1. Sharing the Experience Honoring Choices Minnesota Conference July 19, 2012 Fairview Health Services

2. Who do we serve? 2 7 Hospitals 73K IP admissions 40 Primary 55 Specialty Clinics 1M clinic visits 47 Senior Housing Sites Home Care/ Hospice Fairview Partners 5M Outpt Encounters 20K Employees 3K Physicians FPA, UMP UofM Academic Health Ctr

3. Key Implementation Strategies Broad network of facilitators Leverage partnerships Standardization of language and workflows Mandatory education-all employees Group facilitation sessions Embed/align with system strategies, goals, policies 3

4. Who are we talking to? 4 Primary Clinics 55+ Health Mtc Alert Consult Order Hospitals 18+ IP/OBS Admission Navigator Consult order Home Care Hospice Palliative Care Community Senior Services FV Partners LTC/TCU AL/IL

5. Documenting & Storing Choices EPIC: One click access to ACP information 5 Click on code status for report viewer Click on the word “CODE” for demographics

6. Documentation: Problem List & Smart Phrases 6

7. Turning Challenges into Successes Large system/silos: Encourages relationships – spreads the message New EMR: Evaluate Process/Build Metrics New Intranet : Opportunity for resources System policies : Standardization Limited resources: Improved process Leadership Transitions: Evaluate ROI update strategies Transitions in care: Mutual goals & benefits 7

8. Metrics Is the process working? # trained facilitators: 350+ # locations where ACP performed: 100 int sites + HCH + Comm # Group Facilitations: avg 9-10 mth Forms ordered last yr: HCD: 27.5K + 129 trans POLST 9.5K Patient Education: 19K % pts with ACP on Problem List: FMG clinics 8

9. Metrics : Are we doing it well? Facilitation Satisfaction: 5 point scale 9 Facilitators

10. Metrics - Did we honor people’s choices? Year 1 Metrics from LTC & TCU 10

11. Lessons Learned “all of us is better than one of us” Change outcomes change structure Executive & IT support critical Focus on transitions of care Build the relationships & find the shared benefits Repeat the message…Repeat the message… DON’T WAIT UNTIL YOUR SYSTEM IS PERFECT to start the conversations 11

12. Where do we go from here? Quality of conversations Engage employees personally Metrics- PI Leverage technology & media Expand our reach 12

13. Contact Information: Heidi Meyers, RN, BSN, MBA/HCM System Advance Care Planning Coordinator hmeyers1@fairview.org Kenneth Kephart, M.D. Medical Director Fairview Senior Services Adjunct Professor -Dept of Family Medicine -UofM Medical School kkephar1@fairview.org 13