IT Update from the Chief Medical Information Officer: Dr. Bill Feaster

What’s New With IT These Days?

There are several IT projects underway, with perhaps the most anticipated one being the switch from Groupwise to Outlook for emails, calendaring and other functions. We are currently implementing Microsoft Office 365, the web-based version of Office, and we should have everyone converted over to Outlook by the end of January 2016.

Bill Feaster, MD, MBA, CHOC Children's Chief Medical Information Officer
Bill Feaster, MD, MBA, CHOC Children’s Chief Medical Information Officer

We’re also putting a mobile device tool in place to allow people to access the enterprise network on their phones and tablets. That needs to be completed before we roll out, beginning in spring 2016, the iPad version of Powerchart called Powerchart Touch. The combination of network access and email accounts on Outlook should dramatically improve provider access to and use of our choc.org email accounts.

The promised move to badge authentication into Cerner is also starting soon, but had to wait until we got rid of Groupwise (network incompatibilities). This is another one of those nasty interdependencies, but this project will get underway in the spring and carry over into the next fiscal year.

Is anything happening with CUBS?

The last major specialty to move to electronic documentation and applications is oncology. Work to implement Cerner’s oncology product will begin in May, but take at least a year to complete. Most of our development work outside of oncology will be focused on increasing the usability of CUBS, with the goal of improving provider education on using the system, reducing the number of clicks to do things, and creating specialty-specific views, when available, to better present needed information to the provider.

ICD-10 seemed to go better than anticipated. The world didn’t end after all! It was a very smooth transition to the new coding system. But that took over three years of hard work to complete, several millions of dollars, some very skilled people on the project, and some very savvy providers and coders using the system. Early information is that the bills not only went out on time, but are actually getting paid! We’re still having a few issues with Diagnosis Assistant and a bit of confusion over diagnoses that can’t be fully specified, but fixes and education are in progress.

I’ve heard a lot about population health and the pediatric system of care. How is that going?

We’ve implemented a new Cerner solution called the Healthe Intent platform. It’s a “big data” system that takes in data from multiple sources, including CUBS, and programs running on that data implement evidence-based disease registries for chronic diseases, report on compliance with the measures in those registries, and support our care managers helping patients and parents to navigate the healthcare system. We are piloting the registries in our Garden Grove clinic beginning Nov. 2, and will be rolling the registries out to the rest of the organization soon. We are helping Cerner develop the care management piece of the platform, and it should be ready in the second quarter of 2016.

How Kids Can Heal Doctors | Dr. Anthony Chang | TEDxChapmanU Video

Anthony Chang, MD, MBA, MPH, pediatric cardiologist and CHOC Children’s chief intelligence and innovation officer, was invited to speak at the TEDxChapmanU event, which welcomed “extraordinary game-changers, challengers and thought-leaders to the stage at historic Memorial Hall at Chapman University.” His talk, “How Kids Can Heal Doctors,” addresses the doctor-patient relationship. Dr. Chang believes the training many physicians received in a paternalistic era of medicine coupled with the empowerment of patients has created greater distance between the two groups — a distance he wants to help bridge.

During his candid talk, Dr. Chang shares three patient stories that have impacted his own career path and outlook on medicine. He encourages colleagues to step out of their comfort zones, and to think innovatively on behalf of their patients. Big data and artificial intelligence are helping physicians be even smarter about medicine, creating excitement in the field for doctors and patients, alike. The medical profession is a still a very special one, something Dr. Chang’s patients remind him every day.

To hear more from Dr. Chang and other innovative leaders, please visit PEDS 2040.

CHOC Surgical NICU Reduces Post-Op Hypothermia in Infants

Consistent, standardized efforts across several disciplines helped CHOC Children’s reduce rates of post-operative hypothermia in neonates by nearly 88 percent, results of a quality improvement project show.

Staff decreased the number of babies who returned to the Surgical Neonatal Intensive Care Unit with body temperatures below 36 degrees Celsius from 10.7 percent to 1.3 percent following surgeries between September 2014 and August 2015.

Due to high body surface area, infants undergoing surgery are at risk for hypothermia, especially premature infants with decreased subcutaneous and brown fat. Hypothermia-induced vasoconstriction can lead to impaired wound healing, surgical site infections, impaired coagulation and decreased drug metabolisms, which can collectively increase perioperative morbidity, said Dr. Irfan Ahmad, co-director of the unit.

Though CHOC’s baseline figure was well below the national average rate of 15.6 percent, reducing post-operative hypothermia rates wasmock-surgery-1 identified as an area for quality improvement for the Surgical NICU and staff set out to reduce rates by half, Dr. Ahmad said.

Involving a cross-disciplinary team including nurses, neonatologists, surgeons and anesthesiologists, the project tracked 76 patients. Because infants can be at risk for hypothermia before surgery, intra-operatively and post-operatively, their temperatures were tracked during each operative stage. Staff were then able to identify problem areas and make improvements over each quarter.

Dr. Ahmad attributed the success to consistently implementing measures such as ensuring patients wore hats and blankets while headed to the operating room; pre-warming transport isolettes before placing babies inside; and using intra-operative heating devices during procedures.

Dr. Ahmad presented this data earlier this month to a quality congress held by the Vermont Oxford Network, a nonprofit, voluntary collaboration of health care professionals dedicated to the quality and safety of medical care for newborns and their families.

CHOC established its Surgical NICU in October 2013, and remains one of a handful of hospitals nationwide to cohort infants needing and recovering from surgery in a dedicated space.

Surgical NICU patients receive care from a multidisciplimock-surgery-4nary team that includes neonatologists, surgeons and many other clinicians. The surgical NICU team cares for patients jointly, discussing the cases as a group and forming a treatment plan that often calls for the expertise of other specialties.

Patients and families are a key component of the surgical NICU care team, collaborating and partnering with clinicians on every stage of the patient’s care.

The Surgical NICU rounds out CHOC’s expansive suite of services for neonates, including a main NICU; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.

Learn more about CHOC’s neonatal services.

CHOC Children’s Grand Rounds Video – How we can end hunger in Orange County: Waste Not OC – Dr. Eric Handler

In this CHOC Children’s grand rounds video, Dr. Eric Handler, Orange County public health officer, highlights a unique public-private partnership focused on eliminating hunger and reducing food waste.

The Waste Not OC Coalition uses a three-pronged approach: educate the community about food donations; identify “food insecure” individuals; and connect those individuals to sources of food.  The coalition facilitates the donation of wholesome surplus food from various facilities, including restaurants and hospitals, to local pantries that serve individuals in need.

Since the coalition was formed in 2012, it has increased the visibility of food pantries, raised awareness among business owners of the need for food donations, and empowered clinicians to refer patients to food sources.

View previous grand rounds videos.

News from CHOC Children’s Pediatrician-in-Chief, Dr. Nick Anas – October 2015

It is an exciting time to be at CHOC Children’s. Since the opening of the Holmes Tower in spring 2013, we have clearly adopted a campus-wide “can do” mentality. Our focus on innovation, the acceleration of new and expanded clinical programs, and our increasing academic emphasis are propelling us forward on the path to greatness, and I am very proud to be on this journey with you.

Dr. Nick Anas, CHOC Children's Pediatrician-in-Chief
Dr. Nick Anas,
CHOC Children’s Pediatrician-in-Chief

As the CHOC Clinical Leadership Council (CLC) enters its fourth year of the New and Expanded Clinical Program Process, I am encouraged by both the caliber of concept proposals that are developed each year, as well as the level of support and guidance that CHOC Executive Leadership continues to bring to this process. The result of this model of physician and administrative partnership is the advancement of our clinical vision at CHOC. On a parallel path, earlier this year, Kim Cripe, CHOC Children’s President and Chief Executive Officer, launched our Transformational Program Process, which has to date far exceeded our expectations. The level of enthusiasm has driven a collaborative process that has resulted in some truly transformational concept proposals. I have summarized details on both the New and Expanded Clinical Program and Transformational Processes below.

Again, I would like to share my appreciation along with my true sense of pride at being a part of this this legacy-creating time in CHOC’s history. I look forward to working with you on our continued clinical and academic advancements made on behalf of the children that we serve.

CHOC Clinical Leadership Council – New and Expanded Clinical Programs

FY17 New and Expanded Clinical Program Process

I am pleased to share with you that the CHOC Clinical Leadership Council (CLC) has recently launched our fourth year of the New and Expanded Clinical Program process. For fiscal year 2017 (FY17) projects, the CLC has received a number of exciting concept proposals. The physician and EMT proposal champions have been invited to formally present their concepts to the CLC on November 2nd. The concept proposal ranking provided by the CLC will result in recommendations to the CHOC Senior Leadership Team (SLT) to develop full business plans for the top ranked concept proposals. Our goal is to complete the business plans in time for inclusion in the FY17 budget, which means that they must be finalized by February of 2016 for final presentation to CLC and SLT for approval, allowing them to move onto “green light” implementation stage starting as early as July 2016.

Approved New and Expanded Clinical Programs

During the first three years of the New and Expanded Clinical Program process, CLC recommendations to SLT have resulted in several “green lighted” programs, which are now in various stages of implementation. To date, the CLC has received SLT approval for implementation of the following clinical programs:

  • Sleep Program expansion at CHOC, providing a third sleep station, along with introduction of a new Sleep Program at CHOC at Mission. In Mission we built an entirely new 3-bed sleep lab, and at CHOC we completed physical plant enhancements along with Children’s Specialists (CS) recruitment of Dr. Neal Nakra, board certified sleep and pulmonary specialist, allowing CHOC’s sleep labs to become accredited.
  • Gastroenterology Pill Cam was added as a new service at CHOC; implemented in 2014, the Pill Cam program is serving a growing number of GI patients.
  • Craniofacial Program expansion, including purchase of the Cone Beam CT Scanner (with the first cases completed in August 2015), addition of a physician assistant (to be hired), and expanded marketing and business development support, including robust web-content.
  • Vascular Anomalies Program expansion, including addition of Pulsed Dye V-Beam Laser services at CHOC. Our first three cases were performed on October 6th. The team also added Kim Hai, RN as the full-time nurse coordinator. The team is currently working with CHOC business development and marketing to launch enhanced web-content and print materials to promote the expanded program.
  • Feeding Program expansion provided for dedicated, renovated, fully-equipped inpatient space including 3 beds and the addition of a third feeding team to support program growth. The inpatient unit and 3rd team went live earlier this year.
  • Adolescent and Young Adult (AYA) Program includes design plans that were recently completed, as the team is working toward a build-out and an implementation plan to create a uniquely adolescent space and program for adolescent and young adult patients.
  • Inpatient Telemedicine Program expansion plans include the hiring of our full-time manager, Michelle Jones. In partnership with Dr. Jason Knight, who received a formal Medical Director role, they are focused on increasing utilization, adding subspecialty participation, and bringing on new hospital partners to provide inpatient telemedicine services.
  • Visualase, which provides minimally invasive tumor ablation, will be added to the CHOC Neurosurgery service line as a one-year pilot project approved by Matt Gerlach, CHOC Executive Vice President and Chief Operating Officer. The team is finalizing steps to bring Visualase to CHOC by December of this year.

In addition to these program approvals, CLC received approval for purchase of a portable CT scanner now in use in the CHOC ICU’s, along with several other equipment purchases. Matt Gerlach, has actively engaged the CLC membership to assist in prioritization of requested clinical capital equipment as part of the annual budget process, and is providing additional support to the New and Expanded Clinical Program process through the newly created CHOC Project Management Office (PMO).

The CLC also has several programs in the business plan development stage for consideration. These business plans include expansion of the CHOC Pain Program, creation of an Aerodigestive Disorders Center, and the potential for a Neuro-Intensive Care NICU Program. CLC is also working toward completion of business plans evaluating expansion of the Inflammatory Bowel Disease (IBD) and Eosinophilic Esophagitis (EoE) Programs, as well as review of a plan to develop an Undiagnosed/Rare Diseases Center. As these plans move through the process for consideration, we will keep you posted on their status. While all proposed programs that come through the CLC process are not approved for implementation, the process provides a venue and dedicated resources to all ideas to be further developed, actively discussed, and formally evaluated.

CLC Review of Existing Clinical Programs

As the CLC is focused on advancing the clinical mission of CHOC, we not only support proposals for new and expanded clinical programs, but also focus on promoting the growth and development of programs including the CHOC Institutes, house-based programs including anesthesiology, emergency medicine, pathology, and radiology, along with other premier programs at CHOC. The CLC is the perfect venue for clinical program advancement, bringing together physician and administrative leadership into a cohesive council, working together to help raise CHOC to the next level, as we secure our position as a nationally recognized children’s hospital.

Transformational Program Process

I am so proud of the preliminary results of a very exciting CLC-led concept, The Transformational Program Process. In January 2015, Kim Cripe, CHOC President and Chief Executive Officer, invited CHOC clinical, scientific, and administrative leadership to “dream big.” She asked for ideas that would transform not only CHOC, but change aspects of pediatric healthcare nationally/internationally. This call for ideas resulted in thirty-four proposals, igniting unique and exciting collaborations; ultimately culminating into fourteen transformational concept proposals. Through a formal evaluation process, the CLC recommended that the ten top ranked proposals move forward for further development.

CHOC recently engaged Lori Baker Schena, a talented medical writer, to work with each of the ten groups to develop compelling case statement “briefs.” These case “briefs” will first be shared with CHOC Senior Leadership Team (SLT) for concept approval, and then ultimately with key mega-donors in a collaborative process to develop truly transformational programs at CHOC Children’s. With the case statement writing actively underway, we are excited to move to the next stage of the process.

The somewhat unanticipated early outcome of this Transformational Program Process has been the overall level of commitment and enthusiasm, the unique and dynamic collaborations that have resulted, and the overall sense of “we can do this.” We feel this is a result of the evolving culture of innovation and collaboration at CHOC as we work together to create our legacy for the future. I am so proud to be leading this effort with Jan Lansing, with the dedicated support of Debra Beauregard, along with the entire CLC membership. We will continue to share our progress with you as we continue the Transformational Program Process.

I wish you all my best as we enter the fall of 2015. Please feel free to contact me any time at nanas@choc.org  to discuss ideas, new or expanded clinical program concepts, or your thoughts regarding the CHOC clinical vision or strategic plan.

Nick Anas, MD

CHOC Children’s Pediatrician-in-Chief