AveraChartl e a d s t O r y

i n t h e C O M M U n i t y

ePrescribing Recognized

1PAGE

2PAGE

3PAGE

4PAGE

Avera Supply Chain Initiative

V O l U M e 3 4 n U M B e r 1 this issUe

w i n t e r 2 0 1 2

Woster Celebrated

Heart Month Special Events

Six Avera Hospitals Awarded Grants

a r O U n d t h e s y s t e M

8PAGE

P r e s i d e n t ’ s l e t t e rAveraChart

Cracking the Code

5PAGE

6PAGE

7PAGE

P e O P l e n e w s

Kudos

Bricks and Mortar

Avera Calendar

Leadership on the Move

New Physicians

Medical Staff Notes

an aBridged histOry OF aVeraChartsummer 2005 – early-stage planning culminates in the hiring of Jim Veline, the organization’s first senior vice president of information systems. Paraphrasing Charles darwin, he sets the stage for development of Avera’s eMr saying, “it is not the strongest who survive, nor the most intelligent, but the ones most responsive to change.” Fall 2005 through spring 2005 – new language emerges with talk of bunkers, mantraps, straw dogs and platforms.summer 2006 through summer 2007 – Avera launches 22 standards teams tasked with writing the dictionaries that form the basis of the eMr. We learn to work in “multidisciplinary sandboxes” creating common vocabularies, room nomenclature, drug formulary tables, physician identification and “hundreds and hundreds of tables that have to be maintained going forward,” says Jim.November 2007 – MediteCH’s Client/server version 5.5 goes live at Avera McKennan Hospital & University Health Center.

spring 2008 through summer 2008 – Avera Queen of Peace Hospital, Avera st. Luke’s Hospital and Avera sacred Heart Hospital are brought up on the MediteCH Client/server platform.2009 – Most of the work focuses on implementation for Avera Marshall regional Medical Center, the newest region in the Avera family.2010 through summer 2011 – Avera performs a major platform upgrade to 5.6 software (with new features and functions for enhanced clinical applications) and develops standardized order sets based on evidence-based medicine (some 330 and growing).summer 2011 through February 2012 – the eMr, renamed AveraChart, goes live with computerized provider order management (CPOM), beginning with Avera Queen of Peace Hospital. Clinic and physician eMr implementations grow in numbers to include:

“It helps to have physicians looking at

orders and entering them to make sure

there are no discrepancies — it is very

good. However, I believe the most

important thing we have done is the

basic skeleton of the system … and the

true value is the integration between the

clinic, the hospital and pharmacy.

Suddenly everyone involved in the

patient’s care has a bigger and more

complete picture of what we are doing for

the patient and what needs to get done.”

– Chris Lippert, rn, director of Or/PAr/

sPd/Cr, Avera Queen of Peace “It was a very successful day

with 85 percent of the 5,000

orders in all live units entered

by providers. … These are

amazing statistics given the

scope of this project.””

– Andrew Burchett, dO,

regional Medical information

Officer, Avera McKennan, at

the end of day one of go-live

“I just heard the best CPOM order ever. ‘Dietary order: Please order one cupcake with a candle today as it is this child’s birthday.’” – tad Jacobs, dO, Chief Medical Officer, Avera Medical Group

Clinics PhysiciansPhase 1Financials only 24 83

Phase 2Phase 1 plus nurse documentation 39 183and ePrescribing

Phase 3 Phase 2 plus Laboratory and X-ray orders 10 53

Total 73 319

an aBridged lOOk aheadnow that the groundwork is laid and the tall order of order set development is established, CPOM implementation is underway. “Our stats are high. Holy cow, i cannot believe how high they are!” Jim says of implementation across the Avera regions.

Jim explains that, looking ahead, Avera will concentrate on the clinical effectiveness of AveraChart. “First we will continue to upgrade functionality, activating more clinical decision support tools. some of this is to meet meaningful use requirements and the framework established by health care reform. next we are going to be able to track and trend data that will improve patient care in ways that we haven’t been able to measure before,” Jim notes. “this ability to truly deliver better patient care through tracking, measurement and evaluation is why we have been doing this.”

SuccessIn August 2011, AveraChart, the electronic medical record (emR), reached another milestone with the go-live

of computerized provider order management at Avera Queen of Peace Hospital. “This important step poises

the organization for more advanced use of the emR, and so it is an opportune moment to look back and look

ahead,” says Avera senior Vice President for Information

systems Jim Veline.

‘aVeraCharting’ OUr way tO eMr

“"Our Emergency Department physicians have maintained an average ordering percentage of 87 percent while continuing to give exceptional patient care.“"– Jenni Peterson, rn, coordinator for the eMr rocks Campaign, Avera st. Luke’s Hospital

Shown discarding paper records are the Avera McKennan Neonatal Intensive Care Unit Team (left to right): Roxanne Severson, Meghan Foster, Mary Metzger, Deb Wallenburg, Janet Dutcher, Angela Smithhart and Sarah Dubois.

A

2w i n t e r 2 0 1 2

ePrescribing is a streamlined process that enables clinic- and pharmacy-workflow efficiencies. Benefits include:n Reduced adverse drug events through more accurate dosing; increased legibility; drug interaction checks; decreased inappropriate medication therapy; prior authorizations; and step therapiesn Improved patient adherence through increased first-fill percentages; availability of medication histories; and the ability to prescribe affordable, on-formulary, generic and lower-cost alternative medicationsn Prevention of medication diversionn Cost-saving delivery of pharmacy services

ePrescribing is considered a leading indicator for meaningful use of electronic medical records because it tracks prescription benefit information, medication history and prescription routing. It provides authorized prescribers with secure access to real-time patient-specific prescription benefits and histories. This enables prescribers to make informed decisions that are clinically appropriate and economical for the patients. ePrescribing also enables two-way communication between the prescriber’s office and the patient’s choice of pharmacy that includes new and renewal prescriptions.

Just four years ago, when Chris Sonnenschein, executive director of IT Clinical Support for Avera, waded into the ePrescribing tide, South Dakota lagged the nation in 50th place. In April 2008, Avera began implementing ePrescribing. On Nov. 9, 2011, Avera and South Dakota rode a wave of success as the state was honored as one of the top-10 states in the nation with the highest rates of ePrescribing. South Dakota is new to the top-10 list this year and one of the year’s Safe-Rx Award winners (states that celebrate

leadership and exceptional commitment to advancing health care safety, efficiency and quality through the use of ePrescribing).

south dakota’s progress mirrors the nation’s, which in three short years has gone from less-than-10 percent of physicians who ePrescribe to more-than-50 percent. in the state, 528 physicians actively ePrescribe, 124 pharmacies are enabled for ePrescribing and 53.67 percent of patients have available prescription benefit and prescription history information. “Currently 73 Avera sites (includes clinics, hospitals and other entities) and 325 Avera physicians ePrescribe more than 15,000 prescriptions to dispensing pharmacies each week,” notes Chris.

AVERA RIDES THE CREST OF ePRESCRIBING WAVE TO NATION’S

Chris Sonnenschein, Executive Director of IT Clinical SupportAvera

TOP10

Adele (not her real name) is a lovely older woman who is a resident at Avera Brady Health and rehab in Mitchell, s.d. Like many long-term-care residents, part of her care involves coping with incontinence. A recent hard-working Avera supply Chain value-analysis team (VAt) made certain not only that her needs were met, but also that her dignity and quality of life were improved.

those who don’t work in the long-term-care world may not completely understand the scope of the issue. Julie Hoffmann, director of Nursing, explains, “incontinence impacts all aspects of life. For residents, wet beds can mean bedding changes, interrupted sleep, irritability, depression, weight loss, falls and pressure sores. When bedding is wet in the morning, it takes longer to get residents bathed and ready for the day. this results in a heavier workload for nursing and laundry. there also is an impact on residents’ satisfaction when it takes longer to meet each need or when there are odors.”

Julie praises the staff members at Avera Brady, noting that they work there because they want to make a difference. When incontinence issues aren’t well- managed, it can be hard for staff to feel as though what they are doing makes residents’ lives better.

in Adele’s case, the problem was particularly difficult because she suffers from a syndrome where there is no bladder control, and so there is a continuous overflow. “even with a vigilant toileting program and other interventions, she had a great deal of leakage, which meant up to 15 changes a day, skin care three times a day, intense odor despite neutralizers, constant room cleaning, and ruined clothing and shoes,” notes Administrator Veronnica smith. “despite some cognitive impairment, Adele was aware of her situation and embarrassed by it. she was self-isolating, quiet and didn’t participate in activities.”

Veronnica first learned of a product that could make a difference in Adele’s life early last year when she was “resident for a day” and spent an entire 24 hours living just as residents at the facility do. A sharp vendor of incontinence briefs read her story in the paper, called her and said, “We can help your residents sleep through the night. We have a product that will match the culture you are trying to create.” Avera Brady trialed the product and saw a 48-percent decrease in the quantity of product used, the elimination of some need for bed pads and liners, and a reduction in laundry costs for utilities, products and labor.

then, in April 2011, the Avera supply Chain introduced a VAt to consolidate purchasing of incontinence products across the system. Becky severson, clinical resource manager for Avera supply Chain, explains, “Our work in part is to standardize to a quality product and create cost-savings by purchasing items together at a better pricing tier. some of it is very simple. VAts look at samples and trial the items when necessary.”

Prior to Avera supply Chain, every facility might be doing this work independently. Avera is purchasing some products from as many as 113 different vendors. the organization not only is losing the benefit of aggregated volume pricing, but also it is spending $35 or more to cut each purchase order, a cost that really adds up. Of the incontinence VAt, Becky explains, “initially we were hoping we wouldn’t have to trial products due to the time constraints we were under. … in the end, team members evaluated products and provided feedback, just to assure quality outcomes were maintained.”

lisa Hamm, director of Resident Care at Avera sister James Care Center in Yankton, also was on the VAt exploring incontinence products. representatives from various companies came and demonstrated their products in a side-by-side comparison. “We realized that while we can spend our dollars together as a group to get better pricing, we don’t want to sacrifice quality when we do it. We needed to factor in the costs savings achieved by not using as much product,” she explains. “in the end, it was important to trial the products with front-line staff, who made the ultimate recommendation.”

Both Julie and Veronnica believe whole-heartedly in the VAt process led by Becky, which in the end proposed a similar but even better product for Adele than the one they had arrived at before the VAt. “the product we had chosen was amazing,” explains Julie. “it pulls moisture away from the body. You can put a towel on the wet product, and the towel stays dry. You have to see and smell the difference!” What the collaborative effort of the VAt accomplished was a product with an even-better fit and substantial cost savings.

Veronnica explains that for the VAt to work and save the organization money, all partners need to participate and stick to the contracts. “this isn’t about personal preferences and exceptions. What is decided in the VAt meets very specific mission-related criteria and needs to be followed.” For this reason, after proper trials were completed to ensure quality outcomes for residents, Avera Brady transitioned to the VAt-approved product. she calls the end result of the give-and-take “a great outcome for quality of life.”

Julie reports that Adele has been dry through the night most nights, and she and the other residents love the more dignified, real-underwear-like fit of the new briefs made possible by a stretchy area and Velcro® bar.

As for Adele, Veronnica always used to be able to find her — alone in her room. nowadays she does her own hair and make-up every morning and is out and about. “she is a completely different person,” says Veronnica, who smiles broadly as she explains that Adele has broken in a new recliner, which is something she couldn’t have before due to infection-control and odor issues. “And, she has amassed a collection of colorful Crocs™ shoes, which her family is accustomed to adding to each month. she takes great pride in color-coordinating them with her outfits.”

this is a genuine case of mission accomplished!

Vera sUPPly Chain initiatiVe renews dignity FOr residents

3w i n t e r 2 0 1 2

Avera’s South Dakota regional centers have special plans to celebrate heart health during the month of February. Details of events vary at each location, but all will share the same motivational message.

Making the circuit of events is Donna Hartley, an inspirational speaker who has been featured internationally. She is the author of “Fire Up Your Life!” and “Fire Up Your Intuition!” Donna survived the crash of a DC-10 airplane, beat melanoma and overcame open heart surgery to emerge with a message of change, healing and empowerment.

Avera’s heart month event schedule includes:

aVera welCOMes heart MOnth with sPeCial eVents

editOr: Clare willrOdt

comments,q u e s t i o n s ?

Send comments and questions to:

Avera Health3900 W. Avera Drive Sioux Falls, SD 57108

or allofus@avera.org

For additional information

about Avera, its affiliates

and physicians, or to view

this newsletter online,

please visit our website at

www.Avera.org.

Look no further.

is PUBlished QUarterly By aVera.

its PUrPOse is tO COMMUniCate aCtiVit ies and issUes

Pertinent tO aVera, tO share ideas and inFOrMatiOn

UseFUl in Managing Or del iVering health Care, tO

assist in FOstering a COMMOn aVera CUltUre and

tO re inFOrCe the MissiOn and COre ValUes OF aVera.

One of Avera’s finest supporters and friends was honored this past fall, and a “portrait” sculpture of him by Dale Claude Lamphere was unveiled at the Avera Health and Science Center at South Dakota State University (SDSU). Jim was instrumental in the partnership that led to construction of the center.

Jim is a 1962 graduate of SDSU in animal husbandry. In the predawn hours the day after receiving his degree, Jim began a 40-year career in cattle buying at the Sioux Falls Stockyards.

As his brother, Terry, tells it, “Somewhere along the way, he started visiting the sick at [then] McKennan Hospital. … Whatever the reason, he became famous for his flying trips through the hospital wards, popping in to talk to one patient after another, spreading smiles.”

John Porter, president and CEO of Avera, speaking at the dedication about Avera’s loyal and energetic ambassador said, “I learned a long time ago from the Presentation Sisters an adage in health care and the health ministries: While we cannot necessarily cure all, we can heal all. If I look at the role that Jim has played with us as a partner, he is every bit about the healing aspect of our ministry.” He explained, “Anytime you are in a facility, and you walk down the hall, if Jim is there, it just glows. He makes everybody feel so much better about so many things.”

Dr. David L. Chicoine, president of the university, noted, “Jim does so many things so well and so often that he truly is a special person who makes a difference for our university, for our students, for South Dakota agriculture, for our state and for Avera — and he does it all with that special Jim Woster touch.”

Lamphere, who is from Sturgis, S.D., has completed more than 50 major public commissions from the Basilica of the National Shrine in Washington, D.C., to the Eisenhower Medical Center and the City of Burbank in California.

six aVera hOsPitals awarded grantsrecently the state of south dakota awarded $200,000 in grant funds to 15 critical-access hospitals. Avera facilities are recipients of $98,042 (49 percent of the total funding). the facilities are:

n Avera dells Area Hospital – $15,000n Avera Flandreau Hospital – $15,000n Avera st. Benedict Hospital – $9,675n Platte Health Center Avera – $14,367n Wagner Community Memorial Hospital Avera – $22,000n Avera de smet Memorial Hospital – $22,000

the grants are awarded annually to critical-access hospitals for such programs as medication-error reduction, patient safety, clinical health information technology and hospital-readmission reduction.

Celebrated

Feb. 8 AVeRA HeART HosPITAl “Heart & Soul Ladies’ Night Out” Washington Pavilion, Belbas theater, sioux Falls 6 – 7:30 p.m. — Wine and food pairings, massages and light hors d’oeuvres 7:30 p.m. — speaker tickets $15 at www.AveraHeartHospital.com Or visit the concierge desk, 4500 W. 69th st., sioux Falls

Feb. 9 AVeRA QueeN oF PeACe HosPITAl “Heart & Soul — Fire Up Your Heart” Pepsi theater, Mitchell 5:30 p.m. doors open — Light hors d’oeuvres 7 p.m. — speaker

Feb. 6 AVeRA sT. luke’s HosPITAl “Heart & Soul — Fire Up Your Heart” dakota events Center (deC), Aberdeen 6:30 p.m. — dinner and speaker tickets $15 for sale online and at the hospital Administration Office

Feb. 7 AVeRA sACReD HeART HosPITAl “Heart & Soul — Fire Up Your Heart” Avera sacred Heart Pavilion, Yankton 5:30 p.m. — Health fair, dinner, cooking demonstration and speaker tickets $10 online

OMMUnitYi n t h e

Vera sUPPly Chain initiatiVe renews dignity FOr residents

that sPeCial jiM wOster tOUCh

Jim Woster and Dale Claude Lamphere at the dedication

w i n t e r 2 0 1 2 4

a r O U n d t h e YsteM

aVera MCkennan, aVera saCred heart naMed 2011 QUest® tOP PerFOrMing hOsPitalsOn dec. 20, Avera McKennan Hospital & University Health Center and Avera sacred Heart Hospital were named among 2011 top Performing Hospitals in the Premier health care alliance national QUest (QUality, efficiency, safety with transparency) collaborative. Avera McKennan made this list for the third year in a row.

Both hospitals will receive monetary awards for top performance in:n increasing delivery of recommended evidence-based care to every patient every time by 84 percentn saving lives by reducing avoidable hospital mortalities by 18 percentn safely reducing the cost of care for each patient’s hospitalization

in just 30 months, QUest members saved 25,235 lives and reduced health care spending by $2.85 billion. in addition:n Members’ observed mortality is 5-percent lower than non-participants when compared to what is expected.n Member costs for inpatient care have increased only 4 percent, compared to a national cost increase of 21 percent.n Members began increasing adherence to evidence-based care delivery in patient experience, harm and readmissions last year to support new improvement goals.

aVera heart hOsPital OFFers anOther FirstAvera Heart Hospital is the first hospital in north dakota and south dakota and among the first hospitals in the United states to treat patients with a new stent system that improves the treatment of coronary artery disease. the PrOMUs element™ Plus everolimus-eluting Platinum Chromium Coronary stent system, manufactured by Boston scientific, is built on an innovative drug-eluding platinum chromium platform.

“the stent alloy is designed to make it easier for physicians to guide the stent to the blocked artery and view the stent under X-ray for accurate placement,” says dr. tarek Mahrous, north Central Heart institute, who performed the first implant at Avera Heart Hospital. “We are always looking for innovative treatment options for our patients’ personal needs. that is why we are excited to now offer this new stent technology at our hospital.”

FlOyd Valley hOsPital earns FiFth sUMMit awardFloyd Valley Hospital in Le Mars, iowa, recently announced that Press Ganey Associates, inc., named the hospital a 2011 summit Award® winner. the summit Award recognizes top-performing facilities that sustain the highest level of performance for three or more consecutive years.

Floyd Valley Hospital is one of 98 organizations to receive the prestigious honor in 2011, and one of 87 to receive it for achieving and sustaining excellence in patient satisfaction. the hospital was recognized for emergency department patient satisfaction. “Of the 982 hospital emergency departments that participate, we’re in the top 98th to 99th percentile, so we are in the top 10 to 20 hospitals,” says Administrator Mike donlin. “Our staff makes Floyd Valley what it is,” he adds.

United retireMent Center aVera reCOgnizedA mayoral proclamation was issued by the City of Brookings, s.d., on nov. 22, 2011, to recognize United retirement Center Avera for its outstanding effort on behalf of people with disabilities. the proclamation noted that the Brookings Committee for People Who Have disabilities nominated the center as the community’s Outstanding Large Private employer to compete in the south dakota Board of Vocational rehabilitation’s statewide 2011 Governor’s Awards. the Governor’s Awards program recognizes individuals and employers for their contributions to the rehabilitation and employment of people with disabilities in south dakota.

aVera hOMe health agenCies Make elite listthree Avera home health agencies made the OCs HomeCare 2011 HomeCare elite™ list as top 500 Home Health agencies in the United states. Home health agencies receiving the distinction are:n Avera st. Luke’s Hospital Home Health, Aberdeen, s.d.n Avera Creighton Hospital Home Health, Creighton, neb.n Avera st. Anthony’s Hospital Home Health, O’neill, neb.

OCs HomeCare is a division of OCs (originally Outcome Concept systems) and for almost 20 years has delivered performance improvement benchmarking measures to home health and hospice providers, government organizations and various stakeholders in the home care industry. OCs uses publicly available data from the three domains of performance: quality of care, quality improvement and financial performance.

aVera Marshall reCOgnized FOr CharitaBle giVingAvera Marshall regional Medical Center has been recognized with a Minnesota Business Gives award by the Minnesota Chamber of Commerce in association with the Marshall Area Chamber of Commerce. Minnesota Business Gives is designed to motivate, educate and recognize local businesses in Minnesota for the charitable-giving and community-involvement contributions they make to their local communities.

aVera hOsPitals in tOP 100 CritiCal-aCCess hOsPitalssix Avera hospitals have been named in the top 100 Critical-Access Hospitals in America. the first-ever list was compiled by the national rural Health Association using the Hospital strength index™, an objective way of measuring 56 different performance metrics in three categories: market strength, value-based strength and financial strength. the Avera hospitals to receive the recognition were:n Avera Holy Family Hospital, estherville, iowan Floyd Valley Hospital, Le Mars, iowan Avera Hand County Memorial Hospital, Miller, s.d.n Avera st. Anthony’s Hospital, O’neill, neb.n Hegg Memorial Health Center Avera, rock Valley, iowan sioux Center Community Hospital & Health Center Avera, sioux Center, iowa

aVera MCkennan reCeiVes gOVernOr’s saFety awardthe south dakota safety Council has awarded a Governor’s safety Award to Avera McKennan Hospital & University Health Center for excellence in workplace safety and health. Avera McKennan was one of 10 companies to receive the highest level of award, the Award of Honor, for exceptional accomplishment in reducing injuries and illnesses in the workplace.

aVera reCOgnized By haBitat FOr hUManityHabitat for Humanity – south dakota recognized Avera as the state supporter of the Year at its annual fall recognition banquet nov. 12, 2011, in sioux Falls. Avera was honored for monetary donations and years of support by Avera colleagues on the state support organization’s Board of directors.

Avera st. Luke’s Hospital also was honored as the Habitat for Humanity Aberdeen affiliate supporter of the year. in addition, dan Gergen, former director of Mission at Avera sacred Heart Hospital, was recognized by the Yankton affiliate as its supporter of the year.

aVera st. lUke’s reCOgnized FOr exCellenCe in Patient Care Avera st. Luke’s Hospital was chosen by studerGroup® to receive an excellence in Patient Care Award. Avera st. Luke’s received the award for its exemplary rating on “promptness in responding to calls” on the HCAHPs patient survey. the award was presented at the What’s right in Health Care national conference Oct. 19 – 21, 2011, in Chicago, ill. studerGroup gives its excellence in Patient Care Awards based on very high scores in HCAHPs.

aVera MCkennan Best in FOUr areasHealthGrades has named Avera McKennan Hospital & University Health Center the best in south dakota in orthopedic joint replacement; neuroscience, including stroke and neurosurgery; gastrointestinal (Gi) medical treatment; and critical care. HealthGrades is the nation’s most trusted, independent source of physician information and hospital quality ratings.

Avera McKennan received the Joint replacement excellence Award for 2012, which places Avera McKennan in the top 10 percent in the nation for joint replacement. Avera McKennan is also in the top 10 percent in the nation for Gi medical treatment in 2012.

in addition, Avera McKennan received five-star ratings in five key service lines, including cardiac care, orthopedics/joint replacement, neuroscience, gastrointestinal and critical care.

aVera FlandreaU reCeiVes sPeCial designatiOnAvera Flandreau Hospital recently announced it has achieved Pathway to excellence® designation by the American nurses Credentialing Center. the Pathway to excellence designation identifies elements of work environments where nurses can flourish. the designation substantiates the professional satisfaction of nurses at Avera Flandreau Hospital and identifies it as one of the best places to work.

the Pathway to excellence designation means the organization has successfully undergone a thorough review process that documents foundational quality initiatives in creating a positive work environment as defined by nurses and supported by research. these initiatives must be present in the facility’s practices, policies and culture. nurses in the organization verify the presence of the criteria in the organization through participation in a completely confidential online survey.

the Pathway to excellence designation is perfectly suited to small- and medium-sized health care organizations, but is attainable by all health care facilities around the world.

w i n t e r 2 0 1 2 5

aVera saCred heart Plans new additiOnAvera Sacred Heart Hospital in Yankton, S.D., will begin construction of a $17 million, three-story addition to the northwest side of the hospital next summer. The project is called “Northern Lights” because of its location and because it will have many windows to allow in natural light.

The project will include a new kitchen, cafeteria, pharmacy, laboratory and more. The focus during the planning process was improving hospitality services for patients, visitors and staff. Construction is expected to begin in July and take two years or less. The hospital currently is finishing an $8 million renovation of its surgery facility. The space will provide an opportunity to expand the main hospital in the future

twO new aVera MediCal grOUP CliniCs tO resPOnd tO siOUx Falls grOwthTwo of Sioux Falls fastest-growing neighborhoods are welcoming Avera Medical Group clinics. Avera Medical Group McGreevy West Benson Road opened Dec. 12 just west of Interstate 29 in the city’s northwest corner in the Thelin Centre retail mall. Its address is 4011 W. Benson Road. The clinic provides primary care.

The other clinic is on the city’s southeastern corner at the Shoppes at Dawley Farm near Powderhouse Road. That clinic, Avera Medical Group McGreevy Dawley Farm, will open in late March 2012 and provide both primary and urgent care.

The two clinics, together with the other five existing Avera Medical Group McGreevy clinics, provide Avera primary care coverage across the city of Sioux Falls.

COnstrUCtiOn tO start Mid-sPring in wOrthingtOnWhen spring arrives, residents of Worthington, Minn., will see the start of construction on a new 60,000-square-foot clinic for Avera Medical Group Worthington. The new space will be home to the clinic and all of the specialties offered by 17 physicians and mid-level providers. The project will provide space for growth and new procedure rooms. Southwest Minnesota is a growing area, and the new clinic is indicative of Avera’s commitment to provide quality health care locally to the people who live there.

sPeCialty CliniC jOins aVera MediCal grOUPAvera recently announced its newest specialty clinic, Avera Medical Group Comprehensive Breast Care, and welcomed Dr. Julie Reiland and staff.

Dr. Reiland specializes as a breast surgeon and provides diagnosis, surgery and long-term follow-up care for breast cancer and breast diseases. She also specializes in breast-sparing surgical techniques and is the principal investigator for a new surgical and radiation therapy protocol for breast cancer that helps dramatically reduce the amount of time required for radiation therapy.

Dr. Reiland holds a medical degree from the Sanford School of Medicine at The University of South Dakota, Vermillion. She completed residencies at the Sanford School of Medicine and Creighton University Medical Center in Omaha, Neb. She is certified by the American Board of Surgery.

aVera Marshall Blessedduring recent staff forums and a medical staff meeting, Avera Marshall regional Medical Center staff members participated in a blessing of caregivers’ hands ceremony. Clergy from several area churches offered the blessings at the event organized by sr. sharon Altendorf, vice president of Mission services.

C a l e n d a r

Feb 16 – 17 Avera HealtheCARE™ Forum, Sioux Falls Convention CenterFeb 23 Avera Rural Leadership Meeting, Sioux Falls Convention CenterFeb 23 Joint dinner for Avera Rural Leadership Meeting and Avera Board of Consultors, Sioux Falls Convention CenterFeb 24 Avera Board of Consultors, Sioux Falls Convention CenterMarch 1 – 2 Avera Behavioral Health Retreat, Prairie Center on the Avera McKennan Campus, Sioux FallsMarch 14 Avera Project Management Conference, Holiday Inn City Centre, Sioux FallsMarch 21 – 23 Avera Health Board Education Retreat, Rancho Bernardo Inn, San Diego, Calif.March 29 – 30 Avera Leaders in Ministry Renewal, Broomtree Retreat Center, IreneMay 4 Avera Spirituality and Healing Ministries Conference, Holiday Inn City Centre, Sioux FallsMay 9 Avera PACE Conference, Ramkota, Sioux FallsJune 14 Avera Gerontological Care Conference, Avera Education Center, Sioux FallsAug 22 Avera Quality Congress, Sioux Falls Convention CenterAug 23 – 24 Avera Board of Consultors, Hilton Garden Inn, Sioux FallsSept 12 Avera SDSU Research Symposium, Callaway’s, Sioux FallsSept 19 – 21 SDAHO, Sioux FallsOct 4 Avera Rural Health Conference, Sioux Falls Convention CenterOct 18 Avera Nursing Conference, Sioux Falls Convention Center

2012

BriCks MOrtarand

esCriPtiOn UPdateProgress continues with escription implementation, the backend sophisticated voice- recognition dictation-transcription system that will be implemented at Avera regional hospitals in spring 2012. Because hospitals will share the software, standardization of practices is essential. the regional medical information officers attended a physician workshop nov. 16, 2011, at the Avera Central Office to discuss standardization.

items discussed that will involve changes for dictators, depending on current regional practices were:n dictation voice promptsn information entered at time of dictation via keypadn Keypad commands on phonen report namesn Work type numbersn Prioritization of work types or goal turn-around timesn notification to dictators of blanks within reportsn Automated routing

A need for formal training sessions for dictators isn’t anticipated. new dictation instructions will be made available along with go-live support. A training plan is being developed for transcription staff. Continue to look for information as this project moves forward.

Pastor Amber Ingalsbe from St. Stephen Lutheran Church blesses the hands of Libby Mertz, ultrasonographer from the Imaging Center.

jaCOBs, FliCek lead aVera MediCal grOUP tOgetherThe business of running a medical group is changing, and more clinical accountability is being demanded from both payors and patients according to Dave Flicek, chief administrative officer of Avera Medical Group. To effectively meet the demands, Avera is implementing a physician-administrator leadership pairing that optimizes the administrative strengths of Dave’s role and the clinical expertise of a chief medical officer.

To fill the new position, Avera has tapped the familiar talents of Tad Jacobs, Do. He began his responsibilities on Jan. 3. Many know Tad as chief medical information officer for Avera, instrumental in the implementation of AveraChart, the system’s electronic medical record. Until recently, he practiced as a primary care physician in Flandreau, S.D. He is a tenacious adopter of technologies to advance patient safety and clinical quality, and he brings a strong, collaborative physician voice to health care issues.

“My role is to focus on the development of clinical quality across the medical group through the creation of physician-driven service lines,” Tad explains. “As we work on developing the medical home, Dave is responsible for administrative issues and meeting infrastructure needs to support staffing, computers and IT components. I am responsible for clinical protocols, standards and processes.”

“Tad was highly recommended by the search committee. He has experience bringing people together on the AveraChart project,” notes Dave. The rapport between the two leaders is evident. “I look forward to working with the ‘four-shot wonder’ (hunting jargon for a hunter who needs four shots to get his or her game). I am glad to work with him because he has hunting dogs and I don’t,” jokes Dave about his new leadership partner and sometimes hunting companion.

“Wait a minute,” responds Tad. “In four shots I would have four birds, which would put me over the limit.” All kidding aside, he adds, “I have known Dave since he started with Avera. We have worked together a long time, and I have always appreciated his straight-forwardness and support. I have always had a good working relationship with him.”

Tad says that it is both a privilege and an honor to be in the new role. In 1995 he was one of the first physicians to join the Avera primary care network (now Avera Medical Group), and he values the experience of being part of its growth in camaraderie and strength. “I look forward to further promoting the collegiality of the group and helping it to mature past regional preferences to a common Avera system perspective. We need to collaborate and communicate to meet the reimbursement challenges that lie ahead,” he notes. “We used to call each other about the care we were providing. We have gotten away from that, and the changes we face mean pulling together again to talk about best practices and engage our colleagues so that we give the best possible care every time — as a group.

“Another thing I am tasked with is to work alongside Avera Senior Vice President and Chief Medical Officer Dr. Dave Erickson to continue to foster leadership among physicians in the organization and to help develop physician leadership talent. Avera wants greater physician involvement and leadership, but physicians aren’t necessarily leaders by education,” he explains.

Tad will serve with Dave Flicek on the Avera Operations Council and the Avera President’s Advisory Council, adding another physician voice alongside that of Dave Erickson. He also will continue in his role as Avera’s chief medical information officer until a replacement is hired.

Tad is a graduate of Des Moines University – College of Osteopathic Medicine, Iowa. He completed a residency at Parkview Osteopathic Hospital, Toledo, Ohio, and is board-certified by the American Osteopathic Board of Family Medicine.

w i n t e r 2 0 1 2 6

eWsP e O P l e

new CeO naMed at aVera st. lUke’sTodd Forkel has been named regional president and CEO of Avera St. Luke’s Hospital. He began the new position on Dec. 19, 2011. An Aberdeen native, he most recently was senior vice president of Operations for Essentia in Fargo, N.D.

“We are excited to have Todd returning to Avera in the leadership role at Avera St. Luke’s,” says Fred Slunecka, chief operating officer for Avera. “Todd brings with him a great deal of skill in leadership at both the hospital and clinic levels. His background

and knowledge of the community will help move Avera St. Luke’s strategic initiatives forward.”

Todd is a graduate of Aberdeen Central High School, Presentation College and Northern State University. He started his career at Avera St. Luke’s as a radiology technologist, later serving as director of Radiology and vice president of Clinics. He also has served on the Aberdeen City Council. “I am proud to be back in Aberdeen, my hometown, and back at Avera St. Luke’s, where my health care career began,” says Todd.

At Essentia, he led the implementation of an organizational excellence initiative and the electronic medical record, as well as the integration of clinical and support services. Previously he served as the director of Radiology at Mayo Clinic in Rochester, Minn., where he was instrumental in integration initiatives, implementation of Lean Six Sigma practices and educational efforts on health care reform.

Todd and his wife, Amy, have three children. He takes the place of Ron Jacobson, who retired after more than 22 years with Avera.

dr. jenniFer MCkay aCCePts rOle as MediCal direCtOr OF adVanCed CliniCalsDr. Jennifer mckay is the new medical director of Advanced Clinicals for Avera. She will facilitate physician input and provide physician leadership in the planning, design, development and implementation of clinical information systems for Avera. (Clinical information systems include the various information technology applications that together create a centralized repository of information related to a patient’s care across a variety of settings.) She began the new role on Jan. 3.

Duties also include a focus on the clinical effectiveness of AveraChart, the organization’s electronic medical record. This means facilitating updates and edits to existing and new order sets by physician review teams, facilitating appropriate alerts and warnings to providers, enhancing clinical decision support with provider input, and quality assessment and measurement.

Jennifer continues part-time in her current practice as a hospitalist at Avera McKennan Hospital & University Health Center, coordinating the medical care of acutely ill, hospitalized patients.

Tad Jacobs, chief medical officer for Avera Medical Group, says, “We are thrilled to have Dr. McKay join the AveraChart team. She brings an important knowledge base of the acute-care setting and a passion for quality to the table. Her ability to oversee the electronic medical record’s clinical effectiveness for the hospital setting is a great enhancement.”

She is a graduate of the University of South Dakota Medical School, Vermillion. She completed an internal medicine residency at Washington University School of Medicine, St. Louis, Mo., and is board-certified in internal medicine. Presently, she is pursuing a master’s in patient safety and quality improvement at Northwestern University, Chicago, Ill.

Jennifer was the first full-time hospitalist at Avera McKennan Hospital & University Health Center, and since 2005 has grown the program to include 10 physicians, two full-time nurses and a physician assistant. The program this past year involved more than 23,000 contacts with 4,200 patients.

“My philosophy was inherited from my grandfather, who once turned a failing ice rink in Flagstaff, Ariz., into a booming business. Be friendly, accommodating and helpful — that is the cornerstone of the success of the hospitalist program at Avera McKennan. We are a diverse group of individuals who truly enjoy what we do and are invested always in making things better for patients,” she says. “I am excited to bring this philosophy to my new role at Avera.”

Jennifer fills the position vacated by Dr. James Powell, who is now chief medical officer for Avera Health Plans.

Tad Jacobs, DoChief Medical Officer Avera Medical Group

David FlicekChief Administrative OfficerAvera Medical Group

w i n t e r 2 0 1 2 7

the FOllOwing PrOViders haVe jOined the staFF OF aVera MCkennan hOsPital & UniVersity health Center in siOUx Falls, s.d.:

Dr. enrico ocampo is a graduate of University of the Philippines College of Medicine, Manila. He completed an internal medicine residency and endocrinology fellowship at Montefiore Medical Center, Bronx, new York. dr. Ocampo joins Tyler Medical Clinic

Avera in tyler, Minn.

Dr. Francisco Recalde is a graduate of Universidad Católica de santiago de Guayaquil, ecuador. He completed a pediatric residency at rady Children’s Hospital san diego, Calif. dr. recalde joins Pediatric Critical Care & Hospital Services in sioux Falls, s.d.

Dr. Jeremy storm is a graduate of des Moines University, iowa. He completed an internal medicine residency at sanford school of Medicine, sioux Falls, and an infectious disease fellowship at the University of iowa Hospitals and Clinics, iowa City. dr. storm joins Infectious Disease Specialists, P.C., in sioux Falls, s.d.

the FOllOwing PrOViders haVe jOined the staFF OF aVera saCred heart hOsPital in yanktOn, s.d.:

Dr. Angeline Young is a graduate of dalhousie University, Halifax, nova scotia. she completed a diagnostic radiology residency at University of toronto, Ontario, Canada. dr. Young joins Avera Radiology in Yankton, s.d.

Dr. Ralph Tullo is a graduate of Universidad del noreste school of Medicine, tampico, tamaulipas, Mexico. He completed a diagnostic radiology residency and magnetic resonance imaging fellowship at Mount sinai Medical Center, Miami Beach,

Fla. dr. tullo joins Avera Radiology in Yankton, s.d.

eleVen OF aVera’s Finest hOnOred at aVera nUrsing COnFerenCe OCt. 20eleven Avera nurses received special recognition in seven categories during the Avera nursing Conference on Oct. 20, 2011. recipients in order of award category were as follows:

n mary Pistulka, Avera sacred Heart Hospital, Avera nursing distinguished service Leader Awardn lori Popkes, Avera McKennan Hospital & University Health Center, Avera nursing distinguished service Leader Awardn malinda DeJong, Hegg Memorial Health Center Avera, Avera nursing distinguished service Care Provider Awardn linda schulte, Platte Health Center Avera, Avera nursing distinguished service Care Provider Awardn Clara Johnson, Avera McKennan, Avera nursing Visionary Awardn Gordon Varuska III, Avera McKennan, Avera nursing Commitment to Caring Awardn Amber Topp, Avera Behavioral Health Center, Avera nursing Clinical Quality initiatives, Publication and research Awardn Jolynn Zeller, Avera st. Luke’s Hospital, Avera nursing Clinical Quality initiatives, Publication and research Awardn Jill Rye, Avera McKennan, Avera nursing Clinical Quality initiatives, Publication and research Awardn megan Timmer, Avera McKennan, Avera nursing novice to expert Awardn Amber Jensen, Avera McKennan, Avera nursing Friend of education Award

Other aVera COlleagUes in the news inClUde:n monte Bertsch, director of the Avera McKennan Call Center, is newly responsible for the department of Communication services.n Tom Bosch is Avera McKennan’s new vice president of Hospitality services. Most recently tom was general manager for the Holiday inn City Centre in downtown sioux Falls. reporting to tom will be the Materials Management, Food and nutrition services, Facility services and environmental safety departments, as well as the Avera McKennan Fitness Center.n David Christensen, manager of Policy for Avera, has been appointed to the south dakota risk Pool Advisory Board by Gov. dennis daugaard, effective Oct. 18, 2011 – June 30, 2012. n Chad Cooreman, chef at Avera Marshall regional Medical Center, was awarded the People’s Choice Award for best food at the recent taste of Marshall, an annual event for the Marshall Area Chamber of Commerce.n Will Flett, assistant vice president of Finance at Avera Queen of Peace Hospital, will become vice president of Finance effective Feb. 1, 2012. Pat Clark, currently senior vice president of Finance, retires Jan. 31, 2012, after 36 years of service.n Amy Hanselman, RN, is the new assistant director of nursing at Avera Brady Health and rehab. Amy comes to Avera from Good samaritan society – Corsica where she worked for the past 14 years.n Jean Henes, director of nursing at Avera Creighton Hospital, was honored by the nebraska state Athletic Administrators Association and Creighton Community schools for her outstanding record of service to interscholastic athletics.n lisa kilawee, director of rural Health services for Avera, recently was elected secretary of the national rural Health Association. Lisa has been instrumental in strengthening Avera’s relationship with that organization and its policy on rural health provision.n karen klinkner, ms, RD, lN, director of nutrition services at Avera Queen of Peace and Avera Brady Health and rehab, recently was featured in View Point, the national newsletter of the Premier Foodservice Program. n kate kunz, sAFe Kids director at Avera st. Anthony’s Hospital, was awarded the dr. richard raymond Public Health Champion Award at the north Central nebraska Public Health Banquet in november. Kate brought a sAFe Kids chapter to Boyd, Holt and rock counties and remains strong in her coordination of the chapter.n stephanie Reasy recently accepted the position of director of Clinic Operations at Avera Queen of Peace and began her duties on nov. 28. Previously, she was administrator of Marshall County Healthcare Center Avera, Britton, s.d., for 15 years. n Brian slaba, CeO of Wagner Community Memorial Hospital Avera, recently was named one of three finalists for the American Hospital Association’s shirley Ann Munroe Leadership Award.n sr. mary Thomas, senior vice president of Mission services at Avera McKennan, has added responsibility for the Chaplaincy department to her duties.n Tiffany Weeks, RN, recently joined Avera sacred Heart as the new assistant director of Perioperative surgery. Prior to joining Avera, she worked at sanford Health in sioux Falls.n Brian Wienk, physical therapist at Avera Medical Group McGreevy 7th Avenue, was named Physical therapist of the Year by the south dakota Physical therapy Association at its fall convention.

MediCal staFF nOtesGregory Taylor, radiologist at Avera sacred Heart Hospital, won his age division at the ironman World Championship® triathlon in October in Kailua-Kona, Hawaii. taylor, 57, finished first in the men’s 55 – 59 division, with an overall time of 10:03:43.

aVera st. lUke’s hOsPital radiOlOgists jOin aVera MediCal grOUPAvera st. Luke’s hospital-based physician radiology group joined Avera Medical Group effective dec. 1, 2011. Dr. stephen Peters, Dr. melchor Aguilar, Dr. Daniel Fritz, Dr. Douglas kimmel, Dr. les lenter, Dr. Caroline lundell and Dr. sheryl siegmund-Weekly are now part of Avera Medical Group radiology Aberdeen.

dr. Peters has served as medical director for radiology for many years and continues in this leadership role.

new PhysiCians

Avera Nursing Award recipients left to right: Amber Topp, Jill Rye, Clara Johnson, Amber Jensen, Linda Schulte, Megan Timmer, Gordon Varuska III, Jolynn Zeller, Lori Popkes, Malinda DeJong, Mary Pistulka

8w i n t e r 2 0 1 2

resident’s

John PorterPresident & CEOAvera

l e t t e r

NON-PROFIT ORGANIZATIONU.S. POSTAGE

P A I DSIOUX FALLS, SDPERMIT NO. 7010

3900 W. Avera DriveSioux Falls, SD 57108

the mailing list

All of Us is a publication for employees of Avera and colleagues like Brenda Heinert, RN, an Avera Medical Group float and pediatric nurse at Avera St. Luke’s Hospital, Aberdeen. Brenda is a great team player who volunteers her time for community activities for Avera St. Luke’s, like

portraying Lukie the Lion and participating in the Gypsy Days Parade.

V O l U M e 3 4 n U M B e r 1

P R o B l e m s ?we’d like tO Make it right! Change laBel and Mail BaCk tO Us. Misspelled name

Wrong address

Received more than one

Remove my name from

the mailing list

new Vistas ahead FOr aVeraChartHelen Keller is said to have remarked that a happy life consists not in the absence, but in the mastery of challenges. the first blind and deaf person to earn a Bachelor of Arts (and then go on to be a prolific writer and activist), she was a person well-credentialed to make such a statement. those of us who work in health care today are faced with many challenges, and when we are wise, we find joy in their mastery.

Certainly those of us closely involved with the implementation of AveraChart have cause to celebrate. Like the vista reached on a mountain journey, the point at which we have arrived in the implementation process gives perspective and cause for celebration. the first two stories in this issue give a glimpse of our it implementation accomplishments thus far.

it has been a remarkable journey. i am grateful for the many Avera colleagues from the dictionary “sandbox” dwellers to the hundreds involved in writing order sets to the many more who have coaxed projects and paid careful attention to workflows. in AveraChart, you are

creating a tremendous tool for our patients, our providers and our health system!

throughout this winter, as we continue the implementation of computerized provider order management (which i understand is proceeding very well), we also look ahead to journeying to new heights with AveraChart — in so many ways, we have only just begun. Like the hiker who reaches a vista point, we can see that there is a further climb ahead to reach a fully implemented eMr.

in this issue, you also read about two important appointments who will be instrumental as we plot our path to the summit: dr. tad Jacobs as chief medical officer of Avera Medical Group and dr. Jennifer McKay as Avera’s medical director of Advanced Clinicals. Our post go-live optimization of AveraChart must focus on improvement over time that supports provider adoption and use, so we welcome these two colleagues. they will help us to improve data capture and quality of care to maximize the value of AveraChart.

tad’s new role is particularly pivotal as Avera fosters an inclusive and partnering relationship with physicians working through health care reform, provider adoption and improved patient safety. Jennifer will facilitate physician involvement activating the clinical decision support tools that are built into AveraChart. Her efforts will focus on the clinical effectiveness of the eMr to further improve patient outcomes without sacrificing the productivity of clinician users.

i commend all Avera leaders involved in bringing the project to this point, and also take this opportunity to welcome Avera st. Luke’s Hospital’s new President and CeO todd Forkel. to all involved in this important project, i salute your climb thus far, and i challenge you to delight in the mastery of things to come.

Avera is on track, cracking the code to ensure that all employees and providers are prepared for a smooth transition to iCd-10, the new coding system that will enable the health care delivery system to capture more complete and accurate data on our patients.

the current iCd-9 code system will be replaced by iCd-10 beginning Oct. 1, 2013. Coding is the art of assigning a numerical code to every symptom, disease, injury and procedure that patients experience throughout their lives. these symptoms, diseases, injuries and procedures are translated into code and used for research, filing claims to insurance, measuring quality and safety, setting health policy, monitoring resource utilization, preventing and detecting fraud and abuse, and more.

the current coding system has been in place for more than 30 years and has insufficient space to accommodate new procedures and disease processes. Currently hospitals and doctors use about 18,000 codes in the bills they send to insurers. the new federal mandate expands the coding system to 140,000 codes. not only is the system outdated and losing important detail, but also the United states is the last industrialized nation to make the switch to the iCd-10 classification systems.

the use of iCd-10-CM (diagnosis codes) and iCd-10-PCs (procedure codes) will allow greater specificity when assigning codes for patients’ diagnoses and procedures performed. this classification system includes separate codes for sides of the body (right or left) as well as additional characters and extensions for greater detail. the changes in code structure are shown here:

Let’s compare how a condition or procedure would be reported using iCd-9 versus iCd-10 and see how the latter affords greater detail for specific diseases or injuries: A patient diagnosed with nonunion of a right arm Greenstick humeral shaft fracture:

An example of procedural code is a patient who presents for the excision of a cancerous lesion from the skin of the left upper arm:

Coders rely on provider documentation to give them the level of detail needed to assign the most accurate, specific code(s) for each encounter, so physicians and non-physician practitioners will be a major part of the transition to iCd-10. some departments and areas who will be affected by iCd-10 and taking Avera to the next level of coding and reporting are Health information, Patient Care, information technology, Quality, Patient Financial services, registration and many more. extensive education and training will be offered to all employees within Avera and provided by Avera staff members who are certified iCd-10 trainers who have completed extensive training and testing.

COding OFF the wallimagine! there are new codes for injuries sustained:n By being crushed by an alligatorn From a flying horsen When playing the piano, knitting and crocheting n By being bitten by a sea lion

these give you an idea of some off-the- wall kinds of injuries, but they do happen. the new coding system will provide the health care industry with the opportunity to code any injury or disease that is necessary in accurately reporting a patient’s condition.

Avera system-wide training, including

physician training, will begin in march 2012

and continue through to go-live on

oct. 1, 2013. The training will be provided

in levels of low, medium and high. stay

tuned for more information from Avera and

the regional education Departments.

ICD-10S42.311K – Greenstick Fracture of Shaft of Humerus, Right Arm, Subsequent Encounter for Fracture With Nonunion

86.3 – Local Excision or Destruction of Lesion or Tissue of Skin and Subcutaneous Tissue

ICD-9 Diagnosis Code 733.82 – Nonunion of Fracture

oHBCXZZ – Excision Skin, Left Upper Arm, External Approach, Diagnostic

CrAckInGthe COde

ICD-9 ICD-10Cm Codes Letters and numbers Letters and numbers Three to five characters Three to seven characters

PCs Codes Numbers only Letters and numbers Three to four numbers Seven characters