The DIY Information Technology Strategic Plan Kirk Kirksey, Vice President for Information Resources...
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The DIY Information Technology Strategic Plan Kirk Kirksey, Vice President for Information Resources UT Southwestern Medical Center Adjunct Professor, UT Dallas Chancellor’s Health IT Fellow, UT System [email protected] Better Faster Cheaper
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Transcript of The DIY Information Technology Strategic Plan Kirk Kirksey, Vice President for Information Resources...
The DIY Information Technology Strategic Plan
Kirk Kirksey Vice President for Information ResourcesUT Southwestern Medical Center
Adjunct Professor UT DallasChancellorrsquos Health IT Fellow UT System
kirkkirkseyutsouthwesternedu
Better Faster Cheaper
Typical Strategic Planning Consulting Costs$300 per hour plus expenses
The IT Strategic Plan
Why Plan
What Does Strategy Look Like
The Strategic Planning ProcessA Brief Case StudyYour THoughtsWhat We Did Right Where We Missed the Boat and the New Picture
The CHAOS Report
bull User Involvement 19 points
bull Executive Mgt Support 16 points
bull Clear Statement ofRequirements 15 points
bull Proper Planning 11 points
bull Realistic Expectations 10 points
bull Smaller Project Milestones 9 points
bull Competent Staff 8 points
bull Ownership 6 points
bull Clear Vision amp Objectives 3 points
bull Hard-Working Focused Staff 3 pointsSource The Standish Group International
diams Prescriptive (in which normative assumptions derive from a view that the environment isrelatively constant and the challenge for strategy development is to respond or adjust tothe environment)1048766 Design school1048766 Planning school1048766 Positioning school
diams Descriptive (in which the approach is derived from empirical findings or disciplinaryperspectives and methods)1048766 Entrepreneurial school1048766 Cognitive school1048766 Learning school1048766 Cultural school1048766 Political school1048766 Environmental school
Mintzbergrsquos Strategy Types
Core ldquoDesign Schoolrdquo Model
of Strategy Formulation
Derived from The Rise and Fall of Strategic PlanningHenry Mintzberg
Is IT Planning Worth IT
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Typical Strategic Planning Consulting Costs$300 per hour plus expenses
The IT Strategic Plan
Why Plan
What Does Strategy Look Like
The Strategic Planning ProcessA Brief Case StudyYour THoughtsWhat We Did Right Where We Missed the Boat and the New Picture
The CHAOS Report
bull User Involvement 19 points
bull Executive Mgt Support 16 points
bull Clear Statement ofRequirements 15 points
bull Proper Planning 11 points
bull Realistic Expectations 10 points
bull Smaller Project Milestones 9 points
bull Competent Staff 8 points
bull Ownership 6 points
bull Clear Vision amp Objectives 3 points
bull Hard-Working Focused Staff 3 pointsSource The Standish Group International
diams Prescriptive (in which normative assumptions derive from a view that the environment isrelatively constant and the challenge for strategy development is to respond or adjust tothe environment)1048766 Design school1048766 Planning school1048766 Positioning school
diams Descriptive (in which the approach is derived from empirical findings or disciplinaryperspectives and methods)1048766 Entrepreneurial school1048766 Cognitive school1048766 Learning school1048766 Cultural school1048766 Political school1048766 Environmental school
Mintzbergrsquos Strategy Types
Core ldquoDesign Schoolrdquo Model
of Strategy Formulation
Derived from The Rise and Fall of Strategic PlanningHenry Mintzberg
Is IT Planning Worth IT
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The IT Strategic Plan
Why Plan
What Does Strategy Look Like
The Strategic Planning ProcessA Brief Case StudyYour THoughtsWhat We Did Right Where We Missed the Boat and the New Picture
The CHAOS Report
bull User Involvement 19 points
bull Executive Mgt Support 16 points
bull Clear Statement ofRequirements 15 points
bull Proper Planning 11 points
bull Realistic Expectations 10 points
bull Smaller Project Milestones 9 points
bull Competent Staff 8 points
bull Ownership 6 points
bull Clear Vision amp Objectives 3 points
bull Hard-Working Focused Staff 3 pointsSource The Standish Group International
diams Prescriptive (in which normative assumptions derive from a view that the environment isrelatively constant and the challenge for strategy development is to respond or adjust tothe environment)1048766 Design school1048766 Planning school1048766 Positioning school
diams Descriptive (in which the approach is derived from empirical findings or disciplinaryperspectives and methods)1048766 Entrepreneurial school1048766 Cognitive school1048766 Learning school1048766 Cultural school1048766 Political school1048766 Environmental school
Mintzbergrsquos Strategy Types
Core ldquoDesign Schoolrdquo Model
of Strategy Formulation
Derived from The Rise and Fall of Strategic PlanningHenry Mintzberg
Is IT Planning Worth IT
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The CHAOS Report
bull User Involvement 19 points
bull Executive Mgt Support 16 points
bull Clear Statement ofRequirements 15 points
bull Proper Planning 11 points
bull Realistic Expectations 10 points
bull Smaller Project Milestones 9 points
bull Competent Staff 8 points
bull Ownership 6 points
bull Clear Vision amp Objectives 3 points
bull Hard-Working Focused Staff 3 pointsSource The Standish Group International
diams Prescriptive (in which normative assumptions derive from a view that the environment isrelatively constant and the challenge for strategy development is to respond or adjust tothe environment)1048766 Design school1048766 Planning school1048766 Positioning school
diams Descriptive (in which the approach is derived from empirical findings or disciplinaryperspectives and methods)1048766 Entrepreneurial school1048766 Cognitive school1048766 Learning school1048766 Cultural school1048766 Political school1048766 Environmental school
Mintzbergrsquos Strategy Types
Core ldquoDesign Schoolrdquo Model
of Strategy Formulation
Derived from The Rise and Fall of Strategic PlanningHenry Mintzberg
Is IT Planning Worth IT
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
diams Prescriptive (in which normative assumptions derive from a view that the environment isrelatively constant and the challenge for strategy development is to respond or adjust tothe environment)1048766 Design school1048766 Planning school1048766 Positioning school
diams Descriptive (in which the approach is derived from empirical findings or disciplinaryperspectives and methods)1048766 Entrepreneurial school1048766 Cognitive school1048766 Learning school1048766 Cultural school1048766 Political school1048766 Environmental school
Mintzbergrsquos Strategy Types
Core ldquoDesign Schoolrdquo Model
of Strategy Formulation
Derived from The Rise and Fall of Strategic PlanningHenry Mintzberg
Is IT Planning Worth IT
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Core ldquoDesign Schoolrdquo Model
of Strategy Formulation
Derived from The Rise and Fall of Strategic PlanningHenry Mintzberg
Is IT Planning Worth IT
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Is IT Planning Worth IT
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
What Does Strategy Look Like
Strategic Choice Making
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Supreme Court Justice Potter Stewart
I Know It When I See Itrdquo
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The Von Schieffen Plan
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Strategy Map and Balanced Scorecardfor Southwest Airlines
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Strategy as Perspective
Old New
Strategy as
Position
New
Old
Big Mac Original
Recognizable ProductNew Market Position
Same MarketsNew Perspective
Could This Work
Position and Perspective
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
WalMart ndash What were they thinking
SUPERCENTERS NEIGHBORHOOD MARKET
a) All things to all peopleb) Average size 187000 sqftc) Preferred access ndash major transport artery
a) Grocerypharmacy combob) Average size 43000 sqftc) Preferred access ndash neighborhood accessd) Same Stuff
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The IT Strategic Plan
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Start with the End in MindThe Strategic Plan Table of Contents
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
UTSW IT Strategic Planning Approach
Initiate Project
Business PrioritiesGuardrails amp Assumptions
Business PrioritiesGuardrails amp Assumptions
Vision for ITVision for IT
Define Strategic Context
ManagementOf IT
ManagementOf IT
ApplicationsApplications
TechnologyTechnology
Analyze Gaps
Customer PerceptionCustomer Perception
PerformancePerformance
Assess IT Effectiveness
Management of ITManagement of IT
Develop AlternativesDevelop Alternatives
Select StrategySelect Strategy
Develop Strategy
Define PlanDefine Plan
Strategy CommunicationDocument
Strategy CommunicationDocument
StrategyImplementation Plan
StrategyImplementation Plan
Communicate Plan
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Establishing Strategic Planning Governance
Scope (what is being governed) Decision (who makes decision) Input (who has input) Mechanisms (more meetings)
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Executive Steering Committee (EST)
1 MeetingQtr
Final Approval for IT Strategy and Financing
Project Steering Committee
1 Meeting per Week
Final Approval for Strategy
Recommendation
Consulting Team
strategy formulation
Representative Workgroups
Provide Targeted Input
Gather ExternalInternal
Information
Office of the CIO
The Governance of Strategic Planning
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Glue vs The Inarguable Option
To attract recruit and hire quality individuals to be employees of the City of XXX and develop motivate reward and recognize City of Dallas Employees
At Microsoft we work to help people and businesses throughout the world realize their full potential This is our mission Everything we do reflects this mission and the values that make it possible
To be for the long term our customerrsquos primary trusted technology partner
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Wherersquos the Glue
Recognizable ProductNew Market Position
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Our Glue
The 2004 IT Strategic PlanlsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
The 2010 IT Strategic PlanldquoMission Integrationrdquo ndash Create a computing environment capable of securely integrating the clinical education and research missions of UTSW
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Assess IT Effectiveness
Moderate to high marks for ambulatory and university customers Perceived as poor performers by hospital customers
Customer Perception
Variable performance based on ambulatoryinpatient boundaries
Performance
Separate strategies for separate facilities
Little leverage of common resources
Management of IT
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
300 Employees$40M Operating Budget4 of Institution Operating Budget (12b)
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Bad News
Good News
Application Vulnerabilities ndash ClinicalldquoLots of Stable Applications But They Are Oldrdquo
Functional RiskHigh
High
TechnicalRisk
Epic ChartTracking
Epic EMR
McKesson IBAX Pharmacy
MISYS LaboratoryInfo System
Access to CareNursingDocumentation
OACISCDR
SiemensPACS
Cerner PathnetPharmnetRadnet
Softmed HIM Suite
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Analyze Technology Gaps
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Onestaff Scheduling
Application Vulnerabilities ndash FinancialldquoMany Applications That Do Not Meet Customer Needsrdquo
Functional RiskHigh
High
TechnicalRisk
ADP HR amp Payroll
IDX Billing amp AR IDX Scheduling
amp Registration
OAS Admin System
Eclipsys TSI Dec Support
Siemens Invision
ANSOS Scheduling
ESI Materials Management
Kronos Time amp Attendance
System has technicalproblems is beingsunset or is on old architectures
System has majordeficiencies infunctionalities anddoes not meetcustomer needs
Bad News
Good News
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
SWOT Solution Matrix
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
City of Aberdeen Local Transport Strategy
Strategic Plan ndash East St Louis
Screen Shot of winswot(wwwcymeoncom)
The Many Faces of SWOT
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Politicalecologicalenvironmental issues current legislation home market future legislation Europeaninternational legislation regulatory bodies and processes government policies government term and change trading policies funding grants and initiatives home market lobbyingpressure groups international pressure groups
Economichome economy situation home economy trends overseas economies and trends general taxation issues taxation specific to productservices seasonalityweather issues market and trade cycles specific industry factors market routes and distribution trends customerend-user drivers interest and exchange rates
Sociallifestyle trends demographics consumer attitudes and opinions media views law changes affecting social factors brand company technology image consumer buying patterns fashion and role models major events and influences buying access and trends ethnicreligious factors
Technologicalcompeting technology development research funding associateddependent technologies replacement technologysolutions maturity of technology manufacturing maturity and capacity information and communications consumer buying mechanismstechnology technology legislation innovation potential technology access licensing patents
The PEST Analysis
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Hardware TCO
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The Total Cost of Ownership Pie
Source The Gartner Group
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Costs - Initial Investment
Hardware (platforms networks) Software base price (operating systems layered products
product license) Licensing approach (perpetual seat site concurrent use) Vendorconsultant implementation fees Interface fees Education and training Personnel and salaries Ancillary personnel required (network help desk security
desktop support) ASP outsoursing fees Can system be outsourced or ASPrsquos
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Costs ndash Total Cost of Ownership
Maintenance and support fees Support service levels (7X24 business
hours) New version upgrade costs (included in
maintenance) Ongoing training Ancillary personnel (eg network help desk
desktop support)
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
OASFinanceGeneralLedger
HRMSHuman
ResourcesPayroll
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index
Doc Imaging
AncillariesElectronic Medical Record
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
New Health System IR Vision - 2010
Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT
Patient Access
UTSWFaculty
ProfessionalBilling
UMCHospitalBilling
Passive Enterprise Master Person Index
Documentation Orders
Specialty SystemsPACS
Enterprise Clinical Data Repository
ERP - Finance
ERP ndash Human ResourcesPayroll
ERP ndash Materials Management
Enterprise Business Decision Support
Active Enterprise Master Person Index ()
Doc Imaging
Ancillaries
Electronic Medical Record
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Free Consulting
Where would you focus your efforts Year 1 What is the weakness of the IR Vision
Picture What projects would contribute to the
creation of lsquoSystemnessrsquo How could you break down the lsquoUs and
Themrsquo barriers rampant in IR personnel
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
What Really Happened
The Glue (NOT the MissionVision Thang) List of proposed projects budgets and
timelines supporting vision and goals of the organization
The technology organization needed to successfully deliver these projects
Governance structure capable of implementation and enforcement
lsquoSystemnessrdquo ndash Create a seamless experience for physicians and patients across our clinical delivery enterpriserdquo
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
lsquoSystemnessrdquo ndash Create a seamless
experience for physicians administrators and patients across our clinical delivery enterpriserdquo
To operate as one unified University Health System for our patients and faculty
OVERALL BUSINESS VISION
To improve patient and physician service as put forth in the Clinical Services Initiative
CURRENT BUSINESS STRATEGY
To achieve the financialoperational sustainability of Zale Lipshy amp St Paul University Hospitals
To provide our faculty with world-class IT to improve patient safety amp clinical quality
OVERALL INFORMATION RESOURCES VISION
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
UTSW Health System IR Strategic Plan Total Cost $9712528600
I Hospitals - FinancialRevenue Cycle $702300000 Optimize Revenue Cycle amp Select Scheduling $470000000 Implement Scheduling at Hospitals $140000000 Select and Implement Staff Scheduling System $43100000 Upgrade Kronos Time and Attendance System $49200000
II Ambulatory Services - FinancialRevenue Cycle $455200000 Continue Epic Rollout in Ambulatory Services $249600000 Health System Select amp Implement EMPI across Health System $205600000
III Hospitals - Clinical $2750100000 St Paul Results to OACIS CDR $5000000 Develop Enterprise Clinical Systems Strategy $49600000 Consolidate Lab Systems Select amp Implement $48800000 Complete PACS Rollout SPUHZLUH $700000000 Implement Core Clinical Suite for Hospitals $1647700000 Implement Replacement Laboratory Information System $64000000 Implement Replacement Radiology Information System $151800000 Standardize on Pharmacy Dispensing System $19200000 Select and Implement Surgery Scheduling System at UMC $64000000
IV Ambulatory Services - Clinical $2055300000 Deploy UT Smart EMR to Ambulatory Services $2055300000
V Health System - Cancer Registry $134628600 Deploy Unified Cancer Registry Application $134628600
V Health System - Administrative Management $915000000 Select ERP System AP GL MM PR HR Budgeting $35000000 Implement ERP for the Health System $880000000
VI Enterprise Decision Support $70000000 Create Clean Hospital Reporting Through TSI $60000000 Create Ambulatory P amp L $10000000
VII Upgrade Campus-Wide Technology Infrastructure $2630000000 Upgrade Non-Standard Cabling Health System-Wide $1100000000 Implement Integrated VoiceData System Health System-Wide $1200000000 ReviewUpdate Security Program $330000000
TheList
Our CEO
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
8 IR Strategic Priorities For Yr 1Hospitals Optimize Revenue Cycle amp Implement Hospital Scheduling ($615M)
Hospitals Create Clean Hospital Reporting Through TSI Optimization amp Standardization ($06M)
Ambulatory Create Improved P amp Ls ($100K)
Health System Develop Comprehensive ERP (Finance HR Payroll Supply Chain) Bid ndash ($350K)
Health System Upgrade Infrastructure For Phones Cabling amp Networking ($493M)
Ambulatory UT Smart Medical Record Registration amp Scheduling Rollout ($20M ndash Already Funded)
Hospitals Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K ndash Already Funded)
Health System Implementing Campus-Wide Cancer Registry ($13M)
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Health System Infrastructure PlanPROJECT 1 Phones
New Phone PBX System For University SPUH amp ZLUHbullCurrent equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growthbullZLUH is a node off of Parkland system that Perot will charge us for
PROJECT 2 Cabling
Upgraded Cabling In Every Building To Support High Speed ConnectionbullCurrent building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2 PACS and other bandwidth intensive applications
PROJECT 3 Secure Redundant Campus Network
Redundant Tiered Network To Safeguard University ResourcesbullCurrent network does not provide adequate securityredundancy to protect network resources into future
PROJECT 4 Consolidate amp Upgrade Data Centers For Health System
Upgrade data center for Health System with 24X7 operations modelbullConsolidate UMC data centers into UTSW data center and upgrade technology to allow 24X7 network operations model necessary for ERP amp clinical systems
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Revenue Cycle Patient Access Optimization
Redesign our front-end and back end business processes with associatedconfiguration of existing information systems and implementation of new scheduling system to promote more accurate registration increased charge capture improved cash collections and timely billing and reimbursement
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
Siemens InvisionSoftmed HIM SuiteNew Scheduling SystemNew Document Imaging For Hospitals
BUSINESS UNITS INVOLVED
Admitting Medical Records BusinessOffice Pre-Registration All HospitalDepartments Performing Scheduling
$615MPROJECT OWNER
CFO Health System
INTERNAL IR RESOURCES
Siemens Resources (3)Softmed Resources (2)Interface Resource (1)Technical Resource (1)
ADDITIONAL RESOURCES
Project Manager (1)Front-End Process Expert (1)Scheduling Specialist (1)HIM Re-Design Expert (1)Document Imaging Expert (1)Siemens Resource (1)
TECHNOLOGY COSTS
Siemens ZLUH UpgradeConversionNew Document Imaging System
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Develop Health System ERP Strategy
Work with University administrative departmentsand Health System leadership to determineappropriate information system solution(s) tomeet both administrative needs of Universityand management needs of clinical practiceSystem functional requirements will bedetermined vendors evaluated and systemrecommendation will be made with ROI justification
PROJECT DESCRIPTION
TARGETED INFORMATION SYSTEMS
OAS Administrative SystemSiemens GLAPESI Materials ManagementADP Human ResourcesNew ERP System
BUSINESS UNITS INVOLVED
University Finance Human ResourcesMaterials Management HospitalFinance HR amp Materials Management
$300KPROJECT OWNER
CFO UniversityCFO Health System
INTERNAL IR RESOURCES
OASHRMS Director (1)Hospital Apps Director (2)
ADDITIONAL RESOURCES
Project Manager (1)Finance Expert (025 FTE)Human Resources (025 FTE)Materials Management (025 FTE)
TECHNOLOGY COSTSNone
INTERNAL UTSW RESOURCES
Finance Analyst (1)Human Resources Analyst (1)Materials Management Analyst (1)
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The Information Resources Organization
CIOVP For Information
Resources
Telecommunications
Client Services
Hospital IT Ambulatory IT
Network Services
Medical TV
AdministrativeComputing
330Employees$55M Operating Budget4 of Institution Operating Budget (12b)
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Restructured IT Department
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Governance
French Infantryman (Pantalon Rouge)
German MachineGun Crew
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
The IT Governance Landscape
Defined governanceScope (what is being governed What is not being governed)Who makes the decisionWho has inputWho enforces the decisionGovernance mechanisms Governance style
Consolidation of redundant governance structures to match lsquosystemnessrsquo theme
Introduction of the Project Management Office with standard IT project reportingtime reporting framework
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Successes
Revenue cycle reworked in re-implemented in record time Hospitals at break-even with slight profit Consolidated billing system increased professional fee revenues
De-install unsafe electronic medical record VoIP with wireless installed Campus infrastructure upgraded Cancer registry implemented (avoided de-certification) St Paul integrated into UT Southwesternrsquos patient data warehouse
and master person index Information Resources reorganized New data center operational
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Not So Success
ERP discovery phase doubled Culture clash of University and Health System
Old clinical system governance still in place Now ineffective
Allocation of costs a continual issue Slows IT projects
Strategic Plan scope creep Organizational capacity to change
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Remember Mitznerrsquos Strategy TypesCreate Health SystemFinancial TurnaroundPtDr SatisfactionSystem Wide EMRzHealth System ERP
Focus on hospital financial systems cleanupIR Reorg
Department initiatives growth of outreach new outpatient buildingDisaster recovery new business model
EMR postponed
Health System CreatedFinancial TurnaroundUniversity wide ERPSlow EMR
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Planning Pitfalls
Commitment at the Top(ldquoWherersquos the moneyrdquo)
Commitment Lower Down(Planning for others lowers productivity and satisfaction)
Decentralized Planning(Itrsquos my PampL and those pesky spontaneous strategies)
Too Many Planning Constraints(A wired plan is no plan)
Deterministic vs Contingency Planning(Planning for multiple scenarios)
Bad Data(Too aggregated limited scope too late unreliable)
Understanding governance and the political will to change Bad pictures
(Show causal drivers Read Tufte)
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
10 Ten Issues Reduced tax revenues will lead to continued
cutbacks
Security will drive the re-centralization of the IT organization and governance
LTE and reduced latency will drive delivery of true applications to cellular
Retro-fitting cellular infrastructure
How will we deal with the lsquoCloudrsquo
Antiquated IT organization structure and processes
Control of mobile devices and the further dispersion of corporate information
Dependency on vendor supplied software reduces ability to innovate
Analytics will be the lsquonew frontierrsquo
The rise of the Project Management Office
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
Questions
- Slide 25
- Slide 26
- Slide 40
- Slide 45
- 10 Ten Issues
-
