norwalk demonstration project proposal. proprietary and confidential – not for distribution...
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Norwalk Demonstration Project Proposal
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 2
Overview
Jasperon proposes a demonstration project highlighting its premier educational material and tools for advance care planning with Norwalk Hospital.
Beginning in mid-August, Jasperon and Norwalk Hospital will work together for a period of approximately six months to demonstrate the effectiveness of Jasperon’s unique products and services in a major metropolitan area medical facility.
Jasperon will contribute access to its products and services. We intend to use web technology to integrate physical/hard-copy education material and to teach and train Norwalk’s health care providers to meet quality standards.
Norwalk Hospital will provide access to their professional staff, patients, operations, and related materials and documentation to implement mutually agreed-upon products and services in the hospital environment.
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 3
Overview
Together, Jasperon and Norwalk Hospital will study the benefits and performance changes in the Hospital as a result of using Jasperon’s products and services.
It is Jasperon’s intent to fine-tune its products and services, while providing Norwalk Hospital access to state-of-the-art resources. These resources would improve the quality and quantity of services the Hospital can provide its staff and its patients around advance care planning. Jasperon’s Phase 1 product, which will be running on August 18, 2000, has a professional component to it, but is largely consumer-focused. Jasperon’s deliverables from this effort will allow us to enhance the site and its functionality further for professional users.
Further, it is Jasperon’s intent to provide Norwalk Hospital with the public recognition that it will accrue as a leader in using Jasperon’s state-of-the-art products and services.
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A joint Jasperon/Norwalk Hospital demonstration project offers Norwalk a significant opportunity to take a leadership role in the community.
Demonstration Project
Media focus— This September, Bill Moyers’ four-part PBS special, “On Our Own
Terms: Moyers on Dying,” is expected to create a keen national interest in this issue
• Anticipated audience of 10 million viewers• PBS will host a dedicated web site • Grassroots campaign is already underway
— JAMA• Devoting fall issue to end-of-life care
JCAHO 2001 regulations
AMA EPEC program— Education of end-of-life care provided to every physician
Broader web accessibility and usage across the United States
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Jasperon provides Norwalk Hospital with an understanding of advance care planning beyond today’s common perceptions.
Advanced Care Planning
Advance care planning is more than completing a legally binding form. Done properly and with a broad inter-disciplinary approach, advance care planning enriches lives, brings families together, and provides peace of mind.
Advance care planning is a process during which an individual makes decisions about his or her future health care in consultation with health care providers and family members. Advance care planning is an organized approach to reflection, discussions, and understanding regarding preferences for end-of-life treatment decisions.
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 6
Advance Care Planning
Jasperon’s web-driven solution incorporates insights from a multi-disciplinary expert coalition that guide the presentation of education and informational content
Jasperon’s interactive interface empowers the user with awareness, knowledge, discussion guidelines, and decision-making skills
Jasperon.com is the only site where legal documents related to advance care planning are completed online
Jasperon’s storage and retrieval services will tremendously enhance the effectiveness of advance care planning discussions and documentation
Jasperon provides Norwalk Hospital with a unique solution to developing its own in-house expertise of advance care planning.
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Advance Care Planning
Integrating physical content and material with electronic media in a way that is easy to use, clear, and simple to understand
Delivering education and training using technology
Building and planning to use web technology to deliver products and services that solve problems and increase effectiveness and efficiency
Tailoring solutions to hospitals based on their unique needs and capabilities
Jasperon provides Norwalk Hospital with skills that will help ensure the success of this effort.
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 8
To proceed, we propose the following next steps:
Next Steps
Obtain management approval to participate in this effort
Identify an interdisciplinary core group (with a proper champion) within Norwalk Hospital who will oversee the Demonstration Project
Begin discussions with each member of this group to understand their priorities, concerns, issues, and sense of the particular needs at Norwalk Hospital
Refine the project scope, timing, and objectives from both Jasperon’s and Norwalk Hospital’s perspectives
Begin to develop an overall strategy to ensure broad and active professional participation in the education component of the project
Begin to collect important background information about Norwalk Hospital’s current processes, education materials, policies, utilization, etc.
Sign off on Proposal and Agreement outlining scope, deliverables, timing, and accountability
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Jasperon - Norwalk Hospital Demonstration Project
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 10
Jasperon would like to launch its advance care planning support network with Norwalk Hospital in mid-August 2000.
Advance Care Planning
Mid- August 2000: — Establish interdisciplinary working team— Determine hospital issues and priorities through working team interviews— Identify additional issues and priorities through selected professional
focus groups (2-3)— Establish overall professional education outline and schedule— Establish consumer education program outline
Mid to Late September 2000:— Conduct initial education program with key members of Norwalk Hospital— Initiate an overall public relations and community awareness campaign
timed to coincide with the Bill Moyers special
September through December 2000:— Conduct professional education program with members of Norwalk
Hospital and fine-tune as needs emerge— Identify implementation issues and goals to change advance care
planning policies and processes as well as an overall implementation strategy
— Assess integration issues around incorporating Jasperon into the education, storage, and retrieval processes of the Hospital
— Extend community awareness campaign
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We recognize that this effort will continue into 2001, and will work with Norwalk to define the activities that will carry over.
Advance Care Planning
Likely Activities Into 2001:— Extend professional education program into parts of Norwalk Hospital
system that have not yet participated— Assess effectiveness of alternative approaches to implementation — Continue process improvement implementation to improve compliance
with JCAHO standards— Refine methodology to collect and analyze data that will improve
compliance with JCAHO and other regulatory standards— Implement revitalized consumer education process and plan— Continue community awareness campaign into new segments of the
community— Fine-tune Jasperon’s integration into the education, storage, and
retrieval processes of the Hospital
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 12
For Jasperon, there are three overall goals for this project.
The Goals
Launch and strengthen the community-based education and communication model at Jasperon’s core.
— Implement a community-based education program in the Norwalk area with health care providers, community organizations, and consumers
— Provide Norwalk Hospital with an Advanced Care Planning Support Network that can be used to ensure that awareness, knowledge, and skills are being delivered effectively
Learn how to implement Jasperon in a hospital environment— Assist Norwalk Hospital in identifying the implementation issues of advance
care planning in terms of education, policy, process, and technology — Understand the effectiveness of different approaches to implementation— Incorporate Jasperon into the education, storage and retrieval processes
and policies solution
Refine Jasperon’s web site within the hospital and with professional users— Identify content/architectural/format/navigational issues for professional
users— Identify integration issues between the hospital’s own records and systems
and the Jasperon storage and retrieval process— Refine security, encryption, and privacy protocols within Jasperon
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To achieve these goals, Jasperon is providing Norwalk Hospital with its state-of-the-art products and services.
State-of-the-Art Products and Services
Professional Training and Continuing Education Materials— Online— Physical
Advance Care Planning Process Review, Assessment and Implementation Planning
Consumer Education
Communication Platform
Advance Directive Preparation Tools
Advance Directive Storage/Update/Retrieval
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“Add life to your days, instead of days to your life” “Add life to your days, instead of days to your life”
Jasperon’s professional education material has been developed to reorient many prevalent advance care planning behaviors and attitudes.
Professional Education
Focus professional training and continuing education on the ways medical professionals can further advance care planning through understanding, reflection, discussion, and formulating a clear plan
— Focus on comfortable, palliative care— Involve family in discussions — Work as an interdisciplinary team that will respect personal choices
around advance care plans
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Professional education focuses on skills and competencies that address advance care planning needs of chronically and terminally ill patients.
Professional Education
Objectives of the Education Component of the Project
Differentiate advance care planning from completing an advance directive
Develop strategies for educating health care professionals on advance care planning
Provide educational materials and tools to initiate sensitive discussions with chronically ill and terminally ill patients and their families
Discuss and understand personal and ethical issues relative to end-of-life treatment decisions
Understand the roles and skills required of professionals working as an interdisciplinary team approach
Demonstrate competency in completing and interpreting advance directives
Identify solutions to any of Norwalk Hospital’s barriers and organizational systems in implementing advance care planning
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Jasperon’s advance care planning materials will address a broad range of topics with Norwalk’s professional staff.
Advance Care Planning
Potential Advance Care Planning Curriculum Topics
Definition of Advance Care Planning - Understanding the Language, Concepts, and Tools
Medical Choices That Are Faced - a Decision-Making Model
Ethics, Laws, and Policies - An Overview
Pain and Symptom Management
Communication - Breaking Bad News, Triggering Discussions, Assessing Decision-Making Capacity
Roles of Professionals - Forming and Working as a Team, Improving Professional Skills
Facilitating Completing an Advance Directive
Specific Physician End-of-Life Responsibilities
Continuous Quality Improvement - Focusing on Advance Care Planning Outcomes, Measuring Strategies, and Data Utilization
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Advance Care Planning
What - A series of town meetings along with appropriate media coverage
When - Fall 2000 - in conjunction with or after “On Our Own Terms”
With Whom - Patients, Local Employers/Businesses, Civic Groups, Clergy, Legal Community, Financial Planners
Goals of the Community Action Campaign
Learn and Discuss - Engage the community in talks about the care they want at the end of life, provide education about the choices that are available, and encourage people to consider and express their advance care choices
Act and Communicate - Increase the number of people in the community who talk to their family members and physicians about their choices, complete advance directives, and ask their physician to place their documents in their medical records
The community action campaign portion of this project should position Norwalk as a thought leader in advance care planning.
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offers Norwalk an opportunity to test its compliance with 2001 JCAHO regulations, and establish itself as a “best of breed” site.
The Demonstration Project…
Systematic Data Collection and Analysis Supports JCAHO Quality Improvement - Sample Data That Should Be Evaluated
Where People Die - % in hospital, nursing home, home, hospice, other
Hospital Resource Distribution and Policies— Number of palliative care units/services/consults— Number of patients served by palliative care— Protocols and/or guidelines in place to support delivery of quality palliative care— Arrangements between hospital and hospice for coordinating care— ER protocols for seriously ill patients with DNRs, without DNRs— Protocols for transferability of DNRs between healthcare facilities and providers— Local emergency/911 protocols to honor DNRs and DNH— Number of physicians certified in hospice/palliative care— Number of nurses certified in hospice/palliative care— Number of physicians trained through AMAs EPEC program
Hospice— Number of hospices— Community awareness of hospice— Referral rate— Length of stay
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Activity Category Opportunity Percent Rationale
Patient Scheduling
Forms Completion
Billing
Patient Care
Family Conversations
Case Managementr
By looking at policies and processes, the Hospital also may identify opportunities for increased efficiency and effectiveness in its operations.
Increased Efficiency and Effectiveness
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PatientsNurses Doctors
Ease of Use
Answering Questions
Laggard Behind Average Leading
Completeness of Information
Facilitating Completion of Forms
Facilitating Sharing of Decisions
GoodAreaThe professionals at Norwalk Hospital can provide us with valuable insights about the ease of use, completeness, and helpfulness of the
The Professionals
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Overview of Jasperon’s Business Solution
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The Big Picture
Advance care planning enriches lives, brings families together, and provides peace of mind
Individuals are not empowered with the knowledge or tools to communicate their wishes regarding advance health care planning and treatment
Jasperon provides education and communication solutions to facilitate the process of advance care planning
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Detailed Problems
Technical advances in medicine have outpaced the ethical discussion over how best to use those advances
— high-tech medicine seeks to prolong life at all costs — 25% of Medicare budget spent in the last year of life— more than 80% will endure a period of incapacity at the end of their
lives during which they are unable to make their own health care decisions
Patient preferences are often not known or respected— most individuals (90%) would prefer to die at home, but 80% actually
die in institutions, often in intensive care settings— studies show that physicians are often unable to predict their patients’
preferences with respect to life-saving treatments, and their predictions are often based on their own values rather than the patients’
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Jasperon – Business Structure and Organization
Start-up Company – Founded April 2000
Privately Funded by Venture Quest/Jesse Fink (Co-Founder Priceline.com)
Management Team— Robert Mitchell, MD - Founder— Jesse Fink – CEO— Rob Caione – VP Operations— Steve Resch – VP Business Development
Anticipated Expert and Vendor Affiliations and Alliances— Joanne Lynn, MD and David Introcaso, Ph.D— Bud Hammes, Ph.D, Linda Briggs, RN and Fran Rybarik, RN— Russell Portenoy, MD— Angela Rowley, Chaplain— Alan Lieberson, MD, JD— Peter Strauss, JD — Partnership for Caring – Choices in Dying
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Document Storage & Retrieval Services
The Jasperon Solution
Communication Center
Information & Education Center
Advance Directive Preparation Tool
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 26
Information and Education Services
Centralized source of information, consumer education, professional training, and communication tools on an interactive web site
Alignment with experts to begin solving issues across multiple disciplines
Opportunity to provide accredited continuing medical education courses in advance care planning for professionals
Opportunity to create a support network of health care professionals who are interested and trained in advance care planning
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Communication Platform
Internet chat between family members, friends, and caregivers
“Ask the Expert” service provides Jasperon users with direct access to expert knowledge
Discussion forums around specific topics available for individuals, their families, caregivers, and health care professionals
Guidance and outreach services to provide training on initiating discussion on difficult topics
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Advance Directive Preparation Tool
Up-to-date legal forms for all 50 states
Jasperon user is guided through an online process of completing an advance directive and related legal documents
Interactive “Just-in-time” Help functionality
Easy notification of health care proxy
System informs users of changes in the law that may affect their advance directive document
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Document Storage & Retrieval Center
Centralized, secure database
Fax or online access to documents on demand for providers and proxies
Updating
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Storage and
Retrieval
Education and Service
Caregivers and
Health Care
Providers
Brand/Positioning
•Single process that produces a legally valid national solution
•Able to create, store and retrieve documents in a secure environment
• Clear, senior sensitive, educational approach
• Simple, easy to understand
• Supports sharing of documents between family, friends, health care providers, and caregivers
•Robust content developed from multiple perspectives- healthcare, education, caregiving
•Sensitive educational approach to advance care planning discussions
•Positioning as local company in touch with community resources to support personalized family-based needs
•Emphasis on family-based decisions
Complete “Peace of Mind”
Offering
Jasperon Brings “Peace of Mind”
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Highlights
Multi-disciplinary expert coalition guiding the presentation of educational and informational content
Interactive interface allows user to participate in online activities that build awareness, knowledge, and skills
Only site where legal documents related to advance care planning can be completed online
Storage and retrieval services have the potential to greatly enhance the effectiveness of advance care planning discussions and documentation
Why the Jasperon system is unique
Proprietary and Confidential – Not for DistributionJasperon and Jasperon.com are trademarks of NetDirectives, LLC 32
All parties involved in advance care planning will benefit from the Jasperon total solution
Everyone Benefits
Patients— Peace of mind, better advance care planning experience, enable family
communication, and participation in decision-making
Friends and families— Enriches experience and cohesion, improves education and
communication and relieves financial burden
Physicians, caregivers, hospices, and hospitals— Efficient time-saving conversations, improves relationship with
patient/family and addresses regulatory and compliance requirements
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ExpertsTechnologyInnovation
Community Based
Hardware manufacturesSoftware manufactures
E-CommerceFinancial Services
Pharmaceutical
Eldercare GroupsAARP
Assisted Living
Not-for-Profit Organizations
Managed CareLong-Term Care
ReinsuranceDisease Management
PBS – Moyers Special
Physicians
SNFHospice
Visiting NurseHospitals
EmployersBenefits Managers
Brokers/Benefit PortalsUnions
Employee Assistance Programs
AMA, ABANCQA, HEDIS, JCAHOGovernment
HCFA
Jasperon is building an unsurpassed network of relationships