Health Care Information Consultants, LLC Planning for the Successful Deployment of an Electronic...

Health Care Information Consultants, LLC

Planning for the Successful Deployment of an Electronic Medical Record

George Mason University

College of Health and Human Services

James L. Oakes, Jr., PrincipalHealth Care Information Consultants LLC

[email protected]


James L. Oakes 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


“The Press Can’t

Tell You What to Think, but They Can Tell You What to Think About…”

John Naisbitt


HIMSS 18th Annual Leadership Survey

Top Business Issues Facing Healthcare(2007 vs. 2006 Results) Figure 8

17%

18%

29%

51%

36%

28%

29%

31%

38%

45%

52%

55%

69%

Decrease in Health Insurance Benefits

Availibility of Clinical Staff

Demand for Capital

Adoption of New Technology

Increasing Need for Healthcare Services

Medicare Cutbacks

Patient (Customer) Satisfaction

Improving Quality of Care

2006 Results 2007 Results

N/A

N/A

N/A


Life in the 21st Century


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


Terms Defined

• EMR

• EHR

• CPOE

• IHE

• HIE

• RHIO

• EIEIO


Why was the casualty rate so high in the civil war?


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


Less than 4% of US Hospitals Using CPOE

0 5 10 15 20 25 30 35

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

CPOE Hospitals Possible

CPOE Hospitals Verified

The yellow bar represents the number of hospitals verified in 2003


0 5 10 15 20 25 30

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

<5% Orders Entered

5-50% Orders Entered

>50% Orders Entered

1.3-1.8% US Hospitals w/MD’s Entering >50% Orders

IP Average:54% MD’s entering orders, with a very small percent (1.3-

1.8%) entering >50% of the orders


Current IT Priorities (Within Next 12 Months)(2007 vs. 2006 Results) Figure 6

26%

35%

36%

27%

45%

29%

50%

28%

30%

33%

34%

35%

48%

48%

54%

Improve IS Departmental Services

Process/Workflow Redesign

Connecting IT at Hospital and Remote Locations

Integrate Systems in Multi-Vendor Environment

Business Continuity and Disaster Recovery

Implement an EMR

Replace/Upgrade Inpatient Clinical Systems

Reduce Medical Errors/Promote Patient Safety

2006 Results 2007 Respondents

N/A




Projected IT Priorities(Today vs. Next Two Years) Figure 7

17%

24%

26%

21%

25%

32%

33%

35%

28%

30%

33%

34%

35%

48%

48%

54%

Improve IS Departmental Services

Process/Workflow Redesign

Connecting IT at Hospital and Remote Locations

Integrate Systems in Multi-Vendor Environment

Business Continuity and Disaster Recovery

Implement an EMR

Replace/Upgrade Inpatient Clinical Systems

Reduce Medical Errors/Promote Patient Safety

In Two Years Today



Status of Electronic Medical Record Implementation(Comparison of 2007, 2006, and 2005 Results) Figure 11

1%

17%

22%

42%

18%

1%

12%

24%

4%

36%

24%

1%

8%

16%

6%

37%

32%

Don't Know

No Plans Yet

Developed Plan to Implement

Signed Contract

Installation Begun

Fully Operational System

2005 Results 2006 Results 2007 Results

N/A


15


IT Strategy Alignment

NecessaryEvil

Cost of Doing

Business

IncreasedEfficiency

IncreasedEffectiveness

CompetitiveAdvantage

Today

Short Term

Future


IT Planning Process

Organize Project

Confirm Business Vision and Strategies

Conduct Needs Assessment

Define Future State

Perform Current Environment Analysis

Develop Gap Analysis andIT Strategies and Initiatives

ROI Analysis

Prepare IS Strategic Plan

Prepare Program Action Plan/ Tactical Plan

Phase 1

Phase 2

Phase 3

Phase 4

Phase 5

Phase 6

Phase 7

Phase 8

Phase 9

The process used to develop the plan is comprised of nine phases, with each phase “building” from the information gathered in the previous phase.


FSLHC FSLHC Strategy Strategy

Business and Business and Clinical Initiatives Clinical Initiatives

Information Technology Information Technology St rategy & Portfolio Strategy & Portfolio

IT Projects IT Projects

Strategy

Business &Clinical

Initiatives

IT Strategy

IT Tactical Plan

Bus

ines

s D

rive

rsM

arket Drivers

Sup

port

Directs


EMR Adoption Model

Operating Principles

IS Vision

IS Goals

Common Themes/Interviews

Current MIS Environment Analysis

Strategies

Tactical Plans

Davies Award Winners Analysis

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.

IT Attributes Exercise

IT Attributes Exercise


For Example…

• A metropolitan community hospital

• Full service medical/surgical

• Busy emergency services

• Competitive environment

• Battle for market share


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 state-of-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.


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


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


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


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


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


Start where you are…..

• Understand and document current environment

• Consider all applications

• Be prepared for surprises


Current Information Systems Environment: Application Portfolio

Enterprise Scheduling Eligibility

ADT Registration

ACCESS

CodingHIM

General Ledger

Payroll

Accounts Payable

Human Resources

ENTERPRISE RESOURCE PLANNING

Fixed Assets

Budgeting/ Forecasting

FacilitiesMaintenance

REVENUE

MD Clinical Document-

tation

Order Entry Results Reporting

Care Plans/Pathways

CPOE EMPI

ClinicalDecision Support

CLINICAL

ClinicalData

Repository

Pharmacy Laboratory

Radiology

ANCILLARY/DEPARTMENTAL

Pathology

PACS

Med Admin(barcoding)

Medication Dispensing

Blood Bank

Interdisciplinary ClinDoc

Microbiology

PhysicianAccess

Patient Assessments

ICU

Dietary

Staff Scheduling

Rehab (PT, OT, Sp)

Surgery

CaseManagement

Quality Improvement

Infection Control

Incident Reporting

Utilization Review

Physician Credentialing

Disease Management

Fund Raising

Employee Education

ADE Surveillance Transport

Call Center

ExecutiveSupport

ReportWriting

EKG(Muse)

EmployeeHealth

TumorRegistry

Endoscopy

RadiationOncology

EmergencyDepartment

CardiologyHelpDesk

MedicalLibrary

Anesthesiology

DecisionSupport

CostAccounting

MaterialsManagement

Time &Attendance

AbstractingChartManagement

Dictation &Transcription

Core Vendor

Other Vendors

Not Automated

DocumentImaging

Partially Automated

BillingAR

ElectronicClaims

Submission

CollectionsManagement

ElectronicClaims

Scrubber

ElectronicPaymentPosting

MedicalNecessity

DenialTracking

Nurse CallSystem

TraumaRegistry

GSI PACS(being replaced)

EDPhysician

Documentation

Security


Today’s Information Flow

Patient/FamilyView

Organization View

ProcessView

TechnologyView

AllergiesBlood Panel

Admit

ProgressNoteInsurance

Authorization

Medications


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!


One Organizations Portfolio – Leading to CPOE

UniversalPatient

ID

PatientDemographics

OrderManagement

IntegratedHomeHealth

Radiology LAB Pharmacy

Ad-HOCReporting

Dictation/Transcription

Bar Code SchedulingPhysicianRemoteAccess

ElectronicEKG

Results

ClinicalAlerts

CaseMgmt.

100%Codified

MedicalNecessity

OutpatientAssessments

DocumentImaging

ElectronicSignature

Vital SignsI/O’s

IntegratedMonitors

NursingAssessments

ProblemLists

Today

18 + Months

9 Months

OperatingRoomMgmt.

OnlineMAR

CommonOrderSets

Care Plans

CPOE

OnlineResults


Tomorrow’s Information Flow

Patient/FamilyView

Organization View

ProcessView

TechnologyView

Progress Notes

Allergies

Blood Panel

Medications Insurance

Authorization

Admit


33


ADTRegistration

ACCESS

CodingHIM

General Ledger

Payroll

Accounts Payable

Human Resources


Fixed Assets



REVENUE


tation


Care Plans/Pathways

CPOE EMPI


CLINICAL

ClinicalData

Repository

Pharmacy Laboratory Radiology


Pathology

PACS



Blood Bank

InterdisciplinaryClinDoc

Microbiology

PhysicianAccess

Patient Assessments

ICU

Dietary

StaffScheduling

Rehab(PT, OT, Sp)

Surgery

CaseManagement

Quality Improvement

InfectionControl

Incident Reporting

Utilization Review


DiseaseManagement

Fund Raising

Employee Education


Call Center

ExecutiveSupport

ReportWriting

EKG(Muse)

EmployeeHealth

TumorRegistry

Endoscopy

RadiationOncology

EmergencyDepartment

CardiologyHelpDesk

MedicalLibrary

Anesthesiology

DecisionSupport

CostAccounting

MaterialsManagement

Time &Attendance



DocumentImaging

BillingAR

ElectronicClaims

Submission


ElectronicClaims

Scrubber


MedicalNecessity

DenialTracking

Nurse CallSystem

TraumaRegistry


EDPhysician

Documentation

Security

Hospital


ADTRegistration

ACCESS

CodingHIM

General Ledger

Payroll

Accounts Payable

Human Resources


Fixed Assets



REVENUE


tation


Care Plans/Pathways

CPOE EMPI


CLINICAL

ClinicalData

Repository

Pharmacy Laboratory Radiology


Pathology

PACS



Blood Bank

InterdisciplinaryClinDoc

Microbiology

PhysicianAccess

Patient Assessments

ICU

Dietary

StaffScheduling

Rehab(PT, OT, Sp)

Surgery

CaseManagement

Quality Improvement

InfectionControl

Incident Reporting

Utilization Review


DiseaseManagement

Fund Raising

Employee Education


Call Center

ExecutiveSupport

ReportWriting

EKG(Muse)

EmployeeHealth

TumorRegistry

Endoscopy

RadiationOncology

EmergencyDepartment

CardiologyHelpDesk

MedicalLibrary

Anesthesiology

DecisionSupport

CostAccounting

MaterialsManagement

Time &Attendance



DocumentImaging

BillingAR

ElectronicClaims

Submission


ElectronicClaims

Scrubber


MedicalNecessity

DenialTracking

Nurse CallSystem

TraumaRegistry


EDPhysician

Documentation

Security

Hospital

Patients

Long Term Care

Physician Office

Single View of Virtual Patient Record


System Operational

Patient-Centric Information Systems

February 2007

Sequenced orSimultaneousInstallations

Orange Indicates

FY 08Emphasis

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.

Clinics/Ambulatory/Physician

NTierprise PMHealthmaticsEMR

Home HealthHomeworks

TransitionalCare

AccuCare

Home MedicalEquipmentMestaMed

CodingQuantim Coding*

Homeworks

Medical RecordManagement

Affinity*MRI*, MRA*, MRC*

MedicalNecessity

CaremedicLMRP

Billing & Collections

Affinity*, SSI, Medifax MestaMed, Homeworks,

Medware, Zirmed

MaterialsManagementDimension21

PatientRegistrationAffinity Reg*

NTierpriseHomeWorks, Mestamed

OBQS Sentinel

Order Mgt.Viewable Results

Common Order SetsOrder Mgmt*

PathologyMediSolutions AP

RadiologyRMS

LabMedilab

Pharmacy Affinity Pharmacy*

Etreby

ManagementAd-HOC ReportingCrystal Reports

Dictation/Transcription

Precyse Solutions HealthNotes*, SpeechQ

CaseManagement

MIDAS+

Utilization ReviewMIDAS+

OR ManagementORSOS

ElectronicEKG Results

Pyramis

ElectronicSignature**

Quantim e-Sig**

Document Imaging/Storage

EDM*

ED Documentation

& TrackingT-System EV

Picture Archiving& Communication

System (PACS)

McKesson HMINursing

Assessments**Vital Signs

I/O**

Care PlansProblem Lists**

OutpatientAssessments**

ClinicalAlerts**

OnlineMedication

AdministrationRecord**

Integrated PatientMonitors**

(OB, ICU, ER, Telemetry)

Web-basedPhysician

Remote Access**

ElectronicScheduling**

Web-basedViewable Results**

Computerized Provider

Order Entry**

ElectronicMedicalRecord

System yet to be Installed

Legend

The FOUNDATION REQUIRED to make these components into a Fully Functional Electronic Medical Record includes the following:

* Installed Quadramed Product

**Planned Quadramed Product


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


Understand Your Institution’s Risk Profile

Con

servative

s

Prag

matists

Skep

tics

Inn

ovato

rs

Early A

dop

ters

Chasm

The Healthcare TechnologyAdoption Life Cycle

EarlyMarket

Mainstream

Market

Mainstream

Market

Con

servative

s

Prag

matists

Skep

tics

Inn

ovato

rs

Early A

dop

ters

Chasm

The Healthcare TechnologyAdoption Life Cycle

EarlyMarket

Mainstream

Market

Mainstream

Market

Innovators Mainstream Skeptics

TraditionalTechnology

Adoption Curve


Time

CredentialingCredentialing

Physician OfficeManagement

Physician OfficeManagement

BudgetingBudgeting

EKGEKG

BillingBilling

PharmacyPharmacyRadiologyRadiology

EMREMR

LabLab

RFIDRFID

PACSPACS

AutomatedPathways

AutomatedPathways

Voice Activated Systems

Voice Activated Systems

AIAI


Differing Views of Value

BusinessView

InformationView

ProcessView

TechnologyView

ApplicationView


Hospital Automation Levels for % of Operating Budget

0%

1%

2%

3%

4%

5%

6%

XXX MIS Actual State of the Art High Automation

Medium Automation Low Automation


Return on Investment is Essential

Measurements have focused on tactical items, but should also focus on strategic goals. Broaden your focus: Can technology contribute to the bottom line?

$$$$$$

$$$$

$$

Enterprise LevelEnterprise Level Financial Strategy Marketing Strategy Business Line Strategy Customer Service Strategy

Process LevelProcess Level Work & Process Redesign Functional/Programmatic

Transformation

Tactical LevelTactical Level Incremental Improvement Automation Benefits (ie, cycle

time reduction, FTE reduction, error elimination)

Enterprise LevelEnterprise Level Financial Strategy Marketing Strategy Business Line Strategy Customer Service Strategy

Process LevelProcess Level Work & Process Redesign Functional/Programmatic

Transformation

Tactical LevelTactical Level Incremental Improvement Automation Benefits (ie, cycle

time reduction, FTE reduction, error elimination)

TraditionalTraditionalHealthcareHealthcareIndustryIndustryROIROI

The Economic Value Pathway


Before & After Daily Printing

GSH & NorthMedical Records

prints at GSH

North RadiologyResults

GSH & North Labresults print at

GSH

North CardiologyResults

Results ofDictation/ Test

Prints in MedicalRecords

continuously

Departmenthighlights

physician name onresults

Multiple pagesstapled together

Mailroom picks upevery one hour

Each pile sortedinto mail bins of

specific letter

Stacks resortedwithin each letter

alphabetically

Current Process for Mailing Dictation/ Test ResultsMonday through Friday


Prints indepartmentcontinuously



Multiple pagesstapled togetherby department

Volunteer sortsalphabetically

Volunteer printsoff labels

Volunteer folds &stuffs envielopes

Labels placed onenvelopes

Reports picked upby mailroom 2x/

day

Mailroom prints offlabels for each

report

Reports folded,stuffed in

envelopes &labeled

Results printed indepartment

Departmentmatches all

reports for eachtest, if applicable



physician name

Mailroom picks upreports 3-4x/day

Mail sorted byweight

Mail sent topresort

End

GSH Cardiology &Radiology


Prints indepartmentscontinuously




Mailroom picks up2x/day

Mailroom datestamps reports

Medicenter North

Reports sortedroughly into

several piles byalphabet

Start

At 3PM?? Dictation/ testresults automatically print off

in mailroom sortedalphabetically

Mailroom pulls pulls offreports by grouping and

places in envelopes with clearlabels for addresses & sorts

by weight

Mailed to be weightedmoved to next room,

weighted and metered

Picked up by presort at4:30 pm

End

Conversion of Dictation/Test Results to Clinical MessagingProposed May 2002

Before After


Sample Cost Data

Cost over 5 Years (Rounded) Hardware 9% Software 45% Imp. 40% Int/Conv 6%

Hospital A $10,000,000 $900,000 $4,500,000 $4,000,000 $600,000$15,000,000 $1,350,000 $6,750,000 $6,000,000 $900,000

Hospital A + B (1) $15,000,000 $1,125,000 $5,062,500 $7,200,000 $900,000 $14,287,500$22,000,000 $1,687,500 $7,593,750 $10,800,000 $1,350,000 $21,431,250

Hospital A + B + C (2) $21,000,000 $1,406,250 $6,075,000 $11,520,000 $1,170,000 $20,171,250$31,000,000 $2,109,375 $9,112,500 $17,280,000 $1,755,000 $30,256,875

(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


Pro

ces

s/T

ec

hn

olo

gy

Ma

turi

ty

Value Creation

Data overloadLittle useful infoIndividual heroes

Sketchy Sketchy ProcessesProcesses

AutomateAutomateTransactionsTransactions

Doing the same things quickerTechnology install separate from PI

ProcessProcessImprovementImprovement

Info SilosInfo Silos

Doing things differentlyOperational effectivenessJoint IT & Process Redesign

ProcessProcessRedesignRedesign

ProcessProcessAutomationAutomation

Doing different things Cross-organization collaborationStrategic advantage

ClinicalClinicalTransformationTransformation

DynamicDynamicPartneringPartnering

Evolution to Clinical Transformation


Tactical Plan (EMR)Systems in Support of EMR M J J A S O N D J F M A M J J A S O N S

1 Vendor Decision2 Evaluate, Select and Implement EMPI3 Evaluate, Selection and Implement eMar4.a. Evaluate, Select and Implement

RFID(Barcoding) Pilot4.b. Identify and Implement Other Areas4.c. Integrate with Pharmacy and CPOE5.a. Continue Roll-out of Clinical

Documentation Applications: Patient Assessments, Interdisciplinary Documentation and Care Plans

5.b. Implement Physician Documentation and Charting (Structured Templates)

6 Evaluate, Select and Implement Care Management System

7 Evaluate, Select and Implement Disease Management System

8 Evaluate, Select and Implement Infection Control System

9 Evaluate, Select and Implement Anesthesiology System

10.a. Assess Surgery System 10.b. Re-implement Surgery System (based on

assessment findings in 10.a)11.a. Assess Document Scanning and Imaging

System11.b. Implementation of Document Scanning

and Imaging System (Pending assessment findings in 11.a)

12.a. Evaluate and Selection of Portal Solution (All Views)

12.b. Implement Clinician View

12.b. Implement Employee View12.c. Implement Patient View12.d. Implement Consumer View12.e. Implement Vendor View13 Evaluate, Select and Implement

Laboratory Outreach System

14Evaluate, Select and Implement Clinical Decision Support System

15.a. Assess Clinical Data Repository

15.b.Implement Clinical Data Repository (Pending assessment findings in 17.a)

16Evaluate, Select and Integrate Patient Monitors and Smart-Pumps

17.a.

Reasessment of EMR Strategy/Pre-requisite Systems for enterprise CPOE roll-out

17.b. CPOE Pilot17.c. CPOE Rollout

Q2 2007 Q3 2008 Q4 2008Q3 2007 Q4 2007 Q1 2008 Q2 2008


Tactical Plan (Non-clinical)

Non-Clinical Systems M J J A S O N D J F M A M J J A S O N S

Evaluate, Select and Implement Help Desk SystemEvaluate, Select and Implement Human Resources SystemEvaluate, Select and Implement Bed Management SystemEvaluate, Select and Implement Executive Support SystemWeb Site Strategy Evaluate, Select and Implement Eligibility SystemEvaluate, Select and Implement Cost Accounting System??

Q2 2008 Q3 2008 Q4 2008Q2 2007 Q3 2007 Q4 2007 Q1 2008


Tactical Plan (Services)

Services M J J A S O N D J F M A M J J A S O N S

MIS Staff Certifications/Training: Applications and Technical Staff Project Management Primer Training: Applications, Technical and Clinical Informatics StaffProcess Documentation Primer Training: Applications and Clinical Informatics StaffDepartmental IT Support Certifications/TrainingIncorporate Required Competencies (Certifications/Training Requirements) into Job Descriptions and Performance Evaluation ProcessAssess Training Center Needs (Space, hardware, software) and Enhance Center (Based on Findings)Develop and Implement MIS Cross Training ProgramDevelop Vendor Relations Plan

Q2 2007 Q3 2007 Q4 2007 Q1 2008 Q2 2008 Q3 2008 Q4 2008


Tactical Plan (Technical Infrastructure)

Technical Infrastructure M J J A S O N D J F M A M J J A S O N S

Replace Deficient Equipment: Fire Suppression SystemsReplace Deficient Equipment: HVACReplace Deficient Equipment: UPSReplace Deficient Equipment: Racking EquipmentExecute Data Resilience PlanSUBTASKSDevelop MIS Facilities Maintenance Policies and ProceduresDevelop Network Closet Maintenance Policies and Procedures (Including Ownership and Accountability Policies and Procedures)Develop Plan for and Implement Closet RewiringEvaluate, Select and Implement New Telephone System

Develop Plan for Relocation of Non-Data Center Based Systems to Data CenterDevelop Infrastructure Impact Analysis Policies and Procedures (Incorporate as part of Project Costing)Evaluate, Select and Implement Select Network Management System

Q2 2007 Q3 2007 Q4 2007 Q1 2008 Q2 2008 Q3 2008 Q4 2008


Tactical Plan (Governance)

Governance M J J A S O N D J F M A M J J A S O N S

Develop IS Steering Committee Charter

Develop Policies and Procedures: IS PlanningDevelop Policies and Procedures: Investment Prioritization Develop Policies and Procedures: Vendor SelectionDevelop 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

Q2 2008 Q3 2008 Q4 2008Q2 2007 Q3 2007 Q4 2007 Q1 2008


Tactical Plan (Information Use/Workflow)

Information Use/Workflow M J J A S O N D J F M A M J J A S O N S

Standardize Use of Technology ApplicationsDevelop policies and procedures to incorporate workflow analysis as part of system implementationsDevelop polocies to allocate sufficient hours of training for staff users and incorporate into job descriptionsSTRATEGY FOR PARTNERSHIPS/JOINT VENTURES, ETC?

Q2 2007 Q3 2007 Q4 2007 Q1 2008 Q2 2008 Q3 2008 Q4 2008


Tactical Plan (Culture/Organization)

Culture/Organization M J J A S O N D J F M A M J J A S O N S

Migrate to More Accountable IS Culture: Implement Organizational ChangesDevelop 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

Q2 2007 Q3 2007 Q4 2007 Q1 2008 Q2 2008 Q3 2008 Q4 2008


A few words about governance…

• Good governance won’t guarantee a successful project, but

• Poor governance will almost certainly doom a project


Governance Defined

“Exercising authority or control over the decision to utilize resources in the pursuit of organizational objectives or strategies….”


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


IT Governance Fits Into Overall Enterprise Governance

• IT Governance is an organized framework of roles, responsibilities, policies & methods used to guide, direct & manage IT resources

• IT Governance is an extension of Enterprise Governance, not an “island” function delegated to IT department

• Effective IT Governance requires executive-level involvement & participation by stakeholders

MissionVisionValues

Management &Control

Leadership StrategicPlan

HumanResource

Governance

FinancialGovernance

FinancialGovernance

ITGovernance

ITGovernance

Enterprise Governance


Other IT

Routine IT

Other Strategic Initiatives

CPOE

Requested$

Available$

ISSC PrioritizationMust HaveDeferCancel

12 Month IT Plan

ResourcesProject PlansProject Budgets

Ongoin

gRole 12 Month

Project Portfolio

Executive Sponsors and ISSC Membership Responsibilities: • 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

ISSC RoleCFOCEO

input

Sources of Projects• Strategic Business Initiatives• IT Vision and Plan• Dept Initiated Requests• Maintenance & Upgrades


Four “Ares”

Are we doingthe right things?

Are we gettingthe benefits?

Are we doingthem the right way?

Are we getting themdone well?

Strategic question:•In line with vision•Consistent with business principles•Contributing to strategic objectives

Architecture question:•In line with architecture•Consistent with principles•Consistent with other initiatives

Value question:•Understanding of expected benefits•Accountability for realization•Relevant metrics•Benefits realization processDelivery question:•Management,•Delivery, change mgt•Resources to deliver•Required technology•Required capabilities


Governance “Map”

IS Strategic Governance

Information Systems Steering Committee

IS Management

Senior Mgmt. Team

IT Department

Liaisons

IT Operations

IT Staff Project Teams

Executive Governance

Executive Council


Areas for Action

• Systems • Governance• Services • Technical Infrastructure• Information Use/Workflow• Culture/Organization


“Technology is just a matter of using the right wrench to pound in the correct screw”

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