healthcare leaders embrace reform beyond the emr, cpoe, emar, scm, hit and hies: alphabet soup for...

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

Alphabet Soup / Acronyms A 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”

Discussion Outline Background

Trinity Health Overview Trinity Information Services (TIS) Overview Planning Model

Retrospective: 1999 – 2009 Key Focus Areas Outcomes

2010 – 2020: Looking Forward Environmental Overview Trinity Health Strategic Imperatives IS Key Focus Areas

Summary Thoughts

Q & A

Trinity Health…Who We Are

• Fourth-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

Trinity Information Services ProfileTIS is a business within a business … a wholly owned, $300m / year

subsidiary of Trinity Health

Operational Structure Single IS Organization - Consolidated Application Management,

Infrastructure Management, Financial Management, Planning Workforce - Approximately 1,400 associates

Applications Clinical – Cerner Patient Administration / Revenue Mgmt – McKesson HR / Payroll / GL / FA – PeopleSoft Supply Chain / AP - Lawson

Infrastructure Enterprise Data Centers – Novi MI / South Bend IN Approximately 100,000 Networked Devices

Services & Other Portfolio of Routine IS Services 7*24*365 Help Desk Fielding 720,000 / Year – Specialized Cerner

knowledge Strong Program Management, Change Management Services, and

Benefits Management Nationally recognized leader in deployment and usage of electronic health

records Provider of outsourcing services to external organizations

Planning Approach

What did we complete relativeto what we originally

envisioned?

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 we’ve done into new revenue streams?

What are the organizational requirements to execute?

Retrospective Analysis Prospective Analysis

PotentialCompetitors

PotentialCustomers

Asset / Capability Inventory

PersonnelResources

AmbulatoryCare

Continuum

ComparativeEffectiveness

AnalysisInpatient Other

What are the Trinity Health, industry, and policy implications?

FinancialResources

OtherResources

BusinessModel

What will truly differentiate Trinity Health?

InnovationKey

ProcessesPartnerships

Business Model

Economics

Why did we do this?

What were key decision points? What

decisions did we make? Learnings?

Retrospective: 1999 – 2009 IS Focus Areas

Organizational Consolidation

Infrastructure Standardization

Application Rationalization

Process Redefinition

Y2K .com XP EMR/EHR ADE CPOE SEM URO CDM

HIPAA HIT HIE RAC BMDI POC IPOC EWS ARRA

Major Themes The Soup

Genesis – Trinity Health: Circa 1999 . . .

Tool Diversity Process Diversity Variable PerformanceEastern Division Western Division

Operating UnitsSilver Spring, MD

Columbus, OH

Port Huron, MI

Mt. Clemens, MI Pontiac, MI Livonia, MI

Ann Arbor, MI

Battle Creek, MI

Grand Rapids, MI

Muskegon, MI

South Bend, IN Clinton, IA

Dubuque, IA

Mason City, IA

Sioux City, IA Boise, ID Fresno, CA

Patient Administration

Registration

Patient Accounting

Medical Records

DRG Grouper 3M 3M Quadramed 3MQuadraMed

3M

APC/APG Grouper HSS HSS

Enterprise Resource Planning (ERP)

General Ledger People Soft Global People Soft People Soft

Payroll/Human Resources

GEACCeridian

GEAC

A/P

Materials Management

Cost Accounting

Self Developed (Analysis & DSS)

TSI Mainframe TSI Mainframe TSI AS400


TSI AS400


Contract Management

SARMCMcKesson HBOC

Clinical Systems

Physician Order Management

Eclipsys

Order EntryHBOC STAR

SMS MedSeries 4

HBOC Plus 2000

HBOC Series

SMS MedSeries4 HBOC STAR HBOC STAR

Results ReportingIn-house/3M CWS CWS Cerner In-House

ADEs

Clinical Documentation

EclipsysHBOC Care

ManagerTDS

HBOC Care Manager

TDS EclipsysLifeServ Petronics

LaboratoryHBOC STAR

Cerner Pathnet

Cerner Pathnet

Sunquest ClassicHBOC ALG

Classic Cerner Millenium

Classic ClassicCerner Pathnet

Cerner Millenium

United Clinical Labs Sunquest

Cerner Millenium Sunquest

HBOC STAR

Pharmacy HospitalCerner

MsMedsCerner

MsMedsCerner

MsMedsHBOC Series

Cerner MsMeds

Cerner MsMeds

Cerner MsMeds

Cerner MsMeds

HBOC STARCerner

MsMedsCerner

MsMedsCerner

MsMedsCerner

MsMedsMediware WORX

Surgery Management

RES-Q Healthcare Omni-server

Omni-server

Patient Scheduling HBOC Pathways HBOC Pathways HBOC Pathways

RadiologyHBOC STAR

IDXADAC MARS II

HBOC Series

ADAC MARS II

HBOC STARADAC MARS II

Per-Se'Consort

HBOC STAR

Transcription Softmed Dolbey Softmed Dolbey Softmed Medrite Softmed Dictaphone Softmed SARMC Softmed

HBOC STAR

SMS Med Series4

HBOC

SMS Med Series4

Medline Systems

Global

SMS Med Series4

HBOC Plus 2000 HBOC

Series

TDS TDS

SMS Med Series4

SMS MedSeries

4

HBOC STAR

HBOC

SMS Med Series4

Per-Se'ORSOS

HBOC STAR

HBOC

HBOC Health-Quest

SMS Med Series4

HBOC Health-Quest

Trinity Health: circa 2009

Common Tools + Best Practice Processes = Performance Excellence

1999 – 2009 Outcomes

I T c a n b e F R E E !I T c a n b e F R E E !I T c a n b e F R E E !J o s e p h S w e d i s h

P r e s i d e n t a n d C E O , T r i n i t y H e a l t h

A p r i l 3 0 , 2 0 0 9

J o s e p h S w e d i s hJ o s e p h S w e d i s h

P r e s i d e n t a n d C E O , T r i n i t y H e a l t hP r e s i d e n t a n d C E O , T r i n i t y H e a l t h

A p r i l 3 0 , 2 0 0 9A p r i l 3 0 , 2 0 0 9

Copyright 2008 Trinity Health – Novi, Michigan INTERNAL2

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

1999 – 2009 Outcomes (cont.)


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.

Clinical Benefit Areas

• ADE avoidance

• Order management efficiencies

• Liability expense avoidance

• Reduction in Clinical Documentation time

• Reduced pharmaceutical expense

Revenue Mgmt Benefit Areas

• Reduction in bad debt and operational write-offs

• Increased interest income through AR reductions

• Reduction in claims production error rates

• Improved charge capture

Supply Chain Benefit Areas

• Supply cost savings

• Increased penetration of GPO contracts

• Improved inventory management

• Increased rebates and discounts from vendors

• Reduced forms, paper, printing and postage costs

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

Reduced Severity Adjusted Mortality from 107% of expected to 60%

April 2010: HIT, Uncertainty Remains

2010+ - Where do we go from here?

Healthcare Environmental Challenges

Trinity Health Strategic Imperatives

Key IS Focus Areas for the Next Decade

Strategic Scrabble!

Healthcare Environment / Trinity Strategic Imperatives

Page 16

2010+ Environmental Challenges

Rising costs and reduced funding Increased utilization of high cost technology and medical supplies Reduced access to capital due to market volatility Concerns over healthcare reform and coverage for the uninsured

Increasingly competitive market Evolving business models Rapid change and fluid transformation Increase in transparency Shifts in demand

Workforce challenges Growing need for high quality, efficient healthcare Diminishing pool of experienced talent Difficulty retooling workforce to a more customer-focused mindset

Page 17

Accountable Health Networks

Accelerated Integration

Growth

Financial Stewardship

Physician Alignment

Spiritual Workplace

Best People

Excellence in Care Experience

Community Benefit Ministry

IT DependencyStrategic Imperative

Trinity Health Strategic Imperatives

2010+ IS Focus Areas

Solidifying the Gains

Embracing Reform

Extending the Core

Redefining our Ministry

Evolving our Intelligence

HCRA MU CE GSSP VIT RTE POC IPOC BMDI eICU I____

MDA AHN ACO AEHR BD INNV BI CI ILM CC OMG

Major Themes The Soup

Solidifying Gains:GSSP – Genesis Safety and Simplification Program


Genesis Safety & Simplification Program

Current State: Complex, Fractured Decision Process

Care Area Improvement

Teams……Professional

CouncilsDr. Jones

…Clinical Informatics

Teams …Nursing

Issues Triage Team(CISQIS)…

Dr. Smith…

…Clinical Leadership

Council

Ancillaries…

Dr.Garcia…

…Pharmacy

Many Voices, Many Decision-Making Venues

Future State: Streamlined Decision-Making

Genesis Safety and Simplicity

Team

Triage TeamCISQIS

ALERT TEAM

Work Teams

Clinical Leadership

Council

MO Clinical Informatics

Evolving GSSP Teams & Governance

Chief Medical OfficerChief Quality OfficerChief Information Officer

Simpler is Safer

Solidifying Gains:VIT – IS Value Improvement Teams

30 4 /1 3 /2 0 1 0

T IS S u s ta in in g t h e M in is t r y P r o g r a m O v e r v ie w

T IS M e t r ic s b e in g m o n i t o r e d fo r S u s t a in in g t h e M in is t r y C o n t in g e n c y P la n

• L a b o r s a v in g s a s o f F e b r u a r y 2 0 1 0 , $ 4 .5 m i l l io n , F T E s f a v o r a b le b y 1 5 a s o f F e b r u a r y 2 0 1 0

• V e n d o r r e d u c t io n s - a c h ie v e d $ 5 .5 m i l l io n a s o f F e b r u a r y , t a r g e t is $ 8 m i l l io n .

• L a b o r p r o d u c t iv i t y a c h ie v e d o f 3 .5 % Y T D .

T IS S u s t a in in g t h e M in is t r y T e a m O r g a n iz a t io n S t r u c t u r eO v e r s ig h t T IS /P M O E M G

IS P la n n in g T e a m

P r o g r a m M a n a g e m e n t

T o n i P r a t t ( L e a d ) M a r k K u e b e r ( S u p p o r t )

T e a m L a b o r C o s tL a b o r

P r o d u c t iv i t yV e n d o r

M a in t e n a n c e V a lu eT a le n t

M a n a g e m e n t

T e a m L e a d ( s ) J im E le r t K y le J o h n s o n T e r i H o h e n ta n n e r T o m C e n t l iv r e D e b R o c k e yC a r la R o b e l l i

A r e a o f F o c u s L a b o r C o s ts . A p p r o v a l o f a l l N e w a n d r e p la c e m e n t F T E s a n d C o n t r a c t L a b o r

E l im in a teA u to m a teE d u c a te

- T IS T o o ls- R e d u c t io n in V e n d o r M a in te n a n c e C o s ts

- E v a lu a te S O W s f o r B e n e f i t s- T r a in S ta f f a n d B u s in e s s O w n e r s- T r a c k

- D e f in e T IS L e a d e r s h ip P r o f i le- E n s u r e c o n s is te n c y in p r o m o t io n- M a n a g e c o s ts

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

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

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

Health IT• Funding in stimulus bill

• Bonuses starting 2011 for “meaningful use”

• Penalties start 2015 for noncompliance

Embracing Reform:MU – Meaningful Use

The spirit of “really meaningful use”:1. Implement technologies and processes that improve care2. Ensure they are used3. Measure outcomes and keep going

Extending the Core:MDA – Mergers, Divestitures & Acquisitions

Significant MDA’s last 36 months

MDA produces value when it results in clinical integration that improves care. Increasingly, clinical integration is dependent on technology integration.

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.

Redefining our Ministry:AHN – Accountable Health Networks

Copyright 2009 Trinity Health – Novi, Michigan

Market-Based Accountable Care Organization

Market-Based Accountable Care

Organization (ACO)

Aligned Health System

AcuteCare

LTCare

HomeCare

AlignedPhysician

Organization

Fully integrated(employed) physicians

Contracted(clinical co-

management) physicians

Private practice aligned

physicians

Health 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 ACO

While the ultimate design is uncertain … it is certain to be complex and to vary by market … therefore, Trinity’s technical design must be robust and adaptable

Redefining our Ministry:Accountable Health Networks Technologies

Physician Practices• Enterprise Practice

Management• Electronic Medical Record• ePrescribing• EMPI Integration• Interoperability

Patient Portal

Consumer Portal

Long-term Care• Electronic Medical Record• EMPI Integration• Interoperability

Home Health Care• Care Management• EMPI Integration

Redefining Our Ministry:BD – IS Business Development

|McKinsey & Company 5

Workin

g D

raft -Last M

odified

3/11/200

9 1:44:52 A

MP

rinted

3/10/2009 4:07:1

9 PM

We evaluated 30 Genesis assets with value, offering 15 potential business opportunities; we believe there are 6 promising businesses

PRELIMINARY

SOURCE: McKinsey client experience

Outsourcing

Data

IP

Business opportunities fall into 3 categories

Low priority

Recommended

Total potential market

Cor

e ca

pabi

lity

Fea

sib

ility

Mod

erat

eD

iffic

ult

Low ($0 – 500M) Medium ($500M – 1B) High ($1B+)

ASP ClinRev for physician offices

ASP ClinRev to ASCs

USOservices to providers

End-to-end solutions to Health systems

Clinical knowledge basesApplication

add-ons

Readiness in a box

Sale of clinical

data set

Data analytics

Real-time CDS

Health/wellness programs & patient care communities

Device integration

pilots

Innovation simulation lab

Benchmarking and consulting for providers

ASP of Genesis services

Evolving Our Intelligence:BI / CI – Business & Clinical Intelligence

Stages of BI Maturity

Beginning

Developing

Defined

Advanced

Leading

Spreadsheet driven Significant manual

effort to collect data Limited to operations

and regulatory reporting

Limited knowledge of data sources

Ad hoc models / spreadsheets

Automated reporting limited to transactional systems

Many operational performance measures have definitions, but different values are reported

Organization has a formal BI strategy

Data is gathered from disparate systems

Some integration across business units

Improved information access and delivery

Subject area data warehouses

Developing data governance processes

Information integration across organization

Enterprise data warehouse, including robust metadata repository

Processes exist to integrate additional data sources and domains

Single version of truth Formal data

governance requirements and policies

Personalized dashboards and alerts

Near real-time performance monitoring

Forward looking analytics, forecasting and predictive models

BI competency center to maintain strong governance

Trinity Health’sCurrent Position

Business Intelligence systems allow leaders to manage the enterprise by looking out the windshield rather than the rear view mirror ~

Unknown

Evolving Our Intelligence:CE – Comparative Effectiveness

ImproveQuality

& Efficiency

ComparativeEffectiveness

Research

CaptureData

ChangeOperations

Technology Infrastructure (HIT)

FinancialIncentives

Trinity Health Accelerating the Cycle!

Bundled Payment Methods Aligned Incentives

Pain Management Pressure Ulcers Fall Prevention Enterprise Formulary ICU Utilization Order Set Standards Implant Management CAUTI Reduction

CE Within Trinity

Summary – The Journey Continues

From 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.

I. OrganizationConsolidation

II. StandardInfrastructure

III. StandardData Capture /

Transaction Systems

IV. Extending Core

V. BI / CI

VI. Commercializing

1999 2009 2020

IT-E

nabled Valu

e

Transactional Era Era of Intelligence

Conclusion

IT Can Be Free And IT’s as Easy as ABC!!

HRA MU CE GSSP VIT RTE POC IPOC BMDI eICU I____

MDA AHN ACO AEHR BD INNV BI CI ILM CC OMG

Y2K .com XP EMR/EHR ADE CPOE SEM URO CDM

HIPAA HIT HIE RAC BMDI POC IPOC EWS ARRA

healthcare leaders embrace reform beyond the emr, cpoe, emar, scm, hit and hies: alphabet soup for...

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