2010 CIHDS Workshop Report

The goal of our 2010 workshop was to bring together health care professionals,

industrial partners, public servants, and faculty to discuss an important new

strategic area at Penn State – healthcare delivery systems. Healthcare delivery

is an emerging interdisciplinary field aimed at transforming the healthcare

system into one that is safe, effective, patient-centered, timely, efficient, and

equitable.

Penn State has a variety of strengths in the healthcare delivery field starting

with Penn State Hershey and encompassing a range of Colleges at University

Park and the Commonwealth Campuses. Healthcare professionals have

developed some innovative approaches to care and bring a wealth of

experience to many problems and issues. Industrial partners have innovative

technologies that they are bringing to bear on these problems. Our civil

servants are tasked with improving the general health of the community. We

believe the workshop continued the dialogue on healthcare delivery challenges

as well as opportunities for collaboration in finding innovative solutions

especially as they apply to the Commonwealth of Pennsylvania.

We sincerely thank Siemens for their sponsorship of our 2010 workshop. The

workshop was specifically designed to facilitate discussion, share ideas and

network. We hope you will find the linked PDF files of the keynote address,

panel discussions, breakout sessions and project posters both informative and

energizing.

Cordially, Harriet Black Nembhard, Industrial Engineering S. Diane Brannon, Health Policy & Administration Christopher DeFlitch, Penn State Hershey Janetta DeOnna, Office of Workforce & Economic Development Deb Medeiros, Industrial Engineering Madhu Reddy, Information Sciences & Technology Penn State University Center for Integrated Healthcare Delivery Systems

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Overview

The Institute of Medicine (IOM) recently asserted that American medicine defines the cutting edge in

most fields of clinical research, training, and practice. The Institute also noted that the U.S. hosts the

most competitive innovative manufacturers in the areas of pharmaceuticals, medical devices, and

medical equipment. Yet the frustrating paradox remains that one of the most technologically advanced

healthcare delivery systems in the world remains fraught with error and waste.

Ten years ago, our colleagues at the IOM shocked the profession with projections that approximately

98,000 people die annually in this country because of preventable medical harm—with associated annual

costs of $17-$29 billion (IOM (1999) To Err is Human). With only marginal progress made over the past

decade, and based on these estimates, one could contemplate the real possibility that one MILLION lives

may have been lost, and BILLIONS of dollars have been wasted, since those first estimates were released.

Obviously there is much work to be done, which is why we have come together today.

Transformational change demands multi-disciplinary, innovative approaches that transcend traditional

thinking. The Penn State Center for Integrated Healthcare Delivery Systems (CIHDS) was recently formed

to capitalize on the cross-disciplinary strengths of Penn State and to exemplify a comprehensive

approach to understanding and solving problems related to healthcare access and quality. The Center

was established to promote education, research and networking in both industry and academia, and to

enhance the infrastructure among healthcare providers, policymakers, and systems design personnel.

And perhaps most poignantly, we are preparing 21st century students as leaders in the domain of

healthcare quality through education, project- and research-based activities.

The Commission on System Interoperability (established by the U.S. Secretary of Health and Human

Services) suggested the elements of quality of care:

More complete information available for treatment decisions;

New and more efficient options for patient interaction;

Enhanced ability to demonstrate performance consistent with regulations and recognized

professional standards;

Potential for reduced operational costs and more effective use of resources;

Reduced or streamlined management responsibilities;

Less paperwork;

Automation of repetitive tasks; and

Better efficiency in dealing with other providers and outside parties.

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Many tools for improving healthcare delivery and quality of care exist across various disciplines, and the

Center seeks to use and improve these methods for the current health care model. In particular, systems

principles have been applied to optimize care delivery processes that provide safe, effective, patient-

centered, timely, efficient, and equitable care -- the six quality aims envisioned in the landmark IOM

report, Crossing the Quality Chasm. Application of lean and six sigma methods, operations research tools,

and information technologies has resulted in reducing in preventable infections, patient wait times, error

rates, patient and staff dissatisfaction, and costs. Some current Center projects include patient-centered

workflow, chronic care system modeling, and hospital supply chain management to name just a few.

The 2010 CIHDS workshop was designed to inform you of our successes, establish and/or strengthen

networks, explore potential collaborative opportunities, and to gain insights that will help guide Center

activity and priorities. Browse this document and click on the links that take you to the action and

insights of this successful workshop that infolded in the following six acts.

I. Healthcare Delivery in Action

II. Panel Discussion: A Vision for Research, Education, and Outreach in Healthcare Delivery

III. CIHDS Directions on Research, Education, and Outreach

IV. Breakout Sessions on Performance, Transformation, and Systems & Technology

V. Next Steps

VI. Networking Reception and Poster Session

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I. Healthcare Delivery in Action

Introduction: Henry C. Foley, PhD Vice President for Research and Dean of the Graduate School The Pennsylvania State University

“Modern medicine and science provide technological possibilities that are extraordinary. While such advances make a great deal possible, that does not always equate with a justification for utilization of these technologies. Cost and effectiveness are tradeoffs that must be reconciled against the backdrop of meaningful quality of life. The right healthcare delivery systems offer an

opportunity to integrate the considerations of these dueling issues in an effort to make realistic decisions.”

Dr. Henry C. “Hank” Foley was appointed Vice President for Research and Dean of the Graduate School at Penn State University on January 1, 2010. Prior to this he was the dean of the College of Information Sciences and Technology (IST) at Penn State University. In his role as vice president for research and dean of The Graduate School, Foley is responsible for overseeing a research enterprise with over $765 million dollars in expenditures and over 9,000 graduate students in more than 150 graduate degree programs, including 121 doctorate, 110 academic master’s and 73 professional master’s degree programs.

Dr. Foley earned a B.S. in chemistry from Providence College in 1977, M.S. in chemistry from Purdue University in 1979, and a Ph.D. in physical chemistry from Penn State University in 1982. Foley returned to the University in 2000 as the Walter L. Robb Family Endowed Chair and head of the Department of Chemical Engineering.

Foley's extensive industrial experience includes working for American Cyanamid Company and consulting with Air Products, Monsanto, DuPont, Englehard Corporation, and many other companies. Foley holds numerous memberships in professional and honorary societies including the American Society for Cybernetics, the Computing Research Association, Sigma Xi, Phi Lambda Upsilon, Sigma Pi Sigma, the American Institute of Chemical Engineers (AIChE), the American Association for the Advancement of Science, and the American Chemical Society. He was a founding member of the AIChE's Catalysis and Reaction Engineering Division and served as its chair.

His awards and recognition include the New York Metropolitan Catalysis Society's Excellence in Catalysis Award, the Philadelphia Catalysis Club's Annual Award, the Leo C. Friend Award from the I&EC Division of the American Chemical Society, the Research Innovation Recognition Award from Union Carbide Corporation, the Presidential Young Investigator Award from the National Science Foundation, and the Thiele Lecture at the University of Notre Dame. He has authored more than 100 papers, holds almost 20 patents, and is author of the textbook, Introduction to Chemical Engineering Analysis Using Mathematica, published in 2003.

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Keynote Address:

Sam Brandt, MD Vice President, Chief Medical Informatics Officer Siemens Medical Solutions

"Healthcare in the United States has evolved into a world-leading technical capability with world-renowned centers of excellence. However, its rising costs, uneven accessibility, and practice heterogeneity, associated with world-leading costs and world-trailing population outcomes, have made the current system unsustainable." Legislative reform is insufficient to resolve these issues. This talk will examine the historical, economic, political, and technical barriers to reengineering US healthcare, and the role that the Center for Integrated Healthcare Delivery Systems can play in developing a solution."

Dr. Brandt joined Siemens Medical Solutions in 2000, and is responsible for the company's clinical systems development efforts, including the incorporation of innovations and clinical content within Siemens IT solutions. A board-certified, practicing family physician, he has a passion for leveraging computer technology to help physicians and clinicians provide the most effective and efficient patient care while making their work easier. This includes using workflow engine technology to help ensure safe, reliable, and efficient execution of healthcare processes in a patient-centric manner. It also involves the embedding of clinical knowledge within the information system to anticipate the needs of clinicians and support their decision-making processes.

Dr. Brandt led the development of Siemens strategy to combine workflow engine technology with clinical information system technologies in the new generation healthcare information solution, Soarian

®. He is the primary

author of five pending patent applications pertaining to this effort.

Dr. Brandt is involved with HL7 (Health Level 7) and SNOMED (Systematized Nomenclature of Medicine) efforts to create standards that can be used to represent clinical orders, documentation templates, and workflow process designs in a consistent and portable manner. He is also participating in the national eHealth and ePrescribing initiatives to foster the widespread adoption of clinical information systems. A Diplomat of the Academy of Family Practice Physicians, and a member of the American Medical Informatics Association (AMIA) and the Health Information and Management Systems Society (HIMSS), he is also involved with the American Academy of Family Practice (AAFP) and its Electronic Medical Record initiative.

Previously, Dr. Brandt was Vice President of Medical Informatics and Clinical Processes at Tenet Health Systems, one of the country's largest healthcare corporations. There he was responsible for clinical systems strategy, led the development of an enterprise data warehouse, and served as medical director for Tenet's 1,300-member physician group.

Prior to that, he spent seven years at Kaiser Permanente, culminating in his appointment as Director of Design & Development for its National Clinical Information System Program, while participating on the senior management team of the Kaiser North Carolina region.

Dr. Brandt began his career as a family physician in Rosman, N.C., providing rural medical practice in a medically underserved area. He also served as the chief of staff of Brevard Community Hospital, and as president of the county medical society.

He completed his family practice residency in Asheville, N.C., in a program associated with the University of North Carolina, and received his M.D. from Eastern Virginia Medical School and a bachelor's degree from Duke University. He and his wife, a nurse practitioner, enjoy biking, hiking, cross-country skiing, and volunteering together each week in a medical clinic that serves uninsured patients in Chester County, Pa.

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II. Panel Discussion: A Vision for Research, Education, and Outreach in Healthcare Delivery

Moderator: Peter Schiffer, PhD Where are the synergies in the research, education and outreach missions of Penn State University in regards to advancing healthcare delivery? Technology, especially in the healthcare realm, is advancing incredibly

rapidly often faster than it can be adequately evaluated and certainly

faster than many people can be trained to use it. How should the

healthcare system respond to this very rapid technological advance

and in particular how can Penn State University help in the system’s

response?

Those of us who have been paying attention to the news the last couple of weeks noticed that the Healthcare Reform Bill did get passed. It clearly portends an area of change from the national policy standpoint for healthcare in this country. I would be curious to get the panels thoughts for how the new law will likely change the system and particular how Penn State University can help the nation adapt to the new practices under the law with the full knowledge that some aspects of the law have not completely been worked out yet. As many of the legislators have managed to say, they haven’t read the whole thing. How Penn State and other universities can best work with industry to integrate what we are doing in education, outreach and research to advance the healthcare profession so that our students both gain the disciplinary knowledge, but also learn the broad interdisciplinary and teamwork skills, so that they are ready to contribute to industry where industry need them?

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Audience Question

It seems that most of the discussion has been focused on delivery,

increasing technology and hospitals. As Sam pointed out, a big

component of this will be patient, population and consumer behavior.

How can we motivate and change those behaviors?

Moderator:

Peter Schiffer, PhD Associate Vice President for Research and Director of Strategic Initiatives Professor of Physics The Pennsylvania State University

Dr. Schiffer’s research specialty is the physics of materials, with a focus on magnetic materials and granular materials. He is the recipient of a Career Award from the National Science Foundation, a Presidential Early Career Award for Scientists and Engineers from the Army Research Office, an Alfred P. Sloan Research Fellowship, and the Faculty Scholar Medal in the Physical Sciences from Penn State. Dr. Schiffer is also a Fellow of the American Physical Society. He received his MS and PhD degrees from Stanford University and his BS degree from Yale University.

Panelists:

Chris Calkins, PhD Director, Outreach Health Initiatives The Pennsylvania State University With over 25 years of experience in health care organizations and education, Dr. Calkins brings an applied perspective to many of the health care challenges and policy questions facing the US today. His perspective is informed by previous roles as Clinical Liaison Officer

for the Penn State Hershey Medical Center, Director of Special Projects for the College of Health and Human Development at Penn State, as an educator and through a variety of roles in hospitals and other health care organizations, including: health systems, hospital consortia, insurance, and research. Dr. Calkins earned his PhD from Penn State in Health Policy and Administration.

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Paul Griffin, PhD Peter and Angela Dal Pezzo Department Head Chair of Industrial Engineering The Pennsylvania State University

Dr. Griffin’s research and teaching interests are in health and supply chain systems. In particular, his current research activities have focused on cost-effectiveness modeling of public health interventions, health logistics, health access and economic modeling, and supply chain coordination and control including pricing and contracting mechanisms. Dr.

Griffin joined Penn State in 2009. Prior to that time, he served on the faculty in the School of Industrial & Systems Engineering at Georgia Tech, where he co-founded the Center for Healthcare Logistics and served in the Health Systems Institute.

Ann Kolanowski, PhD, RN Director, Hartford Center of Geriatric Nursing Excellence at Penn State Elouise Ross Eberly Professor of Nursing and Professor of Psychiatry The Pennsylvania State University

For the past two decades Dr. Kolanowski has conducted research on behavioral symptoms exhibited by persons with dementia. Her work has been supported by grants from the National Institute of Health, the Alzheimer’s Association and the Neuroscience Nursing Foundation. Dr. Kolanowski has published extensively in her area of research. She is a Fellow of the American Academy of Nursing and of the Gerontological Society of America.

Dennis G. Shea, PhD

Department Head of Health Policy and Administration The Pennsylvania State University Dr. Shea’s primary field of study is in health economics and the economics of aging. The focus of his research includes inequality in health and economic resources among the elderly, health insurance coverage of older persons, and economic and financing policy

issues in long-term care and mental health care. His most recent research considers Medicare prescription drug coverage, inequality in health and well-being, and aging and mental health policy.

Timothy Simpson, PhD

Director, The Learning Factory Professor of Mechanical and Professor of Industrial Engineering The Pennsylvania State University As Director of the Learning Factory, Dr. Simpson annually coordinates 120 industry-sponsored senior design projects for 600 engineering students. His research spans the field of engineering design, and he has received numerous research and teaching awards, including the 2007

President’s Award for Excellence in Academic Integration. He is a Fellow in ASME and an Associate Fellow in AIAA. His degrees are in Mechanical Engineering: a B.S. from Cornell, and M.S. and Ph.D. degrees from Georgia Tech.

Alan Snyder, PhD Associate Dean of Technology Development, Penn State Hershey College of Medicine Professor of Surgery, The Pennsylvania State University

Dr. Snyder’s research in mechanical circulatory support systems for patients in cardiac failure provided him with broad experience with technological, economic, regulatory, and human aspects of advancement of medical technology. He is responsible for intellectual

property and dissemination of medical technology for the College of Medicine. His teaching duties include research ethics for clinical research trainees and ethics and professionalism for medical students, where he emphasizes that the central purpose of medicine is to help patients achieve their life goals.

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III. CIHDS Directions on Research, Education, and Outreach

Goals

The vision of the Center is to be recognized for excellence in healthcare delivery research, education, and

outreach. The Center will serve as a catalyst for transformational change in US healthcare delivery

through a focus on quality, efficiency, information and effectiveness of care processes and the

integration of these processes into a coordinated system with increased access to care.

The Center has three goals that support Strategic Plan for the Health Sciences at the Pennsylvania State

University as follows.

Goal 1: Build the infrastructure to support translational science and research in healthcare delivery

Collaborators will conduct research in the field, laboratory and in-silico that is expected to lead to

a quantum improvement in healthcare delivery and outcomes. This Center will seek to design and

engineer a new holistic system of care to cover the spectrum of patient needs from prevention to

survivorship. The Center will create a coherent framework to provide visibility for ongoing research in

healthcare delivery.

Goal 2: Foster interdisciplinary, multi-site work around healthcare delivery improvement.

The Center will identify opportunities to improve access to care and quality of care delivery. It

will examine the application of a wide variety of principles involving process modeling, lean thinking, six

sigma principles, healthcare policy, and information technology to varied components of healthcare

delivery. The Center will facilitate introduction of methodologies in healthcare that improve access and

care, increase quality, and eliminate waste.

Goal 3: Create new educational opportunities at Penn State that address regional, state, and national

health workforce, science, and technology needs.

The Center will build an educational core in integrated healthcare delivery using a modular

approach to teach essential elements of the discipline. This core will catalyze interdisciplinary courses,

focused on healthcare systems, for undergraduates, graduates, post-graduates, and adult learners. It will

be designed to complement the University’s existing capabilities to establish programs such as an

undergraduate minor in healthcare delivery systems, master’s degree in Healthcare Service Engineering

(HCSE), medical fellowships in healthcare engineering/IT/systems management/informatics, and

continuing education certification.

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The Industry/University Cooperative Research Center (I/UCRC) Model

Our approach to accomplishing these goals includes establishing the CIHDS as site of the NSF

Industry/University Cooperative Research Center (I/UCRC) on healthcare. In December 2009, the CIHDS

was awarded a planning grant from the NSF to join the Center for Healthcare Organization

Transformation (CHOT) I/UCRC. The CHOT, supported by the NSF and jointly located at Texas A&M and

Georgia Tech, was formed to conduct research supporting major management, clinical, and information

technology innovations in healthcare. Penn State becomes the third university to join the effort, and

other universities are in the process of joining. The mission of the CHOT is to advance, with its industry

partners, transformation in health systems through cooperative applied research.

Of course, the healthcare system is enormously complex. An NSF study (Rardin 2007) offered a six level

breakdown of the healthcare system – referred to as the patient-population-team-organization-network-

environment (PPTONE) model. We have used the PPTONE model to structure a working report,

Healthcare Delivery Systems: Literature Base for Building CIHDS I/UCRC, which is available on our

website. It provides over 100 references on research topics that are organized by level in the PPTONE

model and categorized as technology-based, model-based or practice-based. Each research topic is then

coded according to potential with High, Moderate, and Low potential. Workshop participants with

healthcare research, teaching and outreach interests are invited to review this report on our website

under the “Background” tab and to submit additional published or working papers using the link.

Student Involvement

The Center began a CIHDS scholars program in Spring 2009 directed at attracting graduate and post-

graduate students with an interest in healthcare delivery. These students have already begun working on

some of the themes that are key to the Center’s scope. This work is expected to contribute to their

master theses and doctoral dissertations. We have also co-sponsored undergraduate students through

the Learning Factory student capstone design projects. Rural community access hospitals have provided

field locations for their work. We aim to continue and expand both of these efforts as we move forward.

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IV. Breakout Sessions

A brief description and one (of many possible) key questions are given for each of the sessions. Session leaders will expand the background and ask workshop participants to suggest needs, gaps, opportunities, and directions. A representative from each session will summarize the discussion during the workshop wrap-up and a recorder will transfer the captured post-it notes to posters for display during the networking reception.

Theme 1: Organizational Performance Optimizing Patient Flow –Lead: DeFlitch Admissions delays, transfer delays or refusals, ED crowding, cancelled surgeries – all are symptoms of inefficient patient flow. How can we redesign facilities and workflow to provide safe and timely care for all patients? Identification of Medical Errors –Lead: DeFlitch Hospital medical errors rank among the 8 leading causes of death among Americans, based on estimates from a 1999 IOM study. The majority of errors arise due to faulty systems and processes. How can we systematically identify the root causes and design a safer system?

Patient Adherence to Therapies and Treatments –Lead: DeOnna Patient non-compliance with treatment goals and medical guidance poses significant health risks for the patient and a financial burden on the health care system. How can we assess the underlying performance issues in ways that will help to mitigate the problem?

Theme 2: Organizational Transformation Improving Healthcare Management –Lead: Brannon From expectations inherent in the concept of the primary care medical home to consumer and payer demands for improved quality and safety while containing costs, health care provider organizations across the continuum are challenged to engage in transformation change. How might the Center help leaders meet these challenges? Financial Incentives for Increasing Quality –Lead: Griffin Many organizations such as the Institute of Medicine have called for government payers to increase payments to health care providers who deliver high quality care. In addition, mechanisms such as pay for performance are one of many strategies in use in the private sector to try to align financial incentives with quality. What are appropriate incentives for alignment, and how do we determine the impact of different strategies on intermediate and long-term performance? Active Aging and Aging in Place –Lead: Behr The aim of active aging is to combat the typical aging phenomenon -- the decline in many physical and mental capacities, loss of function, increased risk of chronic diseases, and an increase reliance on informal and formal care giving. How can we develop holistic solutions to support active aging and aging in place?

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Theme 3: Systems & Technology Chronic Care Intervention Strategies–Lead: Nembhard Almost half of all Americans live with a chronic condition. Chronic disease requires ongoing management and frequent patient interaction with the health care system. Despite annual spending of nearly one trillion dollars and significant advances in health care, one-half or more patients still fail to receive proper care. Can data-driven and technology driven-systems be established to help these patients? Health Information Technologies: Security & Privacy –Lead: Reddy Health information technologies (HIT) are gaining more prominence in the health field. Healthcare organizations and the Federal government are spending billions of dollars to design and implement HIT. Two of the key issues affecting the use of these technologies are privacy and security concerns. What are the concerns in this area and how can these concerns be addressed? Design and Development of Medical Devices –Lead: Frecker The demand for advanced medical devices – particularly those that can easily be adapted to individual needs – is growing rapidly. Recognizing that most innovation takes place within teams working at the boundaries of disciplines, how can we develop strong, cohesive teams to tackle the design and development of state-of-the-art medical devices? Session Leaders:

Richard Behr, PhD Charles and Elinor Matts Professor of Architectural Engineering The Pennsylvania State University Dr. Richard Behr came to Penn State University in 1997 as Head of the Department of Architectural Engineering. He served in that capacity until 2007, when he was appointed the inaugural Charles and Elinor Matts Professor of Architectural Engineering and, shortly

thereafter, the founding director of the Penn State Smart Spaces Center: Holistic Research for Successful Aging in Your Community. The Smart Spaces Center is a bold, interdisciplinary initiative for Penn State. Behr’s traditional area of engineering research is related to the structural performance and durability of architectural glass and building envelope systems under the effects of severe windstorms, earthquakes, and accelerated weathering conditions.

S. Diane Brannon, PhD Professor of Health Policy & Administration The Pennsylvania State University Dr. Brannon is one of the nation’s leading experts on work design, training, and organizational structure of long-term care providers. She has applied her expertise in

management theory to the study of the nursing home and home care workforce, quality, and staff turnover and retention. Her work has been supported by grants from several foundations, federal and state agencies. Dr. Brannon currently serves on the Board of Trustees of Mt. Nittany Medical Center (State College, PA). She earned her PhD from Cornell University.

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Chris DeFlitch, MD Associate Professor Emergency Medicine, Penn State University Chief Medical Information Officer, Penn State Hershey Dr. DeFlitch’s focus is core process redesign of medical care delivery system using information systems and industrial engineering principles to challenge traditional notions of practice. He helped lead Penn State Hershey’s conversion to the electronic medical

record, CPOE, clinical decision support, and integrated medications process. He created and reengineered the emergency department without a front-end waiting room, saving millions of dollars in construction and producing groundbreaking patient and systems outcomes. In addition, Dr. DeFlitch created the Emergency Medicine residency and Observation Medicine at Penn State & has been honored with several awards, lecturing across the nation on process, implementation, and design of care related to information systems.

Janetta DeOnna, PhD Project Director, Office of Economic and Workforce Development The Pennsylvania State University Dr. DeOnna holds degrees in nursing, psychology, health education, and workforce development. She engages multi-disciplinary educational and research experts at the regional, state and national levels, seeking opportunities within the healthcare industry

sector to address workforce supply, demand and innovation.

Mary Frecker, PhD Professor of Mechanical Engineering The Pennsylvania State University Dr. Frecker’s research interests are in the areas of smart structures and medical device design. Current research activities include development of new design and fabrication methods for meso-scale surgical instruments and development of high-strength/high-

strain cellular structures. She has received honors including the Pearce Endowed Development Professorship in Mechanical Engineering, the GM/Freudenstein Young Investigator Award (2002), the Penn State Engineering Society Outstanding Advising Award (2002), the Penn State Engineering Society Outstanding Research Award (2005), and an ASME Best Paper Award (2009). She is a Fellow of the ASME and an Associate Editor of the ASME Journal of Mechanical Design. Dr. Frecker has a Ph.D. in Mechanical Engineering from the University of Michigan.

Paul Griffin, PhD Peter and Angela Dal Pezzo Department Head Chair of Industrial Engineering The Pennsylvania State University Dr. Griffin’s research and teaching interests are in health and supply chain systems. In particular, his current research activities have focused on cost-effectiveness modeling of public health interventions, health logistics, health access and economic modeling, and

supply chain coordination and control including pricing and contracting mechanisms. Dr. Griffin joined Penn State in 2009. Prior to that time, he served on the faculty in the School of Industrial & Systems Engineering at Georgia Tech, where he co-founded the Center for Healthcare Logistics and served in the Health Systems Institute.

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Deb Medeiros, PhD Associate Professor of Industrial Engineering The Pennsylvania State University Dr. Medeiros’ research focus is on the optimization of facilities and operations using process simulation. She also studies scheduling, lean manufacturing, and material flow problems. She is author or co-author of over 60 publications in these areas and has advised

50 MS and PhD students. Her healthcare related research includes simulation of emergency department patient flow, forecasting patient census, and nurse scheduling using auctions and optimization. She is active in the Winter Simulation Conference, having held several positions including Conference Program Chair. She is a Trustee of the WSC Foundation. Dr. Medeiros holds a PhD in Industrial Engineering from Purdue University.

Harriet Black Nembhard, PhD Director of the Center for Integrated Healthcare Delivery Systems (CIHDS) Associate Professor of Industrial Engineering The Pennsylvania State University Dr. Nembhard's research mission is to develop and implement methods of quality, productivity, and statistics. She examines ways to combine these methods with economic

measures to improve decision making. Her current applications in the healthcare field include the development of small-scale medical tools, early detection of influenza outbreak, and monitoring the mammograms of women with breast cancer. She is also an ASQ certified Six Sigma Black Belt and has developed the Six Sigma minor for undergraduate students. Dr. Nembhard earned her PhD from the University of Michigan. She has served as a technical consultant for several major companies and is a Fellow of the American Society for Quality.

Madhu Reddy, PhD Assistant Professor of Information Science and Technology The Pennsylvania State University Dr. Reddy’s primary research interests are in the areas of Medical Informatics and Computer Supported Cooperative Work. He is especially interested in the design, implementation and adoption of collaborative healthcare technologies such as electronic

patient records. His current research is focused on how these and other technologies can support multidisciplinary healthcare teams’ collaborative information behavior. Dr. Reddy received his PhD in Information and Computer Science from the University of California, Irvine.

Mark Sciegaj, PhD, MPH Associate Professor of Health Policy and Administration Associate Director of the Penn State Smart Spaces Center: Holistic Research for Successful Aging in Your Community. Dr. Sciegaj is a recognized expert in the area of elder autonomy and participant-directed long-term care models His research focuses on the area of health services research and aging with extensive experience in implementation and evaluation

studies and data collection projects.

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V. Next Steps

We hope that you take from the summary of the 2010 workshop some inspiration, new ideas, and

contacts with like-minded colleagues. We invite you to return next year and share your success stories.

In the interim, the Center will be engaged in several tasks:

organizing a NSF I/UCRC planning meeting to be held this summer

continuing to support the work of the CIHDS Scholars

requesting proposals and awarding seed grants for research in priority areas identified at this

workshop

submitting an I/UCRC proposal to NSF

actively seeking collaborators for all of the above

We welcome your continued support and participation!

VI. Networking Reception & Poster Session

The CIHDS networking reception allowed attendees to engage with one another in discussions, preview

research posters and make new contacts.

Research Posters Displayed

Optimizing Patient Flow in the Emergency Department Chris DeFlitch, MD; Deb Medeiros, PhD; Janetta DeOnna, RN, PhD; Allison Lancos; and Kathryn Wilt, RN, MSN Due to an increase in patient volumes and a decrease in facilities nationwide, Emergency Department (ED) services have become a concern in healthcare delivery. Issues such as long waiting times, patient boarding, and patients leaving without being seen have created an inefficient and sometimes unsafe environment in the ED. To improve these issues, ED’s have been pioneering studies and implementing tools for flow optimization. Williamsport Regional Medical Center, part of Susquehanna Health, is in the process of an ED expansion for 2011. The main objectives of this project will be to analyze and optimize patient flow in the new three-pod design. Simulation modeling and statistical analysis will be used to establish the necessary changes for WRMC to meet benchmark performance metrics.

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Chronic Care Intervention Strategies Min-Jung Kim; Yonmi Jung; Harriet Black Nembhard, PhD; Paul Griffin, PhD; and Rhonda BeLue, PhD Chronic disease such as diabetes and hypertension is a growing health problem world-wide. More than 145 million people – almost half of all Americans – suffer from one or more chronic illnesses and the number is expected to rise continuously. Despite annual spending of nearly one trillion dollars and significant advances in health care, one-half or more patients still fail to receive proper care. Chronic disease requires ongoing management and frequent patient interaction with the health care system. Many public health interventions fall short of their goals because they are made in piecemeal fashion rather than from a whole system perspective. Statistical Modeling is especially necessary in chronic disease management because chronic disease require ongoing management and interaction with the health care system. Statistical Modeling may help view chronic disease intervention as a whole system perspective which may ultimately help reduce gaps in quality care that lead to thousands of deaths each year, avoid 41 million sick days, and avoid wasting more than $11 billion due to inefficiency. Risk Assessment of Medical Devices Nishanth Ramkutty; Chumpol Yuangai, PhD; Harriet Black Nembhard, PhD; Mary Frecker, PhD; and Stephen Piazza, PhD Medical device technology is an important component in health care advancement. Although the advancements hold may hold many exciting prospects for patient care, there are many legitimate concerns about the risks they may pose. The development cycle of medical devices is extended to pass the rigorous testing of safety and adherence to Federal Drug Administration (FDA) standards. Risk management techniques are integrated into the FDA’s Quality System Regulation. Based upon this, the FDA rejects a significant number of applications of devices that reach the investigational stage. For devices that do earn approval, the highest quality standards have to be maintained to avoid recalls. Hence in order to streamline the introduction of medical devices, it is essential to fully understand the regulations and incorporate risk management during the formative stages. Development of an Integrated Model to Predict Patient Compliance Monifa Vaughn-Cooke; Harriet Black Nembhard, PhD; and Jan Ulbrecht, MB, BS Patient non-compliance with treatment goals and medical guidance poses significant health risks for the patient and a financial burden on the health care system. Human Reliability Assessments can be proactively implemented to elucidate and quantify the factors impacting and resulting from patient compliance. The proposed three-stage Human Reliability Assessment methodology aims to provide systematic measures for patient compliance risk identification, evaluation and mitigation with the ultimate goal of informing treatment decisions. In the first stage, a theoretical human response model is developed to qualitatively define why (Performance Shaping Factors), how (unsafe acts) and when (hierarchical tasks) patient non-compliance may occur. In the second stage, a quantitative human response model is built and validated in an empirical study to evaluate the dynamic relationships between human response components. In the third and final stage, a Dynamic Programming algorithm is used to structure the identification of significant non-compliance causal factors and manifestations. The model will be empirically developed for diabetes patients with respect to Self-Monitoring of Blood Glucose (SMBG). Beneficial outcomes of integrating the proposed methodology in treatment decisions include: 1) an increase in patient self-management, 2) a reduction in chronic and acute conditions in the patient population and 3) a significant decrease in patient and healthcare system resource utilization.

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Establishment of the Rural Embedded Assistants for Community Health (REACH) Network Thomas Terndrup, MD; Marilyn Corbin, PhD; Louis Brown, PhD; Ted Alter, PhD; Leigh Gordon, MPH; and Claire Flaherty-Craig, PhD The REACH Network was established to support older adults residing in Mifflin & Juniata counties (Pennsylvania) to allow elders (age 65 yrs or older) to successfully age in place. We hired 8 part-time, locally embedded nurses and emergency medical technicians (EMTs), that we term Community Health Assistants (CHAs), to conduct interventions on a network size of 400 elders. An innovative data acquisition tool was loaded with standardized assessment tools and all CHAs were trained using standardized distance training. The initial interventions include a detailed assessment of home safety and personal immunization status, along with mobility and neurocognitive status using standardized, validated tools. Study design & implementation is carefully coordinated with 8 local community health leaders. The initial outcome measures hope to reduce in home falls and increase immunizations, in addition to providing the participants with recommendations and education in an effort to improve overall health status. Reduction of Catheter Related Blood Stream Infections Following Implementation of a Line Care: Educational Intervention and Standardization of Practice Maria Hamilton, BSE, MBA; Michael Dettorre, DO; and Colleen M. Rafferty, MD, MPH Catheter-related blood stream infections (CRBSI) are the most common and potentially most life-threatening hospital-acquired infection. We conducted a hospital-wide educational intervention to improve central venous catheter care to further reduce the CRBSI rate at our institution. The intervention consisted of a web-based educational program, a pre- and post-test, a return demonstration for nursing competency, electronic documentation of line maintenance on the EMR, and adoption of standardized hospital policy for line care practices. We saw a statistically significant decrease in CRBSI in the 12 months after this intervention compared to the 12 months prior. An Improved Triage Algorithm for Emergency Departments based on Fuzzy AHP and Utility Theory Omar M. Ashour and Gul E. Okudan, PhD In Emergency Department (ED) settings, improving productivity, reducing patient waiting time, and increasing patient safety are important aspects. Decision making (DM) strategies and techniques are crucial to ameliorate relevant performance measures for these aspects. One critical DM process in EDs is the triage. In this paper, we present a triage algorithm that uses Fuzzy Analytic Hierarchy Process (FAHP) along with the Multi-attribute Utility Theory (MAUT) to sort the patients. The FAHP takes into account the changing relative importance of the vital signs based on the primary complaint. Three other attributes along with the status score help define the level of criticality: patient’s age, gender and pain level. MAUT is used to aggregate the variables to arrive at a prioritization. We present the application of the proposed methodology using a clinical data set with actual patient information. Increasing Quality Outcomes with Pay-for-Performance Teja Kadire; Laetitia Mata; Harriet Black Nembhard, PhD; Paul Griffin, PhD; and Chris DeFlitch, PhD The overall quality of healthcare delivered to Americans is suboptimal. There is a misalignment between healthcare provider’s compensation and high quality care. The use of financial incentives varies according to whether providers receive their base compensation by fee-for-service, capitation or mixed payment. Pay-for-performance can be used to motivate provider’s effort across the multiple tasks involved in delivering successful quality care. Key stakeholders and perspectives for future research are identified.

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Diagnosing Lymph Disease Using a Logistic Model Selection Framework Pannapa Changpetch and Dennis Lin, PhD The proposed framework provides a systematic process that will help researchers deal with interactions between categorical variables that are sometimes omitted due to the complexity of involving them in the logistic regression models. We apply the proposed method with the lymphography dataset to predict diagnoses of lymph disease. The result shows that the proposed model outperforms the classical logistic regression models in all criteria. Developing an Emergency Department Material Management Deborah J. Medeiros, PhD; Diane Brannon, PhD; Efren Olguin Chavez; Madhurima Datta; and Julie Marshall With 47 million Americans lacking health insurance, the ED has been taking the place of the primary-care doctor. Currently, hospitals are built around physician needs (to have at hand all the required resources for treating patients e.g. x ray, nurses, labs, etc.) This model was originally developed when medicine was practiced in a more artisanal way. Before the widespread distribution of medical knowledge and scientific equipment that allows more precise diagnosis based on objective data. In many EDs, overstocking is the common practice for assuring access to the right equipment 24 hours 7 days a week. Considering that supply chain costs represent between 15% and 30% of overall hospital net patient revenue is evident that by improving material management it is possible to reduce the cost of treatment. This will also reduce delays in treatment caused by the lack of the right equipment due its unavailability. The objective of this project is to improve patient outcome and reduce costs of an emergency department by standardizing their material management policies, following a PDCA methodology supported by the use of tools from lean manufacturing. Improving the Efficiency and Effectiveness of the Tyrone Hospital Inventory Management through Automation Garrett Siewert, Rahul Panda, Sean P. Fisher, and Christina Noll The cost associated with supplies at Tyrone Hospital is the second highest cost of operations. Currently, the inventory process is entirely manual, labor intensive, and difficult to monitor material levels. PAR (Periodic Automatic Replenishment) leveling is dire not only to patient care but to the financial capability of the hospital. Improving the effectiveness and efficiency of materials management can be performed through automation with use of the existing Meditech information system software and barcodes. Defined will be key stakeholders, the proposed system design, and future work. Health Information Technologies: Privacy and Security Rachida Parks; Gretchen Miller; Siddarth Prakasam; Michael Cwenar; Lindsay Corey; Madhu Reddy, PhD; and David Nembhard, PhD The development, implementation and use of health information technologies (HIT) requires understanding the technical features of the system along with the organizational context in which it will be deployed. One major issue that healthcare organizations and technologies deals with on a continual basis is privacy and security. Privacy and security issues are a paramount concern for most healthcare organizations. Our interdisciplinary team is interested in different facets surrounding the privacy and security problem. However, our common perspective promotes the integration of both the technical features and organizational context involved in systems.

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An Insight on Healthcare Issues in France and Research Developments at Ecole Centrale Paris Emna Benzrati; Benjamin Zimmer; Wided Sghaier; Anis Bouabène; Brigitte Bonan, PhD; Evren Sahin, PhD; Julie Stal Le Cardinal, PhD; and Marija Jankovic, PhD; Optimization and enhancement of healthcare systems has become an international concern. Even though the structure and organization of the healthcare system in France is different from the US system, due to the differences in organization of social security, some of the considerations remain the same: ensuring the quality of diagnostics, surveillance and treatment of the patients; diminishing and optimizing engendered healthcare costs without reducing quality to patients; enhancing and permitting better cooperation between different actors in the healthcare system. The Industrial Engineering Department at Ecole Centrale Paris is a pioneer research organization in tackling these issues by combining systems approaches, industrial engineering and healthcare. The main research streams address the issues of patient safety and healthcare quality; process optimization and developing new organizational approaches in view to the inherent constraints of healthcare; and developing relevant performance indicators as well as appropriate methods for their management and control. The aim of the poster is to illustrate some of the ongoing PhD studies at Ecole Centrale Paris and the collaboration developed with several healthcare organizations is France. Medical Device Development & Applications Mary Frecker, PhD; Jim Brasseur, PhD; Sean Brennan, PhD; Matt Parkinson, PhD; Stephen Piazza, PhD; and Joe Sommer, PhD The poster will cover recent advances in medical device design and applications by the Mechanical-Biomedical Interest Group faculty in the PSU Dept. of Mechanical & Nuclear Engineering. Smart Spaces Center Richard Behr, PhD, PE and Mark Sciegaj, PhD, MPH The Smart Spaces Center: Holistic Research for Successful Aging in Your Community (SSC) began formal operations on July 1, 2008. The mission of the Smart Spaces Center is to create innovative and practical solutions to enable elders to remain at home as long as possible, while maintaining a high quality of life. This poster describes SSC's research framework and activities.

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Participants

Companies & Organizations Astorino

Deborah Linhart, Leader, Health Care Advisor Group and President, Linhart Management Group Centers for Disease Control

Susan Griffin, PhD, Researcher DAGIR Co.

Mark Blair, CEO Derek Mulder, CTO Michael Thomas, SEOIC

Delta Health Technologies, LLC Keith Crownover, President and CEO

Ecole Centrale Paris Marija Jancovic, PhD, Assistant Professor of Industrial Engineering Julie LeCardinal, PhD, Professor of Industrial Engineering

Georgia Tech

Eva Lee, PhD, Associate Professor of ISYE, Director of Center for Operations Research in Medicine & HealthCare, and Co-Director of CHOT

Immersion, Ltd.

Ashley Kranich, General Counsel and Vice President Vinny Sakore, Vice President, Business Development

Johnson & Johnson / Johnson & Johnson Health Care Systems Joseph De Filippis, Customer Marketing Director Mary Gallighan, Director, Customer Development Jeri Thomas, Vice President, New Business Development Janet M. Vargo, PhD, Executive Director, Clinical Trial Design Carole Woodard, V.P. Customer Development

Lockheed Martin

Rich Budka, Director, IS&GS Advanced Concepts Mary Evanston, Business Development Rob Fair, Strategy Ken Farrington, Business Development Rich Koser, Technology Joshi Vaibhav, Chief Architect - AWSSC Program

National Military Family Association

Barbara Cohoon, Deputy Director Government Relations

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Pennsylvania Office of Rural Health

Larry Baronner, Critical Access Hospital Coordinator

Pennsylvania Association of Nonprofit Long-Term Care Providers (PANPHA) Russ McDaid, VP for Public Policy

Pennsylvania State Nurses Association

Patti Gates Smith, Director of Professional Development Pittsburgh Regional Health Initiative

Laura Mahood, Project Manager Precision Therapeutics

Mike Sherwin, Precision Therapeutics Saladax Biomedical, Inc

Kevin Harter, Executive Chairman Siemens Medical Solutions USA, Inc

Sam Brandt, MD, Vice President, Chief Medical Informatics Officer Tom Giannantonio, Program Manager Kathy Lomaskin, Program Director, Siemens One Alliance/Susquehanna Health Steve Wagman, VP & Practice Director Kerry Wright, Director of Staffing

Synurgy Healthcare Solutions, LLC

Mary Ann Derr, President Texas A&M

Larry Gamm, PhD, Professor and Head of the Department of Health Policy & Management and Director of CHOT

Troy Community Hospital

Lori Barnett, BSN, Director of Nursing Greg Jelliff, ED Manager Staci Covey, RN, MS, NE-BC, President

Verizon Business/ Verizon Healthcare Michael Babich, Senior Account Manager Bette Derogatis, Area Vice President Gerard Grundler, Managing Principal Michael Lastowski, Director, Corporate Strategy & Development Administrator

Wellspan Health System

Dave Eitel, MD, MBA, Physician Advisor, Case Management

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Penn State University

College of Engineering

Administration Anthony Atchley, PhD, Associate Dean for Research and Administration Tina Hennessey, Director of Major Gifts Holly Swanson, Senior Editor Architectural Engineering Tanyel Bulbul, Research Associate Richard Behr, PhD, Professor and Director of SMART Spaces Center Sonali Kumar, Graduate Student John Messner, PhD, Associate Professor and Director of CIC Research Program Computer Science and Engineering Padma Raghavan, PhD, Professor and Director of Institute for CyberScience Industrial and Manufacturing Engineering Omar Ashour, Graduate Student Yani Benitez, Alum Eralp Dogu, Visiting Scholar Sean Fisher, Undergraduate Student Yu Feng, Graduate Student Rajesh Gopalan, Graduate Student Paul Griffin, PhD, Professor and Department Head Catherine Harmonosky, Associate Professor Yonmi Jung, Graduate Student Teja Kadire, Graduate Student Min-Jung Kim, Graduate Student Soundar Kumara, PhD, Allen E. Pearce/Allen M. Pearce Chaired Professor Allison Lancos, Graduate Student Laetitia Mata, Graduate Student Deborah Medeiros, PhD, Associate Professor Gretchen Miller, Graduate Student Harriet Black Nembhard, PhD, Associate Professor and Director of CIHDS David Nembhard, Associate Professor Christina Noll, Undergraduate Student Efren Olguin, Graduate Student Elizabeth Olson, Graduate Student Rahul Panda, Undergraduate Student Nishanth Ramkutty, Graduate Student A."Ravi" Ravindran, PhD, Professor Shyam Sundar, Graduate Student Monifa Vaughn-Cooke, Graduate Student Tao Yao, PhD, Assistant Professor Sanghoon Yoo, Graduate Student

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Mechanical and Nuclear Engineering Milton Aguirre, Graduate Student Mary Frecker, PhD, Professor Timothy Simpson, PhD, Professor and Director of Learning Factory Joe Sommer, PhD, Professor

School of Engineering Design, Technology, and Professional Programs (SEDTAPP) Gul Kremer, PhD, Associate Professor

College of Health and Human Development

Rhonda BeLue, PhD, Assistant Professor of Health Policy and Administration Diane Brannon, PhD, Professor of Health Policy and Administration Shane Flickinger, Graduate Student Stephen Piazza, PhD, Associate Professor of Kinesiology Dennis Scanlon, PhD, Associate Professor of Health Policy and Administration Mark Sciegaj, PhD, Associate Professor and Associate Director of SMART Spaces Center Neil Sharkey, PhD, Professor and Associate Dean of Research and Graduate Education Dennis Shea, PhD, Professor and Department Head of Health Policy and Administration Pamela Short, PhD, Professor and Director of the Center for Health Care and Policy Research Jan Ulbrecht, MB, BS, Professor of Biobehavioral Health and Director of GCRC

College of Information Sciences and Technology

Michael Cwenar, Undergraduate Student Lee Giles, PhD, Professor and Director of the Intelligent Systems Research Laboratory Peng Liu, PhD, Associate Professor and Director of the Lions Center and the Cyber Security Lab Rachida Parks, Graduate Student Madhu Reddy, PhD, Assistant Professor Angsana Techatassanasoontorn, PhD, Assistant Professor Heng Xu, PhD, Assistant Professor and Director of the Privacy Assurance Lab

College of the Liberal Arts

Communication Arts & Sciences Rachel Smith, PhD, Assistant Professor

College of Medicine & Hershey Medical Center

Thomas Abendroth, MD, Associate Professor and Chief Information Officer Keith Berry, MD/ US Army Gregory Caputo, MD, Professor and Chief Quality Officer Christopher DeFlitch, MD, Associate Professor and Chief Medical Information Officer Thomas Dykes, MD, Associate Professor and Division Chief, Abdominal Imaging Steven Ettinger, MD, Program Director, Interventional, Heart and Vascular Institute Joseph Geskey, DO, Assistant Professor Leigh Gordon, MPH, Research Coordinator Maria Hamilton, Clinical Performance Improvement Specialist Robert Harbaugh, MD, Professor and Director, Penn State Institute of the Neurosciences Rebecca Jenkins, Administrative Manager, General Clinical Research Center

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Andrea Lazarus, PhD, Administrator, Clinical and Translational Science Institute Lorraine Mulfinger, PhD, Associate Director for Research, The Diabetes and Obesity Institute Joni Pitcher, Chief Operating Officer of the Cancer Institute Colleen Rafferty, MD, General Internal Medicine, Hospitalist Stephen Ross, MD, Associate Professor and Vice-Chair for Clinical Affairs Alan Snyder, PhD, Professor and Associate Dean for Technology Development Darrell Walter, Director, Process Engineering and Redesign

School of Nursing

Donna Fick, PhD, Associate Professor Ann Kolanowski, PhD, Professor Madeline Mattern, MS, CRNP, Coordinator, Outreach Programs Kathy Ann Wilt, RN, Nurse Practitioner Student

Eberly College of Science

Pannapa Changpetch, Graduate Student Timothy Reluga, PhD, Assistant Professor of Mathematics Dennis Lin, PhD, Distinguished Professor of Statistics

Office of Economic & Workforce Development

Christopher Calkins, PhD, Director of Outreach Health Initiatives Janetta DeOnna, PhD, RN, Project Director Tim Franklin, PhD, Director

Office of the Vice President for Research

Hank Foley, PhD, Vice President for Research and Dean of the Graduate School Peter Schiffer, PhD, Associate Vice President for Research and Director of Strategic Initiatives

Office of Corporate and Foundation Relations

Catherine Dufour, Associate Director Eric Reinhard, Assistant Director

Industrial Research Office

Rick Hoover, PhD, Materials/Small Business Specialist Tanna Pugh, Director Edit Radone, Managing Director, Center for Service Enterprise Engineering John Siggins, Associate Director