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AGENDA

University Medical Center of Southern Nevada GOVERNING BOARD

AUDIT & FINANCE COMMITTEE SPECIAL MEETING

June 3, 2015, 4:30 p.m.

800 Rose Street, Las Vegas, Nevada UMC Trauma Building, Conference Room I/J (5th Floor)

Notice is hereby given that a special meeting of the UMC Governing Board Audit & Finance Committee has been called and will be held at the time and location indicated above, to consider the following matters:

SECTION 1. OPENING CEREMONIES

CALL TO ORDER

1. Public Comment

PUBLIC COMMENT. This is a period devoted to comments by the general public about items on this agenda. If you wish to speak to the Committee about items within its jurisdiction but not appearing on this agenda, you must wait until the “Comments by the General Public” period listed at the end of this agenda. Comments will be limited to three minutes. Please step up to the speaker's podium, clearly state your name and address and please spell your last name for the record. If any member of the Committee wishes to extend the length of a presentation, this will be done by the Chair or the Committee by majority vote.

This meeting has been properly noticed and posted in the following locations:

University Medical Center CC Government Center Third Street Building Regional Justice Center

1800 W. Charleston Blvd. 500 S. Grand Central Pkwy. 309 S. Third St. 200 Lewis Ave., 1st Flr.

Las Vegas, NV Las Vegas, NV Las Vegas, NV Las Vegas, NV

(Principal Office)

City of Las Vegas City of Henderson

400 Stewart Ave. 240 Water St.

Las Vegas, NV Henderson, NV

• The main agenda is available on University Medical Center of Southern Nevada’s website http://www.umcsn.com. For copies of agenda items and supporting back-up materials, please contact Cindy Dwyer, Board Secretary, at (702) 765-7949. The Audit & Finance Committee may combine two or more agenda items for consideration.

• Items on the agenda may be taken out of order.

• The Audit & Finance Committee may remove an item from the agenda or delay discussion relating to an item at any time.

• Consent Agenda - All matters in this sub-category are considered by the Audit & Finance Committee to be routine and may be acted upon in one motion. Most agenda items are phrased for a positive action. However, the Governing Board may take other actions such as hold, table, amend, etc.

• Consent Agenda items are routine and can be taken in one motion unless a Committee member requests that an item be taken separately. For all items left on the Consent Agenda, the action taken will be staff's recommendation as indicated on the item.

• Items taken separately from the Consent Agenda by Committee members at the meeting will be heard in order.

NOTICE AND CALL OF SPECIAL MEETING

2

2. Approval of Agenda (For possible action)

SECTION 2. BUSINESS ITEMS

3. Review and discuss proposals for a Consultant to assist with the process of replacing the Electronic Health Record (EHR) clinicals products, and make a recommendation to the Governing Board for final selection; and take other action as deemed appropriate. (For possible action)

COMMENTS BY THE GENERAL PUBLIC A period devoted to comments by the general public about matters relevant to the Committee’s jurisdiction will be held. No action may be taken on a matter not listed on the posted agenda. Comments will be limited to three minutes. Please step up to the speaker’s podium, clearly state your name and address and please spell your last name for the record.

All comments by speakers should be relevant to the Committee’s action and jurisdiction.

UMC ADMINISTRATION KEEPS THE OFFICIAL RECORD OF ALL PROCEEDINGS OF UMC GOVERNING BOARD

AUDIT & FINANCE COMMITTEE. IN ORDER TO MAINTAIN A COMPLETE AND ACCURATE RECORD OF ALL

PROCEEDINGS, ANY PHOTOGRAPH, MAP, CHART, OR ANY OTHER DOCUMENT USED IN ANY PRESENTATION

TO THE BOARD SHOULD BE SUBMITTED TO UMC ADMINISTRATION. IF MATERIALS ARE TO BE DISTRIBUTED

TO THE COMMITTEE, PLEASE PROVIDE SUFFICIENT COPIES FOR DISTRIBUTION TO UMC ADMINISTRATION

AND COUNTY COUNSEL.

THE COMMITTEE MEETING ROOM IS ACCESSIBLE TO INDIVIDUALS WITH DISABILITIES. WITH TWENTY-FOUR

(24) HOUR ADVANCE REQUEST, A SIGN LANGUAGE INTERPRETER MAY BE MADE AVAILABLE (PHONE: 765-

7949).

Consultant Selection Process

Presentation to UMC Audit & Finance CommitteeJune 3rd 2015

Scoring Criteria

Dell TRG Cordea

• Completeness of Response 1 1 2

• Prior Experience 1 1 1

• Methodology 1 2 2

• Team Composition 1 1 1

• Understanding Scope 1 1 1

• Ability to Support 2 1 2

• Price Proposal 2 1 2

Scoring Scale 1=Good 2=Acceptable 3=Unacceptable

Proposal Overview

All three respondents touched all 17 areas of the proposed

statement of work.

All three respondents would do all or any subset of the

proposed statement of work.

Dell had the most intensive resource heavy proposal, with

a minimum of 9 to 12 resources, un-named at this time.

TRG is Brian Rosenberg the owner of TRG, he is local and

would be performing 100% of the work himself.

Cordea is Andy Vassallo the owner of Cordea & Jerry

Davis a senior partner, both would be the only two

individuals performing 100% of the work, traveling when

needed Monday – Thursday, no guarantee of when or

who would be onsite.

Price ProposalsDell’s proposal breaks the work into 3 sub parts with multiple resources, there

is no way to break down an hourly rate, however, the deliverables would all

get accomplished.

Executive Delivery Advisor $250,000.00

System Selection $615,000.00

Change Management $365,000.00

Travel & Expenses @18% $221,000.00

Total for 30 months $1,450.000.00

TRG’s proposal breaks the work down by an average of 110 – 125 hours per

month for 30 months @ $190 per hour.

Brian Rosenberg/30 month average $669,000.00

Cordea’s proposal breaks the work down by a monthly retainer of $30,000 for

months 1-18 and $25,000 for months 19-30.

Andy & Jerry Months 1-18 $540,000.00

Andy & Jerry Months 19-30 $300,000.00

Travel & Expenses @18% $160,000.00

Total for 30 months $1,050,000.00

Pro’s & Con’sDell is a very well known international company with several years in the

Healthcare Services Vertical, they are highly regarded in the industry by

both KLAS and Gartner. They bring specific highly trained resources to

the table. They are not local and the resources cannot be named until the

contract is signed, they will choose from the bench when the contract is

signed and we will get what is available. They will likely work Monday

through Thursday on a travel schedule and be available only normal

business hours.

TRG (Brian Rosenberg) has over 16 years in the Healthcare Services

Vertical, founding, running, and then selling (RPI Consultants) a

successful healthcare consulting business. No industry ranking. Personal

interview with Brian, very personable and knowledgeable, UMC believes

he has the expertise to handle this Statement of Work very well.

Cordea (Andy Vassallo) is a Healthcare only consulting company, Andy &

Jerry have over 60 years of healthcare consulting between them. No

industry ranking. They are not local. Personal interview with both Andy &

Jerry, both are very healthcare experienced and knowledgeable, UMC

feels confident that they can handle the Statement of work very well.

Questions

UMC PROJECT – REPLACE MCKESSON HORIZON

Project Summary University Medical Center (UMC) has recently completed a long journey to select and implement the McKesson Horizon product. The transition to that product has proven to be challenging with the solution not fully meeting the expectations of the user base. In addition, UMC has learned that the Horizon product will be sunset in March of 2018. UMC is now faced with a significant challenge. The Horizon product must be replaced by the sunset date. While that date is nearly three years away, the replacement of this solution represents as large of an effort as the original implementation of Horizon. The fact that the current system will no longer be supported in the future creates an absolute need to make this replacement happen and requires that the medical center move forward at an aggressive pace. At the same time, there is a desire to improve upon the lessons learned from the Horizon implementation through stronger user community engagement. UMC needs to deliver a solution that will meet the basic needs of replacing Horizon, but also wants to improve end user satisfaction, create more efficient workflows, and increase the availability of metrics and information that will allow for better informed decisions that leads to improved patient care and increased profitability for the medical center.

Statement of Work to be Performed

1. Identify the Project Objectives

2. Benchmark the Current State

3. Clearly Define Future Desired State

4. Create a Project Charter

5. Create and Distribute the RFI

6. Establish Universal Buy-In through an Inclusive, yet efficient, process 7. Establish a strong team – and teach them to act as a team 8. Lead the Vendor of Choice Selection

9. Assist with Negotiation of the Contract to obtain Optimal Pricing

10. Evaluate implementation options and assist with negotiation of the implementation contract

11. Create the implementation strategy and project management structure

12. Facilitate Change Management at all stages of the project

13. Create metrics to measure success, and a continuous improvement strategy 14. Monitor the quality of work completed by internal and external resources and ensure accuracy,

completeness, and honesty in project status reporting

15. Provide a monthly Quality Assurance report to project sponsors and the board

16. Tracking and monitoring the project budget

17. Complete post-implementation benchmarking

Request for Proposal

Project:

Replace McKesson Horizon

Submitted to:

University Medical Center of Southern Nevada

Submitted by:

Cordea Consulting, LLC

May 8, 2015

Proprietary and Confidential Cordea Consulting, LLC Page 2 of 14

May 8, 2015 MJ Ernie McKinley Chief Information Officer University Medical Center of Southern Nevada 1800 W Charleston Blvd. Las Vegas, NV 89102 Re: Replace McKesson Horizon Dear Mr. McKinley, Cordea Consulting LLC (Cordea) is pleased to respond to your RFP for assistance on the Project to Replace McKesson Horizon. Cordea is well-prepared and qualified to provide the project assistance as outlined in your “Statement of Work to be Performed” and in support of your goals to:

• Improve upon the lessons learned from the Horizon implementation through stronger user community engagement

• Deliver a solution that will meet the basic needs of replacing Horizon • Improve end user satisfaction • Create more efficient workflows, and • Increase the availability of metrics and information that will allow for better informed decisions

that lead to improved patient care and increased profitability for the Medical Center Cordea understands the challenge of implementing a new “core” information system and the critical importance of organizational alignment, engagement, and adoption. We understand the necessity to learn from the past and have the right objectives, metrics, workflow and monitoring in place to ensure organizational satisfaction, patient care improvement, fiscal responsibility and overall success. Cordea is uniquely qualified for this engagement, in particular:

• Cordea is solely focused on and committed to the healthcare industry and in assisting our client organizations to plan for, select and implement those technologies that best meet their business goals, objectives and budgets.

• As a national healthcare consulting firm we can bring the best consultants, regardless of location, to bear for our clients.

• Because of the critical nature of your engagement Cordea will assign two of our executives to your project. These two consultants combined have nearly 60 years of healthcare consulting


experience and have conducted numerous systems planning, selection, contract negotiations and implementation engagements with all of the major HIS vendors.

• As a privately held firm, Cordea has the autonomy, flexibility and nimbleness to accommodate UMC, unlike publicly owned firms

Further, Cordea Consulting’s founders, and the Cordea team, have served the healthcare IT industry in a variety of roles including executive, consultant, analyst, architect, vendor, trainer, program/project manager, and subject matter expert. Cordea Consulting is dedicated to serving clients to help them achieve the most efficient healthcare systems and processes. Cordea’s success with our clients lies in our ability to assign a team of consultants with the required skills and bring them to bear for our clients. Cordea understands that UMC is looking for a highly qualified consulting firm with skills in:

System Planning Program/Project Management System Selection Change Management Contract Negotiations Team Facilitation HIS Vendor Technologies Optimization Mr. McKinley, we look forward to the opportunity to support UMC. I would be happy to meet and further discuss our services with you and the UMC team. Please contact me with any questions regarding our RFP response. Sincerely,

Jerry Davis Andy Vassallo Vice President President Cordea Consulting, LLC Cordea Consulting, LLC


Table of Contents

Main Response

I. Background & Objectives II. Project Scope III. Project Approach & Deliverables IV. Engagement Staffing V. Professional Fees and Expenses


I. Background & Objectives

University Medical Center (UMC) has recently completed a long journey to select and implement the McKesson Horizon product. The transition to that product has proven to be challenging with the solution not fully meeting the expectations of the user base. In addition, UMC has learned that the Horizon product will be sunset in March of 2018. UMC is now faced with a significant challenge. The Horizon product must be replaced by the sunset date. While that date is nearly three years away, the replacement of this solution represents as large of an effort as the original implementation of Horizon. The fact that the current system will no longer be supported in the future creates an absolute need to make this replacement happen and requires that the Medical Center move forward at an aggressive pace. At the same time, there is a desire to improve upon the lessons learned from the Horizon implementation through stronger user community engagement. UMC needs to deliver a solution that will meet the basic needs of replacing Horizon, but also wants to improve end user satisfaction, create more efficient workflows, and increase the availability of metrics and information that will allow for better informed decisions that lead to improved patient care and increased profitability for the Medical Center.

II. Project Scope

The scope of this project is focused on the planning, selection and implementation of a new HIS to replace the McKesson Horizon product. Cordea’s scope will include the following items as outlined in the UMC “Statement of Work to be Performed”:

1. Identify the Project Objectives 2. Benchmark the Current State 3. Clearly Define Future Desired State 4. Create a Project Charter 5. Create and Distribute the RFI 6. Establish Universal Buy-In through an Inclusive, yet efficient, process 7. Establish a strong team – and teach them to act as a team 8. Lead the Vendor of Choice Selection 9. Assist with Negotiation of the Contract to obtain Optimal Pricing 10. Evaluate implementation options and assist with negotiation of the implementation contract 11. Create the implementation strategy and project management structure 12. Facilitate Change Management at all stages of the project 13. Create metrics to measure success, and a continuous improvement strategy 14. Monitor the quality of work completed by internal and external resources and ensure

accuracy, completeness, and honesty in project status reporting 15. Provide a monthly Quality Assurance report to project sponsors and the board 16. Tracking and monitoring the project budget 17. Complete post-implementation benchmarking


III. Project Approach & Deliverables Phase 0 – Kick off and Initiation

• Initial on-site visit • Team introductions • Confirm expectations and project scope • Identify key stakeholders • Identify key leadership and team involvement • Confirm team structure • Confirm reporting requirements • Perform any UMC badging and authorizations required • Establish work space and tour facilities • Other tasks and activities as requested by UMC leadership 1. Identify the Project Objectives

• Work with UMC’s leadership to establish a complete list of project objectives for the McKesson

replacement project. • Establish a list of key leadership and employees who will participate in this activity. Suggest

representation from all major departments and functions of the organization. • Perform interviews with key stakeholders to gather information. • Send “objectives” questionnaire to a broader set of participants. • Consolidate, normalize and analyze the information collected. • Share information with project sponsor. • Refine and clarify as necessary. 2. Benchmark the Current State

• Benchmark the current state of the McKesson system. • Document the high-level functional utilization and satisfaction with the McKesson System. • Perform departmental walk-throughs and document observations • Interview key leadership

3. Clearly Define Future Desired State

• Working with leadership clearly defined the desired future state and expectations of a new

system. • The desired state would be defined in clear measurable expectations. We would avoid the

temptations to state expectations using buzz words or feel good language that just makes everyone feel good.

• The above activities will be accomplished through interviews and working sessions with frank, meaningful dialog around expectations.

• We will ask the why, then drill down and ask why again and again until a clear picture develops.



• Create a project charter for the replacement system. • Project charter will be anchored by a strong scope statement. • The project charter will include but not be limited the following sections: (sections may be

modified by UMC) o Business justification. o Stakeholder list o Scope o Success criteria o Major structure and roles for the project o High level Schedule o Assumptions and constraints.

• Facilitate charter approval by stakeholders


• Facilitate UMC deciding on a short list of HIS vendors/applications that can replace McKesson and meet the business requirements of UMC

• Prepare a vendor RFI including but not limited the following items: o ability to meet key business requirements o technical requirements o interface requirements o one-time and ongoing costs o Implementation approach o staffing requirements o vendor background information o relevant references o long term vendor vision and R&D plans o User function scenarios

• Issue RFI to vendors • Work with stakeholders and departments to ensure a full list of requirements and objects are

mapped to vendor solutions in the RFI. • Work with finance, purchasing, and other departments necessary to issue the RFI.


6. Establish Universal Buy-In through an Inclusive, yet efficient, process Work with executives and mid-level management to establish and assist with facilitation of an organizational buy-in process. Our methodology will focus on the following:

• Build trust with in the team(s) (This ties into Activity 7) • Make organization aware of the change • Inform organization why the change is necessary • Educate the organization on the benefits / Improvements of the change • Allow organization to participate • Reinforce all of the above, over and over and over again

We recommend the process include a combination of written and live face to face communication in the above areas. Communication should be tailored to be specific to level and department of the organization. Messaging of the who, what, when and why should be tailored to include a system view, a patient view and a personalized view for each person’s area of concern. 7. Establish a strong team – and teach them to act as a team We facilitate and lead the following team building sessions:

• Five Dysfunctions of a Team, online assessments • Five Dysfunctions of a Team, workshops for all executives and mid-level management. • Johari’s Window, team exercise • Team “start/stop” exercise • Team “Contributing / Distracting strengths” exercises.

Additionally you might want to consider having the organization take a Myer-Briggs assessments (optional). Five Dysfunctions of a Team mythology is based on Patrick Lencioni’s book of the same name.


8. Lead the Vendor of Choice Selection • Cordea will prepare a summary analysis of the vendor RFI responses to present and discuss

with the Selection Team • Provide a vendor reference call evaluation template and facilitate completion of vendor

reference calls • Provide vendor product demonstration evaluation templates and facilitate onsite vendor

product demonstrations, including a focus on system capabilities meeting specific business requirements of UMC as outlined in the RFI

• Cordea will update the summary analysis of vendors based on vendor reference calls and product demonstrations. Cordea will present and discuss the updated vendor summary analysis with the Selection Team and facilitate the decision of a vendor of choice (VOC) or if further analysis and evaluation is needed.

• If further analysis and evaluation is needed to determine a VOC, such as additional product demonstrations or reference site visits, Cordea will participate and facilitate that analysis and evaluation as needed.

9. Assist with Negotiation of the Contract to obtain Optimal Pricing In this phase we begin the iterative process of developing an agreement that reflects the business aspects of the proposed deal including pricing, deal content, and structure. We will work with UMC to develop and coordinate efforts for managing vendor communications and other interactions to identify and resolve your issues and questions. We will focus our assistance in this area on the pricing, financial and implementation areas of the contract.

• Prepare for contract negotiations • Facilitate negotiating and contractual terms strategy sessions. • Participate in negotiating sessions


Same as activity #9, only for Implementation. While the price of implementation is important and we will participate and facilitate negotiating optimal pricing, we will focus implementation negotiations on expected outcomes. • Facilitate UMC decision on a overall implementation approach. • Prepare for contract negotiations • Facilitate negotiating and contractual terms strategy sessions. • Participate in negotiating sessions


11. Create the implementation strategy and project management structure We work with the selected vendor and IT and business leaders to develop the implementation strategy. This will be the overall strategy for the implementation and not the actual project plans or pre-implementation activities. The detailed implementation process and activities may be highly dependent on which vendor is selected. Some vendors have a very specific method and process that must be followed for the detailed technical implementations. The enterprise level implementation strategy will include but not be limited the following:

• Governance and oversight definition • How decisions (technical and workflow) will be made • Where decisions will be recorded • Conversation strategy • Customization / consideration parameters • Resource strategy • Risk management strategy

The enterprise level project management structure will include but not be limited the following:

• Follow any existing UMC best practices that exist today • Follow the PMI standard methodology as general framework. • Define change control process • Communications plan • Budget reporting • Issue reporting and escalation.

12. Facilitate Change Management at all stages of the project We suggest facilitating the change management process using the Kotter process. The following are the main steps of the methodology: • Establishing a Sense of Urgency • Creating the Guiding Coalition • Developing a Vision and Strategy • Communicating the Change Vision • Empowering Employees • Generating Short-Term Wins • Consolidating Gains and Producing More Change • Anchoring New Approaches in the Culture Dr. Kotter is an internationally known leader in the change management field and author of the book Our Iceberg is Melting. If UMC has a preferred, alternate change management methodology we will facilitate that process.


13. Create metrics to measure success, and a continuous improvement strategy We will facilitate the development and agreement of the metrics to measure success. In general we believe that simple, easy to understand and measure metrics make the best choices. We will facilitate SMART metrics, defined as follows: • Specific – target a specific area for improvement. • Measurable – quantify or at least suggest an indicator of progress. • Assignable – specify who will do it. • Realistic – state what results can realistically be achieved, given available resources. • Time-related – specify when the result(s) can be achieved. Additionally, metrics will align with all of the activities and deliverables described in this proposal. 14. Monitor the quality of work completed by internal and external resources and ensure accuracy, completeness, and honesty in project status reporting Cordea’s veteran management team will ensure the project is a success with proven Program Management techniques, on site presence, governance participation and clear, transparent and timely communication regarding the program. • Perform Quality Assurance (QA) & Reporting

o Monthly onsite executive review o Participate in governance meetings o Track and monitor scope, deliverables and budget o Assist in issue and risk monitoring and resolution o Track and monitor success metrics

• Review supplier deliverables

15. Provide a monthly Quality Assurance report to project sponsors and the board We will provide an executive monthly quality assurance dashboard. This includes a comprehensive view of the project and metrics. In addition to providing the dashboard we will also present the report to stakeholders and the board as requested. 16. Tracking and monitoring the project budget We will track and report the project budget.


17. Complete post-implementation benchmarking Using the success and key performance metrics identified in pre-implementation activities we will now measure those same metrics post-go live to review and analyze whether improvements were achieved.

• Measure success and key performance metrics identified in the pre-implementation activity • Compare and analyze the differences between pre- and post-go live metrics • Prepare a presentation summarizing the findings of pre- vs. post-go live success and key

performance metrics • Present findings to executive management and key stakeholders


IV. Engagement Staffing

Cordea will assign a seasoned project team of consultant having the requisite skills and expertise in IT systems planning, selection, contract negotiations, implementation and optimization. Andy Vassallo and Jerry Davis, listed below, will be the primary consultants assigned to the project.

Consultant: Role: Certifications / Licenses

Years in Healthcare Experience Summary:

Andy Vassallo (Primary)

Executive Consultant

Certified Advisor 22

• Strategy Execution Leadership • Forecasting & Strategic Planning • Operational Execution & Efficiency • System Selection & Contract

Negotiations • Project & Risk Management • Continuous Process Improvement • Project Recovery • M&A Evaluation • Profit & Loss Management

Jerry Davis (Primary)

Executive Consultant MBA 35

• Strategic IT Planning • Information Systems Selection and

Analysis • Contract Negotiations • Project Management • Physician/Clinician Adoption • Process Redesign/ Productivity

Improvement • Information System Design and

Implementation • Go-Live Support Services


V. Professional Fees & Expenses

Cordea will provide the services listed above for the following fixed monthly professional fee:

Description: Monthly Pro Fee: Months:

Consultant Team

$ 30,000 1 - 18

Consultant Team

$ 25,000 19 – end of project

• Cordea will be on site between 24 and 30 weeks per year. • On site weeks are considered Monday (am) and Thursday (afternoon) travel.

In addition to professional fees, Client will reimburse Cordea for all project-related expenses (e.g., travel, meals, lodging, etc.). Cordea will use commercially reasonable efforts to minimize such expenses. UMC Obligations:

• Provide adequate work space to perform the services. • Provide access to documents, employees and system to perform the services. • Make project (strategic and tactical) decision as necessary and communicate in a timely

manner to allow the team to perform the services. • Help eliminate project roadblocks (as necessary) that the engagement team may face. • Provide basic administrative support to support the project.

May 15, 2014

Mr. Ernie McKinley, CIO University Medical Center – Southern Nevada 1800 W. Charleston Blvd. Las Vegas, NV 89102 Dear Mr. McKinley,

Dell appreciates the opportunity to provide a response to the University Medical Center of Southern Nevada (UMC)’s McKesson Horizon replacement project request Our goal is to provide successful oversight of the development, distribution, and completion of a system selection process, and transition oversight of the system implementation and deployment activities. We will do this by leveraging best practices and lessons learned through many years of similar and successful initiatives with other customers.

It is important for UMC to know that Dell is committed to you and will provide a unique and flexible partnership that ensures project success, while focusing on long-term system stability. The services we provide will support and optimize the work of your team as you replace the Horizon system.

Our team recognizes the importance of using a proven methodology and dedicated subject matter experts (SME’s). UMC’s stated objectives and desire to obtain industry-leading services were the guiding principles used to develop our proposal. Those same objectives and principles are what we will use to deliver consistent, innovative, and quality services as your “Trusted Advisor” partner. Our customer-focused principles include:

● Reduced cost: A solution scaled and staffed to meet the unique requirements of UMC

● Great service: Efficient, consistent, and transparent services focused on Continuous Improvement initiatives

● Right fit: A team specifically assembled to meet your unique needs while leveraging our deep experiences; inclusive of Executive commitment and Dell program sponsorship focused on your success

● One team: Commitment to our combined teams (UMC and Dell) for a service delivery approach predicated on collaboration with a goal to exceed expectations

● Purposeful innovation: Project expertise and thought leadership using our proven methodologies to create new ways of solving problems unique to UMC’s business processes, cultural barriers, and technology environments

Dell is confident our proposed approach is the right one for UMC. We look forward to beginning the project and participating in your journey together. If you have questions or need additional information, please contact me.

Sincerely,

Greg Watson

Professional Services Leader / Engagement Delivery Dell Services | Global Healthcare Consulting 615 947 7092 [email protected]

mailto:[email protected]

University Medical Center of Southern Nevada

System Selection and Replacement Consulting

Dell Services Proposal

May 15, 2015

January 13, 2015

Table of Contents

1 University Medical Center| DELL CONFIDENTIAL

Table of Contents

Table of Contents ........................................................................... 1

A. Proposal Confidentiality ............................................................... 0

B. Dell Background Information ......................................................... 1 Healthcare Experience ............................................................................... 1 Why Dell Services? .................................................................................... 1 What Can Dell Provide? .............................................................................. 2

C. Scope & Project Plan – Executive Delivery Advisor .............................. 4 1.0 Scope ................................................................................................ 4 2.0 Project Timeline .................................................................................. 5 3.0 Deliverables ........................................................................................ 5

D. Project Participants – Executive Delivery Advisor ................................ 7 1.0 Primary Resource ................................................................................. 7 2.0 Additional Resources ............................................................................ 7 3.0 Reporting relationships .......................................................................... 7

E. Cost Proposal – Executive Delivery Advisor ........................................ 8

F. Additional Services & Resources ...................................................... 9 1. System Selection Assistance ................................................................... 9 Deliverable #1 Project Execution Management ................................................ 11 Deliverable #2 Current State Assessment using ADOPTS .................................... 13 Deliverable #3 Summary Analysis of RFP Responses ......................................... 16 Deliverable #4 Request for Proposal to Replace UMC Electronic Health Record ........ 17 Deliverable #5 Executive Summary VOC Results .............................................. 19 Cost Proposal – System Selection Assistance .................................................. 21 2. Organizational Change Management Assistance ........................................ 21 Deliverable #1 Organizational Change Management ......................................... 23 Deliverable #2 Knowledge Management using Benefits (KPI) Realization ................ 27 Cost Proposal – Organizational Change Management Assistance ......................... 29

A. Proposal Confidentiality

© Copyright 2015 Dell Inc. All rights reserved.

Trademarks

Dell, the Dell logo, and Dell’s products and services are trademarks or registered trademarks of Dell. Other trademarks and trade names may be used in this document to refer to either the entities claiming the marks and/or the names of their products. Dell disclaims proprietary interest in the marks and names of others. UMC has the right to retain a reasonable number of copies of this proposal to allow UMC to adequately review and assess the proposal. Dell grants no license, express or implied to any Dell intellectual property by virtue of this proposal.

Our Relationship

This document is not a binding contract. When we conduct business, our relationship will be governed by Dell's standard terms and conditions unless we negotiate a separate written agreement.

Dell takes care to review and verify the information provided in this document. However, we cannot be responsible for errors or omissions that may occur in the production of this document or as a result of the passage of time. In addition, Dell may improve or change this presentation or improve or change its products and service offerings from time to time, without updating this document. Please contact your sales representative for updates or validation of the information in this document.

Subject to our ability to reach a mutually acceptable agreement on this issue, Dell does take responsibility for the actions of its employees and agents that are performed in the scope of their employment.

Confidentiality

All information supplied to UMC for the purpose of this proposal is to be considered Dell confidential.

B. Dell Background Information

Healthcare Experience

With extensive experience with all major vendor clinical, financial, and administrative applications such as Cerner, Epic, McKesson, and MEDITECH, Dell provides healthcare-specific counsel and integrated end-to-end solutions to support your strategic, operational, and financial goals. Our consulting team includes a dedicated group of doctors, nurses, pharmacists, and other clinicians along with business and technology professionals who specialize in clinical implementations, technology solutions, healthcare operations, and transformational change management. Our suite of consulting services addresses every operational and clinical area, from IT strategy and management to systems implementation, optimization, and adoption. We can provide short-term targeted assistance to execute a critical project or become a long-term strategic partner. We can augment your team in critical areas or provide the expertise to lead a project from start to finish. Regardless of the size of your organization, we apply our proven ADOPTS (Assess, Design, Optimize, Prepare, Transform, Sustain) methodology and Six Sigma and Lean expertise to each engagement. Our ultimate goal is to help you improve the efficiency and quality of your healthcare operations, and in turn, improve your patient satisfaction, employee retention, and quality outcomes.

Our consulting services are organized into four practice areas: • Clinical Solutions • Financial/Revenue Cycle Solutions • Performance Improvement Solutions • IT Planning and Advisory Services

Why Dell Services?

Backed by the experience of delivering healthcare services to care providers for more than two decades, Dell Services offers a range of solutions that can be customized specifically for your organization. Our consulting team harnesses the power of their extensive hands-on healthcare experience, clinical and business process improvement solutions, and enabling technology offerings to help you achieve an environment that is interconnected, streamlined, efficient, and patient-focused. Not since the introduction of Medicare and Medicaid has the healthcare industry seen the level of transformational opportunities that we see today. Our team of consultants understands how to develop, design, and implement solutions that drive performance efficiencies and guide you through the transformational change in healthcare delivery enabled by healthcare IT.

Dell Services believes that we are uniquely qualified to provide the requested services based on our proven ability to obtain results using proprietary methodologies, being recognized in the industry as offering the best healthcare transformation skill set, and our unparalleled history as a provider of services to the healthcare industry.

At Dell Services, we stake our reputation for results on our clients' success. We are proud, not only when Dell Services receives positive recognition, but also when the collaborative relationships we enjoy with our clients yield measurable results and stakeholder recognition for them.

The following table illustrates the recognition Dell has received recently:

Dell has a varied set of relationships with our clients. We provide solutions to our clients that include everything from Strategic Planning to full Information Technology Outsourcing. With our deep relationship with our outsourcing clients, we are involved in leading numerous system evaluation and selection processes. These have included evaluations and selections of EMR systems, clinical ancillary systems, general financial systems, patient billing systems, and administrative and support systems. We estimate that we have performed over 50 of these in the last 5 years.

What Can Dell Provide?

To help ensure the success of UMC’s vendor selection strategy and as you embark on the

journey to replace your McKesson Horizon EHR. Dell can apply our experience through:

Seasoned healthcare professionals that possess great expertise in both the subject matter (Cerner, Epic, McKesson, and MEDITECH EMRs) and the important, specialized project management required for this project’s scope of work (skilled care operations, hospital and clinic health services, data migration, and EMR implementation)

Project executive oversight services; and if needed Dell’s branded project management

methodology (PM3) based upon PMI® standards could be make available. (see

Additional Services and Resources section)

Proven structured selection processes and templates, including demonstrations, score

cards, and site visits while encompassing a flexible comparison and scoring process to

assist in the final selection can also be made available (see Additional Services and

Resources section)

C. Scope & Project Plan – Executive Delivery Advisor

1.0 Scope

Dell understands the challenges facing UMC, and appreciates the fact that, by announcing end-of-life for its Horizon product, McKesson has placed an unnatural time constraint on the selection and replacement of a full suite of EMR functionality.

While UMC faces the daunting task of selecting and replacing a system key to the function of the organization, you are being forced to do so: (A) without the confidence in the vendor’s other systems and platforms, and (B) in a manner that ensures a fully functional replacement within the time constraints imposed.

We see this work as being divided into four components:

1. Replacement vendor selection. This would include the following portions of the scope articulated by UMC in their request for this proposal:

a. Identify the Project Objectives

b. Benchmark the Current State

c. Clearly Define Future Desired State

d. Create a Project Charter

e. Create and Distribute the RFI

f. Establish Universal Buy-In through an Inclusive, yet efficient, process g. Establish a strong team – and teach them to act as a team h. Lead the Vendor of Choice Selection

2. Implementation design and vendor contract negotiation. This would include the following UMC items:

a. Assist with Negotiation of the Contract to obtain Optimal Pricing

b. Evaluate implementation options and assist with negotiation of the implementation contract

c. Create the implementation strategy and project management structure

3. System customization and implementation. Although alluded to in the document, and discussed by phone, there are no items in the UMC list that specifically refer to system implementation. Therefore the Dell proposal is void of any system implementation resources and/or assistance.

4. Project Oversight. Include the following UMC items:

a. Facilitate Change Management at all stages of the project

b. Create metrics to measure success, and a continuous improvement strategy c. Monitor the quality of work completed by internal and external resources and

ensure accuracy, completeness, and honesty in project status reporting

d. Provide a monthly Quality Assurance report to project sponsors and the board

e. Tracking and monitoring the project budget

f. Complete post-implementation benchmarking

We understand that UMC is looking for an Executive Delivery Advisor to provide oversight and accountability to UMC’s Senior Leadership and Board for items 1, 2, and 4 listed above.

2.0 Project Timeline We expect the project to proceed approximately according to the timetable below:

Phase Description Number of

Months Estimated

Start Estimated

End

Vendor Selection Develop requirements, produce RFP, evaluate vendors, reach VOC decision

8 June, 2015 January,

2016

Implementation Planning and Contract Negotiation

Design of implementation project, development of implementation project detailed project plan, negotiation of associated vendor contract(s)

5 February,

2016 June, 2016

System implementation and deployment

Installation of required hardware and software, customization, testing, deployment pilots (if desired), full deployment, issue resolution, transition to steady state.

18 July, 2016 December,

2017

Dell recommends a three-month contingency between the completion of the implementation work and the actual McKesson Horizon sunset date.

3.0 Deliverables

To ensure the project meets industry best practice standards, Dell will compare the project progress and process outcomes to our experience. Dell will begin the project with a Project Executive Workshop designed to ensure that all UMC stakeholders are aligned with the Executive strategic plan, project expectations, and tactical approaches. This includes preparing the organization for next steps, anticipated outcomes, and resource requirements. This “kickoff” workshop will be facilitated by the Dell Executive Sponsor with Dell Professional Services leadership as contributors to paneled discussions. The workshop will be scheduled at the convenience of UMC and at a location that is arranged by UMC. Dell will provide presentational content, agenda and anticipated outcomes in preparation for the journey to choose a new electronic health record system vendor and engage in the implementation of the organizational change that will follow. At the conclusion of this workshop, UMC will be in a better position to determine if they have the appropriate internal resources, methodologies, and governance to successfully complete this journey.

Dell will provide monthly project assessments to the UMC executive team and upon request, to the Board of Directors. The monthly assessments will be performed through project document reviews and interviews with key project stakeholders. Document review work will be done periodically throughout each month. On-site reviews will be conducted during one week each month. Each month, a report of our findings will be produced. This report will include observations, conclusions, recommendations and any required supporting detail, in at least the following areas:

- Organizational structure and effectiveness

- Resource consumption

- Project budget

- Timeline status

- Document content and structure

- Project management report accuracy

And any other areas requested by the UMC executives.

D. Project Participants – Executive Delivery Advisor

1.0 Primary Resource

Enhancing the project governance model defined by UMC, and in support of the anticipated organizational project team involvement, the following resources are being proposed.

Dell will provide a senior Executive Consultant (Executive Delivery Advisor) to perform this work. The Dell Executive Consultant will be responsible for any Dell deliverables, as well as the management of any additional assigned Dell project resources. This individual will provide the regular monthly reports described above.

The resource will have deep expertise in the healthcare industry, in-depth knowledge of EHR functionality, and experience with multiple systems selection and/or implementation projects.

This resource will be deployed for the duration of the project, for a total of 31 months.

2.0 Additional Resources

Dell will provide additional resources during times when the project requires it. These Analysts/Subject Matter Experts will be assigned to address any departmental requirements of this project. We may use four types of SMEs given the enterprise scope of the vendor system replacement and impact on the technology foundation. The resources may be drawn from the following types, based on actual requirements of the project at that time:

Clinical/Ancillary Analyst/SME

Financial Analyst/SME

Technical Analyst/SME

System Selection and Implementation SME

Specific Project and Program Management resources will also be provided to conduct the Project Kickoff Workshop as described above.

A Project Coordinator will be assigned to assist the Dell Project Manager and the Dell project team members, with activates such as document preparation and updates, tracking vendor demo and site visits, assisting in evaluation of vendor responses.

3.0 Reporting relationships

The Dell Executive Delivery Advisor will provide status and quality reports (as noted above). This individual is understood to report jointly to the, executive team, and as requested to the Board of Directors. All other Dell resources will report to the Dell primary resource. All UMC resources will report to the UMC project manager.

E. Cost Proposal – Executive Delivery Advisor

Dell is recommending a senior resource for the duration of the project and additional resources as noted above. It is our anticipation that a significant portion of the work can be conducted remotely, except for on-site interviews and report presentations. Based on these assumptions, and our understanding of the project oversight and reporting requirements, Dell will provide all deliverables, as noted in C.3.0 above, for an estimated fixed professional services fee of $250,000.00. Material changes to the scope, requirements, deliverables, or project timeline may result in changes to this price.

Travel and expenses will be billed at cost separate from professional services fees.

F. Additional Services & Resources

1. System Selection Assistance

Dell’s approach to objective System Selection Assistance will result in two major deliverables: Project Execution Management of the System Selection Process and the Final Executive Report which will summarize the process as well as the UMC Steering Committee’s decision regarding Vendor of Choice (VOC).

Tasks, activities, milestones, and resource allocation will be broken down into phases, consistent with the items on the UMC request for proposal document. In addition, delivery will be performed in accordance to the Dell project management methodology PM3® by a project manager who is capable of providing the caliber of services required for this level of work effort.

1. Develop software RFP requirements for core healthcare systems to replace

the McKesson Star and Horizon Clinical Infrastructure

- Project initiation

- Current state analysis

- Prepare scoring matrix for RFP responses

- Develop the RFP

- Summarize results of Vendor responses

- Coordinate onsite demonstrations

- Coordinate customer site visits with core teams

- Prepare final presentation to Project Director for recommendation of VOC

It is our understanding the successful candidate will provide UMC general project management during the enterprise software system replacement RFP process which will culminate in the selection of an enterprise system VOC. The new enterprise platform will replace current clinical software.

Qualified vendor candidates will be vetted using Dell’s vendor selection methodology. Two qualified VOC(s) will be identified, from which the final selection will be made. Dell will provide the process outcomes to the UMC Project Manager.

Dell will deliver professional services to assist the UMC Steering Committee in the evaluation and selection of the most appropriate vendor for the enterprise software replacement. Dell will provide the tools, templates, processes, and evaluation package for the Steering Committee to use in their decision for VOC.

We believe that in order to maximize benefits from the replacement Electronic Record System,

the collective (UMC and Dell) project teams will need to identify the current business and

clinical requirements in addition to those requirements which support UMC’s strategic plan.

The effort invested by UMC into the proper requirements design and organizational change management activities will result in a VOC that is robust and meaningful to the clinicians, ancillary staff, business departments and information technology team.

Dell’s project team will deploy the most effective combination of healthcare transformation practices, combined with the best practices in the healthcare technology for enterprise systems. In combination, these practices are capable of driving the results that you are seeking.

To help ensure the success of the Enterprise Software Replacement RFP process project, as well to help address the longer term goal of sustained patient treatment, payment, and operational improvements this proposal utilizes:

1. Seasoned healthcare professionals who bring both strong subject matter and project management expertise for the project scope of work.

2. Project management services that use a rigorous project management methodology (PM3®) based upon PMI® standards found in the PMBOK©.

3. A rigorous healthcare transformational methodology (ADOPTS) that is results and user adoption-oriented.

Dell brings the following values to the UMC Enterprise Software Replacement RFP Process initiative including:

1. Project Risk Mitigation—our ability to understand the clinicians’, technicians’ and business managers’ concerns, validate their issues and apply action plans to mitigate the risk of incomplete requirements identification, inter-rater reliability variances and department centric versus system centric selection methods.

2. True Transformation of Healthcare— our subject matter experts (SME) are clinicians, technicians and business analysts who, combined with our methods, will truly be able to transform the way that the UMC stakeholders look at their current state workflows and use of the electronic systems in support of patient care against the future state design the VOC may offer with minimal tailoring, if any.

3. Knowledge Transfer— part of our deliverables to your organization will be tools and templates that are used in the scope of work; we educate your project participants about our methods and approaches and hope that the exchange of information will form a part of a new culture and serve you long into the future. Our SME are watchful for demonstrations or declarations of feature/functionality that is dependent upon customization. Rather, our knowledge sharing and transfer will assist the UMC evaluators see the complexity of customization and leverage instead the VOC tools for configuration.

4. Results—Dell Services has a solid record of gaining results for healthcare clients. Our reputation is built one client relationship at a time and we are willing, capable, and confident that we can help you achieve your results. The comparative analysis of the VOC will provide empirical evidence of the vendors’ virtues and challenges as measured against your UMC specific requirements.

5. Long-term Commitment—we understand the challenges that UMC faces from both an operations and strategic decision perspective with regards to retiring a current clinical information system and replacing it with a net new platform. Dell’s philosophy

is one of being your Trusted Advisor, with a sustained relationship that extends beyond the terms of this project. Dell had the privilege of assisting your Information Technology resources with several McKesson upgrades recently under the direction of a highly trained and respected Project Manager. We hope that our continued good-will and sound relationship with UMC will position Dell to be considered among the top candidates for this project. We understand that success is built one project at a time, and believe this endeavor to find your replacement system will further strengthen that Trusted Advisor relationship.

Deliverable #1 Project Execution Management

Develop software RFP for core healthcare systems to replace McKesson Horizon Clinical Applications Dell Services’ patented Portfolio, Program and Project Management Methodology (PM3®) Methodology incorporates a standardized and scalable set of processes for project management. The UMC requirements for this project and how it will be managed (coordination and governance; clearly delineated roles and responsibilities; consistent method for managing project schedules, risks, issues; and consistent documentation of all project meeting agendas and minutes) are foundational concepts in PM3®.

Project initiation

A package of integrated project documents is created immediately upon receipt of the signed contract for Dell to perform the agreed upon scope of work. The engagement begins with a kick-off week that includes a Project Initiation Workshop and results in the project signed project Charter. Draft project documents are prepared by Dell and then progressed to completion using an iterative process with the UMC project sponsor’s approval. Based upon our understanding of your business needs, we will create a requirements matrix, which maps your project’s main objective to the set of defined deliverables and then to the set of activities that are included in the project schedule. The sum of all the parts becomes your Project Plan Document (PPD), which is reviewed by Dell Services to meet the exacting quality standards set forth in our PM3® project management methodology. The PPD outlines the major project activities, project deliverables, preliminary timelines and resources required during the project’s projected life cycle of 8 months. The start-up activities will be completed within the first week of the engagement, with full-time project management provided throughout the engagement. Integration of knowledge transfer methodologies at the outset is important in building momentum for the system replacement selection project. Knowledge transfer must begin at the very outset of the project along with implementation planning and, continue through the end of the project. Dell Services intends to share our knowledge of best practices derived from experiences with other Dell Services clients, and the industry. Lessons learned are captured

and transferred along with other content and skills so that the UMC participants are self-reliant during the initiation, execution and project close phases. Incorporating knowledge transfer from the beginning enables the end users to be ready in time for the eventual replacement activation. Dell’s approach to defining the phases, activities, anticipated time on task and deliverables at a very high is illustrated by the following set of tables. The coordination of UMC’s schedule and the dates that the Dell project team will be onsite will be the responsibility of the UMC and Dell Project managers, with the help of UMC administrative assistants and coordinators.

Deliverable #1: Project Execution Management

Activities Deliverables

Complete administrative logistics of new project (site access, security etc.)

Complete Project Initiation Workshop PIW

Complete Project Charter

Detailed Project Plan

Develop and approve 10month project schedule (timeline, resources, milestones)

Schedule and conduct meeting with project sponsor to review, validate and approve PPD, Schedule, current project reporting expectation, file formats and electronic file repository for UMC documents

Review current PMO mechanisms and tools

Develop knowledge transfer approach for project deliverables

Organize Kick Off Meeting for project stakeholders at a site to be chosen by the UMC project sponsor

Establish an ad-hoc Project Steering Committee with named participants, duties and time on task expectations

Project Management Documents:

Detailed Project Planning Document

Project Schedule

Deliverables Definition Document

Status Reporting with weekly updates to Project Sponsors

Sign-off acknowledgement of deliverables receipt

Project Management Meetings:

Project Kick Off

Project Management Facilitation:

Governance Meetings

Clinical Department meetings

Business/Revenue Department meetings

Ancillary Department meetings

Information Technology Department meetings

Project Management Presentations

Current State Assessment of UMC’s workflow, utilization of resources, efficiencies

Current State Analysis Report and Recommendations

UMC Resource Requirements

UMC Staff Requirements Timeline and Effort Estimation

Confirm Project Sponsor

Confirm Project Lead or Liaison governance of project

Identify department representatives for Steering Committee based upon consultant recommended roles

Identify workspace location for Dell Services consultants

Provide access rights (e.g. badges, IT systems, policies, procedures, reports) as necessary for the consultants to execute tasks of project

Contract negotiation with Dell Services 2 weeks prior to mutually agreed upon Kick off date

Staff Assignment to Project: 2 hours

Kick off meeting: 2 hours

On-boarding of consultant: 4 hours total (ID Badge, security clearance, IT role and system access)

Committee Meetings: 2 hours, prep and attendance for each:

Steering Committee 2x month

Clinical Committees 1x week

Ancillary Committee 1x week

Business Committees 1x week

Information Technology Committee 1x week

Deliverable #2 Current State Assessment using ADOPTS

The first step in redesigning a workflow process is to completely understand how that process is currently being accomplished. Various techniques will be employed to gather the information needed to complete an assessment of UMC’s workflow, current state. The data that will be assessed will include:

Review of Strategic Plans – UMC’s Information Systems

Confirmation of the UMC’s governance charters’ and bylaws for executives for the medical staff (Quality Assurance responsibilities and authority) and the request for inclusion of representatives on the Executive Steering Committee

Confirmation of Medical Director’s duty to this project, per medical staff bylaw, to support effective governance structure (review of vendor selection process, vendor of choice, application future state design and build decisions)

Organization-wide vs. individual stakeholder roles and responsibilities with respect to the enterprise clinical and business replacement system

Standardization efforts within business and clinical services lines to adopt an integrated electronic record, e.g. physician order sets, clinical documentation, business (financial and clinical) rules, alerts and notifications, formulary, tables, lists, protocols.

Reinforcement of communication among various constituent groups: clinical, ancillary, business/ADT and technical (infrastructure)

Deployment of best practices and anticipated changes to scope of service requirements in anticipation of new system implementation

Improved applications deployment

Support for effective work flow design; and,

Support of order set, rules development and clinical decision support – adherence to defined standards once approved by governing/consenting body

The second step in redesigning workflow is to perform a comparative analysis of the current state with the desired future state workflow process. Workflows that were designed during the pre-implementation phase will be audited for completeness and accuracy to current state operational practices, based upon the changes that are expected to occur with the use of the replacement applications. Each workflow will be used to assist the UMC department manager to develop the requirements needed for the new vendor minimum criteria. The workflows will also be used to confirm correlating sets of supporting clinical knowledge objects e.g. order set, alert notification, escalation of non-compliant workflow use – specifically communication path to clinical quality assurance governance structure (adherence to county, state and federal regulatory mandates). The final step in the future state assessment is the identification and inventory of each stakeholder unit’s business and/or clinical requirements from the yet to be selected VOC. The requirements are then ranked into order by using two distinct categories: mandatory and elective. The vendors must respond to each requirement in the following ways:

Written response against the RFP criteria document

Demonstration of actual response during onsite script completion

The VOC will ultimately respond to each requirement in the resulting proposed contract:

Contractually upon negotiated terms and conditions for UMC implementation

agreement (not in scope of this Dell proposal to assist with VOC contract negotiations).

The first assumption of this project is the future state workflow process for an integrated electronic record for UMC is in alignment with the organization’s strategic plan. The second assumption of the project is that the IT Strategic Plan is in alignment with the UMC’s strategic plan. Understanding the consequence of not using a best practice is addressed by the project team.

Deliverable #2 Current State Assessment and Analysis


Conduct Select Executive, Medical Director, Managerial Interviews

Conduct Select End User Focus Groups

Understand Current State of all Workflows for business and clinical services, e.g. patient records, admissions, billing and collections, scheduling, accounting and related systems

Validate Future State Work Flows expected to occur with newly implemented EHR

Review Communication Plan – internal and external marketing of system replacement project

Identify project champions; develop action plans to gain efficiencies during project

Provide coaching and mentoring to system replacement project Steering Committee and begin implementation of recommendations

Current State Analysis Report- Recommendations for Project Scope and Objectives

current state assessment of IS capacity, caregiver workflow, business processes and required interfaces

current state assessment of project Governance model –department and physicians’ role with respect to the project

current state analysis of communication plan

current state assessment of order entry: procurement, billing, delivery and documentation

Analysis of performance gap between use of current system and desired replacement system

Report of Findings, with Analysis and Recommendations

UMC Hospital Staff Requirements


Project Sponsor to complete data request for purposes of the needs assessment, e.g.:

staff roster, contact info and current organizational chart

Current IT architecture and interface matrix

Current formularies, dictionaries, inventories and tables for financial and clinical support

Current healthcare and business regulations for UMC as they relate to the system replacement project

Stakeholder participation in interviews and onsite direct observation of workflow e.g.

Patient care settings

Pharmacy

Billing

Project Sponsor :

Data Request: 2 hours

Schedule interviews – 2 hours

Onsite direct observation: optional, 2 hours per unit or service area

Sponsor interview: 2 hours

Weekly status report receipt and review: 1 hour

Project Stakeholders:

Interview participation: 1 hour each e.g.:

Medical Director

Executive team

Department Managers

Direct observation of work area, one representative for 1 hour per each unit or service area

Information Services: 2 hours

Deliverable #3 Summary Analysis of RFP Responses

Upon completion of the UMC current state assessment and analysis, a set of business and

clinical requirements will be organized in order of project priority, per the recommendation

of the project Steering Committee. Validation of each requirement set will be the

responsibility of the business lead, clinical lead and information system lead as members of

the Steering Committee. The combined set of requirements will be prioritized and leveraged

for a more complete integration across of units of care or service areas. It is this criteria set

that will be used in the development of the Request for Proposal (RFP).

Additionally, a current state assessment of the information services capabilities will be

identified, including the consequences of non-interfaced applications to the projected future

state EHR (vendor unknown at this point). Vendor solutions to interface requirements will not

be fully addressed until proposals from vendors are received. The preferred options and future

state system requirements for business and clinical needs will be stated in the RFP (Deliverable

#4).

The draft requirements document will be prepared in advance of the Steering Committee. It

is anticipated that a series of meetings with the Steering Committee will be required to

organize the list of requirements into categories that will drive the terms of a negotiated

contract with the proposed Vendor of Choice (VOC). Staging requirements is an iterative

process and is predicated on the future state workflow ideal. The level to which UMC

standardize work products (e.g. forms, assessments, orders, inventory, and reports) will

determine both the type of requirement and the importance of the requirement (mandatory,

optional, or future consideration).

An important component of the vendor selection of the new electronic health record and

product implementation is Change Control. Once definitions for an application are

established, based upon the business or clinical requirement, a change control methodology

will be enacted to capture, monitor, and re-stage priorities. Authorization for actual change

to the vendor build and/or implementation schedule must occur and documentation of the

change request and approval process must be captured. The standard operating procedure

of project plan change management will be adhered to beginning with this phase of work and

with this deliverable. Additionally, an escalation procedure will be recommended and agreed

to by the Steering Committee.

Cost estimations will be projected as case models for the Steering Committee. The actual

costs will not be known until contract negotiation with UMC’s legal counsel once a vendor of

choice has been selected. Note: Actual contract negotiation with Vendor of Choice is out of

scope for Dell Services Consultative Professional Services in this option; however, Dell Services

Consultant(s) will provide UMC contract team recommendations for terms and conditions

with regards to the Vendor of Choice implementation plan, e.g. order of module installation,

staging of modules, vendor-based training obligations, implementation team performance

criteria, etc.

A final document will be prepared by Dell that identifies the preferred options for business and

clinical systems and estimated cost ranges for the optimal set.

Develop System Requirements and Preferred Options


Identify, organize and prioritize clinical requirements for an integrated Electronic Record

Identify, organize and prioritize business requirements for an integrated Electronic Record

Identify, organize and prioritize IS technical requirements for an integrated Electronic Record

Steering Committee Meetings

Validate draft prepared document with Project Sponsor

Prepared, written document identifying preferred options and system requirements for integrated electronic health record for UMC

UMC Staff Requirements


Project Sponsor to Chair Steering Committee meetings

Stakeholder participation in Steering Committee

Medical Director (or rep)

Nursing Director (or rep)

IT Director (or rep)

Risk Manager

Quality Manager

Case Manager

Clinical Depart Directors

Pharmacy

Business Managers

o Patient Accounting o Purchasing o Medical Records o Transcription

Project Sponsor :

Steering Committee: 2 hours per session, minimum of 3 sessions for requirements completion

Project Stakeholders:

Steering Committee: 2 hours per session, minimum of 3 sessions for requirements completion

Information Services: detailed requirements review – 8 – 16 hours

Deliverable #4 Request for Proposal to Replace UMC Electronic Health Record

The Dell Services consultant(s) will prepare a draft Request for Proposal (RFP) document for

the Project Sponsor’s final review and approval.

The RFP draft will include:

General Information

Proposal Development and Submission Requirements

Proposal Clarification Methodology

Proprietary Information Notice

Proposal Requirements

Proposal Submission Process

Proposal Selection and Award Process

Standard Terms and Conditions

Attachments

o Vendor Data Sheet

o Reference Data Sheet

o Cost Proposal

o Appeals Process

o Insurance Notification.

It is assumed that the actual RFP posting will be the responsibility of UMC Purchasing and in

accordance with customary mandates for procurement of services and products for the

organization.

In order to facilitate the vendor selection process, a template will be prepared for vendors to

use in submitting their proposed work to UMC.

Additionally, the Dell Services consultant(s) will assist the Project Sponsor in addressing

questions or clarifications that may arise from the RFP posting, as determined by the existing

UMC protocol for proposal submissions.

Develop the Request for Proposals


Identify, organize and prioritize clinical requirements for an integrated Electronic Record

Identify, organize and prioritize business requirements for an integrated Electronic Record

Identify, organize and prioritize IS technical requirements for an integrated Electronic Record

Prepared, written document identifying preferred options and system requirements for integrated Electronic Record replacement system for UMC



Project Sponsor to provide templates for proposal development to Dell Services Consultant(s), should they be required

Project Sponsor will review draft RFP documents and authorize the release of RFP to post publicly

Project Sponsor will identify time period for posting, Proposal submission and legal requirements of State of NV, UMC in order to comply with said mandates

Project Sponsor will identify proposal submission office and staff member

Project Sponsor will release 2 copies of submitted proposals to Dell Services Consultant(s) for project use (consultant and technical review)

Project Sponsor :

Cohort mandated RFP files – 1 hour

Review/edit draft RFP – 4 hours

RFP report to prep and delivery – 1 hour

Proposal Collection Staff Member:

Cohort materials submitted by proposed vendors – 2 hours

Deliverable #5 Executive Summary VOC Results

Deliver software RFP for core healthcare systems to replace the McKesson Star and Horizon Clinical Infrastructure

- Summarize results of RFP responses from potential EHR system replacement vendors

- Coordinate onsite demonstrations

- Coordinate customer site visits with core teams

- Prepare final presentation to Project Director for recommendation of vendor of

choice (VOC)

Upon receipt of proposal responses submitted for the UMC system replacement RFP, the Dell Services consultant(s) will perform an analysis of the written documents, prepare a summary report that compares and contrasts each vendor against the defined preferred options and system requirements and present those findings to the Steering Committee.

The Steering Committee will review, discuss, and determine those vendors who are qualified to meet the specific business and clinical needs of UMC, using the most integrated and comprehensive approach per the written proposals.

The top candidates will be selected to present onsite demonstrations to the Steering Committee for the purpose of down-selecting the top two candidates.

In preparation for the vendor demonstrations, the Dell Services Consultant(s) will prepare scripts that will be submitted to the vendor in advance of their assigned demonstration date. The Steering Committee, with the guidance of the Dell Services Consultant(s), will request that specific Subject Matter Experts (SME) attend the demonstrations for the purpose of scoring the

vendors performance. Both the prepared vendor scripts and the list of business and clinical requirements will be used to score vendor performance.

The Dell Services Consultant(s) will schedule, organize, set-up, and gather the evaluation scorecards from each SME participant. An analysis of the scorecards will be prepared. A summary of findings will be prepared and presented to the Steering Committee

Vendor Selection


Collect, organize and summarize submissions by vendors for the replacement E H R system

Report vendor proposal analysis to Steering committee

Facilitate vendor selection to top 2 qualified candidates

Prepare necessary scoring tools

Prepare necessary scripts for select vendor demonstrations

Schedule, orchestrate and complete vendor demonstrations for named SME from project team

Collect, organize and summarize findings of SME regarding vendor performance and capability to achieve business and clinical requirements.

Organize and summarize reference checks for vendor performance.

Organize and summarize peer to peer reference calls for vendor performance.

Organize off site vendor site visits, optional activity at the discretion of UMC representative and Project Sponsor

Prepared, written document identifying qualified vendor candidates.

Facilitation of Steering Committee session for the purpose of selecting top 2 qualified vendors

Vendor scorecard tools

Vendor demonstration scripts

Facilitation of vendor demonstration day onsite at a location to be determined by UMC

NOTES:

Actual selection of Vendor of Choice is the responsibility of UMC

Notification to vendors of Steering Committee decision will be done by UMC CIO

Legal counsel is Out of Scope



Project Sponsor, Steering Committee to participate in vendor review and/or demonstrations

Project Sponsor and/or acting agent for UMC to name Vendor of Choice

Project Sponsor and/or acting agent for UMC to seek legal counsel and construct contract for Vendor of Choice.

Project Sponsor :

Vendor evaluation, demonstrations and reference check analysis– 40 hours

Contract negotiations – 40 hours

Optional: Site visit to another facility to see vendor product real time 40 hours (20 hours each vendor with travel)

Steering Committee:

Meetings to review evaluations tools, scripts and vendor demo schedule– 2 hours each for 2 meetings

Vendor demo presentations – 16 hours

Optional: Site visit by SME or committee members – 40 hours (2 vendors each 20 hours with travel)

Cost Proposal – System Selection Assistance

Dell is recommending a senior resource(s) for a period 9 months. Based on these assumptions, and our understanding, Dell will provide all deliverables (1-5 as noted above) for an estimated time and materials professional services fee of $615,000.00. Note: if UMC is only interested in certain components of the 5 deliverables, within the System Selection section of the proposal, Dell will recalculate the estimated professional services fee accordingly. Material changes to the scope, requirements, deliverables, or project timeline may result in changes to this price.


2. Organizational Change Management Assistance

Our approach employs our branded methodologies called ADOPTS (Assess, Design, Optimize, Prepare, Transform, Sustain), which provides a foundation for organizational change and adoption of the proposed change. By using the ADOPTS methodology in concert with the PM3® approach, your stakeholders and project team will move to an implementation decision based upon UMC and industry best practices; in addition to Dell’s lessons learned from prior clients. This leverages the success and progress you have already made at UMC.

The methodologies proposed for use at UMC are the Dell-branded ADOPTS and patented PM3® (Program, Project, and Portfolio Management). Each methodology provides the project

with the tools and templates to manage the scope of work throughout the project’s life cycle, and keeps the stakeholders informed.

ADOPTS is a patented, clinical transformation methodology built on years of experience. ADOPTS focuses on clinical transformation based on organizational change, new applications, processes or functionality.

Some of the key principles related to this methodology are:

This is a ‘vendor neutral’ methodology and approach, one that we apply and tailor to the specific nuances of each clinical information system.

We tailor this methodology based on what we learn from our initial discussions and work with our clients; in other words, it is not a ‘one size fits all’ approach.

The ADOPTS and PM3® documents become the foundation for a clinical transformation. Included in our methodologies is the transfer of knowledge. We believe it is our obligation to your organization to transfer what we have learned so that you can achieve sustained success after the consultative project has concluded.

Our ADOPTS Methodology focuses on these six domains necessary for successful outcomes

Six

Ke

y D

om

ain

s

Governance and Leadership

Our practical approach ensures appropriate stakeholder representation, commitment and accountability.

Workflow Redesign

Process redesign optimizes process and systems efficiencies by concentrating on content, workflow, and functionality.

Change Management

Automated readiness assessment and multimedia communications planning provide targeted education and consistent messaging across multiple venues.

Clinician Participation Adoption

Ensures that clinicians are proactively and thoughtfully included in the planning, decision making, and customization of clinical systems to enhanced clinical use and efficiency.

Benefits Realization

We use core indicators measure clinical, operational, quality, and financial outcomes that are attributable to Clinical Transformation.

TechnologyOptimized technology enablement by focusing on process-driven design; clinical and technical staff following standard project management methodology to ensure accountability and risk management.

This approach provides sustainable results.

The successful development and execution of this RFP for the replacement of the existing system – as well as the implementation of the replacement system - requires a concurrent focus on three dimensions—people, processes, and technology.

This three-dimensional approach will realize a greater depth of understanding and bring value to the participants as we identify changes in the project management workflow, and identify organizational change dynamics and how knowledge is used in the organization.

Our methodology is specifically designed to ensure an efficient and optimal change in project management deliverables. However, no one methodology can stand on its own. The key concern of the implementation of any methodology is to ensure optimal, effective, and measurable results.

Deliverable #1 Organizational Change Management

Our vendor-centric methodology and our highly experienced professional resources continuously refine our implementation strategies and execution to increase executional efficiency and stakeholder satisfaction.

The ADOPTS methodology has within it an extensive toolset that has been developed through almost 30 years of engagements in more than 700 hospitals and healthcare settings and is aligned with the any EHR vendor plan.

Prior to the implementation, a series of pre-implementation processes will assist in efficiently governing the relationship between UMC and Dell, while providing adequate interaction with other vendors/partners. Within these processes, it will be imperative to establish a formalized IT request process to ensure that UMC project leadership team appropriately reviews, approves, prioritizes, and executes the various enterprise-wide infrastructure and application projects, as well as project and operational change requests. This prioritization process will be accomplished by partnering with the current governance organization within UMC.

Our competitive advantage in providing these services to UMC is based on our ability to deploy small teams of highly experienced professionals who collaborate closely with you and your strategic planners to improve your business advantages and resources.

Dell Services’ approach to Organizational Change Management is to focus on removing barriers that may cause end-users to resist or completely reject the workflows designed for the future state. The philosophy is to proactively manage impact points on the organization, department or individual. This approach results in minimal disruption to business and patient care, accelerated implementation adoption and optimization of performance levels (evidenced by positive benefits realization metrics).

VALUE

The following table represents the high level approach to Organizational Change Management for a clinical information system implementation across the six phases of ADOPTS.

The 6 domains promote the alignment of people, processes, and technology to achieve ongoing and sustainable healthcare transformation during an EHR implementation.

Governance Model and Process

Governance of organizational change requires each executive and executive committee to formulate a vision, prepare and communicate the strategic plan, and then operationalize the process from current state to future state model. Typically, healthcare organizations leverage their existing standing committees to take up additional effort toward the organizational change endeavor. Dell has found that best practice for effective organizational change includes the addition of a dedicated organizational change ad hoc committee that is chartered to define, collect, analyze and recommend metrics for specific change initiative. Additionally, if the organizational change involves clinical operations, the governance of the ad hoc

committee must be chaired by the entity’s Chief Medical Officer or delegate for effective change management.

Future state visioning by the clinical end users is a prerequisite step in organizational change management and clinical adoption of new processes (pre-implementation tasks for new electronic health record) and new products (implemented vendor of choice application). Whether the scope of service is financial, clinical, regulatory, or supply chain management, defining the future state for end users helps them acclimate to the change, the cycle of procedural edits, and the anticipated outcome that they are held accountable for. Healthcare providers carry a heightened sense of duty for quality of care to the point of zero tolerance for error. Mapping the future events, defining the impacts on schedules and resource allocations, educational mandates and behavioral changes establishes a path of progressive change from current state to strategic vision. Seeing the future changes laid out against the UMC strategic plan and operational/tactical steps will enable each end user to more readily accept and employ the new EHR. Acknowledgement of the known risks to the project’s success to the end users by the project sponsors and key stakeholders portrays a culture of transparency and inclusion. Followed by clear and concise risk mitigation plans to alleviate some the anticipated strain to the UMC workforce goes a long way in achieving group buy-in and robust participation. Dell’s healthcare consultant team will work with the UMC Executive team to carry the future state vision forward.

UMC Staff and Resource Requirements

Governance OCM and KPI

Timeline and Effort Estimation

Executives

Executive Project Sponsor

Project Lead or Liaison

Committee Dashboard, Committee Charters and Metrics

Compliance Lead

Risk Management Lead

Executive Team attendance at monthly Roundtable presentation and discussion session 2 hrs/month

UMC PMO lead and PM team meeting – 1 hour weekly during pre-implementation phase

Compliance and Risk liaison joint interview – 1 hour interview

CMIO interview – 1 hour interview

Scheduled with Physician Advisory session

Committee chairs/delegates interview

30 minutes per committee/ once

Standing Committee meetings

Per regular committee schedule, in first 45 days of project plan timeline only

Governance Model and Organizational Change Management


Onsite review of standing committee meeting charters, most recent meeting minutes, and communication plans (for each committee)

Onsite review of Organizational Change Management

Schedule, conduct and facilitate meetings with UMC Executive sponsors to validate current state governance model for strategic and operational plans.

Review of Executive Dashboard for Key Performance Indicator (KPI) metrics

Analysis/Recommendations Documents:

Summary of findings with SWOT analysis of governance methodology and organizational change management at UMC.

Recommendations for KPI dashboard enhancements or additions.

Weekly meeting with UMC Executive team on Visioning and Governance status with respect to the EHR Pre-Implementation Project – status report of process design optimization during phase of project

Monthly Executive Roundtable hosted by Dell Executive Sponsor and facilitated by the Dell OCM lead. Topic presentation on organizational change management with dialogue/open discussion (may be held at the conference location of UMC choice)

Deliverable #2 Knowledge Management using Benefits (KPI) Realization

Benefits Realization/Business Case

A common approach to benefits realization planning is functional and/or operational, with benefits realization indicators identified just before or during the implementation process. Benefits are usually organized by specific modules being implemented. Dell’s methodology incorporates a strategic approach with benefits realization driving vendor selection. Benefits are usually organized by domains that reflect key business and clinical care imperatives linked to the organization’s strategic goals.

Dell’s integration of the implementation/use of clinical technology with foundational transformation activities creates an improved working environment. However, industry experience points to healthcare measurement science as the way to optimize the impact of technology and transformational efforts on an organization. Dell has developed an approach that hardwires reliable measurement processes into the operation of the healthcare system. The Benefits Realization Program development process serves to:

● Link strategic goals and objectives to operational outcomes

● Create synergy between existing measurement programs

● Promote measurements that promote course correction

● Enhance technology system design for clinicians

● Promote buy-in to the selection and deployment of measures

● Operationalize the assessment of value and opportunities for improvement using a sustainable, reliable approach

Our experience also shows a tendency for healthcare organizations seeking to prove value from transformation activities to select large numbers of metrics to measure success. While we agree with the maxim that you cannot manage what you cannot measure, it is important to make use of a few Key Performance Indicators (KPIs) to focus management efforts on the key strategic objectives of the organization and transformation initiative.

To this end, we have developed a set of KPIs that can be directly linked to a key strategic theme. This Benefits Realization Program, using the acronym “SCORE” (Safety/Quality, Clinical Adoption, Operational Efficiency, Return on Investment, Evidence-Based Decision-Making) provides accountability for improved outcomes with metrics developed for approximately 400 variables and is illustrated below:

Benefits Realization

Safety/Quality Clinical Adoption Operational Efficiency Return on Investment

Evidence-based Decision-making

Medication errors by type

Adverse drug event rate

CMS compliance score

The Joint Commission/ National Patient Safety Goals compliance scores (e.g., Falls, SSI, med reconciliation rate)

Reduced mortality and morbidity

Completion of screening assessments (e.g., vaccinations

Patient education/ discharge teaching compliance

User satisfaction

End user login percent by discipline

Remote access utilization to patient-related information

Help desk calls by reason for call

CPOE utilization rate

Ordering provider electronic signature timeliness

Clinical documentation completion rate

Emergency department Left Without Being Seen (LWBS)

Throughput emergency department (time from door to admit/ discharge)

Missed transfers (bed availability)

Coding compliance (MCI appropriateness)

Worded hours per unit of service by department

Duplicate tests (Lab/Rad) by cancellation reason

Medical records deficiency rate

Time to process (tests/specimens/procedure)

Time to results (Lab/Rad order to final results)

Denials

Discharged Not Final Billed (DNFB)

LOS and costs for top 25 DRGs by payer source

Overall pharmacy cost per case mix adjusted discharged

Operating expense/adjusted discharge

Recruitment cost avoidance

Adverse drug events/1,000 patient days

Reproduction, document storage costs

Use of:

Evidence-based order sets

Alert overrides

Acceptance reminders

Knowledge resource links

Clinical pathways

Patient risk assessment tools

Cost Proposal – Organizational Change Management Assistance

Dell is recommending a senior resource(s) for a period 32 months (one month post live to complete the benefits realization portion of the project). Based on these assumptions, and our understanding, Dell will provide all deliverables (1 and 2 as noted above) for an estimated time and materials professional services fee of $365,000.00. Note: if UMC is only interested in certain components of the two deliverables, within the Change Management section of the proposal, Dell will recalculate the estimated professional services fee accordingly. Material changes to the scope, requirements, deliverables, or project timeline may result in changes to this price.


Thank you for considering Dell!

UMC PROJECT – REPLACE MCKESSON HORIZON

Project Approach Overview and Proposed Role

APRIL 16, 2015 THE ROSENBERG GROUP

Brian G. Rosenberg Las Vegas, NV

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Introduction

The following document provides details as to how I can assist UMC with the selection and

implementation of a replacement for McKesson Horizon. I have also provided a summary of a proposed

approach to the project based upon my conversations with Ernie McKinley, Mason VanHouweling, and

Eileen Raney. I am confident that I can provide UMC with invaluable assistance in ensuring this change

occurs on-time, on-budget, and without disrupting patient care.

As a new resident of Las Vegas, I welcome the chance to work with a local hospital and to be part of this

major transformation. Properly implemented, the new software will improve the patient experience

and provide a modern platform for UMC to continue to grow and expand services in this ever changing

healthcare climate.

For the past 16 years, I have helped healthcare providers to navigate the complicated process of

selecting and implementing software applications. Understanding the desired future state is an

essential element of success. Engagement from stakeholders and users is also required at all stages of

the project so they have ownership over the results. If the information technology department leads

these implementations without user engagement, dissatisfaction is inevitable. Throughout the project,

one of my roles will be to define the desired state, keep the project on-target to that state, and ensure

continued participation of the stakeholders.

As the former owner and CEO of a software implementation firm, I am extremely familiar with the

process of implementing these solutions not only from the hospital point of view, but also from that of

the software implementer. Getting the right implementation team composed of internal and external

resources is vital to keeping projects on-time and on-budget. Once the project has started, these

resources must learn to work together as an effective team. The software implementer must be

carefully managed to ensure they are using their time for the maximum benefit of the project and to

validate that they engage the right resources at each stage, avoiding “bait and switch” of the most

experienced team members. Quality of work must be carefully monitored.

As part of the project, we would create a governance structure that would monitor progress.

Unfortunately, the project timeline has minimal flexibility due to the sunset of the Horizon system.

Therefore dates and milestones must be met. Resources both internally and externally must perform

the tasks assigned to them timely, completely, and at a high level of quality to prevent re-work. Honesty

in status reporting is essential. Potential risks should be identified early and addressed before they

become a reality. Throughout the project, I will provide an independent perspective into the

performance of the project team and the validity of the information in the status reports. Regular

quality assurance reports will keep the governance structure, hospital leadership, and board well

informed.

While engaging my assistance carries a cost to UMC, the costs associated with not engaging this

assistance may be much higher. Implementations can go poorly for many reasons, and the net result

usually is a combination of additional costs and failure to achieve the desired results. At every stage of

the project I will be able to contribute to cost reduction through negotiating best pricing with vendors,

preventing costly re-work, keeping the implementation budget on-track, and ensuring that the end

goals, both financial and operational, are achieved.

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The proposed approach outlined in this document represents just a start based upon a few hours of

conversations. It combines the need to create a strong project and change management structure, the

need to do proper due diligence, and the requirement that we move rapidly and purposely through an

aggressive timeline. Together, we will convert this baseline approach into a more detailed project plan

and methodology that will be further explained in the project planning deliverables, such as the project

charter.

I look forward to working with the UMC team to complete this project. I am also confident that UMC

will find that the work ethic, experience, and expertise that I bring will be an invaluable contribution to

its success.

Thank you,

Brian G. Rosenberg

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Project Summary

University Medical Center (UMC) has recently completed a long journey to select and implement the

McKesson Horizon product. The transition to that product has proven to be challenging with the

solution not fully meeting the expectations of the user base. In addition, UMC has learned that the

Horizon product will be sunset in March of 2018.

UMC is now faced with a significant challenge. The Horizon product must be replaced by the sunset

date. While that date is nearly three years away, the replacement of this solution represents as large of

an effort as the original implementation of Horizon. The fact that the current system will no longer be

supported in the future creates an absolute need to make this replacement happen and requires that

the medical center move forward at an aggressive pace. At the same time, there is a desire to improve

upon the lessons learned from the Horizon implementation through stronger user community

engagement. UMC needs to deliver a solution that will meet the basic needs of replacing Horizon, but

also wants to improve end user satisfaction, create more efficient workflows, and increase the

availability of metrics and information that will allow for better informed decisions that leads to

improved patient care and increased profitability for the medical center.

Overview of Consultant Role

Based upon the discussions that we have had to-date, below are the key aspects of the proposed role to

assist UMC with the completion of this project. Each of these roles is explained in additional detail in

the Project Approach section of this document.

1. Identify the Project Objectives

2. Benchmark the Current State



5. Lead the Vendor of Choice Selection

6. Assist with Negotiation of the Contract to obtain Optimal Pricing


8. Create the implementation strategy and project management structure

9. Facilitate Change Management at all stages of the project

10. Monitor the quality of work completed by internal and external resources and ensure accuracy,

completeness, and honesty in project status reporting

11. Provide a monthly Quality Assurance report to project sponsors and the board

12. Tracking and monitoring the project budget

13. Complete post-implementation benchmarking

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Key Success Factors

UMC identified several Key Objectives for the project. These key objectives have been considered in the

proposed role and project approach:

Minimal to no impact on the success of the Revenue Cycle operations

Increasing Physician Satisfaction

Improving integration between the Emergency Department and the Floors

More efficient workflow for all areas of the medical center

Mobile Access for Physicians

Improving accuracy of expected reimbursement

In addition, I have identified the following Key Success Factors based upon my experiences on similar

projects:

Clearly define the future desired state

Executive and Project Sponsors that are engaged in the project

Establish Universal Buy-In through an Inclusive, yet efficient, process

Establish a strong team – and teach them to act as a team

Create metrics to measure success, and a continuous improvement strategy

Overview of Project Approach

Identifying Project Objectives and Future State

In order for a project to succeed, success must be defined. The first step of the proposed approach is to

develop the project objectives and define the future state of the organization once the new solution is

fully implemented.

UMC is in a unique position because it has recently completed a system replacement. The desired

objectives and issues encountered during that project are fresh in the minds of the hospital staff. This

information will be extremely valuable in determining what should be done differently with the

replacement of Horizon and to clearly define a future state.

One of the key objectives that UMC identified was to increase physician satisfaction. Often physician

satisfaction is an elusive goal. Achieving satisfaction begins with engaging with the physicians early in

the process to determine what is important to them and how the new clinical system can make their job

easier. Physician’s primary task is to care for patients. The easier the clinical software is for them to

use, the less it becomes a distraction from that task.

One of the key steps that will be completed to identify the future state will be to interview stakeholders

to gain a better understanding of their perspectives as to where the organization is now, and where it

needs to be following the replacement of the Horizon system.

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The interviews will be completed with a cross-section of staff members within the organization that we

will jointly identify. The interviews will be conducted to understand staff concerns, learn what would

features/functions them more effective at their job, and to discuss their role in the upcoming

implementation process in order to obtain buy-in.

Each interview will be conducted at a time and place convenient for the staff member, and scheduled in

advance to ensure they have no other distractions. A prepared list of questions will be used as a

guideline during the interview, however additional questions be asked dynamically to achieve the

desired goals and gain as much input from each person as possible in the time allowed.

In addition to completion of the interviews, I would recommend that I shadow a select group of staff

members in clinical areas for several hours each. The goal of these sessions would be to see how they

perform their jobs in Horizon today, and uncover opportunities for improvement in workflow or

processes that we should consider in selecting the new solution. One example of a workflow challenge

mentioned was the process of transferring patients from the ED to the floors. This would be a good

example of a process worth additional exploration to understand what the components of a better

process would be so that we can ensure that we deliver a much better solution during the new clinical

system implementation.

The interview process will be used to compile information that will be used in the Project Charter and in

the RFI/Selection Process. All of the information gathered in interviews will be complied and shared

along with a narrative explaining the wishes of the staff members to be considered in the selection

process and implementation.

Benchmarking Current State

I strongly believe in the value of using metrics to better understand an organization’s challenges and

opportunities for improvement. Metrics can be used to enable better decision making, both on a tactical

and a strategic basis. However, many organizations struggle with determining the right information to

track. Without the correct guideposts to signal areas of concern, it is difficult to develop action plans to

improve results.

With the goal of further defining success and the future state, we will develop a list of metrics that will

be used to quantify the progress of the project towards its goals.

We will begin by identifying what is currently tracked and metrics available from the current system.

Additional metrics will be identified where gaps exist in the information currently available. If possible,

this information will be obtained from the current system. If not, only future state goals will be

established for these metrics.

Each metric will be compared to industry benchmarks and to leadership expectations to determine

where opportunities for improvement exist. The impact of the new system and the business process

changes that will result will be considered in determining goals. Benefits will be assigned to the

improvement of each metric, which may be a combination of financial benefits, operational efficiencies,

and patient care or patient experience enhancements.

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During the course of the software implementation, we will ensure that these metrics are made available

and develop a continuous improvement plan around each one to ensure that appropriate staff are able

to monitor these numbers and act upon them on a regular basis.

Creating the Project Charter

Central to the methodology that I recommend using on healthcare implementation projects is a

document referred to as the Project Charter. This document provides an overview of the project, its

goals, objectives, risks, and benefits. Information gained during the course of the interviews and

benchmarking as well as other activities will be used to create this document. The Charter then

becomes the basis for the criteria to select the software solution and to make future project decisions.

The Project Charter acts as a guide throughout the project, to ensure that the original vision is achieved.

The following is a sample list of the key sections of a typical project charter. I will work with UMC to

determine the final optimal components of the Charter for the Horizon replacement project:

Project Goals and Objectives

Project Governance Structure and Steering Committee Members

Project Overview

List of Champions and Stakeholders

Scope of the implementation

Timeline and Key Milestone dates

Change Management and Communication Plan Overview

Key Changes that will occur in the organization

Benefits expected from the project

Risks and Risk Mitigation Strategies

Metrics and future state goals

Budgetary Impact of the project

o Project Costs

o Factors that will impact costs and budget accuracy

o Hard Savings expected as a result of the project (including how this will be measured)

o Soft Savings expected and how this will be validated

Once completed, the Project Charter will be submitted for validation, input, and approval by project

leadership.

Creating the RFP

UMC has identified three vendors that would be potential fits for the replacement of McKesson Horizon; McKesson’s Paragon, Cerner, and Epic. Based upon my experience, I would agree that these three solutions would be the appropriate ones for UMC to consider for the Horizon replacement. Each offers its potential challenges and benefits. The typical approach to an RFP requires an extensive process over many months to collect all of the business requirements and develop an extremely detailed document with checklists of functions for vendors to validate they can provide. However, UMC leadership is well educated about its options, and has already been able to narrow down the list to the most likely solutions. Therefore my recommended approach would be a document that is an invitation to the selected vendors to propose their solutions

7 | P a g e

to UMC. The benefits of this revised approach to the RFP, which I refer to as an RFP-lite, would include a reduced timeline while still providing the vendors with a baseline of information to work with UMC during the selection. The following is a sample of the information that would be included in the RFP:

Background of the hospital

Overview of the current situation and reasons for a change

Explanation of the desired future state

Summary of identified needs and expected challenges

Timeline requirements for the overall project and the selection process

Overview of the selection process Facilitating the Selection Process

Choosing the right software product is, of course, crucial to the success of the project. Unfortunately,

UMC had a poor experience with the prior software vendor as they made a decision to sunset the

product shortly after completion of the sale. However, having gone through this process not too long

ago, many members of the UMC staff are well informed of the options in the marketplace and that will

allow for the selection process to be expedited.

At the same time we will need to keep the process inclusive and to get buy-in and ownership from

appropriate stakeholders. The selection approach will be designed to balance all of these needs. As the

facilitator of the selection process, I would work with the project governance to create a selection

process structure. In particular, as physician satisfaction is a key desired outcome, engaging physician

champions will be important to the selection process.

Typically an approach to a software selection such as this would include development of a primary

selection committee with a cross-section of organizational leaders. In addition, sub-committees would

be established to provide deeper looks into specific functional areas with additional team members with

more targeted expertise in those areas. Sub-committees may be established for specialty areas within

the hospital as well as for technology integration. A non- binding scoring system would be created to

help to quantify observations and opinions.

In my role as facilitator, I will work with the vendors to coordinate and schedule demonstrations,

reference checks, sites visits, and other activities with the UMC project team. As the primary point of

contact for the vendors, I would ensure fairness in the process. Follow-up with vendors will be

coordinated to ensure that answers to questions are received and documented so expectations and

commitments are clear. Making sure that the vendor is demonstrating what is actually being

implemented will be a priority – with any “vaporware” being clearly identified and the likelihood of that

software being available on the aggressive UMC timeline will be highlighted with the selection team.

Prior to reference checks and site visits, I will prepare starter questions to get conversation started and

ensure the minimum needs are met. In addition to the references provided by the software vendors, I

will work with UMC to combine our respective industry contacts and develop a list of reference checks

to occur outside of the vendor’s preferred list.

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When obtaining pricing, I will assist with ensuring the completeness and accuracy of the vendor quote.

Vendors will be required to include pricing for any software demonstrated during the process, and any

attempt to bait and switch functionality will be identified. Total cost of ownership will be calculated

over an extended period to ensure that we are properly comparing options.

As the leader of the selection committee process, I would lead selection discussions and create

presentation material to facilitate comparison of the potential solutions, ultimately leading the team to

make a decision that the majority believe is in the best interest of the medical center. All team

members will be strongly encouraged to participate and vocalize their thoughts and concerns to the

team. A unanimous team decision will be encouraged – but if that can’t be achieved, at a minimum all

team members will be expected to fully support the final decision.

Negotiation of best pricing and terms

Pricing for the software will likely be complicated and highly subject to negotiation. Once the vendor of

choice is identified, we will work together to ensure that proper and complete pricing is obtained. We

will then optimize the pricing and contract terms to meet the needs of UMC and protect the

organization by ensuring vendor commitments are in writing.

Evaluating pricing will include making sure that all identified solutions are included and at the same time

preventing “over-buying” of software that is not needed or not in the near-term roadmap. License

counts will be verified if an enterprise licensing model is not an option. Vendors will be pushed to

provide best pricing.

While the legal contract review is likely best left to the UMC legal team, I will provide a pre-legal review

to the contract focused on ensuring that all commitments made by the vendor are properly represented

and that any terms are consistent with the goals established in the future state.

Evaluation of Implementation Options

Depending on the specific software selection made, third party implementation firms may be an option

for the medical center. Generally there are benefits and disadvantages to using the software company’s

implementation team. Their team will have a more direct line to internal support teams and

developers. In addition, use of the internal implementation teams protects the medical center from

finger-pointing between the software provider and implementer. However, software provider

implementation teams often have a more “cookie cutter” approach to implementations and don’t get as

deep into assisting with business process redesign. Third party implementation firms often bring more

industry experience and can customize their implementation approach. In many cases, third party firms

are also less expensive.

We will work together to evaluate the options and determine the best implementation partner for the

medical center. Implementation costs will be carefully evaluated with many factors considered

including properly comparing effort, billing models, and resources. Tying a portion of compensation to

success and milestones will be considered. As the former owner of a third party implementation firm, I

can provide considerable additional perspective into this process and work with the implementation

partner to get them the information they need to provide accurate and complete pricing.

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In addition to the outside implementation partner, internal resources will be necessary to complete the

project. This is often very challenging for healthcare providers as resource are already extremely

limited. As part of the implementation evaluation, we will determine what internal resources are

necessary to ensure the project success and determine team members that will participate in the

project part-time or full-time. Any gaps in resources or skills within the organization will be identified so

that those resources can be hired or contracted as necessary.

Implementation strategy will also be determined during this part of the project. This will include

developing a detailed implementation timeline, project plan, and approach. Pilot vs. big bang

approaches will be discussed and any phasing-in of functionality will be evaluated.

Change Management

Change Management will be a critical component of the success of the project and would be a focus of

the project methodology at all stages of the project. This project is about more than replacing a

software solution. Significant changes in business processes will result and it will impact a large portion

of the medical center staff. Managing the people side of the project proactively will ensure a more

engaged user base, leading to a better definition of the future state and increased user satisfaction.

During the early stages of the project we will discuss the aspects of the change management approach

and determine the best change management plan for UMC. The following is a brief summary of the

major components of the proposed change management approach.

Communication Plan - Includes identified parties, planning spreadsheet, key project messages,

communication types and timelines, and feedback loops that will be used to engage end users.

Sponsorship Roadmap - Defines the governance structure, sponsors, and the roles and

responsibilities of each during the course of the project

Coaching Plan – Incorporates team building and skill development that will be vital throughout

the project. Team building will be provided through teaching methodologies such as the “Five

dysfunctions of a team” and through behavioral profiling using DISC or a similar methodology.

Resistance Management Plan – Identifying potential passive and/or active resistance points and

developing proactive strategies to mitigate future interruptions

Healthcare brings many unique challenges to change management. Patient care implications must be

considered in every decision. Physicians need flexibility to meet the needs of patients. Engaging

clinician resources is challenging due to their existing workloads and dynamic roles. However, these

challenges can be overcome with a well-defined and executed change management strategy.

Implementation Quality Assurance

Once the software vendor and implementation partner are identified, my focus will shift to

implementation leadership and quality assurance, ensuring that internal and external resources all

complete their roles as expected.

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While the contracts are being finalized, my focus will be on creating the project structure. This will

include developing the status reporting methods and meeting structure to include meeting schedules,

agendas, and purposes for project teams, sub-teams, steering committees, and other governance.

I strongly believe in the importance of establishing a culture of being up-front in status reporting. Fear

of indicating a status other than “green” often leads project managers and team leads to not raise issues

until they are too late to resolve without an impact on budget, scope, or the timeline. Part of my role

would be to help challenge team members and uncover un-reported or under-reported issues and raise

them to appropriate parties to resolve them.

I would also be responsible to oversee the implementation partner and monitor their “burn rate”

against the budget. It is not uncommon for implementations to fail to properly manage the use of time

early in the project, resulting in budget not being available later, causing change orders or compromises

in scope. Proper monitoring of the budget and the use of resources will manage this risk. Internal

resources will also be monitored to ensure their active engagement and fulfillment of responsibilities.

An additional role would be to participate in and monitor project decisions as the program manager to

ensure that they are consistent with the project charter and the desired future state. Some changes in

the future state may be desirable as more information is known, but these will be informed decisions

with proper escalation when appropriate. Scope will be carefully monitored to prevent compromises in

the quality of the end product, as well as to ensure that resources are not distracted by new scope that

is not consistent with the project objectives, or that risks the timeline or budget.

Each month, a quality assurance report will be prepared providing personal observations and

perspective as to the status of the project. This would be independent of the standard project status

reports, intended to provide an additional an independent perspective of status, risks, and issues. This

information will be presented to appropriate governance.

Process Improvement

Changes in software will result in changes in business processes, and the opportunity to make these

processes more efficient. Improvement in workflow in several areas, such as between the Emergency

department and the floors, is a specific objective identified by UMC for the project.

One of my key skills is helping to identify process improvement opportunities and develop solutions to

achieve the desired results. As appropriate, I will work with UMC and the project team (both internal

and external) to assist in this area.

As a Kaizen certified facilitator, I can lead process improvement workshops to find solutions to

challenging areas, and lead the process to document the future state processes. That information can

also be used to better define business requirements for the implementation team.

Tracking and Measuring Results

The primary goal of the project, to replace the Horizon system before the sunset date, will be easy to

measure and validate that it has been achieved. However, there are many secondary objectives of the

project that would be much more subjective without measurements.

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End user satisfaction with the new product is an important aspect of success, in terms of the efficiency

of the workflow under the new system as well as the ease of use of the application, and ability to

retrieve important information. User satisfaction will be measured through surveys, personal

interviews, and through feedback obtained through feedback loops that will be used at each stage of the

project.

During the months following the go-live date, we will carefully monitor the metrics produced from the

system and compare them to the desired future state benchmarks. Metric owners will be asked to

implement the continuous improvement strategies to improve results and to identify barriers that are

preventing them from meeting the outcome.

Budget, savings, and revenue opportunities identified during the earlier stages of the project will also be

validated. A final report will then be prepared for the project leadership summarizing the results of the

project.

Summary of Timeline

The timeline outlined is based upon the needs of the medical center to replace the Horizon system

before the sunset date. The project is divided into two main sections, the project planning, and the

implementation.

The project planning would occur beginning on June 1, 2015 and continue for a period of one year.

After that time, the project implementation begins and will continue until the system is fully

implemented.

This timeline demonstrates the key milestones during the project planning process:

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The following is an overall project timeline that shows the project planning and implementation process.

The implementation process will be more thoroughly defined during implementation planning:

Level of Effort and Costs

UMC will be billed on a time and expenses basis for the work performed on the project with bills sent on

a monthly basis. Payment terms for all invoices will be due within 15 days of receipt.

Based up on the role identified during our conversations and established within this document, the level

of effort required is estimated to vary from 110-125 hours per month over the course of the project.

The exact number of hours each month may vary as certain periods of the project will be more active

than others. During periods in which less of an effort is required, time will be scaled back so that all

hours spent on the project are productive hours.

My time will be charged at a rate of $190 per hour. No travel expenses are anticipated on the project as

I live in Las Vegas. If any travel does occur as part of the project, such as during a site visit as part of the

selection process, that travel will be specifically approved. In the case of approved travel, TRG will

charge for all reasonable out of pocket expenses including transportation, lodging, parking, and mileage.

Meals will be reimbursed at the GSA per diem rate for that area.

While this time will represent a cost to UMC, the savings that will be created as a result of my work

should provide a significant return on investment to the medical center. Direct savings will be achieved

through assistance with contract negotiation and monitoring the project budget. In addition,

considerable costs will be simply avoided through providing quality assurance to keep the project on

track and to ensure that any issues on the project are identified early and given the proper attention to

prevent them from becoming critical and risking the project timeline or budget. Simply put, as an

advocate for UMC, I will aggressively identify opportunities to lower the costs on the project to prevent

costly mistakes from occurring.

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About Brian G. Rosenberg

I have been helping healthcare organizations to select, implement, and optimize software for the past

sixteen years. I have had the opportunity to work with many of the largest healthcare providers in the

country as they have evaluated and implemented enterprise-wide solutions. I have served on these

project in many roles including leading software selection, project management, quality assurance,

change management, process design, leadership and team development, and training delivery and

development. I am certified in Kaizen workshop facilitation, Lean Six Sigma, and other project and

change management disciplines.

As the founder and Chief Executive Officer of RPI Consultants, I led a consulting firm focused on

software and business process improvement consulting for the healthcare industry. During that time, I

was honored to receive the Smart CEO award two years in a row and was recognized on the Inc.

magazine 1000 list.

In 2013, I sold that company to allow for my family to move to Las Vegas and be closer to my father. I

now have a new firm, The Rosenberg Group (TRG), focused on software selection, business process

improvement, change management, and implementation strategy. Most recently, I have assisted

Dignity Health with consolidation of business functions and related process redesign. I am also

providing leadership development services as the chair of a peer to peer advisory board.

When not working directly for customers, I am a regular speaker and presenter at many industry

conferences and am the Chairman of the Editorial Board for Financial Operations Matters Magazine. I

also publish articles and content on industry best practices, project management, and other topics.

For additional information about my background, please reference my LinkedIn profile.

Linkedin Profile LInk

I would welcome the opportunity to work with UMC and to help ensure that this critical project is a

success.

https://www.linkedin.com/bgrosenberg