LouHIE 6-23-08 Draft Case Statement

Draft

Case Statement

The Louisville Health Information Exchange, Inc.

June 18, 2008

Nice Picture Here

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The Louisville Health Information Exchange, Inc.

Louisville, Kentucky

The Louisville Health Information Exchange, Inc. (LouHIE) is a not-for-profit organization, governed by a healthcare community board.  Its vision is to improve quality and contain rising costs of healthcare in the Louisville area…by providing consumers and their providers anytime, anywhere access to complete healthcare information and decision-support. This anytime, anywhere access will be accomplished by a health record bank, developed through community support.

The Problem

In February, 2008, John Jones was hospitalized at a Louisville area hospital for three weeks and nearly died because his physician did not have electronic access to his current medications list and his family couldn’t remember the name of one of his prescriptions. A medicine was prescribed which adversely interacted with another, turning a minor emergency into a traumatic, and costly, life-and-death situation.1 Unfortunately, events like this happen very day in communities across the country, including Louisville. Why? Because most healthcare information is still on paper or locked inside last-generation computer systems at hospitals and physicians offices. LouHIE has been organized to help address this problem for the greater Louisville area.

The Problem in Context

Louisville’s healthcare sector, like that of the rest of the country, has not yielded to the improvements in service, quality and efficiency made possible by the information technology revolution. This is in part due to the sheer complexity of healthcare information. The subject matter is vastly complex and inexact, and medical synonyms, near synonyms, nuance of language and subtleties of phrasing resist standardization and thus computerization. In addition, healthcare

information resides in numerous and varied locations such as physicians’ offices, hospitals and pharmacies, and there are at present no developed services to gather, organize and share this information. Finally, the software for automating healthcare has to date

been developed using a piecemeal approach. The information systems used across today’s healthcare spectrum are a composite of multiple separate

1 Example of situation that happens at least once every month in Louisville based on literature.

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There is currently no practical way to gather and organize patients’ health information in one place before care is delivered.

systems that communicate imperfectly. Laboratory data is collected and stored in a laboratory system, X-rays in a radiology system and hospital charts in a medical record system, each system contributing to an incomplete and unwieldy patient record. Because of healthcare’s complexity, there presently exists no means to blend these diverse streams of data to form a comprehensive patient medical record.

LouHIE - Part of a Nationwide Strategy

The Louisville Health Information Exchange, Inc. (“LouHIE”) is part of a nationwide effort to address these challenges in healthcare. Organized in March of 2006, LouHIE is the greater Louisville area’s neutral, trusted, nonprofit “Regional Health Information Exchange,” and is working closely with state and national efforts that are underway.

In 2004, with Executive order 13335, the Federal Government initiated a nationwide initiative to bring US healthcare into the 21st century using information technology. Efforts are now underway at five levels: individual, organizational, community, state and national.

- At the individual level, the federal government is encouraging healthcare related organizations across the country to work together to achieve a common vision: a patient medical record available for every American by 2014. These patient medical records would be dynamically linked to multiple physicians, hospitals, pharmacies and other providers. Once in place, each individual’s health information (with their permission) could be available anywhere in the country – much like today’s banking information is available through ATMs. In late 2007 and early 2008, organizations including Google and Microsoft announced initiatives to help support such systems.

- At the organizational level, hospitals, physicians and other healthcare organizations are being encouraged to invest in modern, standards-based electronic medical record systems that can link to patient medical records. This is expensive, so efforts are also being developed to lower costs and subsidize funding for these systems. Investments in such technologies are increasing.

- At the community level, Regional Health Information Organizations (RHIOs) have been asked to develop community-based services to facilitate health information exchange among and between organizations and consumers in the community. LouHIE is Louisville’s RHIO, responsible for facilitating health information exchange for the greater Louisville area.

- At the state level, state health information organizations (HIOs) are forming to develop state-based standards, enable legislation, and create statewide infrastructure. In addition, states may provide funding and grants to

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communities and organizations and help bring Medicaid and state employees into the systems being developed. In 2004, Kentucky’s Senate Bill 2 established the Kentucky e-Health Network as Kentucky’s HIO.

- At the national level, various efforts are underway to create e-health standards, develop national legislation and regulations, provide grants and funding for states, communities and organizations, and coordinate participation by federally funded healthcare services like Medicare (for seniors), the Veterans Administration, and the Centers for Disease Control.

Because this nationwide strategy is still in its early stages, there are significant opportunities for communities and states to take leadership positions in developing these next generation technologies for a 21st century healthcare system.

Introducing LouHIE

As the Louisville area’s Regional Health Information Organization (RHIO), LouHIE has the potential to establish Louisville as a national leader in using electronic health information to improve quality and contain rising costs of care for its 1.2 million residents.

LouHIE’s development began in 2004 through a collaboration between University of Louisville’s School of Public Health and Information Sciences, leading health organizations from across the community and the Kentucky e-Health Network. After three years of development, LouHIE is now established as the Louisville area’s “Regional Health Information Organization” (RHIO). LouHIE is recognized in the state as a part of the emerging Kentucky e-Health Network (authorized under Senate Bill 2). LouHIE is also recognized in the nation as Louisville’s RHIO, and for its innovative “health record banking” approach to community health information exchange. LouHIE is working closely with other RHIOs in Washington State, Kansas City and Oregon, who are taking a similar approach.

LouHIE is organized as a not-for-profit organization, governed by a board of community stakeholders. In 2006-2007, LouHIE raised over $170,000 in contributions, engaged an outside consultant, and conducted a community-wide research effort leading to development of a plan to develop LouHIE as a

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LouHIEThe RHIO for greater Louisville

Initially serving Jefferson, Oldham, Shelby, Spencer, Bullitt, Hardin, Shelby, Clark, Floyd and Harrison.

community asset. The LouHIE plan was approved by the LouHIE board in May, 2008. A list of 2007 organizational sponsors is attached. A 501(c)(3) application is in process, but tax-deductible contributions can be made to LouHIE now through the Greater Louisville Medical Society Foundation.

By implementing this plan, LouHIE and greater Louisville have an opportunity to establish a national leadership position in the emerging “e-health” arena, improving healthcare for its citizens, while driving economic growth.

The LouHIE Plan

LouHIE’s plan is designed to address, at the community level, problems of health care information fragmentation, lack of standards, ambiguity, and disparate software. LouHIE’s plan was developed based on 2007 research conducted with 209 participants in 26 facilitated focus group sessions plus about 800 participants in phone, web and paper surveys. The results of the research are in “The Greater Louisville e-Health Research 2007 Report” available at www.louhie.org.

The plan involves development and delivery of health record banking services for the entire community – including all area consumers, hospitals, physicians, healthplans, pharmacies, and health benefits sponsors such as employers, Medicaid and Medicare.

From a consumer perspective, LouHIE’s plan is to offer free services for all. LouHIE’s plan means that all 1.2 million citizens in the greater Louisville area, including Southern Indiana, will be offered a free health record bank account where their health information can be securely stored and managed – under their control. Healthcare providers will receive free access to the data with consumer consent. See figure 1, attached.

From a physician and hospital perspective, LouHIE’s plan involves a stairstep approach to achieving the vision of “anytime, anywhere access to complete healthcare information and decision-support” for physicians and the healthcare community. This stairstep has four stages.

The first phase of the stairstep is the LouHIE launch, occurring in 2008 and 2009. This phase involves development of the organization and management team, engagement of a core-services vendor to provide the technology infrastructure, conducting a pilot operation of health record banking services in 1st/2nd quarter 2009, and development of non-core services which can link to LouHIE’s infrastructure.

Upon completion of the LouHIE Launch phase, LouHIE will enter its Clinical Information Exchange phase. In this phase, the technology platform developed in the LouHIE launch will be activated to support clinical information exchange. This will involve linking to hospital and physician EMRs, as well as

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other clinical data depositors and withdrawers including lab-data sources, testing center sources, radiology sources, and other clinical data.

The third phase of LouHIE’s development is National Leadership. By completing the first two phases in the timeframe noted, The greater Louisville area community will be positioned to be a national leader in using health information technology to improve quality and contain rising costs of care.

The fourth phase of LouHIE’s development, is titled Community Growth. This is because if the first three phases are successful conducted, LouHIE’s business plan will lead to the potential for community growth for greater Louisvile, measured in both economic terms, and in terms of quality of life.

In the LouHIE Launch phase, LouHIE plans to start simple, launching services focused on medications, medication reconciliation and patient demographics. Milestones for the LouHIE Launch include:

Milestone Completed By

Develop interim management team October, 2008

Engage core services vendor(s) October - December, 2008

Conduct provider workflow study – to study how best to “fit” services into existing provider workflows.

December, 2008

Launch 1-2 non-core services. (Non-core services are external services which can link with LouHIE (ie, e-prescribing)

December, 2008

Pilot of health record banking service with patient clinical summary containing medications, medication reconciliation and demographic data.

January – June, 2009

Roll-out services to community (assuming success of pilot)

Starting July, 2009

Organizational resources

LouHIE’s development to date has been supported through several types of contributions. Significant support has been provided by University of Louisville, made possible in part with funding from the Kentucky Science and Engineering Foundation ($200,000) and the Kentucky e-Health Network ($450,000). The state funding support continues. The Kentucky Hospital Association and the Kentucky Department of Public Health contributed an additional $30,000 in 2006. In addition, an estimated two thousand hours of volunteer time from over 800 individuals and organizations have been

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contributed. Finally, LouHIE has raised direct funding of over $170,000 from participating organizations.

Through mid 2009, LouHIE will be managed by an interim management team using executives drawn from University of Louisville, major healthcare organizations in the community, and area physicians. Thereafter, as funding permits, a permanent management team will be put in place. The permanent team will include an executive director, chief financial officer, chief information officer, chief medical officer, chief development officer, compliance officer, benefits realization manager and administrative support.

Fund-Raising Goals

To support the LouHIE Launch in 2008-2009, LouHIE is seeking a total of $4,359,000 is sought by year-end 2009. $200,000 is sought by end of 3rd quarter, 2008, and an additional $1.25 million by end of 4th quarter, 2008.

LouHIE Launch 2008-2009

Goal: $4,358,000

Funds are budgeted to come from the following sources:

- Underwriting - Major Gifts: $2,500,000- Government Grants: $500,000 - Organizational Contributions: $1,440,000- Individual Contributions: $168,000

Funds will be used to develop, conduct and evaluate a community-wide pilot of the LouHIE Health Record Banking system.

Funds will be raised by LouHIE board and committees, and the interim management team, working with community organizations including the Greater Louisville Medical Society, the Health-Services Council of Metro Louisville, Greater Louisville Inc. and Health Enterprises Network, area employers, Louisville Metro Government and the Kentucky e-Health Network.

LouHIE Program Evaluation and Accountability

There is clear evidence that healthcare quality can be improved, and some healthcare costs mitigated, by making medication data available across the community, especially if linked to e-prescribing systems. Medication reconciliation, the tracking of a patient’s medicines as they traverse the various stations of the healthcare continuum, is a national patient safety goal. Making a

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patient’s medication history more readily available can benefit hospitals and physicians, help consumers receive safer, better care in emergencies and office visits and help employers and health plans reduce avoidable expenses. Studies show that up to 1% of all hospitalizations could be avoided by making more complete medication information available at the point of care. In addition, over the long-term, it has been estimated that health information technology has potential to take to 8% of costs and inefficiencies out of the healthcare system, while significantly improving quality of care.

LouHIE has built into its plan mechanisms to measure actual changes in costs and quality. LouHIE plans to use UofL, the Kentucky Healthcare Infrastructure Authority, and other research institutions to conduct and publish this evaluation research. Research will be used to guide continual improvement in services provided to the community.

LouHIE Openness and Transparency

LouHIE is committed to openness and transparency. Except where confidentiality is needed to protect an individual’s or organization’s privacy, all LouHIE information is posted on the LouHIE website at www.louhie.org. LouHIE’s monthly board meetings are open to all committee members and guests upon request.

LouHIE – Supporting Louisville’s Three Deep Drivers

LouHIE’s plan positions it to catalyze economic development in Louisville. Economic development opportunities which the LouHIE plan supports include:

- LouHIE Jobs - development of employees working for LouHIE and its

vendors (15-30 professional/technical employees). - E-Health Research Jobs - development of new health research

opportunities and jobs – created through access to LouHIE research database.

- Non-Core e-Health Company Jobs - development of new non-core e-health services companies creating new products/services linked to LouHIE.

- Enhancing Louisville Competitiveness - by helping Louisville offer new businesses a “21st century” healthcare system.

These economic development benefits have potential to help Louisville advance in its achievement of its three deep driver goals:

- New professional and technical jobs – through LouHIE, UofL and related e-health firms.

- Increased education attainment – LouHIE ‘s development will increase growth of additional educational degrees and certificates in

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the healthcare sector – e.g. degrees and certifications in health informatics at the associates, bachelors and masters levels.

- Strengthening Louisville’s urban core – LouHIE is open to locating downtown in the UofL “Nucleus” zone, and may encourage its vendors and linked e-health firms to do the same. In addition, LouHIE anticipates working closely with UofL to develop new health research opportunities which can be located in the Nucleus zone.

Now is the time to support LouHIE

LouHIE has studied benefits of moving too quickly, versus moving to slowly, in developing a community RHIO. LouHIE believes now is the time for Louisville to take the next step in moving towards a 21st century healthcare system. By moving now, Louisville will position itself to achieve two gains: 1.) improved healthcare for its 1.2 million citizens, and 2.) opportunities to grow Louisville as a city, by making progress with the three deep drivers.

The full “automation” of US healthcare is a 10-20 year project. Communities and states which lead in this effort will reap the rewards of substantial grants, contracts and economic development opportunities in the long-term. Funding provided now, to help LouHIE move forward with its plan, will also help establish Louisville as a national leader in this emerging area. It will create the foundation for the long-term transformation of healthcare in Louisville, and help Louisville area continue to move up the rankings as a world-class city. Benefits from Supporting LouHIE

LouHIE contributors will be recognized on LouHIE’s website, in LouHIE materials and community events. The tentative recognition format is:

LouHIE Launch 2008-2009Made Possible by

UnderwritersUnderwriter 1Underwriter 2

Etc.

OrganizationsOrganization 1Organization 2

IndividualsIndividual 1Individual 2

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Figure 1: LouHIE Consumer View

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Figure 2: LouHIE Stairstep

Develop Organization - Management Team, facilities, etc. Engage vendor(s) – build HIE infrastructure (MPI, Terminology, etc.) Pilot Health Record Bank – medications, demographics, med rec.

Patient Clinical Summary * PHR links * Hospital/ EMR links

Develop Non-Core Services – eRX, Payor Based Health Record, PHR

Strengthen Organization Expand HIE infrastructure (single-sign-on, etc.) Roll-out Health Record Bank – add labs, tests Fund EMRs; add more non-core services; research.

Outside funding flows increaseLouisville a national leader in improving quality and containing rising costs of care.

2008 2009 2010 2011 2012

Louisville A national leaderIn community health research

National Leadership

Community Growth

ClinicalInformationExchange

LouHIELaunch

LouHIE StairstepApproach

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Development Team

The team includes:

Initial Meeting/Brainstorming

Kenny ZegartLyle GrahamBill HymesLeland Woodmansee (GLMS)Judah ThornewillDennis Riggs (Exec. Dir. Louisville Community Foundation)

Case Statement Drafting Team

Bill HymesLyle GrahamKenny ZegartJudah Thornewill

Social*cap1

Review/Comment/Edits

Above plus Jan HawleySheila AndersenNancy GalvagniLouHIE Board of Directors

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Tentative Outline for LouHIE’s Case Statement

Pulled from a suggested outline for a case statement – see details at end of this document. I’ve attempted to put the text created so far into this format. I’ve incorporated most current text from Bill/Lyle, plus Kenny’s comments on Sat AM,

1. The problem (or opportunity) to be addressed• Talk about community need. Talk about the people who need and want your service.

2. Trends affecting the problem (or opportunity)• Demonstrate your knowledge and insight. What is happening in the world and your community, which has produced this problem and what is happening now (and what do you anticipate happening in the future.)?

3. Your response to the problem (or opportunity)• How does/will your organization respond to the community problem or opportunity. How will you respond to the trends?

4. Your mission• Now is the time to weave in your mission. You exist (your mission) because you wish to respond to community situations. Explain how your response to this particular community situation fits in with your overall mission. (Please don’t just reprint your mission statement!)

5. Your history, track record and marketplace position• Explain why you are the right organization to respond to this community situation. Talk about your track record. Demonstrate why the prospective donor should believe that giving money to your organization is a sound investment. Make sure you position your organization within the marketplace. How are you different than other organization doing the same or similar work? Talk about collaboration.

6. Goals, strategies and objectives• Provide detail about how you will respond to the community situation. What, specifically, are you going to do? Why? When?

7. Organizational resources• Justify, prove that you have the resources necessary to address this situation. Describe your staff, professional expertise, volunteer structure, operations, and so forth. Talk about money. How do you currently finance your organization? How do you propose to finance this new activity? What kind of money is necessary? How will you raise the money and who is helping you raise the money.

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8. Accountability and evaluation• You must assure the prospective donor that you will comply with all relevance regulations and laws, and that you are a good organization, its programs and finances. Also describe how you evaluate program and institutional health.

9. Future plans for your organization• Present your future organization goals and activities that will continue to help the community address the situation in the future.

10. Role of the prospective donor• Engage the prospective donor. Describe how a prospective donor might participate in addressing the community problem or opportunity. Talk about how you can help the prospective donor achieve his or her own goals and dreams. Describe donor acknowledgment and recognition opportunities. Focus on target audiences and the key messages for each audience.

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Case History Definition

Definition: From the Assoc for Healthcare Philanthropy:"...case statement--a concise explanation telling why your organization is worthy of philanthropic support. The case statement describes specific problems facing the community and tells how the organization is helping to solve those problems, It summarizes the mission, goals, and objectives of the organization in a compelling way and invites prospective supporters to invest in the cause. The case statement is not simply a statement of need. People do not (just) give money because your organization needs it..."

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Article: What is a case statement

© Simone P. Joyaux, ACFRE • www.simonejoyaux.com • [email protected] your story: the case statementWhat is a case statement?• “Why you do what you do and what the results are…not what you do and how you do it.”(Tom Ahern, ABC, Ahern Communications)• “An expression of the case, or a clear, compelling statement of all the reasons why anyoneshould consider making a contribution in support of or to advance the cause.”• (Harold J. Seymour, Designs for Fundraising)• “Aim high, provide perspective, arouse a sense of history and continuity, convey a feeling ofimportance, relevance and urgency, and have whatever stuff is needed to warm the heart andstir the mind.” (Ted B. Bayley, ACFRE, Fund Raiser’s Guide to Successful Campaigns)The case statement (case for support) serves as your organization’s communications document,targeted to a particular audience, in order to raise money. You communicate the community need /opportunity and your organization’s response and merits. You explain the benefits to the donor in order tostimulate a gift in return. Information to write case statement includes: history and track record; strategicplan; community needs and trends.Tell your story with personal stories – about real people! Speak from the heart. Use “you” a lot.Engage the listener. Yes, add in some facts also. But facts should never dominate!In summary, the case statement answers the most compelling questions about your organization1. Who are you?2. Why do you exist?3. What is distinctive about you?4. What is it that you want to accomplish and why does that matter?5. How do you intend to accomplish it?6. How will you hold yourself accountable?Resources to help you develop your case for support / case statementSee Joyaux’ Strategic Fund Development: Building Profitable Relationships That Last For tips abouthow to create your case statement. The book also talks about nurturing philanthropic relationships.

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Read Tom Ahern’s Love Thy Reader to learn about how to write better. Get a copy on the followingwebsites: www.aherncomm.com or www.simonejoyaux.com / Resource / Free Library / Fund Development.Better yet, get Tom’s book The Mercifully Brief Real World Guide to Raising More Money ThroughDonor Newsletters Than You Ever Thought Possible. Tom Ahern, ABC, Ahern Communications is one ofNorth America’s leading experts on fundraising communications, including case statements, donornewsletters, and communications plan. Keep your eyes open for Tom’s next book from Emerson & ChurchPublishers, also about donor communications.And, Joyaux and Ahern are co-authoring a book – probably for release sometime in 2007 -- with theworking title of Nonprofit Fundraising Communications: A Practical and Profitable Approach.Your case statement should:• Reflect your organization’s planning (e.g. mission, goals and strategies to achieve goals) and anunderstanding of your constituents' needs and motivations.A case statement should be brief, compelling and demonstrate success. The case statement istargeted to the interests and motivations of a specific audience and describes how the donor’sinvestment will solve a problem or meet a community need or opportunity.Key information to include in your case statement:1. The problem (or opportunity) to be addressed• Talk about community need. Talk about the people who need and want your service.2. Trends affecting the problem (or opportunity)• Demonstrate your knowledge and insight. What is happening in the world and your community,which has produced this problem and what is happening now (and what do you anticipatehappening in the future.)?3. Your response to the problem (or opportunity)• How does/will your organization respond to the community problem or opportunity. How willyou respond to the trends?4. Your mission• Now is the time to weave in your mission. You exist (your mission) because you wish torespond to community situations. Explain how your response to this particular community

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situation fits in with your overall mission. (Please don’t just reprint your mission statement!)5. Your history, track record and marketplace position• Explain why you are the right organization to respond to this community situation. Talk aboutyour track record. Demonstrate why the prospective donor should believe that giving money toyour organization is a sound investment. Make sure you position your organization within themarketplace. How are you different than other organization doing the same or similar work?Talk about collaboration.6. Goals, strategies and objectives• Provide detail about how you will respond to the community situation. What, specifically, areyou going to do? Why? When?7. Organizational resources• Justify, prove that you have the resources necessary to address this situation. Describe yourstaff, professional expertise, volunteer structure, operations, and so forth. Talk about money.How do you currently finance your organization? How do you propose to finance this newactivity? What kind of money is necessary? How will you raise the money and who is helpingyou raise the money.8. Accountability and evaluation• You must assure the prospective donor that you will comply with all relevance regulations andlaws, and that you are good organization, its programs and finances. Also describe how youevaluate program and institutional health.9. Future plans for your organization• Present your future organization goals and activities that will continue to help the communityaddress the situation in the future.10. Role of the prospective donor• Engage the prospective donor. Describe how a prospective donor might participate in addressingthe community problem or opportunity. Talk about how you can help the prospective donorachieve his or her own goals and dreams. Describe donor acknowledgment and recognitionopportunities. Focus on target audiences and the key messages for each audience.

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Powerpoint: Writing a Case Statement

http://www.dol.gov/cfbci/tlc/docs/SustainabilityLibrary_SectionD_4/Writing_Your_CaseStatement.ppt

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Sample “Outstanding” Case Statement

The case statement is the benefits-oriented explanation of the fund raising campaign. From this document, the campaign brochure, campaign prospectus, video, newsletters and other materials can be created. Taking the time to write a comprehensive case statement makes the rest of the campaign material production so much easier. It is a document that the board and staff can rally around and keeps everyone focused on the same story.

The case statement should create the vision of the campaign and explain all the details of the campaign and reasons why the organization is undertaking a major building project. Most important, it should highlight all of the benefits that a successful campaign will provide.

The best way to prepare a high-quality case statement is to evaluate other organizations’ case statements and use the best of each. Remember, your case statement may be very different than other organizations. What is important is that it is concise, easy to read, and prominently features the benefits your prospective campaign will bring about.

The following is an actual case statement used during the successful $5.5 million capital campaign for Carondelet Health Care in Tucson, Arizona.

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CARONDELET HEALTH CARE

St. Mary’s Hospital – St. Joseph’s Hospital

Tucson, Arizona

Historical Perspective

For 111 years, the Sisters of St. Joseph of Carondelet have been a part of Tucson in its move from pioneer, frontier medicine to modern technology with all its scientific knowledge and medical advances. Changes have occurred and expansion has taken place, adding new areas of patient care in an ever more complex setting. Innovative programs, as much a part of vision as of necessity, have continually been undertaken in response to personal and community needs.

In 1880 the call for medical service was answered by the physicians and the sister-nurses who cared for the injured employees of the Southern Pacific Railroad, the poor and medically indigent patients, and everyone who came to the small twelve-bed hospital named St. Mary’s. It is answered today by physicians, nurses, therapists and technicians working on shifts that punctuate the hospital’s twenty-four hour availability.

In 1870, seven Sisters of the Congregation of the Sisters of St. Joseph of Carondelet made an arduous journey from St. Louis, by way of San Francisco, Los Angeles, and finally through the "trek" across the desert to Tucson. Their mission was to answer the plea of the newly appointed Vicar Apostolic of Arizona, Jean Baptiste Salpointe to teach at the Mission School in Tucson. The Sisters quickly expanded their work beyond the school to include an Indian school at San Xavier, a hospital in Prescott for men injured in mining accidents, and a school in Yuma. By 1880, the Sisters of St. Joseph of Carondelet were an established part of life in Tucson.

In 1877 Bishop Salpointe faced a dilemma. He was erecting a trade school for the Indian youth of the area and, with the Indians help, the building was almost complete. However, there was also no questioning the need for a hospital for the community and railroad workers. The painful decision was made - the trade school, named The Mission School, was postponed and the building was turned into a hospital with the Sisters agreeing to staff the new facility. St. Mary’s Hospital was dedicated on April 24, 1880 and received its first eleven patients on May 1. It is Arizona’s longest continually existing hospital.

The past century has seen St. Mary’s pioneer many aspects of health care with numerous "firsts." During the frontier days, the hospital provided such

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revolutionary services as a separate Isolation Cottage for patients with communicable diseases, a separate surgical area, and a Sanatorium. The Sisters also pioneered firsts for Arizona in the area of Nursing Education and Professional Standards for Physicians. The hospital provided Arizona with its first X-ray machine, Intensive Care Unit, and open heart surgery. St. Mary’s Burn Center is still the only such facility in southern Arizona.

Throughout the years, during wars and peace, during good times and bad, the Sisters of St. Joseph of Carondelet offered the citizens of Tucson such cutting edge technology as the first electroencephalogram (EEG) machine. From the original eleven patients, St. Mary’s Hospital grew to 374 beds to be the fourth largest hospital in Arizona and the second largest in Tucson. It offers a full range of medical services.

In 1961, the Sisters of St. Joseph of Carondelet recognized that the city of Tucson was growing at such a rate it was difficult for the residents on the fast-growing east side to utilize the services of St. Mary’s Hospital on the west side. The Sisters then built St. Joseph’s Hospital and created a two hospital system to maximize health care coverage and reduce expenses. Carondelet St. Joseph's Hospital is a 338 bed, comprehensive general, acute-care facility with a major emphasis on ambulatory care. It offers complete OB-GYN services, O’Rielly Care (an eighteen-bed substance abuse treatment center), a comprehensive Cardiac Rehabilitation Center, a Diabetes Care Center, Home Health Care services and a full range of rehabilitation programs. It also provides southern Arizona’s Regional Eye Center and Regional Hand Center.

Incorporated in 1983 as Carondelet Health Care Corporation, today the health care system includes Holy Cross Hospital in Nogales, Arizona and Holy Family Center, an extended care facility in addition to St. Mary’s and St. Joseph’s.

The Situation Today

Today Carondelet Health Care is the largest health care provider in southern Arizona with three hospitals (Holy Cross in Nogales, Arizona and Holy Family Center, a long term care facility) was added to the system in 1987), two hospices, fourteen wellness centers, and a host of outreach programs designed to meet the healthcare needs of the community. Today Carondelet Health Care:

 Has 755 beds available for patient use.  Will admit over 27,000 patients this year.  Will treat an additional 50,000 people on an outpatient      basis.  Will deliver over 2, 000 babies this year.  Will treat over 60,000 people through its 24-hour Emergency

Departments.

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Of Carondelet Health Care’s 27,000 admissions, almost 14,000 of those will be on some type of government assistance program.

Yet even with this tremendous volume, Carondelet retains the mission of the original Sisters to provide quality healthcare for all the people of Tucson.

St. Mary’s Hospital serves the "western corridor" of Tucson and gives special attention to minorities and those with lower incomes. It is the only private hospital serving the west side population. Carondelet Health Care provides over $10,000,000 per year in charitable care to persons who would not otherwise be able to afford quality healthcare.

Both Carondelet St. Mary’s and Carondelet St. Joseph’s retain a commitment to providing the most technologically advanced healthcare in Tucson. Specialized services provided by Carondelet Health Care include:

The Burn Center: The first and only fully accredited burn center in southern Arizona serving the immediate area, surrounding states and Mexico.

Hospice: The first facility in southern Arizona serving the needs of the terminally ill and their families in a compassionate, Christian environment.

Cardiac Rehabilitation Program: Southern Arizona’s largest rehabilitation service for victims of heart problems.

Diabetes Care Center: Arizona’s only Medicare and American Diabetes Association certified care center.

Heart Surgery: Carondelet Health Care system performs more heart surgeries than any other area institution - over 325 this year.

Regional Eye Center and Low Vision Clinic: Carondelet St. Joseph’s is home to southern Arizona’s only Eye Center providing a full range of surgical, laser, ocular prosthetics and low vision services.

Regional Hand Center: Carondelet St. Joseph’s is home to southern Arizona’s only center specializing in the treatment of disorders of the hand.

O’Rielly Care: Specializing in the treatment of alcohol and substance abuse patients.

Nurse Case Management: Carondelet St. Mary’s was selected on January 1, 1991 by the General Mills Foundation to work with thirteen other hospital’s in a National Chronic Care Consortium to develop programs dealing with geriatric chronic care.

Community Health Care Centers: Are located throughout Tucson serving those who do not have ready access to healthcare providers.

The Challenge Facing Carondelet Health Care

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After intense study by experts within and outside the hospital family, Carondelet Health Care has identified the two most pressing healthcare issues which face the citizens of southern Arizona.

1) Maternity and Delivery Services: Currently Carondelet Health Care delivers approximately 2,200 babies each year. This is the maximum number of births the present facilities can accommodate. Carondelet continues to provide the maternity and delivery services to the community, often despite the patients ability to pay. Carondelet Health Care provides well over $1,000,000 in charity care to maternity patients who cannot afford this health care.

Carondelet provides this service to the community, in spite of the adverse financial effects, because of the Sisters’ commitment to Christian family values.

2) Outpatient Rehabilitation and Surgical Services: Currently in Tucson and southern Arizona there is no comprehensive outpatient rehabilitation service facility. Additionally, Carondelet St. Mary’s and the west side of Tucson lack necessary outpatient surgical facilities. This lack of outpatient services on the west side presents a burden on the very people who are least able to acquire medical care.

One major trend in health care in the 1980’s and 1990’s is the move toward outpatient services. A procedure performed on an outpatient basis traditionally costs 30% less than a similar procedure on an inpatient basis. This simple economic statement is the underlying reason insurers and third party payors are insisting on more outpatient services and even refusing to reimburse the total inpatient costs in many cases.

Additionally, the project at Carondelet St. Mary’s Hospital will include a surgical center that will add four inpatient and four outpatient surgical rooms and create a larger recovery room. A gastroenterology laboratory and laser treatment room will also be added. These additions will enable Carondelet Health Care to continue to meet the healthcare needs of the citizens of Southern Arizona.

Because of the location chosen for the new outpatient center, a new chapel will need to be constructed and many of the furnishings of the soon to be displaced St. Catherine’s Chapel will be used in the construction of the new chapel.

Carondelet’s Urgent Response

The Sisters of St. Joseph of Carondelet are still responding to the healthcare challenges of the community. To meet the growing needs of the southern Arizona community, Carondelet Health Care has committed to two exciting and important capital projects. For Carondelet St. Joseph’s Hospital a commitment has been made to reconstruct the maternity facilities to create a new Labor, Delivery, Recovery, and Post Partum (LDRP) Program. At Carondelet St. Mary’s Hospital,

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a commitment has been made to construct an entirely new Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Surgery Center.

Carondelet St. Joseph’s Hospital and Carondelet St. Mary’s Hospital serve distinct communities. The physicians are, for the most part, geographically divided between the two hospitals with less than 10 percent of the active physicians practicing at both. Despite these differences, both hospitals are managed with the same commitment to quality and excellence and are governed by a single board of directors.

To meet the growing need for outpatient services on the west side of Tucson, Carondelet Health Care has chosen to construct an outpatient facility on the campus of Carondelet St. Mary’s Hospital. The facility will be the:

1) Comprehensive Outpatient Rehabilitation Facility (CORF)

Carondelet Health Care is the primary provider of rehabilitation services in Tucson and southern Arizona.

While Carondelet St. Mary’s Hospital was the first accredited rehabilitation center in Tucson, it has, over the last 50 years, performed these services through traditional inpatient facilities. In effect, the outpatient services are "fit in" around inpatient operations, lacking adequate space and equipment to meet patient needs.

CORF will create the only comprehensive rehabilitation location in southern Arizona. It will be medicare certified. It will be located on the first floor of a two story building located next to the hospital. Included as part of the Comprehensive Outpatient Rehabilitation Facility will be Physical Therapy, Occupational Therapy, Speech-Language-Hearing, and Psychological Counseling Services.

The Comprehensive Outpatient Rehabilitation Facility (CORF) will create a center where the treatment plan for each patient’s physical therapy, occupational therapy, and speech therapy will be coordinated and managed together, instead of separately.

CORF will also expand Carondelet’s rehabilitation programming to include clinics to treat chronic diseases such as Multiple Sclerosis and arthritis. CORF will also create an Educational Resource and Technology Center where patients can borrow rehabilitation equipment and receive education on their particular condition and treatment program.

The major difference between the new and the old is the comprehensive nature of CORF. Currently, other rehabilitation facilities for other hospitals are spread throughout the medical center campus’ or even the community. The problem this creates is fairly obvious. People who seek rehabilitation services (for treatment of

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stroke, head and spinal cord injuries in particular) need to attend one area for speech therapy another area, often outside the hospital, for physical therapy, and a third area if they need occupational therapy.

The rehabilitation services of Carondelet Health Care are perhaps its finest example of commitment to maximizing the quality of a patients life and lifestyle.

What good does it do a patient, and in turn society, if we save the lives of stroke victims, heart attack victims, car accident victims, and, by the very act of saving their life, we condemn these people to a life of uselessness and limitations to the point where they are reliant on other people for the basics of life such as eating, drinking, personal hygiene, and other functions we take for granted each day?

Rehabilitation services are good for the patient and the community as well. Experience shows that every year one in twelve Arizona workers is involved in an occupational injury and, on average, 19 work days are lost for each injury.

Perhaps most impressive is the fact that a single dollar spent on rehabilitation saves up to $30 in disability payments.

The CORF will focus on new approaches in therapy utilizing specially designed spaces and equipment including:

the addition of biofeedback capabilities aquatic therapy a fully equipped apartment for those who will need to relearn the basics of

living. The CORF will consist of a variety of therapy programs that will

encompass the therapy needs of virtually every patient. The CORF has been designed to optimally meet the goals of comprehensive rehabilitation. It will include:

a state-of-the-art speech-language-hearing clinic with three separate speech therapy treatment rooms

an aquatic therapy area to provide an alternative environment for exercise to benefit patients with special needs.

a large, fully carpeted conjoint occupational and physical therapy room. a "work hardening" clinic where specialized work injury management

programs will be designed to provide services to major employers. individual treatment rooms for physical and occupational therapy with

specialized areas for orthopedic and manual therapy, splinting and cognitive evaluation.

an area for specialty team programs utilizing coordinated interdisciplinary approaches for arthritis, strokes, brain injuries and other disabilities.

whirlpools for hydro-therapy a fully equipped apartment for those people who will need to relearn the

very basics of living such as cooking, cleaning, etc.

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rooms for group and individual psychological counseling with a state of the art biofeedback program.

community education and resource center with accommodations for support groups and seminars.

"noisy" area for patients who need "work hardening" involving heavy equipment or shop-type trade skills.

a technology center with loaner adaptive equipment for the physically challenged.

Perhaps the greatest benefit to the community is that the CORF is one of the few improvements in medical treatment that will offer better efficiency and service at lower costs.

Additionally, beginning in 1992, the United States Congress has mandated, through the American Disabilities Act, that all businesses must accommodate physically-challenged employees. Carondelet Health Care, through its rehabilitation services, will offer to southern Arizona’s employers services that will enable the employers to be in compliance with this act.

In essence, the CORF will provide southern Arizona residents with a rehabilitation center that can accommodate, in one location, all the tools necessary to fully rehabilitate all patients to their fullest potential.

As part of Carondelet’s commitment to outpatient care, plans also include construction of a new Outpatient Surgical Center which will add four inpatient and four outpatient surgical rooms, enlarge the recovery room, and add a gastroenterology laboratory and laser treatment room.

2) The Labor, Delivery, Recovery and Post-Partum (LDRP) Program

The opportunities at Carondelet St. Joseph’s Hospital are primarily family oriented. Carondelet Health Care, in large part because of the Catholic mission of the Sisters of St. Joseph of Carondelet, is committed to providing an alternative birthing facility for Carondelet’s traditional market.

Meeting the expectations of our patients and their families and efficiency of service and staff are the guiding principles behind Carondelet St. Joseph’s new LDRP concept. Under the LDRP program, the entire maternity experience takes place in one room with one or two nurses throughout. This concept allows the mother and family to avoid the inefficiency and inconvenience of being moved from room to room during the birthing process. The entire process (labor, delivery, recovery, and post-partum) is done in the same room, which allows for more time for the new mother and family to learn about the care of their new baby.

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Each room is especially designed to create a comfortable and relaxing home-like atmosphere with the latest in technology. Included in the rooms are television/VCR’s for the family to use with special educational videotapes supplied by the hospital. This concept combines the comforts of home with the medical technology and safety of the hospital environment.

During fiscal year 1988-89, Carondelet St. Joseph’s hospital provided obstetrical services for 2,200 Tucson families. Over the last several years, families selecting the services of St. Joseph’s have grown from an average of 60 to over 200 deliveries per month. The need for these services will continue to grow over the years until Carondelet may not be able to provide maternity services to all members of the community regardless of their ability to pay without expansion.

Carondelet St. Joseph’s provides comprehensive high technology services as well as family centered care. These service include 24 hour coverage by anesthesiologists, neonatologists, perinatologists, neonatal nurse practitioners and clinicians, and a highly advanced special care nursery.

To continue to provide this quality service, the administration and boards of Carondelet have chosen to convert two wings of its Obstetrical Unit into 25 LDRP rooms to meet growing needs. The Labor Delivery Recovery Post-Partum (LDRP) concept provides for a reduction in the cost of delivery and care of newborn babies. By cross-training the nursing staff the family receives the full attention of their own personal nurse and support staff. The cost is further contained due to the fact that, under the LDRP concept, more deliveries can be handled in the same amount of physical space.

For example, under the current delivery system, St. Joseph’s is delivering about 2,200 babies per year. Under the LDRP concept, approximately 3,400 newborns can be delivered with a minimum increase in hospital staff and no increase in square footage. In essence, the family and baby benefit from the closer experience and the community will have additional resources available to them through contained costs.

Program Financing

The cost of constructing the LDRP at Carondelet St. Joseph’s Hospital will be paid through the Foundation for St. Joseph’s Hospital, a non-profit organization which raises funds for the hospital.

The primary funding for the construction of St. Mary’s Outpatient Facility will be a bond issue of approximately $20,000,000. This bond issue will cover the 80% of the cost of constructing 1) a two-story building consisting of the CORF (first floor) and physician’s offices (second floor), 2) a 500 car parking structure for Carondelet St. Mary’s Hospital, and 3) an Outpatient Surgery Wing adjacent to Carondelet St. Mary’s Hospital. St. Mary’s Second Century Foundation will raise

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an additional $2.4 million to cover the cost of equipping the CORF and building a new chapel.

Both foundations have combined efforts to launch a $5,000,000 fund raising campaign. The funds raised will be spent as follows:

Comprehensive Outpatient Rehab. Facility Equipment $1,900,000 Construction of New Chapel $ 400,000 Renovation and Construction of LDRP $1,900,000 Creation of Endowment for Carondelet St. Mary’s Hospital $ 350,000 Creation of Endowment for Carondelet St. Joseph’s Hospital $ 350,000

A Special Financial Appeal

Carondelet Health Care, through the Foundations of the two hospitals, has chosen to launch a $5,000,000 capital campaign to support construction of the LDRP and purchase necessary equipment for CORF and the Outpatient Surgical Center.. From June, 1990 through June, 1991, executives of Carondelet Health Care and the trustees of the foundations have conducted in-depth planning and study to determine both the necessity and feasibility of conducting a successful campaign.

The feasibility of raising the money was studied. Detailed meetings and interviews were held with community, corporate, business, foundation, and government leaders. Much care and planning went into whether a campaign for Carondelet could succeed. Many obstacles needed to be overcome including a slowdown in the southern Arizona economy, the competition for charitable dollars, and the lack of major, capital fund raising experience on the part of Carondelet Health Care.

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