UK HealthCare IT Transformation HIMSS 2013

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IT Transformation Tim Tarnowski & Vince Willoughby March 2013 DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

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UK HealthCare, an Academic Medical Center in Lexington, KY, highlights of a recent transformation of the Information Technology function. Topics covered include IT Assessment, IT Mission, Vision and Values, IT Governance, IT Strategic Plan and IT Balanced Scorecard. By Tim Tarnowski & Vince Willoughby, March 2013

Transcript of UK HealthCare IT Transformation HIMSS 2013

  • 1. IT Transformation Tim Tarnowski & Vince Willoughby March 2013DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
  • 2. Conflict of Interest Disclosure Tim Tarnowski, CIOVince Willoughby, Strategy Development Has no real or apparent conflicts of interest to report. 2013 HIMSS
  • 3. Learning Objectives Define the process to align IT strategies with medical and business strategies Explain one approach on how IT Governance can prioritize potential IT investments against medical and business metrics Describe how UK HealthCare transformed their IT function by using a framework to define Key Attributes of a World Class IT Organization
  • 4. UK HealthCare Overview Lexington, Kentucky March 2013
  • 5. University of Kentucky Lexington, Kentucky
  • 6. Ranked No. 1 Hospital in Kentucky Nationally ranked in the top 50 for Orthopaedics Ranked high-performing in 10 specialties Cancer Diabetes & Endocrinology Ear, Nose & Throat Gastroenterology Geriatrics Gynecology Nephrology Neurology & Neurosurgery Pulmonology Urology6
  • 7. Information UK HealthCare Five Focus Areas Technology Academic Medical Strengthen 200+ FTEs Center Subspecialties Hybrid FTE Model: State, Not for Profit Expand Geographic Central Reach De-Central Three Hospitals Improve Cost Best of Breed 80+ Sub Specialty Effectiveness Clinics Patient Safety & 1,500 Physicians Satisfaction 8,000 Employees Maintain Financial Key Statistics: Strength 825 Beds 34,453 Discharges 448,673 O/P Visits
  • 8. Dedicated to Patient CareHospitals Outpatient Services UK Albert B. Chandler Hospital Kentucky Clinic UK Good Samaritan Hospital UK Polk-Dalton Clinic Kentucky Childrens Hospital Kentucky Clinic SouthAreas of Excellence UK Family Care Center Gill Heart Institute 80 specialized clinics 150 outreach programs Kentucky Childrens Hospital Kentucky Neuroscience Institute Six Healthcare Colleges Markey Cancer Center Dentistry Maternal-Fetal Medicine Program Health Sciences Orthopaedic Surgery & Sports Medicine Medicine UK Transplant Center Nursing Pharmacy Public Health
  • 9. Benchmark on Discharges UK HealthCare - Benchmarked against COTH Median Teaching Hospital10,200 9,200 8,200 7,200 6,200 5,200 4,200 Shaded area includes Good Samaritan & Chandler 3,200 2004 Q1 2004 Q3 2005 Q1 2005 Q3 2006 Q1 2006 Q3 2007 Q1 2007 Q3 2008 Q1 2008 Q3 2009 Q1 2009 Q3 2010 Q1 2010 Q3 2011 Q1 2011 Q3 2012 Q1 2012 Q3 UK HealthCare Median Teaching Hospital 75th Percentile Teaching Hospital 25th Percentile Teaching Hospital
  • 10. Our Strategic Priorities IT will be a fundamental organizer inrelationship development and making improvements to care delivery. Michael Karpf, MD EVPHA, UK HealthCare June 2011
  • 11. IT TransformationUsing World Class IT Attributes UK HealthCare, Lexington, Kentucky March 2013
  • 12. 2009 Current State Assessment Internal Data Collection/Information Gathering Nov/Dec-08 Interview Summary I.T. Staff Survey (73% Response Rate) I.T. Senior Management Group Reviews Walkthrough I.T. Areas Feedback from Colleagues/Peers Customer Satisfaction Survey External Advisory Services Review 2007 I.T. Assessment/Strategic Plan Participated in Benchmarking Analyze/Benchmark I.T. Structure
  • 13. Current Healthcare IT Industry Trend Source: Healthcare Advisory Board, Innovation Center, 2010
  • 14. The Challenges Evolution of HIT Focus Decade Computing Type Billing 1960 Mainframe Clinical 1970 Minicomputer Billing/Clinical 1980 Computer for Masses Healthcare Reform 1990 Internet Healthcare Reform,ACO, Medical Home, 2000 to HIT Arrives etc. Today Source: Healthcare Information Systems, Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4
  • 15. Conclusions of 2009 Current State Assessment (CSA) Customer IT Staff I.T. is Critical to Success of UK Silos/Lack of Teamwork HealthCare Fragmented Org. Structure Need Enterprise Focus & Integration Confusing Roles & Resp. Current Level of I.T. Services is Lacking Tools & Methods Sub-Standard Not Addressing Low Performers Lacking Overall Strategies/Plan Poor Communication Upcoming Major I.T. Projects Reactive/Not Proactive Weak Infrastructure
  • 16. Future State Needs From 2009 CSA Industry is Rapidly Transforming I.T. is Critical to Success of UK HealthCare Prepare to Meet Healthcare Industry Trends Immediate Tactical Plans for Major I.T. Projects Improved I.T. Governance High Performing I.T. Function Overall I.T. Vision, Strategies & Roadmap
  • 17. I.T. Assessment Conclusions (Updated 2010) Focus Decade Computing Type Billing 1960 Mainframe Clinical 1970 Minicomputer Billing/Clinical 1980 Computer for Masses Healthcare Reform 1990 Internet Healthcare Reform, ACO, Medical Home, 2000 to HIT Arrives etc. Today Source: Healthcare Information Systems,Concept: Our Anticipated Focus Areas 2010 + Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4 Performance Excellence, Always On Improvement & Value Forecast 2010 + Computing Creation
  • 18. Transformational ChangeDenial CommitmentConfusion TeamworkApathy SatisfactionNumbness Clear focus and planIf I ignore this, it will go away. Sign me up!Yeah, right, theyve said this Acceptancebefore.Resistance ExplorationAnger & Fighting Brainstorming new ideasWithdrawal FrustrationCant sleep at night Have a lot to doI gave my all and look what I Trouble focusingget. Open to new thingsI dont like it. How can we do thingsLoss of morale, productivity and differently?communication Source: Unknown
  • 19. Transformational Change White to Blue Totally Transform Our DNA: Gradual Process Allows Acclimation Organized/Documented Transition Walkthrough Changes Over Periods of Time Repeated Messages & Themes Learning Cycles
  • 20. Transformational Change Directly Addressing the Tough Issues is the Work of LeadershipMaintaining Status Quo/Avoiding the Issues Appears to be Easier in the Short Term Outdated Job Descriptions Lack of Infrastructure Investments Immature Methods, Tools, Processes Creates Very Difficult Long Term Issues We Are Here Very UncomfortableLeading Transformational Change is Very Hard Work
  • 21. Transformational Change Year One Roadmap Topic Current State First 4 Months Middle 4 Months Last 4 Months Future StateAcclimation New Employee Orientation, SuperVISION Meet Key Customers Meet Key Customers New Exec. Director Session Acclimated Meet Key Customers Tour/Visit Common Sep Dec 2010 Conference Rooms & Buildings Discuss How Obtain Health ServicesAssessment of Inconsistent Review Operations, Initial Recommendations Obtain Approval for Improvement Method asOperations, Methods & Policies & Procedures Initial Goals Recommendations & Goals Std. Operations &Processes, Processes Learn Current Processes, Final Assessment Road Map to World Class Measurement ScorecardMethods, Tools Methods, Tools Draft of Performance I.T. Service Delivery Scheduled Rounding Clear & In-Depth Scorecard, Service Level Final Performance with Key Customers Understanding of Current Agreements Scorecard Professional IT State Establish Rounding Implement Rounding for Operations Methods Assessment First Draft, Process & Schedule for Key Key Customers (ITIL, SLAs, etc.) Opportunities for Customers and Staff World Class I.T. Service Improvement, Options- Delivery Pros-Cons-Recommend Improve UK HealthCareHR Fragmented Meet Staff Market Wage Survey Lean Training Program for Organization Structure Structure, Review Job Descriptions Career Ladders Areas of Responsibility HR Programs Unclear Roles & (JAQs), Roles & Succession Plans Improvement Method Responsibilities Responsibilities Development Plans Development Program Develop Organization Lean Training Internship Program Structure Participate in Shaping I.T. RestructuringBudget Current Budget Learn Capital & Operating Identify Cost Savings Implement Cost Savings Cost Savings BudgetsProjects Projects Review Key Projects Work with PMO to Record All Projects Managed Managed Collect Inventory of all Projects in PMO Registry Through PMO & In PMO Differently to Projects in Area of Registry Varying Degrees Responsibility of Success
  • 22. World Class IT Attributes Service Strategies IT Governance World Class Attributes Passport IT StrategiesUsed by Permission; Corporate Executive Board, Key Attributes of the World-Class Information Technology Organization.
  • 23. Add Reference
  • 24. IT Transformation Using World Class AttributesUSING WORLD CLASS ATTRIBUTES: Provides a Framework for a New Team Creates a Common Language Good Tool to Build TeamworkADDITIONAL COMMENTS: This is One Approach Other Frameworks Can Be Used Pick Something & Stick With It
  • 25. IT AlignmentUK HealthCare, Lexington, Kentucky March 2013
  • 26. Aligned ITSP Interview Teams with Org Chart Questions: Strategies Activities How Can IT Help?
  • 27. Eight IT Strategies Foundation for IT Approaches Very Long Term
  • 28. IT Strategic Plan Service Strategies IT Governance World Class Attributes Passport IT Strategies
  • 29. IT Strategic Plan Service Strategies Ambulatory Services Strategy What Ambulatory Services is Doing How IT Can Help
  • 30. Benefits of IT AlignmentMAIN BENEFIT: Ensure IT Investments are Directly Contributing to Medical & Business StrategiesADDITIONAL BENEFITS: Align Strategic Plans (IT & Business) Market Your IT Function IT Governance Participation/Ownership
  • 31. IT GovernancePrioritization Process UK HealthCare, Lexington, Kentucky March 2013
  • 32. Add Reference
  • 33. IT Governance IT Governance World Class I.T. Service Delivery Physician IT Infrastructure &Project Priorities Data Warehouse Service Requests Advisory SecurityGrowth/Outreach Data as Strategic Usability Usability Always OnUnified Comm. Asset EMR Interoperability Computing EMR MD Clinical Decision IMPACT (Improving Pt. Care Documentation Support Using IT)
  • 34. ONEList Demand Management
  • 35. ONEList Rate vs. Signature Metrics e n l lenc dati o e ty l enc p act Safe y Exce m enIT Exec. Council Rating: IT Governance Rating: xcel ienc th I m0 = No Impact L = Low l ity & re ecom ice E Effi c emi c1 = Little Impact M = Medium l Sco Gr ow3 = Moderate Impact C = Critical Qua Serv R Acad9 = Significant Impact Tota ITG# Ref Request Name 807 519 73 817 127 Totals by1 1 Patient Access & Registration/Revenue Cycle 9 9 0 9 9 362 40 Ambulatory EMR (Single Patient Record) 9 3 3 3 9 273 174 Central Telemetry monitoring (cockpit) 9 9 0 9 0 274 4 Closed Loop Barcode Med Administration 9 9 0 9 0 275 5 CPOE-OR-Co-Path/SCM 9 9 0 9 0 276 155 Intraoperative CPOE (SCM Orders to OR) 9 9 0 9 0 277 6 Intrapartum utilization of GE 9 9 0 9 0 278 193 BCMA-Bar Coded Medication Administration 9 9 0 9 0 279 181 Co-location Data Center Space 3 3 0 9 9 2410 14 Core Measure / NSI Hardwiring 9 3 3 9 0 2411 11 Develop Data Center Strategy 9 3 0 3 9 2412 3 Develop Integration Engine Strategy 9 3 0 9 3 2413 15 EMR Completion 9 3 3 9 0 2414 13 Order set clean up 9 3 3 9 0 24
  • 36. ONEPage Executive Summary How will requested item relate to signature metrics?
  • 37. ITSP How IT Can Help 10 Year Funding Model Project Name FY13 FY14 FY14 FY15 Single Patient Record $0 $0 $0 $0 Remote Clinic Access 0 100 100 100 Referring Physician Access 00 00 Clinic and Building Growth 0 250 250 250 Standardization of Clinic Systems 00 00 Practice Management System 00 00 Patient Access 00 0 500 Role-based System Access 00 00 Standardized Model Clinics 050 50 50 GRAND TOTAL $400 $400 $900 Sample Amounts
  • 38. Benefits of IT Governance PrioritizationMAIN BENEFIT: IT Governance Decides Which IT Investments Meet Medical and Business Strategies.ADDITIONAL BENEFITS: IT Governance Participation/Ownership Organize Approved/Unapproved Requests
  • 39. ResultsUK HealthCare, Lexington, Kentucky March 2013
  • 40. UK HealthCareIT Leadership Structure Assoc. V.P. & CIO CMIO Tim Tarnowski Carol Steltenkamp, MDJanuary 2013 I.T. Service Line Director - COM Steve Welch Architects: I.T. Portfolio Mgt Applications Technology Executive I.T. Security Director Informatics Executive Michelle Gerding Executive Director Executive Director Director Doug Fee Director Ben Nicholls Michelle Cassin Doris Miller Mark Eimer Cecilia Page Strategy Analyst: Vince Willoughby
  • 41. UK HealthCareIT Leadership Structure Assoc. V.P. & CIO CMIO Tim Tarnowski Carol Steltenkamp, MDJanuary 2013 I.T. Service Line Director - COM Steve Welch Architects: I.T. Portfolio Mgt Applications Technology Executive I.T. Security Director Informatics Executive Michelle Gerding Executive Director Executive Director Director Doug Fee Director Ben Nicholls Michelle Cassin Doris Miller Mark Eimer Cecilia Page Strategy Analyst: Vince Willoughby Support (Apps, Tech, Security) Architecture Strategy & Stabilize Select & & Implement Optimize (Informatics) Transition (PMO) (All) Innovate (Innovation)
  • 42. IT Team Composition All Staff 2009 All Staff 2010 All Staff 2011 2% 3% 6% 33% 65% 97% 94%Leadership 2009 Leadership 2010 Leadership 2011 17% 3% 3% 49% 48% 97% 83% UK HealthCare UK External
  • 43. Results: IT Governance Top PrioritiesITG Top Priority 2009 2010 2011 2012 2013AssessmentIT TransformationNew HospitalCommunity Hosp.Ambulatory EMR Selection RolloutData Center Move AppsARRA/MUICD-10/Regulatory
  • 44. http://ukhealthcare.uky.edu/IT/
  • 45. Passport for Our Improvement Journey
  • 46. Passport for Our Improvement Journey
  • 47. UK HealthCare IT Capital Spend (2002 2012) & Forecast (2013 2023) (Figures in $000s) TCO Avg. $43M Capital Avg. $26M
  • 48. Lessons Learned UK HealthCare, Lexington, Kentucky March 2013
  • 49. Lessons Learned Restructuring: Does Not Equal Team Building Challenge to Maintain Service Delivery While In Process Need to Develop Common Language/Understanding Customer Demand Always > IT Supply Critical Success Factors are: ONEList Customers Prioritize Requests Against Signature Metrics Customer Turnover Impacts Priorities Over Communication is NOT Possible
  • 50. Lessons Learned IT Strategic Plan: Help Areas Without Documented Strategies Alignment is a Very Difficult & Repetitive Process World Class Attributes Multiple Years to Build Establishes a Common Language/Understanding IT is All About the TEAM
  • 51. Transformation without workand pain, without suffering,without a sense of loss is justan illusion of true change. Source: Cross Roads, by William Paul Young
  • 52. Thank You! [email protected]@uky.edu www.ukhealthcare.uky.eduwww.ukhealthcare.uky.edu/IT March 2013