Monday, February 23, 2015

A Trip to Verona, Wisconsin in the winter?

Last week, I traveled to the Midwest with Dave Hynson, GBMC’s Chief Information Officer, Dr. Fred Chan, our Chief Medical Information Officer, Cindy Ellis, the Epic Project Director, and Mary Swarts, the Epic Nurse Champion. We went to Verona, Wisconsin, a suburb of Madison, the capital of Wisconsin, to visit the headquarters of Epic Systems Corporation. It was quite a trip.

Epic, the vendor of the new information system that we are about to begin building and implementing, has the reputation of being the company that is out in front of the others in the creation of a medical record that meets the needs of the patient, care providers, and those leading enterprises to deliver care. After meeting Judy Faulkner, principal owner of Epic and the person who started the company, I now can see how Epic got to the point of being the leader in this field. Judy described the origins of the company (1979) when she was helping create databases for clinical faculty members at the University of Wisconsin. People kept telling her that she should start a company. As a mathematician and computer scientist, she really didn’t know how to do this or even if it was a good idea. She took the advice and built a company with the motto: “Do good and have fun.” (Later she added “and make money”). Today, her company employs 8,000 people, 1,500 of the employees are programmers, on a sprawling 1,200 acre campus. 

The company moved to its present location in the early 2000’s and the buildings each have a Disney-esque feel and theme. Unlike most companies that use the conventional wisdom that individual offices for staff are not necessary and therefore build cubicles for their people, Epic has offices for just about everyone under the belief that a quiet space is necessary for people to maximize their productivity. 

We met with many people who explained to us the capabilities of the software and the importance of building it for GBMC in a way that will allow us to get the most out of it. We got a “test drive” of the software and we were all really impressed. When I last cared for patients I was using an electronic record but the capabilities of Epic are very advanced. Our colleagues demonstrated how easy it is to use telemedicine to communicate test results to a patient using their mobile app. They also showed us how notes can be created to maximize the discreet data that is captured for analysis later while allowing the provider to use voice recognition software to minimize typing.

Technology cannot create a vision or change a culture, but, it certainly can accelerate the rate of change toward a vision. I am very excited about implementing Epic so that each patient will only have one record at GBMC and it will make it easier to treat everyone the way we want our own loved ones treated. We have a lot to do between now and October, 2016 when we go live. Thanks to all who will help us get there and beyond!

Join the GBMC 50th Team for the Aids Walk & Run Baltimore on Sun. May 3rd

My good friend, Dr. Sam Ross, President of Bon Secours Hospital, asked me to support a cause that really needs help from the community. While some of us have not been focused on it, the AIDS/HIV epidemic has raged on, especially in the City of Baltimore. There are many undiagnosed cases of this terrible and treatable disease. On Sunday, May 3rd at 8AM there will be a walk and 5K run at the Maryland Zoo in Baltimore to raise money for AIDS awareness and testing.
I have started a team called GBMC 50th and I am asking all of my GBMC colleagues to consider coming out and walking or running with me as another fun way to celebrate our 50th Anniversary and give back to our community. If you want to get some exercise that morning or lend financial support (or both!) click on this link and follow the directions under “join a team”:


Thursday, February 12, 2015

Our People are Safer on the Job

The GBMC vision includes becoming the healthcare system where our team derives more joy from helping people. We have recognized that if our staff is not safe on the job, they clearly will not experience the joy in their work. For this reason, since fiscal 2013 we have had an annual goal to reduce employee injuries. In fiscal 2012 we had 370 injuries – more than 1 per day! In fiscal 2013 we had 327 and last fiscal year we had 231. This fiscal year, through January we have had 92. In the month of January, we had 7 employee injuries, the lowest since we started measuring!

We have not accomplished this by wishing or hoping or by lecturing our people. We did it by a thoughtful study of each individual injury. Mindy Beckwith, our Manager of Employee Health and our Employee Injuries Team have done a fabulous job in overseeing this system. When an employee is injured, his or her manager immediately studies the event and completes a form that includes a narrative about what happened. Every morning, the day’s injuries from 2 days prior (to allow adequate time for study) are reported on the Executive Lean Daily Management board. Our senior team looks for the learning from the injury and shares it at each of the LDM boards (we now have 30 of them) and later in the day, an email goes out to all that explains the nature of the injuries with suggestions for preventing them.  We have had major success in reducing employee strains and sprains especially from lifting. In addition, our learning from splash injuries and making the use of protective eyewear standard work, has almost eliminated blood borne pathogen exposures to the eyes.

We should celebrate everyone’s hard work in making us all safer but we cannot stop until we get to zero employee injuries. Thanks to all and keep up the great work!

Follow-up on the Timely Reading of EKGs

Last October, I wrote a blog about how Phil Komenda, our Director of Imaging and Cardiac Services, and his team were working to move our electrocardiogram (EKG) reading closer to 100% reliability and in turn moving us closer to our vision.
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Since that posting, Phil and a selection committee made up of nurses, biomed techs, cardiology techs, and IT, purchased 21 ELI 350 EKG carts that were distributed to the inpatient units, Emergency Department, and the Diagnostic Center.  Upon their arrival they were successfully configured and tested on the network. 

So, why is this important?

These new carts will offer significant enhancement for our staff and patients by improving operational efficiency and patient safety.  They will transmit the EKG tracing wirelessly by the push of a button; eliminating the previous wasteful steps where staff on our inpatient units had to find a wall jack, plug the cart into the jack, and then transmit electrocardiograms. These new machines transmit wirelessly once the study is completed thereby freeing up the staff member to do other work and eliminate waste in the system, as well as reduce transmission delays.

The second important enhancement is that all the demographic and clinical information is entered automatically through work list management. The nurse can either scan the patient’s bracelet with a barcode reader or type in a few letters of the patient’s last name to call up the patient from a list of orders on the EKG work list.  This process eliminates the time it takes to type in all the demographic and clinical information, as well as reduces error rates. When demographic information is typed incorrectly, the EKG cannot be matched to the order.

Training with the new carts is close to completion and will GO LIVE on Wed. Feb 18th. We expect that this enhancement will bring more joy to the areas providing care, and improve care by reducing transmission delays and the probability of the EKG not being read within 24 hours of the study.
I want to thank Phil and his colleagues for all their hard work and their commitment to our quadruple aim. 

Television Stars

Last week, Bonnie B. Stein, our HealthCare Board Chair, and I participated in a taped interview with our media partner, WMAR-TV, regarding the 50th anniversary celebration for GBMC HealthCare.  More on this at a later date.

What made me really proud was the touching story, on WMAR-TV, that highlighted the integral role GBMC played in meeting the healthcare needs and enhancing the quality of life for one family.  If you haven’t seen this clip, please watch it by clicking on the link below.  It will make you proud  to be part of a big team that delivers the care that one would want for their own loved ones!

Tuesday, February 3, 2015

Making It Easier (and Safer) to Get the Work Done on an Inpatient Unit

In August of 2012, I wrote a blog about the 6S process. ( Since then, we have used this Lean tool to improve the work environment in a number of areas from physician office practices to the operating room support areas.

Last week, a Team led by our new Lean facilitator, Ishmel Fulton, and the Nurse Manager, Cecelia Gayhardt,  made the workplace more organized and safer on Unit 48. To refresh your memory, 6S stands for:
1.    Sort: eliminating everything not required for the work being performed.
2.    Separate: efficiently placing and arranging equipment and material.
3.    Shine: tidying and cleaning.
4.    Standardize: standardizing and continually improving the previous three.
5.    Sustain: establishing discipline in sustaining workplace organization.
6.    Safety: creating a safe work environment.

The Team applied this methodology to the manager’s office (which became an equipment room), the supply room (which became the manager’s office), the med bays, the nursing station, and the break room….all in all 506 square feet of space. They filled 3 dumpsters with “stuff” that was outdated or no longer needed. The Team added 90 new storage solutions including bins and file holders and marked them with 190 labels. They managed 16 wires to make them less of a hazard and created 31 visual controls such as signs, standardized locations and color coding.

A neat and clean workspace where everything is in its place reduces inventory costs, frees up space for other uses, eliminates some types of error, reduces motion and time searching for things and can significantly improve morale. Just look at the before and after photos!

I am very grateful for the hard work of the Unit 48 6S team. They have made it easier to get the job done. The Team will now be creating the standard work to sustain their efforts. Team members include (from left to right): Ishmel Fulton; Lilian Isabor; Cecilia Gayhardt; Christine Collier; Rikki Pullet; Susan Stevens; Courtney Hendon; Rachel Olsen; Beverly Edwards and Teresa Schorr (not pictured).


Internal Medicine Residents Demonstrate Their Knowledge
This weekend, a team from our Internal Medicine Residency Program won second place in the Doctors' dilemma contest at the Maryland Chapter of the American College of Physicians (ACP) meeting. Our Team will now be moving on to the competition at the National ACP meeting at Boston in April.

While other teams consisted of 3rd and 2nd year residents, the GBMC team consisted of three 1st year and one 2nd year resident. Our team included: Dr. In kyu Yoo (2nd year), Dr. Azharuddin Soudagar (1st Year), Dr. Faizan Babar(1st year), and Dr. Laurel Cummings (Preliminary year, Dermatology).

Please join me in congratulating our team and in wishing them luck in Boston!