ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
July 27, 2006

On June 13th through 15th, Coney Island Hospital was the first HHC acute care hospital to be surveyed by the Joint Commission on Accreditation of Healthcare Organizations this year under JCAHO’s new unannounced survey procedure. The hospital performed extremely well during the surprise visit despite the fact that the staff just completed the move into the new bed tower in May. Special thanks go to Dr. John Maese who, on very short notice, made himself available to participate in the Leadership Interview, a critical component of the survey process.

On the heels of this outstanding evaluation, the hospital received further praise when it was selected as one of two hospitals statewide to receive IPRO’s annual Quality Award for excellence in the care of patients with Acute Myocardial Infarction (AMI), heart failure and pneumonia. IPRO is the health care quality review organization that oversees Medicaid and Medicare quality control for all public and private healthcare providers throughout New York State.

On both a state and national basis, Coney Island Hospital has demonstrated that HHC’s emphasis on patient safety and the consistent implementation of evidenced-based best practices continues to raise the quality of care as confirmed by independent oversight agencies. Congratulations to Pete Wolf and all of his staff for their excellent pace-setting performance.

Elmhurst Hospital was one of only five hospitals in the state that were approved last week to perform angioplasty on an elective, non-emergency basis. The designation by the New York State Department of Health came after Elmhurst's highly successful participation for the past three years in the nationwide C-PORT demonstration project. That trial program allowed 11 hospitals in New York State without cardiac surgery programs to perform emergency angioplasty on patients that met specific criteria. The program was developed to make the potentially life-saving procedure available to many heart attack victims who might not be able to reach a cardiac surgery center in time. Elmhurst has done over 200 emergency angioplasties with a mortality rate of less than 1% - below the national average of 1.5% for cardiac surgery centers. Elmhurst has a second cardiac catheterization lab and a well-structured cardiac program already in place, enabling it to launch the elective angioplasty program without significant additional capital outlays. The hospital was also selected because of the demonstrated need for additional cardiac services in Western Queens. However, the new program will be a boon to all Queens residents, since only one other hospital in the borough is approved to do elective angioplasties and over 85% of the patients in Queens have had to travel out-of-borough for the procedure.

Earlier this year I reported that I had set a goal of enrolling 45,000 diabetic patients in our system-wide electronic disease registry by June 30th. I can now report that our staff exceeded that goal by more than 3,000, enrolling more than 48,000 patients in the system as of the end of last month. As you know, the registry is a sophisticated web-based clinical information tool fed by our electronic medical record data warehouse. The electronic registry allows our clinical teams to more closely track patients with diabetes, more readily identify those in need of additional intervention, and guide the development of more effective evidence-based treatment. Our two facilities that have piloted the electronic registry over the last two years have demonstrated that this tool facilitates more focused care and can dramatically increase the percentage of our diabetic patients who have well-controlled blood sugar, blood pressure and cholesterol. With over 95% of our adult diabetic patients included in this database, all of our providers are now poised to use this powerful tool to help produce more positive health outcomes for our diabetic patients throughout the system.

As part of New York City's coordinated response to the recent power outage in Queens, Elmhurst Hospital led HHC's efforts to provide needed health services to the affected community. Elmhurst deployed a mobile medical unit to the heart of Astoria with medical personnel and a supply of essential prescription drugs such as insulin, inhaled corticosteroids for Asthma and hypertension medication. The mobile unit provided clinical services to area residents over several days. In addition, HHC deployed thirteen vehicles from our fleet to transport area residents to the mobile medical unit, HRA’a Special Services Center, or various senior centers as needed. Elmhurst Hospital and our Brooklyn-based Cook-Chill Plant also supplied hundreds of meals for the area’s senior centers and for city employees and volunteers working to assist community residents. I want to publicly thank all the Elmhurst Hospital staff and central office staff in our transportation department who worked through the weekend, as well as acknowledge the excellent work of Chris Constantino who represented the corporation very ably at two weekend press briefings.

HHC’s commitment, investment and leadership in providing linguistically competent care for patients from diverse backgrounds were recently acknowledged with a prestigious national award for our TEMIS program. Operating at Bellevue and Gouverneur and soon to be expanded to Kings County, the TEMIS system was designated as a 2006 Honors Program Laureate by the Computerworld Foundation at a June awards ceremony in Washington, DC. This national recognition honors innovations from around the nation that improve people's lives through technology. As you know, TEMIS is our United Nations-style simultaneous translation system that provides quality remote medical interpretation services in eight languages and allows patients and providers to communicate with each other more efficiently and effectively. The New York City Council, which generously supported the program in FY 06, has agreed to continue funding for the program in FY 07, with an allocation of $1 million.

Gouverneur also recently received well-deserved support for its LEP program when the United Hospital Fund awarded a grant for $40,000 to train bilingual volunteers to help patients better understand prescription labels and communicate more effectively with their healthcare providers. The trained volunteers will work with patients in the pharmacy and other locations where they can have the greatest impact on improving patient health literacy.

Last week I joined Commissioner Frieden at a press conference announcing the Health Department’s release of its first report on immigrant health. Key findings show that foreign-born adults are less likely to be insured, to have a regularly primary care provider or receive regular health screenings. It also underscores that one of the main challenges faced by immigrant New Yorkers is limited access to health care providers, largely because of language barriers. It is not surprising that the report's findings support and reaffirm the activist approach and preventive health programs that HHC has long deployed throughout our system. As you know, we are leading the way in addressing many of these disparities.

With the HHC Options program we have helped thousands of uninsured foreign-born patients enroll in health insurance programs for which they qualified. Our proactive primary care strategies, early detection efforts, and ambulatory care redesign efforts help ensure that patients receive the preventive care with provider continuity that best promotes good health outcomes. HHC long ago recognized the needs of limited English speakers and has invested nearly $30 million in recent years to fund interpretation services and translation of patient information, policies and signage. And, of course, we remain committed to designing interventions that target foreign-born New Yorkers, like Bellevue’s Hepatitis B program targeting Chinese and Korean Americans, Coney Island’s Healthy Heart campaign focused on South Asians, Jacobi’s outreach to Albanian New Yorkers, and our wide variety of efforts targeting the city’s Latino communities.

I want to thank Commissioner Frieden for his leadership in providing this and other community-focused data that can be used by the City's medical community to improve health care for all New Yorkers. I'm proud that HHC is addressing so many of the key health needs of our foreign-born patients and we look forward to continuing our partnership with DOHMH as we work to keep the families of immigrant New Yorkers healthy.

There is an item on today's agenda requesting the Board's approval of an extension of HHC's contract with Misys Hospital Systems for the continued development and support of our electronic medical record system over the next 3-5 years. The implementation of this system across HHC over the last 12 years has been instrumental in enhancing patient safety and has created the foundation upon which other critical clinical innovations have been built, including our electronic chronic disease registry.

Last week the national Institute of Medicine released a report, highlighted in many newspaper articles and editorials, which detailed the appalling frequency of medication errors in most hospitals, the effectiveness of computerized medication ordering systems in preventing many life-threatening mistakes, and the relatively scant number of hospitals across the nation that have implemented these electronic systems. We can be proud that our early adoption of an electronic medical record puts us on the leading edge of clinical information technology. To stay there, we need to not only maintain and strengthen our current system but also to closely examine other competing systems to determine whether a migration to a different system serves our long term interests. This proposed contract extension will enable us to do both and I urge you to approve it.

Sarah Jones, winner of a 2006 Tony for her one-woman hit show Bridge and Tunnel, will premiere her newest show A Right To Care on September 19th at the landmark Hudson Theatre, in a special benefit for the HHC Foundation. In her Broadway hit, Ms. Jones portrayed immigrant New Yorkers who represent the diversity of the communities served by HHC facilities. Her new work, which tackles the subject of inequality in health care, promises to provide another spectacular showcase for her extraordinary talent. Ms. Jones has received grants and commissions from the WK Kellogg Foundation, Lincoln Center Theater and the Ford Foundation, as well as an Obie, a Helen Hayes Award, two Drama Desk nominations and HBO's US Comedy Arts Festival Award. Proceeds from the benefit performance will support HHC's LEP programs to improve health literacy and healthcare access for multi-lingual patients and their families. The evening has all the ingredients of a great artistic and philanthropic success and I look forward to reporting the results to you at the September meeting.

On July 5th, the first free standing community health center on Staten Island opened its doors to patients, following nearly a year of hard work by community health advocates. As you know, last summer HHC formed a steering committee to facilitate a community response to the evident lack of sufficient health care access on Staten Island. The committee identified the need for a health center on the north shore to provide primary care for low-income residents and worked with many stakeholders to form a volunteer board of directors and create a non-profit organization – the Richmond Community Support Organization – to develop and maintain such a facility. Now that the clinic is open, it will continue to expand over the next few years, eventually creating 2 or 3 sites and serving at least 45,000 individuals. This is an important healthcare resource for the people of the north shore and we are honored to have been part of its development. HHC will continue to work with the center to ensure its success.

As I stated briefly last month, the Mayor and City Council reached an agreement on the City's FY 2007 Budget and were in the process of passing it on the same day as our Board meeting. This budget agreement restored nearly all funding for ongoing programs that were not baselined in the FY 2006 budget. This includes $5.3 million in funding for child health clinics and an additional $700,000 to continue efforts to identify ways to increase underserved children's access to primary care services through these clinics; $2.4 million for waivers of the pharmacy administrative fee; and $6.1 million for mental health and substance abuse programs. The Council also voted to continue funding that was newly provided last year – $3 million for expansion of our rapid HIV testing initiative and $1 million for the TEMIS program.

On the Capital side, City Council members agreed to provide approximately $5.8 million in new funding for local projects and agreed to keep nearly $13 million for Capital projects that were budgeted last year for FY 2006 and FY 2007 but were subject to reauthorization this year.

I again would like to thank the Mayor, members of the Administration, Speaker Christine Quinn and the members of the Council for their support of HHC. Our thanks also go to our Community Advisory Boards, the Commission on the Public's Health System and our partners in labor for all their work on HHC's behalf over the past few months.

Queens Hospital Center learned last week that the New York City Council has committed $2.1 million to purchase a Positron Emission Tomography (PET)-CT scanner for its Cancer Center. PET scans produce digital pictures that can identify numerous forms of cancer, damaged heart tissue, and brain disorders such as Alzheimer’s and Parkinson’s disease and epilepsy. The PET-CT scanner is an integral component of cancer care in cancer centers throughout the United States. With the addition of this new state-of-the-art equipment, HHC and the Queens Cancer Center are well positioned to remain at the forefront of cancer care not only in the borough Queens, but throughout the city.

Lincoln Medical and Mental Health Center will receive $470,000 from the Office of Bronx Borough President Adolfo Carrión for advanced cardiology technology. Another $740,000 has been allocated to Lincoln through City Council Member Maria del Carmen Arroyo for renovation and expansion of the Women's Imaging Center and additional digital imaging equipment.

Gouverneur will receive $200,000 in federal funding, through the efforts of Congresswoman Nydia Velazquez, for renovations that will support "culture change" – a nation-wide movement to restructure patient care in long term nursing facilities. These efforts are designed to change institutional settings to residential environments with homelike kitchens, bathing and recreational areas that improve quality of life for patients and residents.

The Corporation’s major modernization projects at Kings County Hospital Center, Harlem Hospital Center, Queens Hospital Center, and Jacobi Medical Center are continuing to progress satisfactorily.

In their June 2006 issue, NY Construction News magazine cited the new Kings County Diagnostic, Treatment and Emergency Care Pavilion and the new Bellevue Ambulatory Care Pavilion as two of the top 20 construction projects in the tri-state area in an annual survey.

On July 24, 2006, Coler-Goldwater Specialty Hospital and Nursing Facility held a ribbon cutting for the newly renovated patient lounge in the Atrium at Coler. The City Council allocated $250,000 towards the $378,000 required for the renovation and the Coler Auxiliary provided the funding required for furniture and a state-of-the-art high-definition television that will provide many hours of enjoyment for patients and residents as they relax and socialize in the beautifully renovated Atrium lounge.

On July 20, 2006, the HHC Art Collection opened a new exhibit, entitled “Salon,” an exhibition of artwork created by 50 women artists. The exhibition is part of the celebration to mark the 70th anniversary of the Art Collection, and it will be on view in the Atrium at Bellevue Hospital through August 24, 2006.

The City’s Office of Labor Relations, representing HHC, has reached an agreement with DC 37 on the financial terms and conditions for a collectively bargained labor agreement for 32 months, from 7/1/05 through 3/2/08. Wages for DC 37 members will be increased by 3.15% on July 1, 2005, by 2% on August 1, 2006, and by 4% on February 1, 2007. HHC's cost for the 2005 and 2006 increases is about $65 million. A significant term of the labor agreement was the elimination of the city residency requirement for DC 37 employees. Employees will now be permitted to live in six other contiguous counties within New York State.

Last week I joined the Mayor to announce a major community service and temporary public art project to be launched in the Fall of 2007, as part of the City's celebration of the 100th anniversary of New York's first metered taxi. Beginning this September, thousands of children and adults will participate in the creation of large, colorful flower decals that will be applied to New York City's yellow taxicabs as a traveling art exhibition from September through December of 2007. HHC has been invited to include the work of its pediatric patients. The privately-funded project is being led by the not-for-profit organization Portraits of Hope, which has particular expertise in bringing the arts to even the sickest children and can readily work with patients who have medical and physical limitations. We welcome the opportunity to bring a fun and therapeutic experience to some of our pediatric patients who are hospitalized as well as to those who visit our clinics. The whimsical project promises to bring smiles to everyone and we look forward to seeing the creative efforts of some of our youngest patients lining the city’s streets next Fall.

• July 4- New York Post reported that HHC facilities have saved an estimated 332 lives by establishing safety measures recommended by the Institute for Healthcare Improvement in the 100,000 Lives Campaign.

• July 8- In a Letter to the Editor of The New York Times, HHC President Alan D. Aviles highlighted how the City’s public hospitals were among the first in the country to support the national 100,000 Lives Campaign organized by the Institute for Healthcare Improvement. He reported that patient mortality decreased by almost 10 percent across the system.