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August 17, 2015

Table of Contents

ICD-10 Coding System Coming to BMC in October

Do you have a patient who was sucked into a jet engine for the second time? Or perhaps they were burned when their water-skis caught on fire? Soon, you’ll be able to code for these issues, as well as the more common problems patients have, when ICD-10 is rolled out throughout the Boston Medical Center and the country as a whole on October 1, 2015.

Currently, hospitals use the ICD-9 system, which is mandated by the Centers for Medicare and Medicaid Services, for coding and billing. In this system, physicians working in clinics assign codes to patients in each patient’s electronic health record, while coders assign the codes for inpatients. Each code corresponds to a particular disease or condition, with additional codes for symptoms, external causes, and other items related to health conditions.

ICD-9 was first put into use in 1978 and while minor updates have been made annually, the system is out of codes to use. The journey to ICD-10 implementation began in 2008, when the U.S. Department of Health and Human Services set a target date of October 2013 for the implementation of new codes. However, the implementation was delayed to 2014 and again to 2015, due to lack of preparedness among hospitals. The implementation will not be delayed again, according to Erika Gaudreau, Senior Director, Patient Access and Director of the ICD-10 Program. ICD-10 will be mandatory for hospitals as of October 1. BMC’s ICD-10 program is ready and has prepared our systems to accommodate the new code structure, and our organization to adopt the new code set.

The main difference between ICD-9 and ICD-10 is the added specificity of ICD-10. In ICD-10, the code set has been expanded from five positions (first one alphanumeric, others numeric) to seven positions. The codes use alphanumeric characters in all positions, not just the first position as in ICD-9. As of the latest version, there are 68,000 existing codes, as opposed to the 13,000 in ICD-9.

For example, instead of simply coding for diabetes in a patient’s chart, providers will have the ability to code for diabetes and a comorbidity in one code, or to code specifically for high cholesterol caused by a genetic condition, rather than just coding for high cholesterol generally. This will help providers and researchers better understand the causes of many conditions and their effects, which will ultimately lead to better and more targeted treatment for patients.

Providers have undergone three rounds of training to learn how to use ICD-10, including training specific to each department. In addition, coders have been trained and have been using dual coding with ICD-9 and ICD-10 on subsets of patients since November 2014. The ICD-10 Program team has also conducted analysis on reimbursement in the new system – which showed that implementing ICD-10 should be revenue neutral for the hospital – and areas where departments will have to include additional specificity in ICD-10 codes. This information was shared with departments during training. The ICD-10 team is currently working on online awareness training for administrative staff and clinical staff who may not use the coding system but are affected by the changes.

“Our coders are ahead of the industry benchmark,” says Janet Briand, CSI Healthcare, ICD-10 Training Coordinator. “They have incredibly good accuracy and productivity scores with the new system, so we feel very good about our coder readiness.”

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BMC Improves How We Work with Project Evolve

Each day, many employees clock in and out to ensure their working hours are logged, while others submit weekly time sheets to keep track of their hours. However, those processes, among other human resources-related ones, will change beginning in September, when Boston Medical Center implements Project Evolve, a hospital-wide initiative focused on increasing operational efficiency and business intelligence, with the ultimate goal of improving decision making and freeing up time for BMC staff. With Project Evolve, BMC will implement two new systems: Workday and Kronos.

All employees will use Workday, which is an employee self-service tool that will allow employees to have easier access to contact and personal information. Workday will replace many of the functions currently in myBMC. Employees will have the ability to view and make updates to their contact and personal information – such as address or phone number changes, benefit election, and payroll information – directly in the system. Employees will also be able to manage their performance management process, view earned time, and request cash out if eligible. Managers will be able to use Workday for administrative changes, recruiting, and the annual performance review process.

Kronos is a time and attendance software that will be used for time capture, scheduling, and access to other time-related information. Employees will be able to access their time information including earned time, accurately track their work time, and request time off through the system. Managers will also use Kronos to manage staff time, approve time off requests, and schedule work for nurses.

With the implementation of Kronos, clocks will be installed around campus for employees to record their time on. The clocks will run a system called InTouch, which identifies employees using three points of their fingertips. Most employees will use this system, while others will record their time through a Kronos portal on their computers. Employees assigned to use the InTouch clock system will be enrolled by their managers.

“Kronos and Workday will have many benefits for employees, and for BMC as an organization,” says Lisa Kelly-Croswell, Senior Vice President of Human Resources. ”Most importantly, implementing these systems will free up more time and resources for focus on our patients and the patient experience, which is a key priority in FY16. These systems will also help us meet our goal to become more effective and efficient, including making it easier to access information and eliminating paper timesheets, which will contribute significantly to our green goals. We are very excited to improve on the foundation for taking BMC performance to the next level.”

All employees will be trained on how to use Workday and Kronos, though the amount and type of training will depend on an employee’s role and department. For most employees, training will consist of a series of briefings by their manager and an Evolve Super User. These trainings will take approximately an hour total. Training for managers will take approximately four hours for Kronos (more for Nursing managers) and two hours for Workday; managers will be contacted with training information.

Training for managers will take place during the month of September. In September, Kronos will go live for all employees except those in the Nursing Division. Employees in the Nursing Division will go live in Kronos for time keeping and scheduling (ANSOS replacement,) in December.

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SPARK Center Serves Boston’s Most Vulnerable Children

Boston Medical Center has a long history of serving vulnerable populations of all ages, including children. The highest-risk of these children are served by the SPARK (Supporting Parents and Resilient Kids) Center, which provides comprehensive therapeutic day services for infants, toddlers, and preschoolers with complex medical and psychiatric needs.

SPARK, which is the only center of its kind in New England, was founded in 1989 by the Boston Public Health Commission as the Children’s AIDS Program. In 1995, it became part of Boston Medical Center (then Boston City Hospital). The center serves approximately 60 children from birth to age 24 annually, most of whom are living in poverty; SPARK’s unique program provides an alternative to expensive daytime treatment options for these children, while helping to stabilize families who are often marginalized and struggling to maintain jobs and housing. Services provided by SPARK include nursing care, early education and intervention, care coordination, intensive behavioral health services, and family engagement programs. SPARK also takes care of children who are at the end of life. SPARK also runs a program, TICKET to Success, which serves young adults in transition who have complex medical needs, which provides participates with job training, treatment adherence counseling, social support, adult life skills, and educational support. Some TICKET youth also work with younger patients in SPARK classrooms.

“The kind of child that SPARK serves typically has multiple health challenges, as well as developmental and emotional challenges that can accompany health problems,” says Martha Vibbert, PhD, Executive Director of the SPARK Center and faculty member in Psychiatry and Pediatrics at BU School of Medicine. “For example, SPARK has extensive expertise in caring for very fragile infants, like those that are born severely premature – as early as 24 weeks – or born after being exposed to substances in utero. Some also have genetic, metabolic, or chronic disease, such as HIV, severe asthma, or diabetes. It’s not uncommon for children at SPARK to be fed through gastric tubes or to need repeated medications and therapies throughout the day. Our goal is to make all of this normal for children, so that they can grow up with a sense of self-acceptance and competence related to recognizing and managing their symptoms.”

Most children at the SPARK Center are referred by pediatricians at BMC or community health centers. Others are referred by the Massachusetts Department of Children and Families (DCF) because of emotional and behavioral issues secondary to the trauma of parental separation, domestic violence, and neglect/abuse. Some of these children also experience multiple foster care placements. Many of the children referred by DCF also have health challenges and neurodevelopmental delays.

“An example of a case at SPARK is a boy who came to us at the age of four months, after spending two months in the NICU owing to severe prematurity and low birth weight, with repeated brain hemorrhages and respiratory challenges,” says Vibbert. “He had trouble feeding well and growing. During the course of three years at SPARK, his parents gained confidence about how to meet his needs, his mother was able to return to work, his sleeping and eating routines stabilized, he got on track with cognitive development, he gained healthy social skills with his peers, and by the time he left us, he was able to graduate into kindergarten without the need for special services. It was a real victory.”

SPARK operates as part of the Pediatrics department at BMC and is overseen by Vibbert and three other clinicians. The center has 23 staff members, including pediatric RNs, a pediatrician, a child psychologist, early childhood and special needs educators, developmental specialists, a therapist, a program coordinator, and a nutrition coordinator. In addition, SPARK hosts early intervention specialists on site, and trains graduate interns every year in the fields of education, child life, psychology and public health. The center also partners with many community organizations and academic institutions, such as Wheelock College, BU School of Education, the Boston Public Schools, the Massachusetts Department of Public Health, and the Center for Multicultural Training in Psychology at BU School of Medicine.

SPARK also has a variety of international partnerships that focus on caring for children with pediatric HIV and support and education for parents about early interaction with their babies, which encourages brain development. These partnerships include the testing of Universal Baby (UB), an innovative video and mobile intervention for creating and delivering culturally competent parent education and coaching. In this program, local implementers upload video footage of local parents’ reciprocal interaction with their children, in their own culture and communities. The UB team collaborates with local providers to select strong moments of key “serve and return” interactions that encourage brain development. Graphics, montage, animation, and local language narration are added to edited video clips to help parents recognize positive and helpful interactions and learn the connection between these moments and neuronal connections forming in a baby’s brain. The videos can be downloaded to mobile phones to help disseminate information to caregivers who otherwise might not have access to child development knowledge. This program is currently being tested in Boston, with the Cherokee Nation in Oklahoma, Peru, and Zambia.

In addition to the importance of SPARK’s programs for the children they serve, this type of program has a significant impact on the overall health care system. Research has shown that children with complex medical conditions or who have suffered abuse or neglect early in their lives are more likely to experience health, educational, and psychological challenges later in life. Care for children and adolescents with these challenges comes at a huge cost to our health care system, both directly and indirectly. However, children who receive services such as the ones SPARK provides have been shown to improve behavioral and emotional competences, improve academic achievement – which leads to higher tax revenues and labor market success – and reduce their long-term social welfare use. In concrete terms, early childhood interventions have been found to generate a return to society ranging from $1.80 to $17.07 for each dollar spent on the program.

Please visit the SPARK program website or contact Ms. Barbara Hughes or Dr. Martha Vibbert for more information or to arrange a tour: 617-414-0502; [email protected]; [email protected].

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BMC Hosts Fellows from China

Boston Medical Center is well-known throughout Boston and New England, but it is also known internationally, particularly as a top trauma center. That international reputation brought two health care professionals, Shuyuan Cheng, MPH, and Jian Yang, MD, from China to BMC to learn about hospital operations and BMC’s quality and patient safety initiatives.

According to Cheng and Yang, it’s common for hospital employees from China visit hospitals in other countries to learn how they operate. Cheng and Yang specifically came to BMC because they are interested in how the hospital, as the biggest trauma center in New England, operates. In addition, one of the major operational issues they would like to learn about is how BMC was able to convert a major operating loss to its much improved current financial state.

Both work at large hospitals in China. Cheng is from Guangzhou, a city known as the medical capital of south China and works as a manager in the outpatient department of a hospital that sees over 4.9 million patients a year and has over 3,000 beds. Yang, a cardiologist, is from Yichang, a city in Central China, and serves as Assistant Manager of the Heart Center and Associate Chief Physician at a hospital that sees over two million patients a year and has over 2,500 beds.

At BMC, Cheng and Yang will be meeting with various departments at BMC, including Finance, Human Resources, Quality and Patient Safety, and members of the senior leadership team, such as Alastair Bell, MD, Chief Operating Officer, Stanley Hochberg MD, Chief Quality Officer, Nancy Gaden, RN, Chief Nursing Officer, and Ravin Davidoff, MD, Chief Medical Officer.

They will sit in on the departments’ daily business meetings, as well as in clinics to gain an understanding of the patient experience at BMC. In addition, they plan to learn about how BMC gathers, analyzes, and uses data in our strategic plan and in daily hospital operations. Cheng will stay at BMC for three weeks, and Yang will stay at BMC for three months. He plans to spend some of those three months working specifically with cardiology as an observer.

While in Boston, Cheng and Yang both also plan on seeing what the city has to offer outside of the walls of BMC, such as walking along the Charles, and taking side trips to the other hospitals and universities in the city.

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What do you do, Brendan Whalen?

Name: Brendan Whalen
Titles: Director of Design and Construction
Departments: Clinical Campus Redesign
Time at BMC: 2 years

What brought you to BMC?
BMC offered me a great opportunity to work on projects that truly help with the hospital’s mission to promote exceptional care without exception. I seized upon the offer to work on the clinical campus redesign project and it’s been one of the most rewarding jobs I’ve ever had. The opportunity to run the day-to-day operation of the hospital’s clinical campus redesign project is one of the best jobs anyone in my field could attain.

What do you do here?
My primary role is to implement and execute the hospital’s clinical campus redesign (CCR) project. The CCR project is one of the most challenging hospital renovation projects any hospital in the country, not just Boston, has ever attempted. Working inside a tight urban environment with few open areas, we are rebuilding a hospital while keeping it operational all times, which is very demanding and stressful on staff, patients, and visitors. My team is very aware of this and we constantly ask the designers and contractors to think like a staff member or patient to better understand how our actions effect hospital operations.

The CCR is broken into four distinct project teams: the Menino Addition and Renovations, Moakley Addition, Yawkey Renovations, and Enabling (early construction and infrastructure) projects. Each project has its own management, architectural and construction teams, each with its own unique contractual, program, and execution challenges from design, construction, and regulatory standpoints. I oversee all of this.

There’s a lot going on with construction! What can you tell us about what’s coming up over the next few months?
The fruits of our labor will start to see results very shortly. The first phase of the Moakley addition project will open in September. The Alan D. Solomont & Susan Lewis Solomont Clinical Simulation & Nursing Education Center, Otolaryngology, Command Center, and Digestive Disorders are all scheduled to open to patients throughout the month. Exterior landscaping will be completed in late October and the MBTA and Healthnet bus stops will relocate in early November back to their original location, which will now be in front of the new addition.

The first phase of the Yawkey building renovation construction will also be complete over the next 4 months. Surgical Admitting will relocate from Menino to a new space on the first floor in Yawkey in early September, and the Food Pantry will relocate from Dowling 4 to the Yawkey basement, where it will have a bigger space. The Yawkey lobby and cafeteria will open in early November and finally, Maternity will relocate from Menino 3 to new spaces in Yawkey 3 in December.

What’s one thing about the construction team that people might not guess?
There are a lot of people and companies working on the CCR project. Right now there are well over 300 people working full time on the CCR project. To date, over 100 design, construction, and specialty companies have worked on the project from when master planning started in 2012 to now.

Do you have any tips for navigating all the changes on campus?
We constantly strive to minimize disruption to operations and movement around the campus, but unfortunately there are times when we must make modifications in order to move construction forward. I would recommend staff look at the BMC Campus Redesign web page on as well as the weekly communications about the project for information on upcoming changes that effect staff, visitors, and patients.

What do you like most about working at BMC?
The interaction with the hospital operations staff has been fantastic. Everyone understands the big picture and the need to work together to get the project done. No two days, or two hours for that matter, are the same and although it appears that progress is slow, I can look back every week and see positive change to the project and the hospital, which is very rewarding.

What do you do for fun outside of work?
I enjoy spending time with my wife and 5 year old son. I also enjoy playing golf, although the project is killing my game! My handicap just keeps on going up, and up, and up.

Do you know a staff member who should be profiled? Send your suggestions to [email protected].

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In Their Words

Patients share their BMC experience

Good Afternoon Sarah, Dave, Connie, Nancy and Dr. Jacobs,

This morning one of my employees had a significant cardiac event in our Oral Surgery Clinic at Yawkey and subsequently went into full cardiac arrest. Today, I witnessed exceptional care and amazing team work. It validates why I have stayed here so many years. BMC is really a great place.

The care was truly exceptional, from the time team arrived, through transport to ED, and from the ED trauma team, Social Services, Nursing and Cardiology!

Connie and Dave – Please thank the Security team and Transport. When things were going very bad they jumped right into action. Some ran ahead to make sure all the doors were open so we could move quickly. They had the trauma team called and the room open and ready when we got there.

Sarah – Liz from the ED social work team was so kind and helpful. We could not track down the employee’s family and Liz went above and beyond to help me. She arranged for Maria from Pedi social work to meet with my staff at noon, as they were, as you would expect, very upset by what they saw happening to their friend and colleague. She greeted the employee’s husband when we got back and she was professional and empathetic. Please thank them for me!

The ED response team, residents, and nurses were all on point and yet had time to be thoughtful and keep me updated. Please thank them as well!

Nancy - The nurse from the ED medical emergency team who came to clinic was awesome. I am sorry I can’t remember her name. She actually made me feel ok as we were rushing to the ED. The nurses in the waiting room triage area were very kind. When I arrived with her husband they moved from one of their rooms so the resident could explain what they were doing. The staff in the cardiac cath room were so terrific. After her procedure they let her husband spend some time with her because all he wanted to do was “see her.” They showed greatest respect for her and explained everything to him in a way that he could understand.

Dr. Jacobs – the cardiologist, I am sorry, don’t remember his name was awesome. He listened, his demeanor with her husband was compassionate, and he did a nice job at explaining what he saw and the plan for the next few hours. He was a gentleman!

The irony of this story – she was not feeling well before coming to work, her husband told me he suggested that she call out sick. She told him no because other staff were out and she needed to be there. Interestingly, that decision and being at BMC probably saved her life!!

I write this because I wanted to make sure you know what a great job your teams did today for a member of my BMC family. It is appreciated and I am so grateful. She is now safely on 8N at Newton and we all hope for a great recovery. She is an awesome person and I need her back!!

While I don’t know all that were involved and all the names, it really is a team sport, so please share and thank them all for a job well done.

A grateful BMC employee

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News of Note

Jeffrey Kalish, MD, Named Associate Chief Medical Information Officer
Jeffrey Kalish, MD, Director of Endovascular Surgery at Boston Medical Center and Assistant Professor of Surgery and Radiology at BUSM, will be assuming the role of Associate Chief Medical Information Officer. Currently, Kalish is the Inpatient Physician Lead for Epic and the co-chair of the IT Clinical Prioritization and Standards Committee. In his new role, where he will be part of the IT leadership team, Kalish will focus on inpatient IT clinical issues.

Kalish is a graduate of Harvard University in Massachusetts and New York University School of Medicine in New York. He completed general surgery training at Boston Medical Center and a fellowship in vascular surgery at Beth Israel Deaconess Medical Center in Boston.

BMC Mourns Loss of Fr. Roger Bourgea, SM, Hospital Priest
BMC’s longtime priest, Fr. Roger Bourgea, SM, died peacefully at the hospital July 23. Fr. Roger, a member of the Marist community, was first appointed Catholic chaplain to University Hospital in 1990. In 1997, he was assigned to a parish and a hospital in Brooklyn, New York, where he learned Spanish to better serve his congregation and patients there.

Fr. Roger came back to BMC in 2014, where he reassumed the position of Catholic chaplain, providing both sacramental and pastoral care to patients. He was known as a devoted and loving priest to all whom he served.

Cullen Carter, MD and Chaitan Narsule, MD Join Department of Surgery
Cullen Carter, MD and Chaitan Narsule, MD have joined the Department of Surgery. Carter will serve as Attending Surgeon in the Section of Minimally Invasive and Weight Loss Surgery at BMC, and Assistant Professor of Surgery at BUSM. Narsule will serve as Attending Surgeon in the Sections of Acute Care and Trauma Surgery and Surgical Critical Care at BMC. He will also be Assistant Professor of Surgery at BUSM.

Carter received his medical degree from University of Virginia School of Medicine in Charlottesville, VA. He completed his residency in general surgery at Brigham and Women’s Hospital, a fellowship in surgical critical care also at BWH, and a fellowship in minimally invasive surgery at Wake Forest University Baptist Medical Center. He is board certified by the American Board of Surgery in General Surgery and Surgical Critical Care.

Narsule received his medical degree from Robert Wood Johnson Medical School (UMDNJ) in Piscataway, NJ. He completed a residency in general surgery at Rhode Island Hospital & Warren Alpert Medical School of Brown University in Providence, RI. Following a year of private practice as a general surgeon, he pursued clinical and research fellowships in thoracic surgery at BMC and Tufts University School of Medicine, prior to returning to BMC for a fellowship in surgical critical care. He is board certified by the American Board of Surgery in General Surgery and Surgical Critical Care.'


Cancer Support Services Holds Art in the Moment Event
Boston Medical Center cancer survivors came together on Saturday, August 8, to let their creative juices flow at the second annual “Art in the Moment” event put on by BMC’s Cancer Support Services. Survivors were invited to engage and express themselves freely as they worked together to create collages that involved 2D and 3D objects, sound and liquid elements, word cards, body movement, and more.

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Awards and Accolades

Neena McConnico, PhD, LMHC, Honored at Women of Excellence Awards
Neena McConnico, PhD, LMHC, Program Director of Child Witness to Violence, was named a Woman of Excellence by Youth Villages, a nonprofit dedicated to helping emotionally and behaviorally troubled children and their families live successfully. The Women in Excellence award recognizes inspirational women who are making a difference in the lives of girls through their professional, volunteer, or advocacy efforts.