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					Planning for the Successful Deployment
    of an Electronic Medical Record

      George Mason University
     College of Health and Human
               Services
              James L. Oakes, Jr., Principal
         Health Care Information Consultants LLC
                   joakes@hcicllc.com


              Health Care Information Consultants, LLC
                              James L. Oakes
   Thirty years in healthcare information systems and management engineering
   Extensive experience as an operating manager, vendor executive, and consultant
   Specializes in helping healthcare providers plan and optimize use of information resources,
    systems, and technology to improve clinical, operational, and financial outcomes
   Worked with return on investment methodologies and analysis for over 25 years and pioneered
    the use of healthcare-specific economic analysis of healthcare information technology, including
    financial, clinical, and decision support
   Developed and deployed healthcare value-based planning methodology for healthcare now
    adopted at a 600 bed regional medical center, a nationally known pediatric referral center, etc.
   Served as interim Chief Information Officer in 3 healthcare institutions in financial or operational
    turnarounds and provided CIO level leadership assistance and development in 12+ others
   Assisted in the development of a business case and pilot methodology for a community-wide
    health information exchange initiative (HIE) and currently working on planning and implementation
    options for a statewide HIE
   Co-authored the recently released book, Return on Investment for Healthcare: Maximizing the
    Value of Healthcare Information Technology (HIMSS 2003 book of the year) and advocates the
    development of a disciplined business case for technology investments
   Appeared on the Hospital Satellite Network and spoken at numerous professional conferences,
    including CPRI, HFMA and HIMSS on such issues as effective governance, value realization, and
    strategy alignment
   Holds a Bachelor of Industrial Engineering and a Master of Industrial Management




                                    Health Care Information Consultants, LLC
                          “The Press Can’t
                            Tell You What to
                            Think, but They
                            Can Tell You
                            What to Think
                            About…”

                                           John Naisbitt




Health Care Information Consultants, LLC
HIMSS 18th Annual Leadership Survey



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


                  Improving Quality of Care                                                69%
                                                                        36%
            Patient (Customer) Satisfaction                                       55%
                                                                                51%
                                                                                52%
                         Medicare Cutbacks         N/A

    Increasing Need for Healthcare Services                                   45%
                                                   N/A
              Adoption of New Technology                              38%
                                                                  29%
                         Demand for Capital                        31%
                                                            18%
                                                                  29%
                  Availibility of Clinical Staff           17%
      Decrease in Health Insurance Benefits                       28%
                                                   N/A

                                                         2006 Results     2007 Results




                               Health Care Information Consultants, LLC
Life in the 21st Century




     Health Care Information Consultants, LLC
Health Care Technology in the 21st Century

• Still predominately paper
  based
• Systems not
  interoperable
• Slow, expensive
  implementations
• Increasing public
  pressure to “do
  something”
• Continuing economic
  pressures


                    Health Care Information Consultants, LLC
            Terms Defined

•   EMR
•   EHR
•   CPOE
•   IHE
•   HIE
•   RHIO
•   EIEIO


             Health Care Information Consultants, LLC
Why was the casualty rate so
  high in the civil war?




         Health Care Information Consultants, LLC
      State of the Industry - Reality

• Successful CPOE implementations are still
  rare
• Fully functioning EMRs are at least as rare
• Much of the information in the record will
  continue to be paper-based for years to
  come
• A failure can cost the CIO his or her job
• Failure to act can cost his or her job

               Health Care Information Consultants, LLC
     Less than 4% of US Hospitals Using CPOE

                                                                                         CPOE Hospitals Possible

   Cerner Millennium                                                                     CPOE Hospitals Verified

         CliniComp

      Eclipsys SCM

      Eclipsys TDS

        Eclipsys XA

      Epic EpicCare

       GE Centricity

       IDX Carecast

       IDX LastWord

  McKesson Horizon

     MEDITECH C/S

  MEDITECH MAGIC

      Misys Patient1

    Siemens Invision

            Custom

                       0        5           10           15            20           25         30          35


The yellow bar represents the number of hospitals verified in 2003

                                              Health Care Information Consultants, LLC
 1.3-1.8% US Hospitals w/MD’s Entering >50% Orders


Cerner Millennium

      CliniComp                                                <5% Orders Entered
                                                               5-50% Orders Entered
   Eclipsys SCM
                                                               >50% Orders Entered
   Eclipsys TDS

      Eclipsys XA

    Epic EpicCare

    GE Centricity

     IDX Carecast

    IDX LastWord                                                       IP Average:
McKesson Horizon

  MEDITECH C/S
                                                                   54% MD’s entering
MEDITECH MAGIC                                                     orders, with a very
   Misys Patient1

 Siemens Invision
                                                                   small percent (1.3-
         Custom
                                                                  1.8%) entering >50%
                    0   5   10           15             20              25            30
                                                                      of the orders


                             Health Care Information Consultants, LLC
HIMSS 18th Annual Leadership Survey


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


     Reduce Medical Errors/Promote Patient Safety
                                                                                         54%
                                                                                       50%
       Replace/Upgrade Inpatient Clinical Systems                                     48%
                                                                         29%
                               Implement an EMR
                                                                                     48%
                                                                                    45%
       Business Continuity and Disaster Recovery                              35%
                                                    N/A

    Integrate Systems in Multi-Vendor Environment                          34%
                                                                       27%
   Connecting IT at Hospital and Remote Locations
                                                                           33%
                                                                             36%
                      Process/Workflow Redesign
                                                                         30%
                                                                            35%
                Improve IS Departmental Services
                                                                        28%
                                                                       26%

                                                          2006 Results        2007 Respondents




                                   Health Care Information Consultants, LLC
HIMSS 18th Annual Leadership Survey


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


    Reduce Medical Errors/Promote Patient Safety
                                                                                          54%
                                                                            35%
      Replace/Upgrade Inpatient Clinical Systems                                    48%
                                                                           33%
                              Implement an EMR
                                                                                    48%
                                                                           32%
      Business Continuity and Disaster Recovery                             35%
                                                                     25%
   Integrate Systems in Multi-Vendor Environment                           34%
                                                                  21%
  Connecting IT at Hospital and Remote Locations
                                                                        33%
                                                                     26%
                     Process/Workflow Redesign
                                                                       30%
                                                                    24%
               Improve IS Departmental Services
                                                                      28%
                                                              17%

                                                               In Two Years       Today




                                     Health Care Information Consultants, LLC
HIMSS 18th Annual Leadership Survey



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


                                                                      32%
       Fully Operational System                                24%
                                                         18%
                                                                         37%
              Installation Begun                                        36%
                                                                               42%
                                            6%
                Signed Contract      N/A
                                           4%

                                                      16%
    Developed Plan to Implement                               24%
                                                            22%
                                              8%
                   No Plans Yet                    12%
                                                         17%
                                       1%
                    Don't Know        1%
                                      1%

                   2005 Results    2006 Results     2007 Results




                           Health Care Information Consultants, LLC
15

     Health Care Information Consultants, LLC
            IT Strategy Alignment
                                                                           Future

                                                                          Competitive
                                         Short Term                       Advantage
                                                            Increased
                                                          Effectiveness

                                 Increased
   Today                         Efficiency
            Cost of
             Doing
            Business
Necessary
   Evil




                       Health Care Information Consultants, LLC
                IT Planning Process
The process used to develop the plan is comprised of nine
phases, with each phase “building” from the information gathered
in the previous phase.

                                                                 Prepare Program Action Plan/
                                                   Phase 9
                                                                         Tactical Plan

                                              Phase 8         Prepare IS Strategic Plan


                                         Phase 7                ROI Analysis

                                                     Develop Gap Analysis and
                                    Phase 6
                                                    IT Strategies and Initiatives

                                                     Perform Current
                               Phase 5
                                                   Environment Analysis

                          Phase 4              Define Future State


                     Phase 3        Conduct Needs Assessment

                                Confirm Business Vision
               Phase 2
                                     and Strategies

           Phase 1             Organize Project




                               Health Care Information Consultants, LLC
              FSLHC
             Strategy
            Strategy


           Business
         Business and &
       Clinical Initiatives
              Clinical
             Initiatives


       Information Technology
         IT Strategy
          Strategy & Portfolio
          St rategy & Portfolio




    IT Tactical Plan
         IT Projects




Health Care Information Consultants, LLC
The planning process includes an assessment of the current state
and defining a future state. The resulting gap analysis laid the
foundation for the recommended IS strategies and tactical plans.



                           Common
                       Themes/Interviews

       Current MIS Environment
               Analysis
                      IT Attributes Exercise

                                                                                Strategies
                                                                                Tactical
                                                                                Plans
                    EMR Adoption
                       Model           IS
                                     Vision
       Operating     IT Attributes
       Principles      Exercise
                       Davies Award Winners
         IS Goals
                              Analysis




                                     Health Care Information Consultants, LLC
               For Example…

•   A metropolitan community hospital
•   Full service medical/surgical
•   Busy emergency services
•   Competitive environment
•   Battle for market share




                 Health Care Information Consultants, LLC
        Mission Statement and Vision
• Mission Statement
   – We are a not-for-profit healthcare provider guided by the needs of our
     patients and community. We distinguish ourselves through service
     and clinical excellence, affiliations with the XXX and YYY, and state-
     of-the-art technology and facilities. We are committed to continuous
     improvement and appropriate use of resources. We create an
     environment that encourages the success and fulfillment of our
     physicians, staff, and volunteers.
• Vision
   – ZZZ Hospital Healthcare System will set the standard for excellence
     in healthcare in the metropolitan region. Through our affiliations, we
     aspire to provide world-class patient care, technology, and clinical
     research.




                          Health Care Information Consultants, LLC
         Business and Market Drivers
• Development of services based on community need, market
  position, competitors’ positions, margin, recruitment, etc.
• Continuing shift from acute care to outpatient services
• Development of alternate physician practice models:
   – Based on locale and structure of local health care market, and market
     forces (e.g. Number of practices, practice size, strengths and
     weaknesses of local hospitals, patient demographics, etc.)
   – Objective of changing flow of patients and delivery of healthcare
     services
   – Combat particular physician shortages
• Organizational alliances and partnership models
• Increasing expenditures (faster than general rate of inflation)
• State regulated revenues (70% regulated, 30% negotiated) and
  other regulatory requirements




                          Health Care Information Consultants, LLC
        Business and Market Drivers
• Emphasis on quality, safety, expense control
• Focus on shortage of professional staff such as RNs and other
  clinical technicians
• Continuing capital constraints
• Consumer awareness, patient satisfaction, customer service
• Need for readily available clinical information
• Emphasis on Return on Investment (and more recently “Value”) as
  part of purchasing decision
   – “Balanced scorecard” including non-financial (quantitative and
     qualitative) and financial measures




                         Health Care Information Consultants, LLC
                            Key Strategies
• Demonstrate flexibility by promoting patient care and physician
  strategies:
    – Traditional acute care
    – Off campus services and joint services
    – Increased focus on physician practices
         • Develop stronger relationships with physicians and tie physicians into the
           organization
         • Make it an easy place for physicians to practice; “Endear physicians” and
           improve MD satisfaction
         • Demonstrated successes:
              – Hospital-based physicians including Hospitals, Intensivists, Radiologists,
                Emergency Medicine, Anesthesiologists, etc.
              – Specialty Care Medical Group
• Differentiate through program development where expertise and
  base exist
    –   Orthopedics (Joint program has doubled in volume since its inception)
    –   Trauma (County trauma center)
    –   Neurology and Neurosurgery (NIH protocol)
    –   Oncology (Focus on differentiation strategies)
    –   Open Heart Surgery

                                 Health Care Information Consultants, LLC
                       Key Strategies
• Stabilize existing outpatient programs and partnerships
  and capitalize on new programs/partnerships/alignments

• Focus on quality and patient care
   – Improve in State, JCAHO and other regulatory measures
   – Advance existing and conduct new internal process
     improvement initiatives
       • Medication reconciliation
       • Patient throughput and turnaround
           – ED to inpatient
           – ICU to non-critical care units
           – Recent implementation of observation status
   – Improve patient satisfaction




                          Health Care Information Consultants, LLC
                      Key Strategies
• Continue to develop human resource strategies to address
  personnel shortages and retain talent
   –   Recruitment
   –   Benefits and compensation
   –   Recognition and reward
   –   “Make ZZZ an easy place to work”
   –   Improve employee satisfaction
• Improve financial position
   – Grow volumes
   – Stabilize existing outpatient programs
   – Advance partnering opportunities (e.g. XXX
• Promote image of “smaller community hospital doing big hospital
  things”
   – Cross between smaller hospital and high tech
   – Increase awareness of community outreach programs
• Continue development and execute campus enhancement program



                         Health Care Information Consultants, LLC
        Start where you are…..

• Understand and document current
  environment
• Consider all applications
• Be prepared for surprises




              Health Care Information Consultants, LLC
                             Current Information Systems Environment: Application Portfolio
             ACCESS                                           Electronic            REVENUE                                                   CLINICAL
                                             Billing
                                                               Claims                                                                             Clinical
                                              AR                                                                                Results                                Patient
                                                             Submission                                       Order Entry                          Data
  Registration         ADT                                                                                                     Reporting                            Assessments
                                                                                                                                                Repository
                                           Electronic                            Electronic
                                            Claims            Collections
  Enterprise                                                                     Payment                                                              MD Clinical         Clinical
                     Eligibility           Scrubber          Management                                       Care Plans/    Interdisciplinary
  Scheduling                                                                      Posting                                                             Document-          Decision
                                                                                                              Pathways            ClinDoc
                                                                                                                                                        tation           Support
                                            Medical             Denial
                                           Necessity           Tracking                                                                                Physician         Document
                                                                                                                    CPOE             EMPI
                                                                                                                                                        Access            Imaging

ANCILLARY/DEPARTMENTAL             Medication           Med Admin         Emergency           ED
                                                        (barcoding)       Department       Physician                                                    ENTERPRISE RESOURCE
                                   Dispensing                                                                   General         Accounts
                                                                                          Documentation                                                      PLANNING
                                                                                                                Ledger           Payable

 Pharmacy          Laboratory      Radiology               PACS             Surgery      Anesthesiology
                                                                                                              Budgeting/         Fixed                  Cost              Time &
                                                                                                              Forecasting        Assets              Accounting         Attendance
 Pathology         Microbiology    Blood Bank             Rehab                                  EKG
                                                                              ICU
                                                        (PT, OT, Sp)                            (Muse)
                                                                                                               Human                              Materials             Executive
                                                                                                                                 Payroll
                                                                                                              Resources                          Management             Support
     Help            Quality          Case               Infection         Disease
     Desk          Improvement     Management                                                  Cardiology
                                                          Control         Management
                                                                                                               Decision                               Facilities
                                                                                                                                 Security
                                                                                                               Support                               Maintenance
    ADE             Incident       Utilization
 Surveillance       Reporting                           Transport           Dietary           Endoscopy
                                    Review
                                                                                                              HIM          Chart                                          Dictation &
   Report            Tumor         Radiation            Employee           Employee            Physician                                    Coding        Abstracting
   Writing                                                                                                              Management                                       Transcription
                    Registry       Oncology             Education           Health            Credentialing

  GSI PACS          Trauma          Medical                                Nurse Call
(being replaced)                                        Call Center                           Fund Raising            Core Vendor
                    Registry        Library                                 System
                                                                                                                      Other Vendors
    Staff
  Scheduling                                                                                                          Not Automated

                                                                                                                       Partially Automated


                                                                  Health Care Information Consultants, LLC
                     Today’s Information Flow

Patient/
Family
View
                             Admit
             Blood                                                     Allergies
             Panel

Organization
View                                                                               Progress
                                                     Insurance                       Note
                         Medications                Authorizatio
                                                         n
Process
View




Technology
View

                            Health Care Information Consultants, LLC
    Develop a vision for the future….

• Phase in applications in a logical manner
• If moving towards a “core vendor” strategy,
  phase in as contracts expire
• Look for “quick wins” along the way
• Recognize that users must see continuing
  benefits to support a long term plan
• Be prepared to adapt plan as circumstances
  dictate
• Communicate, communicate, communicate!

                 Health Care Information Consultants, LLC
One Organizations Portfolio – Leading to CPOE



                                                                        CPOE



18 + Months
                                                           Problem
                                                                                  Care Plans
                                                            Lists
 9 Months

                                                                                             Common
  Today                                       Integrated          Nursing
                                                                                              Order
                                               Monitors         Assessments
                                                                                               Sets


                             Outpatient          Document            Electronic         Vital Signs         Online
                            Assessments           Imaging            Signature             I/O’s            MAR


                     Electronic                                                                                    Operating
                                      Clinical             Case                100%              Medical
                       EKG                                                                                          Room
                                      Alerts               Mgmt.              Codified          Necessity
                      Results                                                                                       Mgmt.

                                                                                                                         Physician
               Online             Ad-HOC               Dictation/
                                                                                  Bar Code            Scheduling          Remote
               Results            Reporting          Transcription
                                                                                                                          Access

   Universal                                                     Integrated
                       Patient              Order
    Patient                                                        Home                  Radiology                 LAB           Pharmacy
                     Demographics         Management
      ID                                                           Health


                                               Health Care Information Consultants, LLC
               Tomorrow’s Information Flow
Patient/
Family
View


                                       Admit                                    Allergies
                      Blood
                      Panel                                                       Progress
Organization                                                                       Notes
View
                 Medications
                                                                           Insurance
                                                                          Authorizatio
Process                                                                        n
View




Technology
View



                               Health Care Information Consultants, LLC
                                                                                                                                                                                                                                  Single View of
                                                                                                                                                                                                                                  Virtual Patient
                                                                                                                                                                                                                                  Record

                                                                                                                                                                                                                                                                                                                     Hospital
                                                                                                                                                                                                                                                    ACCESS                                           Electronic            REVENUE                                                  CLINICAL
                                                                                                                                                                                                                                                                                    Billing
                                                                                                                                                                                                                                                                                                      Claims                                                                            Clinical
                                                                                                                                                                                                                                                                                     AR                                                                               Results                                Patient
                                                                                                                                                                                                                                                                                                    Submission                                       Order Entry                         Data
                                                                                                                                                                                                                                         Registration         ADT                                                                                                    Reporting                            Assessments
                                                                                                                                                                                                                                                                                                                                                                                      Repository
                                                                                                                                                                                                                                                                                  Electronic                            Electronic
                                                                                                                                                                                                                                                                                   Claims            Collections
                                                                                                                                                                                                                                         Enterprise                                                                     Payment                                                             MD Clinical         Clinical
                                                                                                                                                                                                                                                            Eligibility           Scrubber          Management                                       Care Plans/   Interdisciplinary
                                                                                                                                                                                                                                         Scheduling                                                                      Posting                                                            Document-          Decision

                                                                                 Hospital                                                                                                                                                                                          Medical
                                                                                                                                                                                                                                                                                  Necessity
                                                                                                                                                                                                                                                                                                       Denial
                                                                                                                                                                                                                                                                                                      Tracking
                                                                                                                                                                                                                                                                                                                                                     Pathways


                                                                                                                                                                                                                                                                                                                                                           CPOE
                                                                                                                                                                                                                                                                                                                                                                        ClinDoc


                                                                                                                                                                                                                                                                                                                                                                           EMPI
                                                                                                                                                                                                                                                                                                                                                                                              tation

                                                                                                                                                                                                                                                                                                                                                                                             Physician
                                                                                                                                                                                                                                                                                                                                                                                              Access
                                                                                                                                                                                                                                                                                                                                                                                                               Support

                                                                                                                                                                                                                                                                                                                                                                                                               Document
                                                                                                                                                                                                                                                                                                                                                                                                                Imaging
                 ACCESS                                         Electronic            REVENUE                                                  CLINICAL
                                               Billing                                                                                                                                                                                 ANCILLARY/DEPARTMENTAL                                                                        ED
                                                                 Claims                                                                            Clinical                                                                                                               Medication           Med Admin         Emergency
                                                AR                                                                               Results                                Patient                                                                                                                                                   Physician
                                                               Submission                                       Order Entry                         Data                                                                                                                  Dispensing           (barcoding)       Department                            General       Accounts                 ENTERPRISE RESOURCE
      Registration        ADT                                                                                                   Reporting                            Assessments                                                                                                                                                 Documentation                                                     PLANNING
                                                                                                                                                 Repository                                                                                                                                                                                            Ledger         Payable
                                             Electronic                            Electronic
                                              Claims            Collections                                                                                                                                                             Pharmacy          Laboratory      Radiology               PACS             Surgery
      Enterprise                                                                   Payment                                                             MD Clinical        Clinical                                                                                                                                              Anesthesiology
                       Eligibility           Scrubber          Management                                       Care Plans/   Interdisciplinary                                                                                                                                                                                                      Budgeting/        Fixed                  Cost              Time &
      Scheduling                                                                    Posting                                                            Document-         Decision
                                                                                                                Pathways           ClinDoc                                                                                                                                                                                                           Forecasting       Assets              Accounting         Attendance
                                                                                                                                                         tation          Support
                                                                                                                                                                                                                                        Pathology         Microbiology                           Rehab                                  EKG
                                              Medical             Denial                                                                                                                                                                                                  Blood Bank                                 ICU
                                                                                                                                                                                                                                                                                               (PT, OT, Sp)                            (Muse)
                                             Necessity           Tracking                                                                               Physician        Document                                                                                                                                                                     Human                             Materials             Executive
                                                                                                                      CPOE            EMPI                                                                                                                                                                                                                             Payroll
                                                                                                                                                         Access           Imaging                                                                                                                                                                    Resources                         Management             Support
                                                                                                                                                                                                                                            Help            Quality          Case               Infection         Disease
                                                                                                                                                                                                                                            Desk          Improvement     Management                                                  Cardiology
                                                                                                ED                                                                                                                                                                                               Control         Management
     ANCILLARY/DEPARTMENTAL          Medication           Med Admin         Emergency                                                                                                                                                                                                                                                                 Decision                              Facilities
                                                          (barcoding)                        Physician                                                                                                                                                                                                                                                                 Security
                                     Dispensing                             Department                            General       Accounts                 ENTERPRISE RESOURCE                                                                                                                                                                          Support                              Maintenance
                                                                                            Documentation                                                                                                                                  ADE             Incident       Utilization
                                                                                                                  Ledger         Payable                      PLANNING                                                                  Surveillance                                           Transport           Dietary           Endoscopy
                                                                                                                                                                                                                                                           Reporting       Review
     Pharmacy        Laboratory      Radiology               PACS             Surgery      Anesthesiology                                                                                                                                                                                                                                            HIM
                                                                                                                Budgeting/        Fixed                  Cost            Time &                                                           Report                                                                                                                 Chart                                          Dictation &
                                                                                                                                                                                                                                                            Tumor         Radiation            Employee           Employee            Physician                                   Coding        Abstracting
                                                                                                                Forecasting       Assets              Accounting       Attendance                                                         Writing                                                                                                             Management                                       Transcription
                                                                                                                                                                                                                                                           Registry       Oncology             Education           Health            Credentialing
     Pathology       Microbiology    Blood Bank             Rehab                                  EKG
                                                                                ICU
                                                          (PT, OT, Sp)                            (Muse)
                                                                                                                 Human                             Materials            Executive                                                        GSI PACS          Trauma          Medical                                Nurse Call
                                                                                                                                  Payroll                                                                                              (being replaced)                                        Call Center                           Fund Raising
                                                                                                                Resources                         Management            Support                                                                            Registry        Library                                 System
        Help           Quality          Case               Infection         Disease
        Desk         Improvement     Management                                                  Cardiology
                                                            Control         Management                                                                                                                                                     Staff
                                                                                                                 Decision                              Facilities
                                                                                                                                  Security                                                                                               Scheduling
                                                                                                                 Support                              Maintenance
        ADE           Incident       Utilization
     Surveillance     Reporting                           Transport           Dietary           Endoscopy
                                      Review
                                                                                                                HIM         Chart                                       Dictation &
       Report          Tumor         Radiation            Employee           Employee            Physician                                   Coding        Abstracting
       Writing                                                                                                           Management                                    Transcription
                      Registry       Oncology             Education           Health            Credentialing

      GSI PACS        Trauma          Medical                                Nurse Call
 (being replaced)                                         Call Center                           Fund Raising
                      Registry        Library                                 System

        Staff
      Scheduling




                                                                                                                                                                                                                                                                                        Physician Office



                                                                                                                                                                                                        Patients




                                       Long Term Care
33

                                                                                                                                                                                       Health Care Information Consultants, LLC
Legend
    System
    yet to be
                    Sequenced or
                    Simultaneous
                                                                                          Electronic
    Installed        Installations                                                         Medical                                         Patient-Centric
                                                                                            Record
                       Orange
                                                                             Web-based               Computerized
                                                                                                                                        Information Systems
   System             Indicates                                                                                                                      February 2007
  Operational           FY 08                                             Viewable Results**           Provider
                      Emphasis                                                                       Order Entry**

  * Installed Quadramed Product
  **Planned Quadramed Product                                Integrated Patient           Web-based               Electronic
                                                                 Monitors**                Physician             Scheduling**
                                                          (OB, ICU, ER, Telemetry)      Remote Access**


                                            Picture Archiving            Care Plans             Outpatient             Clinical            Online
                                            & Communication            Problem Lists**        Assessments**            Alerts**          Medication
                                                 System                                                                                 Administration
                                                 (PACS)
                                                                                                                                          Record**
                                            McKesson HMI
                                       Electronic      Electronic      Document           ED                                Nursing                 Vital Signs
                                      EKG Results     Signature**    Imaging/Storage Documentation                       Assessments**                 I/O**
                                        Pyramis      Quantim e-Sig**      EDM*         & Tracking
                                                                                      T-System EV

                                   OB                Management         Dictation/                       Case             Utilization Review       OR Management
                               QS Sentinel        Ad-HOC Reporting    Transcription                   Management                MIDAS+                 ORSOS
                                                    Crystal Reports Precyse Solutions                   MIDAS+
                                                                           HealthNotes*, SpeechQ

                  Materials                Patient                Order Mgt.             Pathology                Radiology                  Lab                     Pharmacy
                 Management              Registration          Viewable Results        MediSolutions AP             RMS                     Medilab              Affinity Pharmacy*
                 Dimension21              Affinity Reg*       Common Order Sets                                                                                         Etreby
                                          NTierprise              Order Mgmt*
                                      HomeWorks, Mestamed
Clinics/Ambulatory        Home Health              Transitional           Home Medical               Coding             Medical Record             Medical               Billing &
     /Physician            Homeworks                  Care                 Equipment             Quantim Coding*         Management               Necessity             Collections
   NTierprise PM                                    AccuCare                MestaMed               Homeworks                Affinity*             Caremedic        Affinity*, SSI, Medifax
 HealthmaticsEMR                                                                                                        MRI*, MRA*, MRC*            LMRP           MestaMed, Homeworks,
                                                                                                                                                                     Medware, Zirmed
The FOUNDATION REQUIRED to make these components into a Fully Functional Electronic Medical Record includes the following:
1. Business Continuity Plans that provide for Redundant Storage and Communications to ensure constant availability of the systems
2. An adequate number of appropriate user devices connected to a Robust Infrastructure that provides data that is shared (interfaced or integrated) across the
        continuum of care
3. Common Identification of the Patient across the continuum of care
4. Adequate Technical Support to ensure continuous operation.          Health Care Information Consultants, LLC
         Things to keep in mind….

• You can’t do everything at once
• Not all applications need to be state-of-the-art
• Paper will always be with us
• Value is in the mind of the beholder
• You must decide how far out on the “bleeding
  edge” your institution wants to be
• A well implemented system is more valuable
  than a snazzy one that is poorly implemented



                  Health Care Information Consultants, LLC
Understand Your Institution’s Risk Profile

                       The Healthcare Technology
                              Adoption Life Cycle



                                                     Traditional
                                                     Technology
                      Early
                                                   Adoption CurveMainstream
                                                                 Mainstream
                      Market                                                             Market
                                                                                         Market

                                         Chasm
                                                             Pragmatists
                                                             Pragmatists




                                                                                     Conservatives




                                                                                                      Skeptics
         Innovators


                        Early Adopters
                        Early Adopters




        Innovators                                     Mainstream                                    Skeptics




                                          Health Care Information Consultants, LLC
                          No Longer         Last             State of the             Leading             Emerging     In the Lab
                          Supported       Generation             Art                   Edge             from the Lab




                                                       Radiology        Pharmacy
Number of Installations




                                                                                             Automated
                                                                                             Pathways

                                                 EKG

                                                                      Lab




                                                                            EMR
                                                                                                                RFID
                                                       Billing
                             Physician Office                                     PACS
                              Management                                                                                       AI



                                                                                                   Voice
                                                 Budgeting
                                                                                                  Activated
                                                                                                  Systems
                                 Credentialing


                                                                                   Time


                                                                 Health Care Information Consultants, LLC
Differing Views of Value

                      Business
                       View




Process             Application                      Information
 View                 View                              View




                    Technology
                       View




          Health Care Information Consultants, LLC
     Hospital Automation Levels
     for % of Operating Budget
6%

5%

4%

3%

2%

1%

0%
       XXX MIS Actual           State of the Art             High Automation
       Medium Automation        Low Automation



                  Health Care Information Consultants, LLC
  Return on Investment is Essential
      The Economic Value Pathway
                                                             Enterprise Level
                 $$$                                          Financial Strategy
                                                              Marketing Strategy
                                                              Business Line Strategy
                                                              Customer Service Strategy

                  $$                                         Process Level
                                                              Work & Process Redesign
                                                              Functional/Programmatic
                                                               Transformation
Traditional
Healthcare         $                                         Tactical Level
                                                              Incremental Improvement
Industry
ROI
                                                              Automation Benefits (ie, cycle
                                                               time reduction, FTE reduction,
                                                               error elimination)

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

                       Health Care Information Consultants, LLC
 GSH & North
Medical Records
                             Current Process for Mailing Dictation/ Test Results                                         Conversion of Dictation/Test Results to Clinical Messaging
 prints at GSH                            Monday through Friday
                                                                                                                                            Proposed May 2002
    Results of
  Dictation/ Test
 Prints in Medical                        GSH & North Lab                          Medicenter North
                      GSH Cardiology &                          North Cardiology                       North Radiology
     Records                               results print at
                         Radiology                                  Results                                Results
   continuously                                 GSH


   Department             Results of
    highlights          Dictation/ Test   Results printed in                            Results of                                                        Start
physician name on          Prints in        department                               Dictation/ Test
      results            departments                                                     Prints in
                         continuously                                                  department
                                                                                      continuously
                                             Department
                                             matches all                                                                                        At 3PM?? Dictation/ test
  Multiple pages         Department
                                           reports for each                                                                                   results automatically print off
 stapled together         highlights
                                          test, if applicable                         Department                                                   in mailroom sorted
                      physician name on                                                                                                               alphabetically
                                                                                       highlights
                            results
                                                                                   physician name on
                                                                                         results
Mailroom picks up                            Department
 every one hour                                                                                                                                   Mailroom pulls pulls off
                        Multiple pages        highlights
                                           physician name                                                                                        reports by grouping and
                       stapled together
                                                                                     Multiple pages                                           places in envelopes with clear
                                                                                    stapled together                                           labels for addresses & sorts
                                                                                     by department                                                       by weight
 Mailroom date
 stamps reports                            Multiple pages
                      Mailroom picks up   stapled together
                            2x/day

 Reports sorted                                                                                                                                  Mailed to be weighted
                                                                                    Volunteer sorts
   roughly into                                                                                                                                   moved to next room,
                                                                                    alphabetically
 several piles by                         Mailroom picks up                                                                                      weighted and metered
     alphabet                             reports 3-4x/day

 Each pile sorted
 into mail bins of                                                                  Volunteer prints
   specific letter                                                                     off labels                                                Picked up by presort at
                                                                                                                                                        4:30 pm

Stacks resorted
within each letter
 alphabetically                                                                    Volunteer folds &
                                                                                   stuffs envielopes

                                                                                                                                                           End
Mailroom prints off
 labels for each
      report
                                                                                   Labels placed on
                                                                                      envelopes

 Reports folded,
   stuffed in
  envelopes &
    labeled
                                                                                   Reports picked up
                                                                                    by mailroom 2x/
                                                                                         day
  Mail sorted by
     weight




                                  Before                                                                                                           After
   Mail sent to
    presort




       End
                                                                           Health Care Information Consultants, LLC
                                        Sample Cost Data


                           Cost over 5 Years
                              (Rounded)            Hardware 9%       Software 45%          Imp. 40%          Int/Conv 6%
Hospital A                         $10,000,000           $900,000        $4,500,000          $4,000,000            $600,000
                                   $15,000,000         $1,350,000        $6,750,000          $6,000,000            $900,000


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

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


(1) Assumes: 25% increase in hardware, software; 80% increase in implementation; 50% increase in interfaces/conversions
(2) Assumes: 25% increase in hardware; 20% increase in software; 60% increase in implementation; 30% increase in interfaces/conversions




                                                    Health Care Information Consultants, LLC
                                Evolution to Clinical Transformation


                                                                                                       Clinical
Process/Technology Maturity




                                                                                                   Transformation
                                                                                 Process           Doing different
                                                                                 Redesign           things
                                                     Process                 Doing things         Cross-organization
                                                   Improvement                differently           collaboration
                                 Sketchy                                                           Strategic
                                                                             Operational
                                Processes         Doing the same             effectiveness         advantage
                                                   things quicker            Joint IT & Process
                              Data overload      Technology install                                   Dynamic
                                                                              Redesign
                              Little useful info  separate from                                       Partnering
                              Individual heroes   PI                           Process
                                                                               Automation
                                                      Info Silos
                                 Automate
                               Transactions



                                                      Value Creation

                                                    Health Care Information Consultants, LLC
                                Tactical Plan (EMR)   Q2 2007       Q3 2007           Q4 2007           Q1 2008           Q2 2008           Q3 2008           Q4 2008


        Systems in Support of EMR                     M    J    J      A      S   O     N       D   J      F      M   A     M       J   J      A      S   O     N       S
1       Vendor Decision
2       Evaluate, Select and Implement EMPI
3       Evaluate, Selection and Implement eMar
4.a.    Evaluate, Select and Implement
        RFID(Barcoding) Pilot
4.b.    Identify and Implement Other Areas
4.c.    Integrate with Pharmacy and CPOE
5.a.    Continue Roll-out of Clinical
        Documentation Applications: Patient
        Assessments, Interdisciplinary
        Documentation and Care Plans
5.b.    Implement Physician Documentation and
        Charting (Structured Templates)
6       Evaluate, Select and Implement Care
        Management System
7       Evaluate, Select and Implement Disease
        Management System
8       Evaluate, Select and Implement Infection
        Control System
9       Evaluate, Select and Implement
        Anesthesiology System
10.a.   Assess Surgery System
10.b.   Re-implement Surgery System (based on
        assessment findings in 10.a)
11.a.   Assess Document Scanning and Imaging
        System
11.b.   Implementation of Document Scanning
        and Imaging System (Pending
        assessment findings in 11.a)
12.a.   Evaluate and Selection of Portal Solution
        (All Views)
12.b.   Implement Clinician View
12.b.   Implement Employee View
12.c.   Implement Patient View
12.d.   Implement Consumer View
12.e.   Implement Vendor View
13      Evaluate, Select and Implement
        Laboratory Outreach System
        Evaluate, Select and Implement Clinical
14      Decision Support System
15.a.   Assess Clinical Data Repository
        Implement Clinical Data Repository
15.b.   (Pending assessment findings in 17.a)
        Evaluate, Select and Integrate Patient
16      Monitors and Smart-Pumps
        Reasessment of EMR Strategy/Pre-
        requisite Systems for enterprise CPOE roll-
17.a.   out
17.b.   CPOE Pilot
17.c.   CPOE Rollout

                                                    Health Care Information Consultants, LLC
                           Tactical Plan (Non-clinical)

                                             Q2 2007       Q3 2007           Q4 2007           Q1 2008           Q2 2008           Q3 2008           Q4 2008
Non-Clinical Systems                         M    J    J      A      S   O     N       D   J      F      M   A     M       J   J      A      S   O     N       S
Evaluate, Select and Implement Help
Desk System
Evaluate, Select and Implement Human
Resources System
Evaluate, Select and Implement Bed
Management System
Evaluate, Select and Implement
Executive Support System
Web Site Strategy
Evaluate, Select and Implement Eligibility
System
Evaluate, Select and Implement Cost
Accounting System??




                                                       Health Care Information Consultants, LLC
                               Tactical Plan (Services)

                                              Q2 2007         Q3 2007           Q4 2007           Q1 2008           Q2 2008           Q3 2008           Q4 2008
Services                                      M    J      J      A      S   O     N       D   J      F      M   A     M       J   J      A      S   O     N       S
MIS Staff Certifications/Training:
Applications and Technical Staff
Project Management Primer Training:
Applications, Technical and Clinical
Informatics Staff
Process Documentation Primer Training:
Applications and Clinical Informatics Staff
Departmental IT Support
Certifications/Training
Incorporate Required Competencies
(Certifications/Training Requirements) into
Job Descriptions and Performance
Evaluation Process
Assess Training Center Needs (Space,
hardware, software) and Enhance Center
(Based on Findings)
Develop and Implement MIS Cross
Training Program
Develop Vendor Relations Plan




                                                        Health Care Information Consultants, LLC
  Tactical Plan (Technical Infrastructure)
                                            Q2 2007         Q3 2007           Q4 2007           Q1 2008           Q2 2008           Q3 2008           Q4 2008
Technical Infrastructure                    M    J      J      A      S   O     N       D   J      F      M   A     M       J   J      A      S   O     N       S
Replace Deficient Equipment: Fire
Suppression Systems
Replace Deficient Equipment: HVAC
Replace Deficient Equipment: UPS
Replace Deficient Equipment: Racking
Equipment
Execute Data Resilience Plan
SUBTASKS
Develop MIS Facilities Maintenance
Policies and Procedures
Develop Network Closet Maintenance
Policies and Procedures (Including
Ownership and Accountability Policies and
Procedures)
Develop Plan for and Implement Closet
Rewiring
Evaluate, Select and Implement New
Telephone System
Develop Plan for Relocation of Non-Data
Develop Infrastructure to Data Center
Center Based SystemsImpact Analysis
Policies and Procedures (Incorporate as
part of Project Costing)
Evaluate, Select and Implement Select
Network Management System




                                                     Health Care Information Consultants, LLC
                        Tactical Plan (Governance)

                                          Q2 2007       Q3 2007           Q4 2007           Q1 2008       Q2 2008           Q3 2008           Q4 2008
Governance                                M    J    J     A       S   O     N       D   J     F   M   A     M       J   J     A       S   O     N       S
Develop IS Steering Committee Charter

Develop Policies and Procedures: IS
Planning
Develop Policies and Procedures:
Investment Prioritization
Develop Policies and Procedures: Vendor
Selection
Develop Policies and Procedures: Major
Project Structure and Implementation
(Mandatory components to include
Charter, Executive Sponsor, Scope, and
Workplan; other components may
include ROI Analysis and Success
Metrics)
Reassess IS Strategic Plan
Establish Advanced Clinical Systems
Governance Structure




                                                    Health Care Information Consultants, LLC
       Tactical Plan (Information Use/Workflow)



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


Information Use/Workflow                   M    J      J      A      S   O     N       D   J      F      M   A     M       J   J      A      S   O     N       S
Standardize Use of Technology
Applications
Develop policies and procedures to
incorporate workflow analysis as part of
system implementations
Develop polocies to allocate sufficient
hours of training for staff users and
incorporate into job descriptions
STRATEGY FOR
PARTNERSHIPS/JOINT VENTURES,
ETC?




                                                    Health Care Information Consultants, LLC
           Tactical Plan (Culture/Organization)

                                           Q2 2007        Q3 2007           Q4 2007           Q1 2008           Q2 2008           Q3 2008           Q4 2008
Culture/Organization                       M    J     J      A      S   O     N       D   J      F      M   A     M       J   J      A      S   O     N       S
Migrate to More Accountable IS Culture:
Implement Organizational Changes
Develop IS Customer Service Culture:
Develop Service Level Agreements

Develop IS Customer Service Culture:
Develop Operational Support Structure in
support of IS-User Department Support
Model (Charter, Responsibilities,
Performance, SLA Expectations)
Develop and Implement Physician
Engagement Strategy
Evaluate customer service training
programs to enhance/instill customer
service attitude




                                                     Health Care Information Consultants, LLC
   A few words about governance…

• Good governance won’t guarantee a
  successful project, but
• Poor governance will almost certainly
  doom a project




               Health Care Information Consultants, LLC
Governance Defined

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




   Health Care Information Consultants, LLC
          IT Governance Goals

• Create a fast, flexible and effective
  process
• Strategically align decision-making and
  accountability
• Be selective and apply the best thinking
  within the organization so not all decisions
  are sent through governance
• Measure IT performance and value

                Health Care Information Consultants, LLC
     IT Governance Fits Into Overall Enterprise Governance

        Enterprise Governance

                   Mission
                    Vision
                    Values                    • IT Governance is an organized
                                                framework of roles,
                                                responsibilities, policies &
                                                methods used to guide, direct &
    Leadership                     Strategic
                                     Plan       manage IT resources
                                              • IT Governance is an extension
                                                of Enterprise Governance, not
                                                an “island” function delegated
                 Management &                   to IT department
                    Control
                                              • Effective IT Governance
                                                requires executive-level
  Human           Financial                IT   involvement & participation by
 Resource        Governance          Governance
Governance
                                                stakeholders



                              Health Care Information Consultants, LLC
Sources of Projects                                      ISSC Role
• Strategic Business Initiatives                                   CFO
• IT Vision and Plan                                               CEO
• Dept Initiated Requests                                         input
• Maintenance & Upgrades           Requested
                                      $                                                         ISSC Prioritization
                                                                                                Must Have
                       Other IT                                 Available                       Defer
                                                                   $                            Cancel
                     Routine IT

               Other Strategic
                    Initiatives                                                               12 Month IT Plan


                                                                                                Resources
                           CPOE                                                                 Project Plans
                                                                                                Project Budgets




                                                Executive Sponsors and ISSC Membership Responsibilities:
                                                •   Set objectives & policy
                                                •   Measure performance & business value
                                                •   Cascade strategy, policy & goals throughout organization
                                                •   Facilitate communication
                                                •   Establish clear accountabilities
                            12 Month
                                                •   Manage risk
                         Project Portfolio      •   Remove barriers
                                                •   Improve processes, organization structure & knowledge

                                             Health Care Information Consultants, LLC
                         Four “Ares”
Strategic question:                                                     Value question:
•In line with vision                                                    •Understanding of
                          Are we doing                Are we getting
•Consistent with                                                         expected benefits
                            the right                 the benefits?
  business principles                                                   •Accountability for
                             things?
•Contributing to                                                         realization
  strategic objectives                                                  •Relevant metrics
                                                                        •Benefits realization
                                                                         process
Architecture question:                                                  Delivery question:
•In line with architecture                                              •Management,
•Consistent with principles Are we doing                  Are we
                                                                        •Delivery, change mgt
•Consistent with other        them the                  getting them
                             right way?                  done well?     •Resources to deliver
  initiatives                                                           •Required technology
                                                                        •Required capabilities




                             Health Care Information Consultants, LLC
Governance “Map”
    Executive Governance
         Executive Council


    IS Strategic Governance
         Information Systems
          Steering Committee

            IS Management
 Senior Mgmt.                           IT
                                  Department
    Team                           Liaisons




             IT Operations

    IT Staff                          Project
                                      Teams


     Health Care Information Consultants, LLC
                  Areas for Action
•   Systems
•   Governance
•   Services
•   Technical Infrastructure
•   Information Use/Workflow
•   Culture/Organization




                     Health Care Information Consultants, LLC
“Technology is just a matter of
using the right wrench to pound
in the correct screw”




         Health Care Information Consultants, LLC

				
DOCUMENT INFO
Description: Business Case Electronic Medical Record document sample