Our EHR Journey - Amazon S3s3.amazonaws.com/rdcms-himss/files/production/public/... ·...

Our EHR Journey: EMRAM Stage 7 and MU Stage 2

John Jay Kenagy, PhD

CIO Forum 2014

November 18, 2014

Or…

2

Hey, Legacy Health, you were awarded Stage 7 and just attested

for Meaningful Use Stage 2, what are you going to do next?

I’m going to Disneyland

The Nixon Library!

November 18, 2014

Our Time Together

Legacy Overview: Pictures and numbers.

Our EHR Journey: Third time’s a charm.

EHR Stewardship: The role of clinical informatics.

Our EHR Accomplishments: Benchmarking success.

What’s on our radar?: Great! Now what?

> Strategic Projects

> IS Commitment and Capabilities

What keeps me up at night?

October 7, 2014 3

November 18, 2014

Legacy’s EHR History

5

Year System Functionality

1986 Cerner Laboratory Information System

1997 Cerner Radiology Information System

1999 IDX LastWord ADT, Order Communication

2000 IDX LastWord Inpatient clinical documentation

2001 Cerner Surgery Information System

2001 IDX LastWord Ambulatory Scheduling & Documentation

2003 PICIS ICU System (NICU & PICU

2004 T-System ED Information System

2005 Cerner Hospital & Ambulatory EHR (LSCMC)

November 18, 2014

Legacy’s Epic Journey

Date Planning Stages

Fall 2007 Exploration begins;

Epic demonstrations;

Leadership conversations

Jan 2008 Contract Signed

Mar – Jun

2008

Project Team formation;

Certification training

Jul 2008 Official Kick-off

Nov 2008 Initial Workflow Validation

Feb 2009 Final Workflow Validation

Sep 2009 Multi-phased Testing

Begins

Jun 2010 Data Conversions Begin

6

Date Go-Live Events

Aug 2010 Initial Clinics Go-Live (Battleground and Fisher’s Landing, WA)

Epic Ambulatory installs preceded

hospital activation by 1-2 months

Nov 2010 Salmon Creek Medical Center

Apr 2011 Emanuel Medical Center &

Randall Children’s Hospital

Jun 2011 Good Samaritan Medical

Center

Aug 2011 Meridian Park Medical Center

Sep 2011 Mount Hood Medical Center

Oct 2012 Version 2010 Upgrade

September 2007- August 2010 Plan, Design Build, Test

August 2010 – September 2011 Train, Implement

November 18, 2014

http://www.epic.com/

EHR Stewardship:

The Role of Clinical Informatics

November 19, 2014 8 8

Legacy Clinical Informatics Goal

Optimize patient outcomes and care delivery

through the deep integration of information

and technology into the practice of clinical care.

Primary Functions of Clinical Informatics

Develop and implement strategy for information and

clinical technology acquisition, use and integration

Guide EHR optimization and adoption

Facilitate access to meaningful data and analytics from

EHR

Conduct ongoing review of documentation and work

processes to:

> Ensure compliance with standards

> Improve user efficiency

> Provide training and support to end-users

November 19, 2014 9

November 19, 2014 10

Measures of Success

Improved performance on quality and patient safety

indicators

Patient involvement in their care through MyHealth

(access to notes and clinical results; care team

communication)

Increased clinician adoption and satisfaction with the

EHR

Meaningful use of the EHR while achieving Meaningful

Use measures

Improved compliance of patient care documentation

with regulatory standards

November 19, 2014 11 11

Clinical Informatics Governance

Current structure developed to support:

> Effective collaboration between clinical operations,

revenue cycle operations, informatics, and IS

> Ongoing clinical/operational commitment to adoption of

standardized processes

> Integration between disciplines and functions system-wide

> Oversight to ensure attention to highest priority work

Informatics Council structure

> Founded in principles of shared governance

> Developed “organically” from the Legacy “way”

> Influenced by best practices from other institutions

November 19, 2014 LEGACY HEALTH 12

Informatics Governance Structure

IS Governance

Informatics

Governance

Physician

Advisory

Council

Nursing

Advisory

Council

Rev Cycle

Advisory

Council

Pharmacy

Advisory

Council

Education

Advisory

Council

Technology

Advisory

Council

Specialty User Groups

CIO

CNO

CMO

CMIO

CNIO

Clinical Specialty User Groups

11/19/2014 LEGACY HEALTH 13

Physician

Advisory Council

(PAC)

Nursing Advisory

Council

(NAAC)

Ambulatory / HOD

Pediatrics

Surgery

Adult Inpatient

Women’s

Emergency

Imaging

Cardiopulmonary

Hospice

Anesthesia

Revenue Cycle Specialty User Groups

11/19/2014 LEGACY HEALTH 14

Revenue Cycle

Advisory Council

Hospital Billing

Professional Billing

Patient Access

HIM

Clinical Informatics Division

Dyad leadership of CMIO and

CNIO

Dotted line to CMO and CNO

Physician Informaticists (3.0 FTE

comprised of 10 individuals from

0.1 – 0.7)

Principal Trainers (14, mostly

RNs plus RT and PharmD)

EHR Clinical Experts (4 RNs)

EHR Support Center (12 RNs)

October 7, 2014 15

Benchmarking our Success

Legacy achieves EMRAM Stage 7 system-wide Based on wide-scale Epic deployment, all Legacy hospitals and ambulatory

clinics received the designation of EMRAM Stage 7 (May 30, 2013)

Notable Accomplishments included:

Governance: very strong informatics leadership; physician engagement; collaboration

Analytics: Using data to improve care and operations

Health Information Exchange: Widespread use; a “step ahead of any other State 7 site”

Enterprise standardization: Diffusion of innovation and best practices across all hospitals

Community standardization: Legacy lead in city-wide creation of common discharge summary

Medical imaging integration: Exemplary imaging accessibility from the EMR

Biomedical device integration: Connection of bedside monitors and clinical devices was the most

advanced the surveyors had ever seen

17 November 18, 2014

Meaningful Use Stage 2

From Is Meaningful Use Dead? Wells Fargo Securities. September 24, 2014


IS Strategic Perspective

Optimize our Electronic Health Record (EHR) • Drive excellent Clinical Quality and Patient Safety • Motivate active Patient Engagement

Transform Care Delivery and Reimbursement • Power our Clinically Integrated Network • Deliver Population Health services • Embrace Accountability for health

Empower Decision Makers through Business Intelligence (BI)

Engage the broader Health Care Ecosystem

Optimize our Enterprise Resource Planning (ERP)

Optimize our Revenue Cycle

Build our “medical-grade” infrastructure • Enable the Intelligent Hospital and Clinic • Support the Master Facility Plan and Expansion Projects • Deliver reliable, cost-effective IT Infrastructure

Protect our systems and data through Information Security

Maintain regulatory compliance • Convert successfully to ICD-10 • Achieve Meaningful Use and pass external audits

Legacy Health IS Strategic Areas of Focus


Strategic Projects (2015): What’s on our radar screen

Clinical Quality & Patient Safety

• Epic 2014 enhancements

• Barcode unit collect lab specimen

• Patient Safety Alerting tool

• Pyxis ES Upgrade

• Epic Willow Ambulatory Pharmacy

• Epic Phoenix Transplant

• Philips Monitor Replacement

Care Transformation Projects

• Epic Healthy Planet

• Population Health

• Clinically Integrated Network

• At-risk reimbursement support

Italics denote project at conceptualization stage

Patient Engagement

• Epic 2014 enhancements to

MyHealth/Lucy Patient Personal Health

Record/MyChart Central

• Get Well Network

• Telehealth expansion

• Patient Education materials

• MyChart Bedside

Engaging the Health Care

Ecosystem

• Community Connect (LEAP) Expansion

• Health Information Exchange

• Community Orders Process

Enhancement (online imaging orders)

• Customer Relationship Management


Business Intelligence Projects

• Epic Cogito Ergo Sum

• Data “Universes” and Self-Service Tools

• SharePoint Dashboard

Enterprise Resource Planning (ERP)

Projects

• Infor Upgrade: Major Release

• Infor Analytics for Healthcare: Supply Chain,

Financial Management, and Workforce Analytics

Point of Sale Solution(s)/PCI

Revenue Cycle Projects

• Positive Patient Identification (hand scans)

• SSN# account identification elimination

Italics denote project at conceptualization stage

22


Physician Support Systems

• Enterprise MD scheduling

• Credentialing and privileging

• Medical Staff/Physician Portal

• eNotification and Secure Text Messaging

• Physician compensation process

improvement

Employee Support Systems

• MyTime (Time and Attendance)

• Enterprise Staff Scheduling

• CASE/HR Customer Service Tool

• Remedy/IS Customer Self Service

Regulatory

• Ambulatory PQRS

• ICD-10

• Meaningful Use Stage 3

November 18, 2014

Diagnostic Systems Projects

• PACS virtualization, database

centralization, vendor neutral archive

• Lab Helix

Information Security

• Secure text messaging

• Managed Security Services/Security

Information and Event Management

• Privacy monitoring

• Business continuity/disaster recovery

• Perimeter protection (Firewall)

IT Infrastructure Enhancements

• Office 365

• Desktop video conferencing

• Print management

• Wireless capacity expansion

“Intelligent Hospital” Projects

• Enhanced RTLS and nurse call

integration; Standard functionality

• Mobile Communication devices

• Remote Monitoring

Construction/Facilities Projects

• Lab building activation

• Mt Hood Ambulatory Surgery

Center/MOB 4

• GS Emergency Dept. Remodel

• EH OR/ICU Tower Design

Lifecycle Replacements

• 2,000+ end-of-life PCs

• Core phone switch and VoiceMail

• Migrating off Windows Server 2003

• Server and network Infrastructure

23


November 18, 2014

Customer Experience

Employee Experience

Highly Engaged IS Employees Highly Satisfied IS Customers (Operational Partners)

•Tap PE processes and tools to uncover and implement improvement opportunities (eliminate waste/delay, enhance throughput and reliability, reduce cost)

•Steward our financial resources effectively

Performance Excellence

•Establish and meet customer communication standards (strategic road-mapping, proactive change and project engagement, service recovery) to improve measurable service performance

•Implement IT Service Management best practices (service catalog, user self service) in Remedy tool

Service Excellence

•Diffuse PM best practice to effect project-driven organizational change

•Implement resource management system to enhance forecasting and reporting

Project Excellence

Goals

Initiatives • 2015 Tactics

Foundation IS Competencies

Technical & Business Skills

IS Culture Values & Behaviors

IS Structure Organization & Tools

2015 Performance Plan: IS and Informatics

External Environment

Internal Environment

Our World

Our Community

Our Patients

Our People

Measure: IS Customer Survey Score Q2: I was kept informed of the status of my request Metric: Rolling 12-month “top box” (4 or 5) scores.

Target: 87.7%

Measure: Legacy Pulse Score Employee Support Index Metric: Annual survey top box scores. Target: Baseline + 5%

Legacy Mission

Legacy Vision

Legacy Values

What keeps me up at night?

Spell it right!

Okay, it’s a Petty Pet Peeve…

Epic, not EPIC

(And it’s MEDITECH, not Meditech)


Are our real EHR achievements

more appreciated externally

than internally?

A Series of Firsts and Early Adoption

Legacy Health’s history of advanced use:

First Health System to achieve EMRAM Stage 7 at all hospitals and

clinics (2013)

One of first 11 sites to achieve Epic Accreditation for Community

Connect (2014)

One of first 73 US hospitals to achieve MU Stage 2 (Apr-Jun 2014)

One of top 2% of CareEverywhere (Epic HIE) message volume

Early adopter/influencer of Epic clinical applications

> Cardiology

> Anesthesiology

> Home Health for hospice care and administration

> Transplant


Internal Marketing Barriers

General lack of understanding or appreciation for how

tough our work really is

> The “Homefront CIO” Syndrome

Tendency to avoid self-promotion; tradition of humility

Hard message to craft: Declaring victory when we’ve

just started the optimization journey

Energy and attention focused on next thing and don’t

take opportunity to pause and celebrate last win


Are our users delighted?

~Our Customer Service~

Advisory Board Survey of Physician Engagement: Q. This hospital is pursuing an effective EMR/EHR

strategy

0

10

20

30

40

50

60

70

80

90

100

stronglydisagree

disagree tend todisagree

tend to agree agree strongly agree

Agree / Strongly Agree Total Exceeds

AB Benchmark by 15%


Advisory Board Survey of Physician Engagement: Q. I have the information I need to assess my productivity

and care quality

0

10

20

30

40

50

60

70

80

90

100

strongly disagree disagree tend to disagree tend to agree agree strongly agree


Qualitative Input: Themes 1. Better service/support

2. Improve training: Content, specialty focus, value the provider’s time

3. Extract data from Epic

4. Decrease redundant/unnecessary work

5. Improve connectivity with other EMRs

6. Engage physicians in decision making

7. Decrease unnecessary emails

8. More computers

9. Improved access to Legacy email from outside

10. Documentation support/scribes

11. Patient safety reporting system

12. Referrals (external)

13. Fix radiology orders

14. Replace Dragon head-sets with power-mics


Who is going to do all the work?

Recruiting and Retaining Talent

Lean Visual Management Board: Vacancies


Resource Demand Graph

Capital Project Resource Needs IS Team/Resource Role

Team Size 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03

IS Ambulatory and Community - Applications Analyst 19 -3.07 -3.17 -3.26 -3.51 -5.20 -5.96 -6.15 -6.98 -7.84 -7.71 -7.66 -7.96 -7.76 -8.03 -8.13

IS Bus Intel And Data Services - Programmer Analyst 3 3.83 3.80 3.87 3.34 3.92 3.45 2.76 2.69 2.12 2.09 2.42 1.82 2.10 1.34 1.41

IS Bus Intel And Data Services - Technical and DBA 5 1.08 1.53 0.66 3.42 3.01 2.55 1.62 0.74 1.05 0.88 0.78 0.07 0.01 -0.44 -0.21

IS Bus Intel And Data Services - Collaboration Analyst 2 -0.97 -0.95 -0.95 -0.95 -1.05 -1.05 -1.05 -1.05 -1.05 -1.05 -1.05 -1.05 -1.05 -1.05 -1.05

IS Bus Intel And Data Services - Reporting Analyst 10 -1.77 -1.29 -1.96 6.00 6.08 5.21 4.88 4.36 3.61 4.21 2.89 2.52 2.52 0.65 0.49

IS Clinical Informatics - Trainer 13 10.36 9.68 10.11 9.03 -2.21 -1.05 -0.93 -1.37 0.01 0.24 1.16 0.10 0.52 0.15 0.02

IS Clinical Systems - Applications Analyst 23 7.59 5.02 6.43 -2.16 -7.78 -6.19 0.53 1.74 0.68 0.96 -3.27 -5.28 -8.51 -8.84 -8.98

IS Diagnostic Systems - Applications Analyst 10 1.21 0.93 0.88 8.40 6.41 6.03 7.29 8.63 6.72 6.33 5.74 4.19 -1.62 -2.22 -2.93

IS Diagnostic Systems - PACS Administrator 6 -0.96 -1.12 -3.55 6.98 8.20 7.25 7.26 8.35 7.25 7.35 7.51 6.85 5.96 5.05 4.78

IS End User Computing - Desktop Support Specialist 19 0.97 1.08 2.67 3.23 3.93 3.56 3.40 3.87 2.63 2.49 3.98 2.30 -10.64 -10.97 -11.42

IS Enterprise Mgmt Systems - Applications Analyst 12 0.65 0.20 0.04 8.88 11.35 11.69 12.73 12.02 11.00 11.47 11.82 10.02 0.73 -0.04 -0.47

IS Epic Infrastructure System and Services - Cache DBA 2 0.25 0.32 0.34 0.25 -0.36 -0.80 -0.80 -0.80 -0.80 -0.80 -0.80 -0.80 -0.80 -0.80 -0.80

IS Epic Infrastructure System and Services - Client Service Mgmt 3 0.07 0.35 0.40 -0.47 -1.40 -1.50 -1.50 -1.50 -1.50 -1.50 -1.50 -1.50 -1.50 -1.50 -1.50

IS Epic Infrastructure System and Services - Interfaces 4 0.27 -0.60 -0.68 1.19 1.39 1.31 3.11 3.10 1.87 1.42 0.81 0.08 12.72 -1.66 -1.69

IS Epic Infrastructure System and Services - System Integration 3 0.28 0.38 0.48 0.43 0.21 0.06 0.19 0.11 0.13 0.58 0.23 0.19 9.82 -1.40 -1.55

IS Epic Infrastructure System and Services - Unix Administrator 3 -0.84 -0.84 -0.84 -0.52 -0.66 -0.52 0.35 0.08 0.26 -0.52 -0.51 -0.54 5.16 -0.89 -0.89

IS Information Security - Info Security Analyst 4 -1.20 -1.30 -1.15 -0.12 0.70 0.22 -0.38 0.21 -0.36 -1.01 -1.14 -1.60 -3.57 -3.86 -3.86

IS Program Management Office - IS Project Manager 9 3.12 2.79 2.45 1.94 2.60 2.01 1.62 2.33 1.85 1.96 1.65 0.73 -0.09 -0.54 -0.71

IS Revenue Cycle Systems - Applications Analyst 17 4.69 3.45 5.45 8.81 5.00 3.44 3.76 2.73 0.91 1.51 1.37 1.39 -12.10 -12.32 -12.45

IS Support Center - Applications Systems Analyst 5 0.36 0.37 1.07 2.50 2.35 2.57 1.94 1.97 1.82 2.07 2.31 2.04 -2.76 -2.90 -2.99

IS Support Center - Identity and Access Management 3 0.22 0.22 0.22 0.35 0.53 0.62 0.22 0.23 0.08 0.36 0.51 0.34 -2.56 -2.45 -2.73

IS System Engineering and Data Center - Applications System Analyst 1 -0.37 -0.37 -0.37 -0.15 -0.21 -0.24 -0.50 -0.51 -0.51 -0.51 -0.51 -0.51 0.22 -0.86 -0.74

IS System Engineering and Data Center - Data Center Operations 1 -1.00 -1.00 -1.00 -1.00 -0.70 -0.66 -0.87 -0.85 -1.00 -1.00 -1.00 -1.00 -1.00 -1.00 -1.00

IS System Engineering and Data Center - Desktop Engineer 7 -0.93 -1.15 -0.88 0.64 0.44 0.21 -1.57 -1.23 -1.71 -1.27 -1.54 -1.78 7.33 -6.35 -6.56

IS System Engineering and Data Center - Server Administration 7 -1.03 -1.03 -0.68 5.67 7.34 6.66 3.78 3.03 2.03 0.21 -0.40 0.07 6.53 -5.04 -5.45

IS System Engineering and Data Center - Storage and Backup Systems 3 -1.05 -0.92 -0.91 0.73 1.40 1.14 0.62 -0.32 0.21 -0.21 -0.48 -0.03 1.79 -1.30 -1.85

IS Telecom and Networking - Network Engineer 7 0.33 1.68 1.73 6.22 6.10 5.86 3.53 2.47 3.41 2.88 2.39 0.91 -3.69 -3.88 -3.96

IS Telecom and Networking - Telecom Engineer 8 -0.94 -0.43 0.07 1.42 0.70 0.72 -0.84 -1.05 -1.27 -1.48 -1.64 -1.69 -5.24 -5.20 -5.38


I’ve always relied on the kindness

of strangers…

A Streetcar Named Meaningful Use

Attestation includes measures that aren’t

under the control of the EH/EP

Transitions of Care: Community adoption of

HIE technologies, direct messaging addresses

Active use of patient EHR portal


It’s a Nasty World Out There

Who ever heard of ransomware till now?

Information Security

Legacy performs

HIPAA/HITECH Annual risk

assessments

In Federal FY15 (Oct 2014),

Legacy received pre-payment

audit notices for 49 eligible

professionals (Stage 2 Year 1).

Audits required security risk

assessment and remediation

plans for past three years


Legacy Security Improvement (2012-2014)

41

HITRUST Domains 2012 2013 2014 Legend

1. Information Security Policies Not Aligned

2. Laptop & Workstation Security Partially Aligned

3. Mobile Media Security Aligned

4. Wireless Security

5. Malware Protection

6. Configuration Management

7. Vulnerability Management

8. Secure Disposal

9. External Breach Protection

10. PHI Transmission Protection

11. Password Management

12. Access Control and Monitoring

13. Remote Access & Authentication

14. Training and Awareness

15. Third-Party Security Management

16. Incident and Breach Response

17. Business Continuity Management

18. Auditing

November 18, 2014

Disaster Recovery 2014


My Successor’s Worry


We’ve just spent $100M and 3 years

building a fully integrated EHR…

But, look, shiny and new!

Integrated, Patient-Centric EHR?

The Post-EHR Era:

> BI and HIE (use it and share it)

The new sales angle?

> Population Health

> Managing risk in a pay-for-value world

> Clinically Integrated Network

October 7, 2014 46

Thank You! [email protected]

Our EHR Journey - Amazon S3s3.amazonaws.com/rdcms-himss/files/production/public/... ·...

Documents

Transcript of Our EHR Journey - Amazon S3s3.amazonaws.com/rdcms-himss/files/production/public/... ·...