common sense strategies for uncommon times · single electronic health record across continuum of...
TRANSCRIPT
Common Sense Strategies for Uncommon Times
Presented by:
Tim Tindle, Executive Vice President & Chief Information Officer
Overview of Harris Health
Our Transformational Journey
Managing Leadership’s expectations during a time of transformational change
Shifted dollars from “Running / Supporting the business” to Growing or Transforming the business
Meeting Ever Increasing Support Needs
What Will We Cover Today?
HARRIS HEALTH SYSTEMOVERVIEW
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Harris Health is the safety net health system for Harris County, Texas. (Houston, TX)
Population: 4,180,894 (2011)
3rd most populous in U.S.
1.25 million uninsured
Harris Health System Overview
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Primary teaching hospitals and clinics
Baylor College of Medicine
UTHealth
Our workforce
8,500 employees
5000+ Physicians & Students
$1.3 billion annual budget
Caring for Harris County, Texas (Houston)
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Three Hospitals
964 licensed beds
Level 1 Trauma Center
Level 3 Trauma Center
182,099 Total Emergency Room Visits
38,634 Total Inpatient Discharges
40+ Ambulatory Locations
1,950,472 Total Outpatient Visits
Harris Health Overview
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The Patients We Serve (FY-15)*
*Source: FY2014 Financial Report
Payer Mix % By Source
Charity and Self Pay 63.6%
Medicaid / CHIP 20.7%
Medicare 9.5%
Commercial / Other 6.2%
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How We Are Funded (FY-15)
Payer Source % Revenue
Amount ($Millions)
Property Tax 44.9% $574.3
Net Patient Services 28.6% $365.6
DSH / Uncompensated Care
18.4% $235.8
Other Revenue 8.2% $105.0
Total Revenue 100% $1,280.0
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Harris Health SystemOur Transformational Journey
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Electronic Health Records
Meaningful Use
Interoperability
Analytics
ACOs
Pay for performance
ICD-10
Population Health
Disease Management
Healthcare Industry Undergoing Transformation
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Board Technology Committee
IT Executive Committee (C-Suite, EVPs, & Medical Schools)
Division(Hospital / Ambulatory / Admin)
Service Lines(Hospital / Ambulatory / Admin)
Harris Health IT Governance Structure
Board
ITEC
Division
Service Lines
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Integration vs Best of Breed
Buy vs Build: Software / Systems
Solutions Must Conform to Infrastructure Standards
Internal Cloud
Guiding Principles for IT Strategic Plan
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All New Services Require Business Case
Implementation Costs (HW, SW, Services)
Ongoing Costs (Staff, HW / SW Maintenance)
Return On Investment (5 Year)• Hard Benefits with Assigned Accountability
Increased Revenue
Decreased Cost
Quality Impact
Compliance
Governance Review / Approval
Guiding Principles for IT Strategic Plan
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Epic Enterprise
Ambulatory, Inpatient EHR, Ancillary
Revenue Cycle Live
PeopleSoft ERP
Financials, Supply Chain, HR
Business Intelligence (Analytics)
SAP Business Objects
Epic Cogito
IT Enterprise Platform
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Medical Records Before…
Hospitals
Specialty LocationsSame Day Clinic LocationsPrimary Care Locations
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Single electronic health record across continuum of care.
Single source of truth
Primary, Specialty, Acute, EC, Sub-Acute
Available across our system
Used by all!
Facilitate & coordinate access to care
Leverage analytics to managing the health of our community and for process improvement
EHR Vision
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Harris Health EHR Implementation
Phase 1
Ambulatory EHR
Full CPOE / Clinical
Documentation
Go-Live:
2005 - 2007
Our Journey
Multi-phased, highly integrated approach Phase 4
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Harris Health EHR Implementation
Phase 1
Ambulatory EHR
Full CPOE / Clinical
Documentation
Go-Live:
2005 - 2007Enterprise
Scheduling
Registration
ADT
Revenue Cycle
Bio Patient ID
Go-Live:
2009
Our Journey
Multi-phased, highly integrated approach
Phase 2
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Harris Health EHR Implementation
Phase 1
Phase 3
Ambulatory EHR
Full CPOE / Clinical
Documentation
Inpatient EHR
Full CPOE /
Clinical
Documentation
Go-Live:
2005 - 2007
Go-Live:
2010
Enterprise
Scheduling
Registration
ADT
Revenue Cycle
Bio Patient ID
Go-Live:
2009
Our Journey
Multi-phased, highly integrated approach
Phase 2
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Harris Health EHR Implementation
Phase 1
Phase 3
Ambulatory EHR
Full CPOE / Clinical
Documentation
Inpatient EHR
Full CPOE /
Clinical
Documentation
Go-Live:
2005 - 2007
Go-Live:
2010
Enterprise
Scheduling
Registration
ADT
Revenue Cycle
Bio Patient ID
Go-Live:
2009
Our Journey
Multi-phased, highly integrated approach
Phase 2
Go-Live:
2012+
Analytics / EDW
Clinical
Operations
Costs
Quality
Phase 4
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MANAGING EXPECTATIONS
Managing the Board’s and Sr. Leadership’s expectations during a time of transformational change that’s driving dramatic increases in IT investment.
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Huge increases in IT investments
Combined Operating and capital budgets reaching between 5-6% of provider organization's budget
Boards, CEOs & Sr. Leaders are Asking:
What is a Reasonable IT Spend?
Managing Expectations
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Benchmarking resources
Vendor Benchmarking (EPIC, PeopleSoft..)
Gartner Key Metrics
Gartner Benchmarking Service
IT Governance: Review and Educate
CEO & Leadership (ITEC)
Board Information Technology Committee
Managing Expectations
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Harris Health Benchmarking Efforts
Areas Benchmarked
• Budgets, Staffing and Process Maturity
Benchmark comparison groups
• Peer based
• Workload based
• Industry Key Metrics
What is a Reasonable?
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Objective
Transparent
External experts
Demonstrate good fiscal stewardship
Provides a basis for decision making
Benchmarking Benefits
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DID WE GET OUR MONEYS WORTH?
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Hospitals & Health Networks Awards
Health Care's Most Wired (2011, 2012, 2013, 2014, 2015)
Innovation Award for Supply Chain
HIMSS Analytics Stage 6
Hospitals (2011, 2012, 2013, 2014, 2015)
Ambulatory (2012, 2013, 2014, 2015) (2nd in Nation)
GHX Best 50 Healthcare Supply Chain Automation
Named Emdeon’s #1 Clean Claim Customer
Benefit Realization Benchmarking
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Epic: Projected Economic Benefit
Clinical and Business Program Cost Estimate
$72 Million
Estimated Economic Benefit (5 Yr Est.)
Increase Net Patient Revenue : $310 Million (+36%)
Meaningful use: $19.0
Grant: $600k (ARRA Homeless EMR)
Current 5 Year Estimated ROI
$329.6 Million (FY-10 thru FY-15)
ROI Management & Reporting
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Leveraging Epic, Harris Health continuously improved overall productivity and utilization
Holding the increase in cost per adjusted patient day to only 3.1% over 5 years
Additional ROI
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SHIFTING IT SUPPORT DOLLARS TO GROW AND TRANSFORMING DOLLARS
After massive capital investments Implementing IT Systems, support and maintenance costs are skyrocketing.
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Almost one third of the IT Budget is spent on Hardware and Software Maintenance
The vast majority of salaries are spent supporting existing application functionality
External Cloud solutions chew up operating dollars and typically cost more than an internal Cloud
Support and Maintenance Cost
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Integrated Enterprise Applications Strategy
Epic Enterprise
PeopleSoft Suite (HR, finance and supply chain)
SAP Business Objects (Analytics)
More time delivering enhanced functionality Vs. managing interoperability issues between large numbers of systems
Standardization: Creating Your Own Cloud
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Desktop Standards
SSDs extend life
Use of Citrix minimizes performance issues
Refresh in 7th year
Utilization of Thin Clients (~25%)
Very low cost and very long life
Automated imaging and application provisioning
Remote support / Advanced Help Desk
Lower Desktop Infrastructure Costs
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Standardization / Consolidation / Virtualization
90% Servers (~1000)
Network
Converged Platforms (Simplify)
IBM Pure Flex
HP
Enterprise Licensee Agreements
Cisco, Oracle,…
Automation
Standardization: Lower Data Center Infrastructure Cost
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Infrastructure Consolidation
Existing IBM Tape Library (14 feet long)
New IBM Tape Library (1 cabinet, 2 feet wide)
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Wintel Platform
Legacy Wintel Environment
(many individual commodity servers)
New Wintel Environment
(leveraging blade enclosures and virtualization)
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Unix Platform
Legacy AIX Environment
(EPIC, ERP in multiple cabinets)
New AIX Environment
IBM Pure/Flex Blade Enclosure
GROWTH
GROWTH
GROWTH
GROWTH
GROWTH
GROWTH
GROWTH
GROWTH
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Old Data Center
6000 Sq. Ft.
64 Racks
New Environment
10 Racks in Co-Location Space
Savings
Space, Power, Personnel
SW / HW Cost
SW / HW Maintenance Cost
Infrastructure Cost Reduction
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IT SERVICE MANAGEMENT
Meeting Ever Increasing Support Needs
As the organization’s reliance on Information Technology increases, support expectations change and are generally higher than before.
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Establishing ValueDefined Our Services
What Information Systems assists are covered What services do we provide
Service Level Agreements (SLAs) Turnaround time commitment by service PC break fix = 4 hours time to repair Simple Report = 5 business days Medium system enhancement = Governance assigned release cycle
Ongoing Service Level Negotiation Changes in funding = Change In Service Level
Measure and Report Performance Actual vs SLA Customer Satisfaction
IT Service Management
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SLA Performance 12 Months Ending July 2014
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Customer Surveys Received Performance 12 Months Ending July 2014
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Overall Satisfaction
Created: 15-Jul-2014 12:38 PM
Questions?