Transcript Electronic Medical Record

Planning for the Successful Deployment
of an Electronic Medical Record
George Mason University
College of Health and Human
Services
James L. Oakes, Jr., Principal
Health Care Information Consultants LLC
[email protected]
Health Care Information Consultants, LLC
James L. Oakes
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Thirty years in healthcare information systems and management engineering
Extensive experience as an operating manager, vendor executive, and consultant
Specializes in helping healthcare providers plan and optimize use of information resources,
systems, and technology to improve clinical, operational, and financial outcomes
Worked with return on investment methodologies and analysis for over 25 years and pioneered
the use of healthcare-specific economic analysis of healthcare information technology, including
financial, clinical, and decision support
Developed and deployed healthcare value-based planning methodology for healthcare now
adopted at a 600 bed regional medical center, a nationally known pediatric referral center, etc.
Served as interim Chief Information Officer in 3 healthcare institutions in financial or operational
turnarounds and provided CIO level leadership assistance and development in 12+ others
Assisted in the development of a business case and pilot methodology for a community-wide
health information exchange initiative (HIE) and currently working on planning and implementation
options for a statewide HIE
Co-authored the recently released book, Return on Investment for Healthcare: Maximizing the
Value of Healthcare Information Technology (HIMSS 2003 book of the year) and advocates the
development of a disciplined business case for technology investments
Appeared on the Hospital Satellite Network and spoken at numerous professional conferences,
including CPRI, HFMA and HIMSS on such issues as effective governance, value realization, and
strategy alignment
Holds a Bachelor of Industrial Engineering and a Master of Industrial Management
Health Care Information Consultants, LLC
“The Press Can’t
Tell You What to
Think, but They
Can Tell You
What to Think
About…”
John Naisbitt
Health Care Information Consultants, LLC
HIMSS 18th Annual Leadership Survey
Top Business Issues Facing Healthcare
(2007 vs. 2006 Results)
Figure 8
Improving Quality of Care
69%
36%
55%
51%
52%
Patient (Customer) Satisfaction
Medicare Cutbacks
Increasing Need for Healthcare Services
N/A
45%
N/A
Adoption of New Technology
Demand for Capital
18%
29%
Availibility of Clinical Staff
Decrease in Health Insurance Benefits
38%
29%
31%
17%
28%
N/A
2006 Results
Health Care Information Consultants, LLC
2007 Results
Life in the 21st Century
Health Care Information Consultants, LLC
Health Care Technology in the 21st Century
• Still predominately paper
based
• Systems not
interoperable
• Slow, expensive
implementations
• Increasing public
pressure to “do
something”
• Continuing economic
pressures
Health Care Information Consultants, LLC
Terms Defined
•
•
•
•
•
•
•
EMR
EHR
CPOE
IHE
HIE
RHIO
EIEIO
Health Care Information Consultants, LLC
Why was the casualty rate so
high in the civil war?
Health Care Information Consultants, LLC
State of the Industry - Reality
• Successful CPOE implementations are still
rare
• Fully functioning EMRs are at least as rare
• Much of the information in the record will
continue to be paper-based for years to
come
• A failure can cost the CIO his or her job
• Failure to act can cost his or her job
Health Care Information Consultants, LLC
Less than 4% of US Hospitals Using CPOE
CPOE Hospitals Possible
CPOE Hospitals Verified
Cerner Millennium
CliniComp
Eclipsys SCM
Eclipsys TDS
Eclipsys XA
Epic EpicCare
GE Centricity
IDX Carecast
IDX LastWord
McKesson Horizon
MEDITECH C/S
MEDITECH MAGIC
Misys Patient1
Siemens Invision
Custom
0
5
10
15
20
25
The yellow bar represents the number of hospitals verified in 2003
Health Care Information Consultants, LLC
30
35
1.3-1.8% US Hospitals w/MD’s Entering >50% Orders
Cerner Millennium
<5% Orders Entered
5-50% Orders Entered
CliniComp
Eclipsys SCM
>50% Orders Entered
Eclipsys TDS
Eclipsys XA
Epic EpicCare
GE Centricity
IDX Carecast
IDX LastWord
McKesson Horizon
MEDITECH C/S
MEDITECH MAGIC
Misys Patient1
Siemens Invision
Custom
0
5
10
15
20
IP Average:
54% MD’s entering
orders, with a very
small percent (1.31.8%) entering >50%
of the orders
Health Care Information Consultants, LLC
25
30
HIMSS 18th Annual Leadership Survey
Current IT Priorities (Within Next 12 Months)
(2007 vs. 2006 Results)
Figure 6
Reduce Medical Errors/Promote Patient Safety
Replace/Upgrade Inpatient Clinical Systems
29%
48%
45%
Implement an EMR
Business Continuity and Disaster Recovery
Integrate Systems in Multi-Vendor Environment
Connecting IT at Hospital and Remote Locations
Process/Workflow Redesign
Improve IS Departmental Services
54%
50%
48%
35%
N/A
34%
27%
33%
36%
30%
35%
28%
26%
2006 Results
Health Care Information Consultants, LLC
2007 Respondents
HIMSS 18th Annual Leadership Survey
Projected IT Priorities
(Today vs. Next Two Years)
Figure 7
Reduce Medical Errors/Promote Patient Safety
Replace/Upgrade Inpatient Clinical Systems
33%
Business Continuity and Disaster Recovery
25%
21%
Connecting IT at Hospital and Remote Locations
Process/Workflow Redesign
Improve IS Departmental Services
48%
48%
Implement an EMR
Integrate Systems in Multi-Vendor Environment
54%
35%
17%
32%
35%
34%
33%
26%
30%
24%
28%
In Two Years
Health Care Information Consultants, LLC
Today
HIMSS 18th Annual Leadership Survey
Status of Electronic Medical Record Implementation
(Comparison of 2007, 2006, and 2005 Results)
Fully Operational System
18%
24%
N/A
6%
4%
16%
Developed Plan to Implement
8%
No Plans Yet
Don't Know
2005 Results
32%
37%
36%
Installation Begun
Signed Contract
Figure 11
12%
24%
22%
17%
1%
1%
1%
2006 Results
2007 Results
Health Care Information Consultants, LLC
42%
15
Health Care Information Consultants, LLC
IT Strategy Alignment
Future
Short Term
Increased
Effectiveness
Increased
Efficiency
Today
Cost of
Doing
Business
Necessary
Evil
Health Care Information Consultants, LLC
Competitive
Advantage
IT Planning Process
The process used to develop the plan is comprised of nine
phases, with each phase “building” from the information gathered
in the previous phase.
Phase 9
Phase 8
Phase 7
Phase 2
Phase 1
ROI Analysis
Perform Current
Environment Analysis
Phase 5
Phase 3
Prepare IS Strategic Plan
Develop Gap Analysis and
IT Strategies and Initiatives
Phase 6
Phase 4
Prepare Program Action Plan/
Tactical Plan
Define Future State
Conduct Needs Assessment
Confirm Business Vision
and Strategies
Organize Project
Health Care Information Consultants, LLC
FSLHC
Strategy
Strategy
Business
Business
and &
Clinical
Initiatives
Clinical
Initiatives
Information Technology
Strategy
St rategy &
& Portfolio
Portfolio
IT Strategy
IT Projects
IT Tactical
Plan
Health Care Information Consultants, LLC
The planning process includes an assessment of the current state
and defining a future state. The resulting gap analysis laid the
foundation for the recommended IS strategies and tactical plans.
Common
Themes/Interviews
Current MIS Environment
Analysis
IT Attributes Exercise
Strategies
Tactical
Plans
EMR Adoption
Model
Operating
Principles
IS Goals
IT Attributes
Exercise
IS
Vision
Davies Award Winners
Analysis
Health Care Information Consultants, LLC
For Example…
•
•
•
•
•
A metropolitan community hospital
Full service medical/surgical
Busy emergency services
Competitive environment
Battle for market share
Health Care Information Consultants, LLC
Mission Statement and Vision
• Mission Statement
– We are a not-for-profit healthcare provider guided by the needs of our
patients and community. We distinguish ourselves through service
and clinical excellence, affiliations with the XXX and YYY, and stateof-the-art technology and facilities. We are committed to continuous
improvement and appropriate use of resources. We create an
environment that encourages the success and fulfillment of our
physicians, staff, and volunteers.
• Vision
– ZZZ Hospital Healthcare System will set the standard for excellence
in healthcare in the metropolitan region. Through our affiliations, we
aspire to provide world-class patient care, technology, and clinical
research.
Health Care Information Consultants, LLC
Business and Market Drivers
• Development of services based on community need, market
position, competitors’ positions, margin, recruitment, etc.
• Continuing shift from acute care to outpatient services
• Development of alternate physician practice models:
– Based on locale and structure of local health care market, and market
forces (e.g. Number of practices, practice size, strengths and
weaknesses of local hospitals, patient demographics, etc.)
– Objective of changing flow of patients and delivery of healthcare
services
– Combat particular physician shortages
• Organizational alliances and partnership models
• Increasing expenditures (faster than general rate of inflation)
• State regulated revenues (70% regulated, 30% negotiated) and
other regulatory requirements
Health Care Information Consultants, LLC
Business and Market Drivers
• Emphasis on quality, safety, expense control
• Focus on shortage of professional staff such as RNs and other
clinical technicians
• Continuing capital constraints
• Consumer awareness, patient satisfaction, customer service
• Need for readily available clinical information
• Emphasis on Return on Investment (and more recently “Value”) as
part of purchasing decision
– “Balanced scorecard” including non-financial (quantitative and
qualitative) and financial measures
Health Care Information Consultants, LLC
Key Strategies
• Demonstrate flexibility by promoting patient care and physician
strategies:
– Traditional acute care
– Off campus services and joint services
– Increased focus on physician practices
• Develop stronger relationships with physicians and tie physicians into the
organization
• Make it an easy place for physicians to practice; “Endear physicians” and
improve MD satisfaction
• Demonstrated successes:
– Hospital-based physicians including Hospitals, Intensivists, Radiologists,
Emergency Medicine, Anesthesiologists, etc.
– Specialty Care Medical Group
• Differentiate through program development where expertise and
base exist
–
–
–
–
–
Orthopedics (Joint program has doubled in volume since its inception)
Trauma (County trauma center)
Neurology and Neurosurgery (NIH protocol)
Oncology (Focus on differentiation strategies)
Open Heart Surgery
Health Care Information Consultants, LLC
Key Strategies
• Stabilize existing outpatient programs and partnerships
and capitalize on new programs/partnerships/alignments
• Focus on quality and patient care
– Improve in State, JCAHO and other regulatory measures
– Advance existing and conduct new internal process
improvement initiatives
• Medication reconciliation
• Patient throughput and turnaround
– ED to inpatient
– ICU to non-critical care units
– Recent implementation of observation status
– Improve patient satisfaction
Health Care Information Consultants, LLC
Key Strategies
• Continue to develop human resource strategies to address
personnel shortages and retain talent
–
–
–
–
–
Recruitment
Benefits and compensation
Recognition and reward
“Make ZZZ an easy place to work”
Improve employee satisfaction
• Improve financial position
– Grow volumes
– Stabilize existing outpatient programs
– Advance partnering opportunities (e.g. XXX
• Promote image of “smaller community hospital doing big hospital
things”
– Cross between smaller hospital and high tech
– Increase awareness of community outreach programs
• Continue development and execute campus enhancement program
Health Care Information Consultants, LLC
Start where you are…..
• Understand and document current
environment
• Consider all applications
• Be prepared for surprises
Health Care Information Consultants, LLC
Current Information Systems Environment: Application Portfolio
ACCESS
Registration
Enterprise
Scheduling
Billing
AR
Electronic
Claims
Submission
Electronic
Claims
Scrubber
Collections
Management
Medical
Necessity
Denial
Tracking
ADT
Eligibility
ANCILLARY/DEPARTMENTAL
Order Entry
Electronic
Payment
Posting
Medication
Dispensing
Med Admin
(barcoding)
Emergency
Department
Pharmacy
Laboratory
Radiology
PACS
Surgery
Pathology
Microbiology
Blood Bank
Rehab
(PT, OT, Sp)
ICU
Help
Desk
ADE
Surveillance
Quality
Improvement
Case
Management
Infection
Control
Disease
Management
ED
Physician
Documentation
Anesthesiology
EKG
(Muse)
Results
Reporting
Care Plans/
Pathways
Interdisciplinary
ClinDoc
CPOE
EMPI
Patient
Assessments
MD Clinical
Documenttation
Physician
Access
Clinical
Decision
Support
Document
Imaging
ENTERPRISE RESOURCE
PLANNING
General
Ledger
Accounts
Payable
Budgeting/
Forecasting
Fixed
Assets
Cost
Accounting
Time &
Attendance
Human
Resources
Payroll
Materials
Management
Executive
Support
Decision
Support
Security
Facilities
Maintenance
Cardiology
Incident
Reporting
Utilization
Review
Transport
Dietary
Endoscopy
Report
Writing
Tumor
Registry
Radiation
Oncology
Employee
Education
Employee
Health
Physician
Credentialing
GSI PACS
Trauma
Registry
Medical
Library
Call Center
Nurse Call
System
Fund Raising
(being replaced)
CLINICAL
Clinical
Data
Repository
REVENUE
HIM
Chart
Management
Coding
Core Vendor
Other Vendors
Staff
Scheduling
Not Automated
Partially Automated
Health Care Information Consultants, LLC
Abstracting
Dictation &
Transcription
Today’s Information Flow
Patient/
Family
View
Admit
Allergies
Blood
Panel
Organization
View
Medications
Process
View
Insurance
Authorizatio
n
Technology
View
Health Care Information Consultants, LLC
Progress
Note
Develop a vision for the future….
• Phase in applications in a logical manner
• If moving towards a “core vendor” strategy,
phase in as contracts expire
• Look for “quick wins” along the way
• Recognize that users must see continuing
benefits to support a long term plan
• Be prepared to adapt plan as circumstances
dictate
• Communicate, communicate, communicate!
Health Care Information Consultants, LLC
One Organizations Portfolio – Leading to CPOE
CPOE
18 + Months
Problem
Lists
Care Plans
9 Months
Integrated
Monitors
Today
Outpatient
Assessments
Electronic
EKG
Results
Online
Results
Universal
Patient
ID
Document
Imaging
Clinical
Alerts
Ad-HOC
Reporting
Patient
Demographics
Electronic
Signature
Case
Mgmt.
Dictation/
Transcription
Order
Management
Common
Order
Sets
Nursing
Assessments
Integrated
Home
Health
Vital Signs
I/O’s
100%
Codified
Online
MAR
Medical
Necessity
Bar Code
Radiology
Health Care Information Consultants, LLC
Operating
Room
Mgmt.
Physician
Remote
Access
Scheduling
LAB
Pharmacy
Tomorrow’s Information Flow
Patient/
Family
View
Admit
Blood
Panel
Organization
View
Allergies
Progress
Notes
Medications
Insurance
Authorizatio
n
Process
View
Technology
View
Health Care Information Consultants, LLC
Single View of
Virtual Patient
Record
Hospital
ACCESS
Registration
Enterprise
Scheduling
Hospital
ACCESS
Registration
ADT
Enterprise
Scheduling
Eligibility
ANCILLARY/DEPARTMENTAL
Pharmacy
Pathology
Laboratory
Microbiology
Help
Desk
Quality
Improvement
ADE
Surveillance
Incident
Reporting
Billing
AR
Electronic
Claims
Submission
Electronic
Claims
Scrubber
Collections
Management
Medical
Necessity
Denial
Tracking
REVENUE
Order Entry
Electronic
Payment
Posting
Med Admin
(barcoding)
Emergency
Department
Radiology
PACS
Surgery
Rehab
(PT, OT, Sp)
ICU
ED
Physician
Documentation
Anesthesiology
EKG
(Muse)
Case
Management
Infection
Control
Disease
Management
Cardiology
Utilization
Review
Transport
Dietary
Endoscopy
Report
Writing
Tumor
Registry
Radiation
Oncology
Employee
Education
Employee
Health
Physician
Credentialing
GSI PACS
Trauma
Registry
Medical
Library
Call Center
Nurse Call
System
Fund Raising
(being replaced)
CLINICAL
Clinical
Data
Repository
MD Clinical
Documenttation
Clinical
Decision
Support
EMPI
Physician
Access
Document
Imaging
Electronic
Claims
Scrubber
Collections
Management
Eligibility
Medical
Necessity
Denial
Tracking
Medication
Dispensing
REVENUE
Order Entry
Electronic
Payment
Posting
Med Admin
(barcoding)
Emergency
Department
ED
Physician
Documentation
Pharmacy
Laboratory
Radiology
PACS
Surgery
Anesthesiology
Pathology
Microbiology
Blood Bank
Rehab
(PT, OT, Sp)
ICU
EKG
(Muse)
Quality
Improvement
Case
Management
Help
Desk
ENTERPRISE RESOURCE
PLANNING
Electronic
Claims
Submission
ADT
ANCILLARY/DEPARTMENTAL
Patient
Assessments
Interdisciplinary
ClinDoc
CPOE
Medication
Dispensing
Blood Bank
Care Plans/
Pathways
Results
Reporting
Billing
AR
Infection
Control
Disease
Management
Accounts
Payable
ADE
Surveillance
Incident
Reporting
Utilization
Review
Transport
Dietary
Endoscopy
Budgeting/
Forecasting
Fixed
Assets
Cost
Accounting
Time &
Attendance
Report
Writing
Tumor
Registry
Radiation
Oncology
Employee
Education
Employee
Health
Physician
Credentialing
Human
Resources
Payroll
Materials
Management
Executive
Support
(being replaced)
GSI PACS
Trauma
Registry
Medical
Library
Call Center
Nurse Call
System
Fund Raising
Decision
Support
Security
Facilities
Maintenance
Chart
Management
Coding
Abstracting
CLINICAL
Clinical
Data
Repository
Patient
Assessments
Care Plans/
Pathways
Interdisciplinary
ClinDoc
MD Clinical
Documenttation
Clinical
Decision
Support
CPOE
EMPI
Physician
Access
Document
Imaging
General
Ledger
ENTERPRISE RESOURCE
PLANNING
Accounts
Payable
Budgeting/
Forecasting
Fixed
Assets
Cost
Accounting
Time &
Attendance
Human
Resources
Payroll
Materials
Management
Executive
Support
Decision
Support
Security
Facilities
Maintenance
Cardiology
General
Ledger
HIM
Results
Reporting
HIM
Chart
Management
Coding
Abstracting
Dictation &
Transcription
Staff
Scheduling
Dictation &
Transcription
Staff
Scheduling
Physician Office
Patients
Long Term Care
33
Health Care Information Consultants, LLC
Legend
System
yet to be
Installed
Sequenced or
Simultaneous
Installations
System
Operational
Orange
Indicates
FY 08
Emphasis
Electronic
Medical
Record
Computerized
Provider
Order Entry**
Web-based
Viewable Results**
* Installed Quadramed Product
**Planned Quadramed Product
Integrated Patient
Monitors**
(OB, ICU, ER, Telemetry)
Picture Archiving
& Communication
System
(PACS)
Web-based
Physician
Remote Access**
Care Plans
Problem Lists**
Patient-Centric
Information Systems
February 2007
Electronic
Scheduling**
Outpatient
Assessments**
Clinical
Alerts**
McKesson HMI
Electronic
Electronic
Document
ED
EKG Results
Signature**
Imaging/Storage Documentation
Pyramis
Quantim e-Sig**
EDM*
& Tracking
T-System EV
OB
QS Sentinel
Management
Dictation/
Ad-HOC Reporting
Transcription
Crystal Reports
Precyse Solutions
Case
Management
MIDAS+
Online
Medication
Administration
Record**
Nursing
Assessments**
Vital Signs
I/O**
Utilization Review
MIDAS+
OR Management
ORSOS
HealthNotes*, SpeechQ
Materials
Management
Dimension21
Clinics/Ambulatory
/Physician
NTierprise PM
HealthmaticsEMR
Patient
Registration
Affinity Reg*
Order Mgt.
Viewable Results
Common Order Sets
NTierprise
HomeWorks, Mestamed
Home Health
Homeworks
Pathology
MediSolutions AP
Radiology
RMS
Lab
Medilab
Order Mgmt*
Transitional
Care
AccuCare
Home Medical
Equipment
MestaMed
Coding
Quantim Coding*
Homeworks
Medical Record
Management
Affinity*
MRI*, MRA*, MRC*
Medical
Necessity
Caremedic
LMRP
The FOUNDATION REQUIRED to make these components into a Fully Functional Electronic Medical Record includes the following:
1. Business Continuity Plans that provide for Redundant Storage and Communications to ensure constant availability of the systems
2. An adequate number of appropriate user devices connected to a Robust Infrastructure that provides data that is shared (interfaced or integrated) across the
continuum of care
3. Common Identification of the Patient across the continuum of care
4. Adequate Technical Support to ensure continuous operation.
Health Care Information Consultants, LLC
Pharmacy
Affinity Pharmacy*
Etreby
Billing &
Collections
Affinity*, SSI, Medifax
MestaMed, Homeworks,
Medware, Zirmed
Things to keep in mind….
•
•
•
•
•
You can’t do everything at once
Not all applications need to be state-of-the-art
Paper will always be with us
Value is in the mind of the beholder
You must decide how far out on the “bleeding
edge” your institution wants to be
• A well implemented system is more valuable
than a snazzy one that is poorly implemented
Health Care Information Consultants, LLC
Understand Your Institution’s Risk Profile
The Healthcare Technology
Adoption Life Cycle
Traditional
Technology
Adoption CurveMainstream
Mainstream
Early
Market
Market
Market
Chasm
Health Care Information Consultants, LLC
Skeptics
Mainstream
Conservatives
Pragmatists
Early Adopters
Innovators
Innovators
Skeptics
No Longer
Supported
Last
Generation
State of
the Art
Number of Installations
Radiology
Leading
Edge
Emerging
from the
Lab
In the Lab
Pharmacy
Automated
Pathways
EKG
Lab
EMR
RFID
Physician Office
Management
Billing
PACS
AI
Voice
Activated
Systems
Budgeting
Credentialing
Time
Health Care Information Consultants, LLC
Differing Views of Value
Business
View
Process
View
Application
View
Technology
View
Health Care Information Consultants, LLC
Information
View
Hospital Automation Levels
for % of Operating Budget
6%
5%
4%
3%
2%
1%
0%
XXX MIS Actual
State of the Art
Medium Automation
Low Automation
Health Care Information Consultants, LLC
High Automation
Return on Investment is Essential
The Economic Value Pathway
$$$
$$
Traditional
Healthcare
Industry
ROI
$
Enterprise Level
 Financial Strategy
 Marketing Strategy
 Business Line Strategy
 Customer Service Strategy
Process Level
 Work & Process Redesign
 Functional/Programmatic
Transformation
Tactical Level
 Incremental Improvement
 Automation Benefits (ie, cycle
time reduction, FTE reduction,
error elimination)
Measurements have focused on tactical items, but should
also focus on strategic goals. Broaden your focus: Can
technology contribute to the bottom line?
Health Care Information Consultants, LLC
GSH & North
Medical Records
prints at GSH
Results of
Dictation/ Test
Prints in Medical
Records
continuously
Current Process for Mailing Dictation/ Test Results
Monday through Friday
GSH Cardiology &
Radiology
Department
highlights
physician name on
results
Results of
Dictation/ Test
Prints in
departments
continuously
Multiple pages
stapled together
Department
highlights
physician name on
results
Mailroom picks up
every one hour
Mailroom date
stamps reports
Reports sorted
roughly into
several piles by
alphabet
Multiple pages
stapled together
Mailroom picks up
2x/day
GSH & North Lab
results print at
GSH
Results printed in
department
Department
matches all
reports for each
test, if applicable
North Cardiology
Results
Medicenter North
Conversion of Dictation/Test Results to Clinical Messaging
Proposed May 2002
North Radiology
Results
Results of
Dictation/ Test
Prints in
department
continuously
Department
highlights
physician name on
results
Department
highlights
physician name
Multiple pages
stapled together
by department
Start
At 3PM?? Dictation/ test
results automatically print off
in mailroom sorted
alphabetically
Mailroom pulls pulls off
reports by grouping and
places in envelopes with clear
labels for addresses & sorts
by weight
Multiple pages
stapled together
Volunteer sorts
alphabetically
Mailroom picks up
reports 3-4x/day
Each pile sorted
into mail bins of
specific letter
Volunteer prints
off labels
Stacks resorted
within each letter
alphabetically
Mailed to be weighted
moved to next room,
weighted and metered
Picked up by presort at
4:30 pm
Volunteer folds &
stuffs envielopes
End
Mailroom prints off
labels for each
report
Labels placed on
envelopes
Reports folded,
stuffed in
envelopes &
labeled
Reports picked up
by mailroom 2x/
day
Mail sorted by
weight
Mail sent to
presort
End
Before
After
Health Care Information Consultants, LLC
Sample Cost Data
Cost over 5 Years
(Rounded)
$10,000,000
$15,000,000
Hardware 9%
$900,000
$1,350,000
Software 45%
$4,500,000
$6,750,000
Imp. 40%
$4,000,000
$6,000,000
Int/Conv 6%
$600,000
$900,000
Hospital A + B (1)
$15,000,000
$22,000,000
$1,125,000
$1,687,500
$5,062,500
$7,593,750
$7,200,000
$10,800,000
$900,000
$1,350,000
$14,287,500
$21,431,250
Hospital A + B + C (2)
$21,000,000
$31,000,000
$1,406,250
$2,109,375
$6,075,000
$9,112,500
$11,520,000
$17,280,000
$1,170,000
$1,755,000
$20,171,250
$30,256,875
Hospital A
(1) Assumes: 25% increase in hardware, software; 80% increase in implementation; 50% increase in interfaces/conversions
(2) Assumes: 25% increase in hardware; 20% increase in software; 60% increase in implementation; 30% increase in interfaces/conversions
Health Care Information Consultants, LLC
Process/Technology Maturity
Evolution to Clinical Transformation
Sketchy
Processes
Process
Improvement
Doing the same
things quicker
Data overload
Technology install
Little useful info
separate from
Individual heroes
PI
Automate
Transactions
Process
Redesign
Doing things
differently
Operational
effectiveness
Joint IT & Process
Redesign
Process
Automation
Info Silos
Value Creation
Health Care Information Consultants, LLC
Clinical
Transformation
Doing different
things
Cross-organization
collaboration
Strategic
advantage
Dynamic
Partnering
Tactical Plan (EMR)
Q2 2007
Systems in Support of EMR
1
2
3
4.a.
4.b.
4.c.
5.a.
5.b.
6
7
8
9
10.a.
10.b.
11.a.
11.b.
12.a.
12.b.
12.b.
12.c.
12.d.
12.e.
13
14
15.a.
15.b.
16
17.a.
17.b.
17.c.
M
J
Q3 2007
J
A
Q4 2007
S
O
N
Q1 2008
D
J
F
Vendor Decision
Evaluate, Select and Implement EMPI
Evaluate, Selection and Implement eMar
Evaluate, Select and Implement
RFID(Barcoding) Pilot
Identify and Implement Other Areas
Integrate with Pharmacy and CPOE
Continue Roll-out of Clinical
Documentation Applications: Patient
Assessments, Interdisciplinary
Documentation and Care Plans
Implement Physician Documentation and
Charting (Structured Templates)
Evaluate, Select and Implement Care
Management System
Evaluate, Select and Implement Disease
Management System
Evaluate, Select and Implement Infection
Control System
Evaluate, Select and Implement
Anesthesiology System
Assess Surgery System
Re-implement Surgery System (based on
assessment findings in 10.a)
Assess Document Scanning and Imaging
System
Implementation of Document Scanning
and Imaging System (Pending
assessment findings in 11.a)
Evaluate and Selection of Portal Solution
(All Views)
Implement Clinician View
Implement Employee View
Implement Patient View
Implement Consumer View
Implement Vendor View
Evaluate, Select and Implement
Laboratory Outreach System
Evaluate, Select and Implement Clinical
Decision Support System
Assess Clinical Data Repository
Implement Clinical Data Repository
(Pending assessment findings in 17.a)
Evaluate, Select and Integrate Patient
Monitors and Smart-Pumps
Reasessment of EMR Strategy/Prerequisite Systems for enterprise CPOE rollout
CPOE Pilot
CPOE Rollout
Health Care Information Consultants, LLC
Q2 2008
M
A
M
Q3 2008
J
J
A
Q4 2008
S
O
N
S
Tactical Plan (Non-clinical)
Q2 2007
Non-Clinical Systems
M
J
Q3 2007
J
A
Q4 2007
S
O
N
Q1 2008
D
J
F
Evaluate, Select and Implement Help
Desk System
Evaluate, Select and Implement Human
Resources System
Evaluate, Select and Implement Bed
Management System
Evaluate, Select and Implement
Executive Support System
Web Site Strategy
Evaluate, Select and Implement Eligibility
System
Evaluate, Select and Implement Cost
Accounting System??
Health Care Information Consultants, LLC
Q2 2008
M
A
M
Q3 2008
J
J
A
Q4 2008
S
O
N
S
Tactical Plan (Services)
Q2 2007
Services
M
J
Q3 2007
J
A
Q4 2007
S
O
N
Q1 2008
D
J
F
MIS Staff Certifications/Training:
Applications
and Technical
Project
Management
PrimerStaff
Training:
Applications, Technical and Clinical
Informatics Staff
Process Documentation Primer Training:
Applications and Clinical Informatics Staff
Departmental IT Support
Certifications/Training
Incorporate Required Competencies
(Certifications/Training Requirements) into
Job Descriptions and Performance
Evaluation Process
Assess Training Center Needs (Space,
hardware, software) and Enhance Center
(Based on Findings)
Develop and Implement MIS Cross
Training Program
Develop Vendor Relations Plan
Health Care Information Consultants, LLC
Q2 2008
M
A
M
Q3 2008
J
J
A
Q4 2008
S
O
N
S
Tactical Plan (Technical Infrastructure)
Q2 2007
Technical Infrastructure
M
J
Q3 2007
J
A
Q4 2007
S
O
N
Q1 2008
D
J
F
Replace Deficient Equipment: Fire
Suppression Systems
Replace Deficient Equipment: HVAC
Replace Deficient Equipment: UPS
Replace Deficient Equipment: Racking
Equipment
Execute Data Resilience Plan
SUBTASKS
Develop MIS Facilities Maintenance
Policies and Procedures
Develop Network Closet Maintenance
Policies and Procedures (Including
Ownership and Accountability Policies and
Procedures)
Develop Plan for and Implement Closet
Rewiring
Evaluate, Select and Implement New
Telephone System
Develop Plan for Relocation of Non-Data
Center Based
SystemsImpact
to DataAnalysis
Center
Develop
Infrastructure
Policies and Procedures (Incorporate as
part of Project Costing)
Evaluate, Select and Implement Select
Network Management System
Health Care Information Consultants, LLC
Q2 2008
M
A
M
Q3 2008
J
J
A
Q4 2008
S
O
N
S
Tactical Plan (Governance)
Q2 2007
Governance
M
J
Q3 2007
J
A
Q4 2007
S
O
N
Q1 2008
D
J
F
M
Develop IS Steering Committee Charter
Develop Policies and Procedures: IS
Planning
Develop Policies and Procedures:
Investment Prioritization
Develop Policies and Procedures: Vendor
Selection
Develop Policies and Procedures: Major
Project Structure and Implementation
(Mandatory components to include
Charter, Executive Sponsor, Scope, and
Workplan; other components may
include ROI Analysis and Success
Metrics)
Reassess IS Strategic Plan
Establish Advanced Clinical Systems
Governance Structure
Health Care Information Consultants, LLC
Q2 2008
A
M
Q3 2008
J
J
A
Q4 2008
S
O
N
S
Tactical Plan (Information Use/Workflow)
Q2 2007
Information Use/Workflow
M
J
Q3 2007
J
A
Q4 2007
S
O
N
Q1 2008
D
J
F
Standardize Use of Technology
Applications
Develop policies and procedures to
incorporate workflow analysis as part of
system implementations
Develop polocies to allocate sufficient
hours of training for staff users and
incorporate into job descriptions
STRATEGY FOR
PARTNERSHIPS/JOINT VENTURES,
ETC?
Health Care Information Consultants, LLC
Q2 2008
M
A
M
Q3 2008
J
J
A
Q4 2008
S
O
N
S
Tactical Plan (Culture/Organization)
Q2 2007
Culture/Organization
M
J
Q3 2007
J
A
Q4 2007
S
O
N
Q1 2008
D
J
F
Migrate to More Accountable IS Culture:
Implement Organizational Changes
Develop IS Customer Service Culture:
Develop Service Level Agreements
Develop IS Customer Service Culture:
Develop Operational Support Structure in
support of IS-User Department Support
Model (Charter, Responsibilities,
Performance, SLA Expectations)
Develop and Implement Physician
Engagement Strategy
Evaluate customer service training
programs to enhance/instill customer
service attitude
Health Care Information Consultants, LLC
Q2 2008
M
A
M
Q3 2008
J
J
A
Q4 2008
S
O
N
S
A few words about governance…
• Good governance won’t guarantee a
successful project, but
• Poor governance will almost certainly
doom a project
Health Care Information Consultants, LLC
Governance Defined
“Exercising authority or
control over the
decision to utilize
resources in the
pursuit of
organizational
objectives or
strategies….”
Health Care Information Consultants, LLC
IT Governance Goals
• Create a fast, flexible and effective
process
• Strategically align decision-making and
accountability
• Be selective and apply the best thinking
within the organization so not all decisions
are sent through governance
• Measure IT performance and value
Health Care Information Consultants, LLC
IT Governance Fits Into Overall Enterprise Governance
Enterprise Governance
Mission
Vision
Values
Leadership
Management &
Control
Human
Resource
Governance
Financial
Governance
• IT Governance is an organized
framework of roles,
responsibilities, policies &
methods used to guide, direct &
Strategic
manage IT resources
Plan
• IT Governance is an extension
of Enterprise Governance, not
an “island” function delegated
to IT department
• Effective IT Governance
requires executive-level
IT
involvement & participation by
Governance
stakeholders
Health Care Information Consultants, LLC
Sources of Projects
• Strategic Business Initiatives
• IT Vision and Plan
• Dept Initiated Requests
• Maintenance & Upgrades
ISSC Role
CFO
CEO
input
Requested
$
ISSC Prioritization
Available
$
Other IT
Routine IT
Other Strategic
Initiatives
Must Have
Defer
Cancel
12 Month IT Plan
Resources
Project Plans
Project Budgets
CPOE
Executive Sponsors and ISSC Membership Responsibilities:
12 Month
Project Portfolio
•
•
•
•
•
•
•
•
Set objectives & policy
Measure performance & business value
Cascade strategy, policy & goals throughout organization
Facilitate communication
Establish clear accountabilities
Manage risk
Remove barriers
Improve processes, organization structure & knowledge
Health Care Information Consultants, LLC
Four “Ares”
Strategic question:
•In line with vision
•Consistent with
business principles
•Contributing to
strategic objectives
Are we doing
the right
things?
Architecture question:
•In line with architecture
•Consistent with principles Are we doing
them the
•Consistent with other
right way?
initiatives
Are we getting
the benefits?
Are we
getting them
done well?
Health Care Information Consultants, LLC
Value question:
•Understanding of
expected benefits
•Accountability for
realization
•Relevant metrics
•Benefits realization
process
Delivery question:
•Management,
•Delivery, change mgt
•Resources to deliver
•Required technology
•Required capabilities
Governance “Map”
Executive Governance
Executive Council
IS Strategic Governance
Information Systems
Steering Committee
IS Management
Senior Mgmt.
Team
IT
Department
Liaisons
IT Operations
IT Staff
Project
Teams
Health Care Information Consultants, LLC
Areas for Action
•
•
•
•
•
•
Systems
Governance
Services
Technical Infrastructure
Information Use/Workflow
Culture/Organization
Health Care Information Consultants, LLC
“Technology is just a matter of
using the right wrench to pound
in the correct screw”
Health Care Information Consultants, LLC