Healthcare Leaders Embrace Reform

Beyond the EMR, CPOE, eMAR, SCM, HIT and HIEs:Alphabet Soup for the Next Ten Years

Paul Browne, MPH/MHA, SVP & CIO, Trinity Health

Page *Alphabet Soup / AcronymsA word formed from the initial letter or letters of each of thesuccessive parts or major parts of a compound term; or

An abbreviation formed from initial letters

Radar Radio Detection and Ranging

CIO Chief Information Officer

FAQ Frequently Asked Questions

SNAFU Situation Normal All Fouled Up

Information Superhighway - Interactive Network For Organizing, Retrieving, Manipulating, Accessing And Transferring Information On National Systems, Unleashing Practically Every Rebellious Human Intelligence, Gratifying Hackers, Wiseacres and Yahoos

Page *Discussion OutlineBackgroundTrinity Health OverviewTrinity Information Services (TIS) OverviewPlanning Model

Retrospective: 1999 2009Key Focus AreasOutcomes

2010 2020: Looking ForwardEnvironmental OverviewTrinity Health Strategic ImperativesIS Key Focus Areas

Summary Thoughts

Q & A

Page *Trinity HealthWho We AreFourth-largest Catholic health system in the United States (based on Operating Revenue)

47,000 full-time equivalent employees

More than 8,000 active staff physicians

19 Ministry Organizations, encompassing 47 hospitals 35 owned, 12 managed

Revenues of $7 billion

Nearly $400 million in community benefit ministry

Page *Trinity Information Services ProfileTIS is a business within a business a wholly owned, $300m / year subsidiary of Trinity Health

Operational StructureSingle IS Organization - Consolidated Application Management, Infrastructure Management, Financial Management, PlanningWorkforce - Approximately 1,400 associatesApplicationsClinical CernerPatient Administration / Revenue Mgmt McKessonHR / Payroll / GL / FA PeopleSoftSupply Chain / AP - LawsonInfrastructureEnterprise Data Centers Novi MI / South Bend INApproximately 100,000 Networked DevicesServices & OtherPortfolio of Routine IS Services7*24*365 Help Desk Fielding 720,000 / Year Specialized Cerner knowledgeStrong Program Management, Change Management Services, and Benefits ManagementNationally recognized leader in deployment and usage of electronic health recordsProvider of outsourcing services to external organizations

Page *Planning ApproachWhat did we complete relativeto what we originallyenvisioned?What outcomeswere achieved?What did we spend?Where do we go from here? Can we generate an even better return on investment within TH (quantity / quality / distribution of data)? What will it take?Can we turn what weve done into new revenue streams?What are the organizational requirements to execute?Retrospective AnalysisProspective AnalysisPotentialCompetitorsPotentialCustomersAsset / Capability InventoryPersonnelResourcesAmbulatoryCare ContinuumComparativeEffectivenessAnalysisInpatientOtherWhat are the Trinity Health, industry, and policy implications?FinancialResourcesOtherResourcesBusinessModelWhat will truly differentiate Trinity Health?InnovationKey ProcessesPartnershipsBusiness Model EconomicsWhy did we do this?What were key decision points? What decisions did we make? Learnings?

Page *Retrospective: 1999 2009 IS Focus Areas

Organizational Consolidation

Infrastructure Standardization

Application Rationalization

Process RedefinitionY2K.comXPEMR/EHRADECPOESEMUROCDMHIPAAHITHIERACBMDIPOCIPOCEWSARRAMajor ThemesThe Soup

Page *Genesis Trinity Health: Circa 1999 . . .Tool Diversity Process Diversity Variable Performance

Page *Trinity Health: circa 2009 Common Tools + Best Practice Processes = Performance Excellence

Page *1999 2009 Outcomes

IT can be FREE!

Joseph SwedishPresident and CEO, Trinity HealthApril 30, 2009

Copyright 2008 Trinity Health Novi, Michigan INTERNAL

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This title is meant to catch your attention!

IT stands for Information Technology ..things that many of us take for granted (mainframes, servers, PCs with split second response time, telecommunications, etc)

The letters F..R..E..E in capital letters do not comprise an acronymthe emphasis is on the ability to achieve greater benefits than the cumulative expenses required of this infrastructure

I want to share some perspective of Trinity Healths ongoing journey

Copyright 2008 Trinity Health Novi, Michigan INTERNAL

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Like Quality, IT Can Be Free

Quality Is Free 1980 best seller by Philip Crosby How to manage quality so that it becomes a source of business profits

At Trinity Health, IT is free

Internal studies identify specific, technology-enabled benefits

Many external studies support the findings within Trinity

Year-over-year increased demand for IT solutions

People, process and culture evolve along with technology

Copyright 2008 Trinity Health Novi, Michigan INTERNAL

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In his best-selling 1980 book Quality is Free, author Philip Crosby argued that the benefits of investments in quality initiatives far outweighed the cost by eliminating the inefficiencies associated with re-work

At Trinity Health, IT is free, but only if we continue to leverage our investments and prove the ROI

Today, I will show you how we have identified and delivered IT-enabled benefits that flow right to our bottom line and to our patients.

Page *1999 2009 Outcomes (cont.)Reduced Severity Adjusted Mortality from 107% of expected to 60%

Copyright 2008 Trinity Health Novi, Michigan INTERNAL

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Genesis Outcomes: Quantified Benefits

Dozens of Genesis-related benefits studies have been completed and there are many areas of likely benefits still to be studied and quantified.

Over the expected 15 year life of Genesis, Trinity Health expects $1.5b - $3.0b in benefits

Clinical Benefit AreasADE avoidanceOrder management efficienciesLiability expense avoidanceReduction in Clinical Documentation timeReduced pharmaceutical expenseRevenue Mgmt Benefit AreasReduction in bad debt and operational write-offsIncreased interest income through AR reductionsReduction in claims production error ratesImproved charge captureSupply Chain Benefit AreasSupply cost savings Increased penetration of GPO contractsImproved inventory managementIncreased rebates and discounts from vendorsReduced forms, paper, printing and postage costs

Copyright 2008 Trinity Health Novi, Michigan INTERNAL

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The overall benefits amount of $1.5billion - $3.0 billion is based on Genesis Outcomes Analyses Retrospective information presented to the Board in March 2009. The low end of an annual range ($100 million) is a conservative amount of benefits based on a defined set of analyses. The higher end ($200 million/year) accounts for additional benefits as more Genesis implementations occur and other areas are studied for benefits________________________________________________________________________________

Measures savings in:Supplies Expense, Supply Chain Management Consolidation, Supply Chain administrative efficienciesPharmacy Department SavingsA/R ReductionLiability Cost ReductionOnline Physician NotesURO (for future)

Genesis Impact Study Controlled study looking at Before and After timeframes for 1st 9 activationsSeverity Adjusted Mortality decreased from 106% of expected to 84% of expected; a 22% reductionEquates to 1,600 to 2,600 lives savedClinical Process Metrics (core measures)17 of 25 improved significantlyHeart Failure Composite Score increased from 83% to 87%Pneumonia Composite Score increased from 84% to 89%

Page *April 2010: HIT, Uncertainty Remains

Page *2010+ - Where do we go from here?Healthcare Environmental Challenges

Trinity Health Strategic Imperatives

Key IS Focus Areas for the Next DecadeStrategic Scrabble!

Page *Healthcare Environment / Trinity Strategic Imperatives

Page *2010+ IS Focus Areas

Solidifying the Gains

Embracing Reform

Extending the Core

Redefining our Ministry

Evolving our IntelligenceHCRAMUCEGSSPVITRTEPOCIPOCBMDIeICUI____

MDAAHNACOAEHRBDINNVBICIILMCCOMGMajor ThemesThe Soup

Page *Solidifying Gains:GSSP Genesis Safety and Simplification ProgramSimpler is Safer

Page *Solidifying Gains:VIT IS Value Improvement Teams

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Embracing Reform:HCRA Health Care Reform Act BTW HCRA is aka PPACA + HCEARA Payment Alignment Bundled payments Value-based payment Readmission penalties Primary care/medical home Chronic care coordination

Comparative Effectiveness Research Finding what works Elimination of unnecessary variation Appropriate standardization of care Foundation for value-based payment Health IT Funding in stimulus bill Bonuses starting 2011 for meaningful use Penalties start 2015 for noncompliance

Page *Embracing Reform:MU Meaningful UseThe spirit of really meaningful use:Implement technologies and processes that improve careEnsure they are usedMeasure outcomes and keep going

Page *Extending the Core:MDA Mergers, Divestitures & AcquisitionsSignificant MDAs last 36 monthsMDA produces value when it results in clinical integration that improves care. Increasingly, clinical integration is dependent on technology integration.

Page *Extending the Core:RTE Real Time Enterprise

Instrumentation

Intelligence

Interoperability

POCIPOCBMDIeICUPrivate HIEPublic HIEPortalsEWSEtc.Significant technology innovations and cost reductions in the ability to capture, move, and use data will increase information velocity allowing for real-time or near real-time decision-making in many aspects of healthcare.

Page *Redefining our Ministry:AHN Accountable Health NetworksHealth reform and market forces are driving more integrated models of care it is expected that each Trinity Health market will evolve to some form of an ACOWhile the ultimate design is uncertain it is certain to be complex and to vary by market therefore, Trinitys technical design must be robust and adaptable

Copyright 2009 Trinity Health Novi, Michigan

Market-Based Accountable Care Organization

Market-Based Accountable Care Organization (ACO)

Aligned Health System

Acute Care

LTCare

HomeCare

AlignedPhysicianOrganization

Fully integrated(employed) physicians

Contracted(clinical co-management) physicians

Private practice aligned physicians

Copyright 2009 Trinity Health Novi, Michigan

Page *Redefining our Ministry:Accountable Health Networks TechnologiesPhysician PracticesEnterprise Practice ManagementElectronic Medical RecordePrescribingEMPI IntegrationInteroperabilityPatient PortalConsumer PortalLong-term CareElectronic Medical RecordEMPI IntegrationInteroperabilityHome Health CareCare ManagementEMPI Integration

Page *Redefining Our Ministry:BD IS Business Development

Page *Evolving Our Intelligence:BI / CI Business & Clinical IntelligenceStages of BI MaturityBeginningDevelopingDefinedAdvancedLeadingSpreadsheet drivenSignificant manual effort to collect dataLimited to operations and regulatory reportingLimited knowledge of data sourcesAd hoc models / spreadsheetsAutomated reporting limited to transactional systemsMany operational performance measures have definitions, but different values are reported

Organization has a formal BI strategy Data is gathered from disparate systemsSome integration across business unitsImproved information access and deliverySubject area data warehousesDeveloping data governance processesInformation integration across organizationEnterprise data warehouse, including robust metadata repositoryProcesses exist to integrate additional data sources and domains Single version of truthFormal data governance requirements and policiesPersonalized dashboards and alertsNear real-time performance monitoring Forward looking analytics, forecasting and predictive modelsBI competency center to maintain strong governanceTrinity HealthsCurrent PositionBusiness Intelligence systems allow leaders to manage the enterprise by looking out the windshield rather than the rear view mirror ~ Unknown

Page *Evolving Our Intelligence:CE Comparative EffectivenessImproveQuality & EfficiencyComparativeEffectivenessResearchCaptureDataChangeOperationsTechnology Infrastructure (HIT)FinancialIncentivesTrinity Health Accelerating the Cycle!Bundled Payment Methods Aligned IncentivesPain ManagementPressure UlcersFall PreventionEnterprise FormularyICU UtilizationOrder Set StandardsImplant ManagementCAUTI Reduction

CE Within Trinity

Page *Summary The Journey ContinuesFrom 1999 to 2009, the primary focus of Trinity Health was levels I, II, and III of the IS Maturity & Value Model. From 2010 to 2020, the primary focus will be increasing value in levels IV, V, and VI.

OrganizationConsolidationStandardInfrastructureStandardData Capture /Transaction SystemsIV. Extending CoreV. BI / CIVI. Commercializing199920092020IT-Enabled ValueTransactional EraEra of Intelligence

Page *ConclusionIT Can Be Free And ITs as Easy as ABC!!HRAMUCEGSSPVITRTEPOCIPOCBMDIeICUI____

MDAAHNACOAEHRBDINNVBICIILMCCOMGY2K.comXPEMR/EHRADECPOESEMUROCDMHIPAAHITHIERACBMDIPOCIPOCEWSARRA

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****Policy makers understand that a missing element in healthcare is consistent application of the mechanism depicted on the left side of this slideThis mechanism exists in most other industries because of market forces that drive organizations to consistently improve quality and cost effectivenessOver three decades healthcare has tried in fits and starts to hardwire this cycle through application of TQM, CPI, Six Sigma, and LEAN techniquesResults have been very inconsistent and typically not sustained because of limited technology infrastructure to capture data and to re-enforce operational changeWhats different now is that integrated clinical information systems do exist that can both capture the necessary data and re-enforce operational change at the point of carePolicy makers are using the hammers of value-based-payment models and accreditation status to force evolution of this cycle in healthcareThe impact is that clinical documentation requirements are growing very fast from a payor perspective, if you didnt document it, you didnt do itRecent increases in documentation requirements in present on admission requirements and medication reconciliation requirementsIn the near future much more onnerous requirements will come to bear ICD-10 and Claims Attachments (HIPPA)The impact on clinician productivity is clearly negative in the short-term with the intent that in the long term productivity will improve as we eliminate the re-work associated with errors and redundancyNote that with respect to Comparative Effectiveness Research, whether get our act together and get proficient at it or not, payers (including the feds) are getting very proficient at it and are going to use their capability to accelerate changes in quality expectations and how we are paidPolicy makers are considering using some of the funds recovered in RAC audits to subsidize electronic health records for providers because policy makers know the more digital info they can get, the more efficient they can be in recovering incorrect payments and driving new policies