle fracture surgery” will all give you different sets of pictures, and your patients will probably want to look at all three.

From there, they can click right to Google-Web or Video to read articles or see movies (they can even see their surgery if they wish).

Some other useful web sites include Web-MD, or for orthopedics – Orthoinfo.org (written for laymen by the American Academy of Orthopedics), POSNA.org (Pediatric Orthopedic articles), and ORLive.com (videos of all kinds of surgeries!)

My patients love this and are very appreciative of being better informed. They can spend as much or as little of their own time as they want, and they end up with a much greater understanding of their treatment.

News from the PIC – July 2012

Clinical Leadership Council Update

The Clinical Leadership Council (CLC) continues to identify opportunities to advance the clinical vision and program development strategies for CHOC Children’s.  As we rapidly approach the opening of the CHOC South Tower, scheduled for April 2013, the CLC is working in concert with CHOC Senior Leadership Team (SLT) to complete a number of important projects. Most recently, our focus has been directed to the following:

Clinical Program Development Process:

The CLC, in partnership with Elaine Bauer, Chief Strategy Officer (CSO) and the SLT, has been working to create a formal CHOC Clinical Program Development Process. It is evolving into a detailed, thoughtful, and collaborative process for clinical program review and approval, whereby medical staff leaders partner with physician colleagues and administrative leadership to discuss clinical program visions through concept proposals for program growth and development. If recommended by CLC and approved by SLT, the goal is to follow through with the development of a formal business/strategic plan. The formal plan, once completed, will come back to CLC for review and approval, and would then be forwarded to SLT for final consideration. The evaluation process will provide a formal mechanism for timely review of program development proposals in order to evaluate, prioritize, and implement those that are approved.

CHOC Clinical Program Presentations:

Sleep Center Expansion:

As one of our first formal program reviews, the CLC worked closely with Bruce Nickerson, MD and Mary Zupanc, MD, along with CHOC Operations and Business Development teams, in obtaining SLT approval to expand the CHOC Sleep Center. As a result, within the next year, facility upgrades to our three sleep rooms will be made to allow for certification through The American Academy of Sleep Medicine (AASM). As part of the expansion, CHOC and the CHOC Children’s Specialists will begin recruitment for a Sleep Center Director certified in Pediatric Sleep Medicine. Additionally, the Sleep Program Team plans to establish outpatient clinics dedicated to sleep disorders and will continue exploring expansion into South County through a proposed satellite site based at CHOC Children’s at Mission Hospital (CCMH). We are very excited about the program expansion project and will keep you posted on our progress.

CHOC Institute Presentations:

As part of our process to advance CHOC’s clinical vision, the CLC is scheduling a series of concept/vision proposal presentations to include the CHOC Institutes. As a first step, the CHOC Neuroscience Institute presented its concept/vision proposal to the CLC. Dr.’s Mike Muhonen, William Loudon, and Mary Zupanc, along with administrative lead, Linda Campbell, provided their multi-year vision to advance the CHOC Neuroscience Institute toward becoming a nationally recognized center. Their concept proposal was endorsed by the CLC and was subsequently presented to SLT for approval to proceed in development of a formal business/strategic plan. We are pleased to announce that the SLT approved development of an updated plan based on the concept/vision proposal. Once completed, the formal plan will be reviewed by CLC for formal recommendation to SLT.

As we continue to finalize the CHOC Clinical Program Development Process, we look forward to on-going opportunities to partner with physician leaders to advance the clinical programs at CHOC.

 

Pediatrician-in-Chief/Chair Interview Project

In my role as Pediatrician-in-Chief (PIC) at CHOC, I recently had the opportunity to complete a series of interviews with Pediatrician-in-Chief/Chairmen or their equivalent at 13 Children’s Hospitals across the country. Debra Beauregard, my Interim Chief Administrative Officer, and I partnered in the completion of this project.

The interviews were focused on children’s hospital and university partnerships, physician integration and leadership models, and on strategies and processes to advance clinical and academic programs. We selected the children’s hospitals and universities based on a variety of factors, including their national stature, size, and their current models of affiliation and physician alignment. The Institutions included in the interview project were:

  • Children’s Health Center of Atlanta/Emory University
  • Children’s Hospital of Boston/Harvard Medical School
  • Children’s Hospital of Philadelphia/University of Pennsylvania
  • Children’s Hospital of St. Louis/Washington University
  • Children’s Hospital of Wisconsin/Medical College of Wisconsin
  • Children’s Medical Center (Dallas)/University of Texas Southwestern
  • Akron Children’s/Northeast Ohio Medical University
  • Cincinnati Children’s Hospital Medical Center/University of Cincinnati
  • Le Bonheur Children’s Hospital/University of Tennessee
  • Lucille Packard Children’s Hospital at Stanford/Stanford University
  • Rady Children’s Hospital/University of California, San Diego
  • Seattle Children’s Hospital/University of Washington
  • Texas Children’s Hospital/Baylor University

Through the interview process, a number of clear, universal, themes emerged. One of the most critical factors to successful relationships presented by all 13 PIC-Chairs was the importance of a campus-wide dedication to strategic partnerships; including relationships with physician partners as well as relationships with partnering institutions. The success of these partnerships lies in the alignment of a shared mission and vision. The large majority of the institutions interviewed had decades of experience in integrating cultures and working toward alignment of mission and vision, and all shared that this is an ongoing process, requiring continuous effort and dedication. The PIC-Chairs encouraged us to remain committed to nurturing and growing our partnerships as we continue on the path toward clinical and academic excellence.

It was inspiring for us to have the PIC-Chairs invite further discussion, and we plan to continue engaging in dialogue with them. Their willingness to openly provide information; and to welcome ongoing discussions serves as a reminder that there is an extreme wealth of information available for the asking; as we have colleagues throughout the county who will share their knowledge and experience with us.

We are extremely pleased with the outcome of our interviews, and we look forward to sharing more insights with you in future PIC Newsletters and through other CHOC forums.

 

CHOC House-Based Medical Directorship Recruitment Updates

I am pleased to announce that in preparation for the opening of the CHOC South Tower, several key house-based physician recruitments are in process. There are currently three active Search Committees for recruitment of CHOC Medical Directors of Emergency Medicine, Radiology, and Pathology. These committees consist of both physician and administrative leadership. We are working in close partnership with Emergency Medicine Specialists of Orange County (EMSOC), Moran, Rowen, and Dorsey (MRD), and Orange County Pathology Medical Group (OCPMG) as we collaborate on the recruitment of these critical positions. We will keep you posted as to the progress of these important recruitment efforts.

2012 Has Arrived (No, it’s not New Years again)

For those who have been accessing CUBS Powerchart, you’ve noted some changes more related to the color scheme than any new functionality.  That may seem like a minor upgrade, but under the “hood” is a major release of new code (2012) in which our new Tower applications have been built and which paves the way for implementing ICD-10 coding.  Unlike our recent unscheduled down time (see below), the transition to our new code was very well planned and extensively tested before going live.  Kudos are due to our IT staff and Cerner for making this pretty much a non-event for our clinicians.  There are still a few issues being investigated and fixed, but they’re relatively minor in nature.

Not so well planned was our unexpected downtime through much of the working day on July 23rd.  Cerner maintains our application servers and database back in Kansas City.  Many other clients have also chosen this “remote hosting” option, which has proven to be quite reliable.   A human error that took several hours to correct brought systems down for all these remote-hosted clients.  I know this created a lot of extra work for everyone providing care here at CHOC.  Thank you all for your dedication in helping us recreate the care provided in the system.

We are beginning to discuss training needs for physicians utilizing new technology related to our new Tower services.  Training strategies will vary based on the department.  Once we have a plan in place, we’ll let you know what resources will be available to you for this training.  Based on needs, there will be a combination of web-based training, classroom training, on-the-job training, and “cheat sheets” to serve as reference materials.  There will be specialty-specific needs and strategies to fill them.

About Dr. Feaster

Bill Feaster, M.D.
Bill Feaster, M.D.

First, I want to thank everyone I have met during my first few weeks here at CHOC for all of their help getting me “up to speed” on everything going on in this wonderful institution.  I meet new physician colleagues every day and hope to meet as many of you as possible in the coming months.  I won’t be working clinically yet at CHOC until our new ORs open, but will be back at Lucile Packard Children’s Hospital (LPCH), working a couple days a month.  Prior to becoming the CMIO here at CHOC, I was actively practicing pediatric anesthesia at LPCH, and responsible for their perioperative information systems (Surginet).   As additional background, I am boarded in Pediatrics and Pediatric Critical Care (now expired) and spent the first half of my career as an intensivist, so I’m pretty familiar with the clinical activity in a children’s hospital.  I’ve met several of you in my prior roles, and even started my critical care practice in the pulmonary group at Children’s Hospital Oakland with Dr. Nickerson. (Way too many years ago to state!)  In addition, much of my career has be focused on IT, helping implement clinical and administrative systems at several institutions.  I have a great deal of experience with Cerner, and have served as a consultant for them in their perioperative business unit.   Enough about me…now for a brief update…

Next week, we will present you with yet another upgrade of our Cerner EHR (CUBS).  Recently, the look and navigation changed somewhat with the implementation of “Enhanced View” within Powerchart.  That was the prerequisite for moving to the latest code level (2012).  Jumping to this new code was necessary to enable a move to ICD-10 in the near future.  It has some potential new functionality we haven’t yet implemented, so about all you will notice now is a change in color scheme.  If you’re not partial to blue, you may not be thrilled with the change!  Please let me or the CI docs (Drs. Andreef, Chang, Grant and Taraman) know if you have any issues with the new code.  For any significant problems you find, please fill out a help desk ticket.

As we move forward the next few months, 4 new “Nets” will go live to support operations in the new tower.  Stabilizing the existing system before copying in all of the new Nets will require that we severely limit changes to the system.  If you have been eagerly awaiting that specific enhancement you’ve requested, you’ll have to be patient.  We can’t do the testing we need to do and assure that everything is working properly if we keep changing things in our current system.

I hope that I can soon move my focus from operations and opening the tower to future IT development initiatives at CHOC.  The technology world around us is moving to mobile devices, social networking, cloud based computing and the like faster than the medical field and we need to keep pace.  Our patients are getting more web-savvy and are looking for more direct access, we have needs to share information across institutions, we have to continue to improve the care we provide to stay competitive, we need to support research and advance the knowledge in our specialties, etc.  We also need to improve the usability of all the systems we have put into place so that they just facilitate care, not make care more difficult.  The plate will continue to be full as we continue our development in IT, but it will be truely exciting times!  I hope you can enjoy them with me.

My current location is the 8th floor of Centrum in Suite 88O (ISD).  My email is wfeaster@choc.org.  My cell is 714-403-1692.  Feel free to contact me.  Bill Feaster