1

ALeadershipPerspective

Information & TechnologyServices

Alfred M. Barea© 2013

2

Contents

Summary Executive Summary

Vision Today’s Business Pressures Leveraging Technology IMAGine Your Future

Appendix Detail on: People are the Key Governance Infrastructure Value

Demonstrating Value Through Publications

3

Executive Summary

The following slides summarize details I discuss in greater depth later in the

appendix. In the 80’s I ran a software division for a major company. Their motto was “People are the Key”! This holds true to this day. My success is directly attributable to the staff I have hired, coached, and helped develop and use their greatest ideas.

I am more than an “IT Geek”. Through association with several McKinsey & Co. associates I have honed my business acumen to the benefit of employers. I have managed to put a software competitor out of business, failed to merge opposed cultures and learned from it to succeed in a second opportunity, turned around several organizations, improved satisfaction and reliability to a predictable point, and moved physicians point of view to desire CPOE.

What you will see here has been achieved already and is history. The key was accepting the challenge and re-inventing myself, copying new methods and/or ideas and breaking down obstacles to achieve success at large IDNs. That is the business creativity I bring to the table. I will solve your problems!

4

People are the KeySuccess Stories

Culture Modification – IMBED workers of opposing cultures together + new ideas & started in small training groups

Leadership Development Boot Camps on ‘how to’ Retention Program – Employee Survey Based Hiring to a Profile – Perot Methodology Orientation – Formalized with Rounding Repeatable Results

Employee Turnover – was >20% left @ <5%Customer Satisfaction – was <70% left @ >90%

5

Governance Success Stories

Engaged Board MembersObtained and sustained support for CPOE since 1999

Educated Executives on IT and Hidden Costs Information Management Advisory Group – “IMAGine”

Medical Informatics Group (physicians)Clinical Informatics Group (hospital clinicians)System Project Owners (executive sponsor over enterprise)

Executive Compensation Accountability Proactive Vendor Management & Accountability

Report Cards Formal Project Management – via Project Mgmt Office Capacity & Priority Planning – By IMAGine

6

Infrastructure & OperationalSuccess Stories

Change Management and Operational ReliabilityNew ToolsNetwork Reliability – was <<<85% left @ 99.96%

Report Cards on OurselvesMetrics & Dashboards – Available on the IntranetTransparency to Constituents – Holes in the Boat Reported

Help Desk Analytics 7500 calls per month analyzedDetermines risk areasDetermines investment levels for FTE’s and $$

Project Management Using MS, Sharepoint, Web Implementation Efficiency – improved by over 50%

7

Business Value Success Stories

As Presented to the:Board with ROI, IRR, ValuePatients in their Education and AccessClinicians by Ability to Provide Improved Quality CareExecutives in Perception of IT 1996 vs. 2006

Financial & Service Line StakeholdersBond RatingsBusiness Intelligence ToolsWillingness to reengineer SCM; Surgery; ER; CBO

Published Success Stories

8

Leverage TechnologyFrom Other Industries

Today you can schedule a flight, book a ticket, select a seat, pay for the ticket, check-in for the flight from home, waitlist for upgrades, check flight status, without ever having to wait in lines or interact with airline personnel. The airline will also link you with other travel partners-car rental agencies and hotels

The auto industry has moved to a proactive inventory management process where they predict their supply needs and view the processes of all players in the supply chain as one process. All players (raw material suppliers, manufacturers, distributors, assembly lines and retailers) are in constant communication and utilize continuous information feedback loops that optimize the supply chain at all levels, significantly improving efficiency and quality of the end product—the car

Banking today is a “bank wherever you happen to be” business. With automatic deposit, wire transfers, debit cards, online bill paying, eLoans and ATM’s everywhere the need for physical banks and tellers is almost nonexistent. The consumer no longer needs to go to a bank, the bank has been brought to the consumer

These industries have leveraged the disruptive nature of information technology and have radically changed their business models. They have used technology to automate and improve core processes, expanded their market reach, provide 24 hour access to customers, and improved profitability

9

Thoughtsfor theFuture

Ideas created or improved upon From my experience

From consultantsOr

Copied from you!

Alfred M. Barea2008

10

Today’s Business Pressures

Managed Care Margin Erosion Competitors (large & small) Targeting Profitable

Business Sectors and Establishing Own Brand Quality Improvement and Transparency of Reporting Supply Chain Costs and Contracting Increasing Operational Efficiency Capital Pressures from Re-Construction of Facilities

11

Pressures Addressed by:

Managed Care Margin Erosion Use of business intelligence software (eg. TrendStar) or contract

management software to mine cost databases for variances. Explore McKinsey rapid innovation ideas for health care payments.

Competitors (large & small) Targeting Profitable Business Sectors and Establishing Own Brand Integrate the doctors ahead of the curve (including office EMR-

electronic medical record) and make it difficult to separate. If not, form partnerships offering extended use of IDN systems to run new business. Take advantage of ePrescribing and EMR laws to share technology with practices.

Quality Improvement and Transparency of Reporting Use business intelligence databases with financial and clinical data for

mining of quality report cards.

12

Pressures Addressed by:

Supply Chain Costs and ContractingProcess re-design, then integration of materials management,

Med-Surg and OR usage data for comparison to contracts.Develop tight contracting standards for implantable components

and policy & procedures on vendors use of non inventoried items in surgery.

Increasing Operational EfficiencyProcess re-design of EMR, PACS, pharmacy & lab robots,

nursing integration; automated documentation; physician support systems.

Capital Pressures from Re-Construction of FacilitiesNew facilities built with wireless and digital capabilities.

13

Pressure from Science

Healthcare Dollars SpentImpact on Longevity from Bio-Tech

Resources ConsumedHealth Status

80%$$$

High

Low

Age

90%/10%

Future

Current

20% /$$$ $$$

High

Low

14

Applications ready “now”

Pressure from TechnologyThe Gartner Hype Cycle

15

Position IT to Leverage Technology

Select a direction:

Market Differentiation

Efficiency ReturnsCost Reductions

• High Capital Investment• Bleeding/leading-edge IT• Qualitative ROI• Market/National Recognition• Competitive Markets• Clinical Focus• High Capital Access

• Low Capital Investment• Proven IT• Quantitative Reductions• Laggard Adopter• Financially Pressured • Survival Focus• Minimal Capital Access

• Medium Capital Investment• Proven IT• Quantitative ROI• Mainstream Adopter• Cost Competitive Markets• Financial/Resource Focus• Moderate Capital Access

16

Leverage Technology fromOther Industries

Healthcare is unique? It deals with humans, as do airlines, banks. Inpatients provide a variability, but we can design solutions

incorporating this variability If the quality and care we provide is acceptable, how do we

raise the bar? If the quality and care is not the best, how do we fix it? Why does it take 10 to 15 years to adopt other industry examples

and practices within healthcare?

17

IMAGine a Health System

With “Superior Patient Value” as described in

Redefining Healthcare by Michael E. Porter &

Elizabeth Olmsted Teisberg Where industries of the future will turn to for ideas on

leveraging technology and maximizing value Delivering precise, efficient and compassionate care Where 90’s technology like “ECMO” now evolves to

“Novalung” for support of asthma & cystic fibrosis patients

And the window to that world is your INTERNET!

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IMAGine the Future of Health Care

WHERE

Improved access to care helps develop continuous healing relationships Information access allows the patient active participation Customization is based on patient needs and values Shared knowledge is the free flow of information to all clinicians Evidence-based decision making reduces care variation Quality & safety are automatically built into the workflow Public accountability for quality demands transparency Disease & care management anticipates rather than reacts Providing the right care at the right time leads to a decrease in waste An active team approach to care, by groups of clinicians and doctors on

a particular diagnosis, is standard

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Electronic

Health

Record

IMAGine a Patient/Family And the roles of information technologies

Staying as

Healthy as

Possible

•Consumer Portal •Scheduling

Accessing a

Network of Care

Getting

In

Getting

Treatment

Accessing a

Network of Care

Finding

My Way

•Medical Records •Patient Accounting•Cost Accounting•Financial Reporting•Quality and safety reporting•Research

Leaving

•Patient management•Registration•Patient wristbands/bar-coding

•Patient tracking•Way-finding

•Clinical documentation•Orders and results•Medication Management•Radiology•Laboratory

Douglas D. Hawthorne, FACHEPresident and CEO Texas Health Resources

20

IMAGine being Patient Centricwith fully Electronic Records

First defined in the late 80’s by the Institute of Medicine as the CPR or computerized patient record

Evolved to a more marketable model as the EMR or electronic medical record

Patients were given electronic access and a PHR concept evolved or personal health record

The government healthcare IT Tsar declared a RHIO was needed or the regional health information organization/exchange, like the old CHIN’s but larger and built around a new marketable term the EHR or the electronic health record

Many states have initiated development of RHIO’s as an experiment and Robert Wood Johnson Foundation has sponsored a ‘Project HealthDesign’ to rethink the power and potential of Personal Health Records

And what is your strategy?

21

People

Coaching to Consensusand/or

Majority Thinking

22

Culture Eats Strategy for Lunch

23

The Reality of Change

A Clinical System is extremely complex and high risk

Organizational Change(Process & Culture)

CPOE

New

T

echn

olog

y

Low Risk High Risk

Lo

w

Hig

h

Financial System

PACS

Adapted with permission from Cap Gemini Ernst & Young

HR & Payroll

NursingDocumentation

EHR

Physician Portal

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Attitude Curve: Response to Change

Current Conditions Commitment

Satisfaction w ith the Dedication continues

w ay things are. Denial Responsibility until a new change

occurs.

Unpleasant facts are Responsibility is

ignored or dismissed is accepted

in favor of more Resistance Exploration decisions are

satisfying thoughts. made and

Security and There is actions are taken

other needs are recognition that to improve

threatened so something must conditions.

overt defenses Attitude Trough be done.

are employed.

Negative emotions

include resentment,

anger and w orry.

Some people live in

this attitude trough.

25

First Fix Ourselves

Initiated a Self Assessment (next slide) Focused on Weak Points

Leadership changes and ongoing personal developmentRetention program to keep the good, weed out the ‘notso’Education to change mindsetsProfile hiring to bring in a new breed of employeeStructured corporate and hospital IT employee orientation

with emphasis on ‘walk a mile in my shoes’

Set New Standards for Quality of WorkSee upcoming pictures

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Applications

Software

Lifecycle maintenance

Integration/interfaces

Data standards

Major contracts

Development tools

Organization

Leadership

Staffing levels

Skill sets

Job descriptions

Training/education

Pay scales

Technology

Physical infrastructure

LAN technologies

WAN technologies

Remote access technologies

Network services

Network applications

Shared resources

Desktop devices

Management systems/services

Processes

Project management

Production support

Administrative support

Customer services

Strategic management

Project prioritization

Governance/funding

Security/control & compliance

Disaster recovery

Self Assessment 1997

Good Fair PoorIT CQI area of focus

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Instill pride in quality work….

THEN

NOW

28

Then Fix our Customers Satisfaction of ITS

Incidents/Call Volume/Hospital Survey Scores

52.7

42.4

49.8 48.352.4

64.5

75.2

87.3 88.3

23.621.3

42.5

51.1

40.3

10.38.4 8.9 8 6.6

8.210.2

16.815

75.6

81.484.8

87.4 87.489.9 89.7 89.1

2526.9

33.1

27

84.4

0

10

20

30

40

50

60

70

80

90

100

Mar-99

Jun-99

Sep-99

Dec-99

Mar-00

Jun-00

Sep-00

Dec-00

Mar-01

Jun-01

Sep-01

Dec-01

Mar-02

Jun-02

Sep-02

Dec-02

Mar-03

Jun-03

Sep-03

Dec-03

Mar-04

Jun-04

Sep-04

Dec-04

Period

Nu

mb

er

Total Calls / 1000

Total BHS Incidents / 100

Hospital Incidents / 100

Hospital Satisfaction Scores

29

Governance

Educate, Include in the Processand

Hold Accountable

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Education & Communication

Phase 1Education

Initial – Value of

ITS

Ongoing – Additional

ITS Services

Key Stakeholders – CEO, Hospital Pres, CFO and CIO

Primary Communication Source – BHS CIO

Method/Tools:

Face-to-Face Meetings/Value of ITS to Hosp – Financial Analysis and Expected Benefits (From Business Plan)

Conference Calls/Initial education on ITS; Status Report from Face-to-Face Meetings

Divisional Meetings/Update on ITS

Frequency:

Face-to-Face – Once/Quarter

Conference Calls -- Monthly as needed

Divisional Meetings – As scheduled

Sample Improvement – Recommendations to better present ITS value to HOSP executives; Prioritization of services

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REQUEST FOR INITIATIVEREQUEST FOR INITIATIVE

User/Steering Committee --with representation from:• Physicians• Laboratory• Pharmacy• Radiology• Nursing/Patient Care• Contract Management• Health Plan• Patient Accounting• Financial Systems

Information Management Advisory Group (IMAGine)

Log and Analyze Request

Inform and

Advise

As Appropriate

• Executive Council• Physician Advisory

Council

Responsibilities include:• Set high-level policies • Approve I/S strategic plans• Evaluate strategic projects or projects over

$500,000• Approve project funding • Approve project prioritization• Delegate authority for project-related decisions

Responsibilities include:• Evaluate appropriate-sized projects

(between $50,000-$500,000)• Monitor initiative progress and benefits

realization • Resolve inter-entity issues• Recommend project prioritization • Prioritize and assign resources• Prepare project requests for Presidents

Council review

Responsibilities include:• Evaluate appropriate- sized

projects (under $50,000)• Represent the operational

viewpoint• Assist with project

prioritization• Identify and investigate

cross-functional issues• Prepare project requests for

review

Presidents Council

IT Oversight &Approval Processes

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Executive Comp Plans     

Goal Achievement Levels & Measurements    

  %New FY Level 1 Level 2 Level 3

GoalsWeig

htTarg

et      

           

1. System Financials        

a. Operating Margin15%

$30,073

30,073,000 - 35,185,410 35,185,411 - 40,297,820 40,297,821 or >

b. Days Cash 10% 250 250 - 260 261 - 270 271 or >

2. Supply Chain Goal

10%  

Establish BHS corporate contracting department. Interview and hire a department Director and two Supply Chain analysts. Train the analysts to continue to monitor implemented savings and to provide analysis for on-going cost savings initiatives.

Implement Level I plus the tools and operational processes to manage and measure realized contract savings. In addition, implement McKesson proposed savings equal to or greater than $2M annualized

Implement Levels I and II plus the McKesson proposed savings equal to or greater than $4M when annualized.

3. Clinical Goal -

10%

 

As a potential substitute for JCAHO certification, the system will investigate ISO 9001 2000 registration by performaing a gap analysis on all system hospitals. Such analysis of system practices will determine the efforts required to achieve certification.

In addition to Level I, meet at least 10% of the National top 10% targets for quality and 25% of the National target indicators for quality.

In addition to achieving Levels I and II, deploy system-wide teams to correct all shortfalls from the gap analysis and be prepared for an ISO 9001 2000 registration survey by fiscal year end.

4. System IT Goal-Facillitate information services using technology and performance improvement for succesful outcomes

25%

 

Ensure that projects on the IS Dashboard comply with all components of the Project Mgmt. method. Finish the implementation of 1. Admin Rx, 2. Surgical Mgr., 3. Lab (2 sites) by the end of FY06

In addition to Level 1, complete 5 of the following 6 projects through the individual milestones as approved by the EPR, by the end of FY06:1. PAN Lite for Nurses (remove Lab Access); 2. PAN Online MAR Access & Cardio Web Center of Excellence; 3. Accudose deployed one hospital 100%; 4. HED live at CBH and establish pilots at other sites; 5. LAB standardized and live @three sites; 6. IP Logicare upgraded all sites.

In addition to Levels 1 and 2, complete the following projects by the end of FY06. 1. PAN/CAN and BEN established as standards for access. 2. Order set integration with PAN for physician offices; 3. LAB live at all sites to replace Misys.

33

Vendor Report CardsAssociated in Contracts

Vendor Report Card 2000-2005

2.5

2.6

2.7

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

3.6

3.7

3.8

3.9

4

4.1

4.2

4.3

4.4

Jan-

00M

arM

ay July

Sept

NovJ-

01 Mar

May Ju

lySep

tNov

02-J

anM

arM

ay July

Sept

Nov

03-J

anM

arM

ay July

Sept

Nov

Jan-

04M

arM

ay July

Sept

Nov Jan

Mar

May Ju

ly

34

Capital Budget Categorization ReportThe IMAGine Committee uses this report during the budget process to prioritize projects. Projects are shown for the upcoming fiscal year sorted using a multi-level scoring matrix.

System AcquisitionProjects that are not part of the BEST Program, Evolving Technologies or infrastructure strategy are requested through the System Acquisition Process. This process allows hospitals the opportunity to request projects that meet specific hospital needs and are not part of a strategic initiative.

The completed System Acquisition Request form and worksheet are used to justify and score projects during the budget process.

Management Tools

35

Project PortfolioThe Project Portfolio is a linked set of active and future project plans drawing from the IT resource pool. As projects are added, over allocation of resources is identified enabling management of resources through reallocation, time-line changes, scope changes, etc.

IS Resource Allocation ReportThe Resource Allocation Report replaces the “IS Resource Matrix”. The report shows required FTE’s by skill. Job categories that are over allocated are shown in yellow.

Management Tools

36

Management Status Review and Executive Project Review

The Management Status Review (MSR) is a bi-weekly report summarizing project status and identifying issues that could adversely impact the project.

The Executive Project Review (EPR), a monthly report utilized for large projects with significant financial impact. The EPR summarizes the high-level project status, issues and budget review.

Management Tools

37

Technical Status Review

The Technical Status Review (MSR) is a bi-weekly report summarizing technical project status and identifying issues that could adversely impact the project.

Management Tools

38

IT Dashboard

A monthly project status report, the IT Dashboard provides a visual representation of the progress and status of major projects. Individual IT Project Coordinators or IT Directors enter data into the Dashboard report.

Dashboard Review

October 2005

Management Tools

39

Infrastructure

Through Metrics Provide OperationalSmoothness, Reliability

andFiscal Responsibility

40

Improved Management

• ESX – Virtual Servers• Blades – Servers & PCs• Etc., Etc., Etc….

• HP Openview – Network• Citrix – Applications• Radia - Workstations

41

Operational Reliability

Network Applications

89.70

99.72 99.60 99.84 99.90 99.90

85

90

95

100

105

FY97 FY98 FY99 FY00 FY01 FY02

98.70

98.9598.82

99.30

99.50

99.10

98

100

FY97 FY98 FY99 FY00 FY01 FY02

42

Representative Report Card

Support Calls/Week

32

6069

4550

55 59 61 58 59

01020304050607080

01/0

1/97

01/0

8/97

01/1

5/97

01/2

2/97

01/2

9/97

02/0

5/97

02/1

2/97

02/1

9/97

02/2

6/97

0

20

40

60

80

100

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Installations to Date

PCs Printers OtherInformation Systems Function Integration Support Current Involvement

Dat

a S

tand

ards

&

Com

mon

Sys

tem

s

Sin

gle

Iden

tific

atio

n

Sys

tem

Dat

a A

cces

s ac

ross

Con

tinuu

m

Sys

tem

-wid

e D

ata

Rep

osito

ries

Cen

tral

ized

Bus

ines

s Fu

nctio

ns

Req

uest

ed P

artn

er

Sup

port

Ven

dor

Coo

rdin

atio

n

Mat

eria

ls

Man

agem

ent

Fina

nce

Hum

an R

esou

rces

Man

aged

Car

e

Mar

ketin

g &

Pla

nnin

g

MS

O S

ervi

ces

PR

OM

INA

Gw

inne

tt

Hea

lth S

yste

m

PR

OM

INA

Nor

thw

est H

ealth

PR

OM

INA

Pie

dmon

t Hea

lth

PR

OM

INA

Sou

th.

Reg

. Hea

lth S

yste

m

Strategic Initiatives Data Warehouse Projects Managed Care Projects Master Patient Index ESI Implementations Integral Implementations System-wide Communications Computerized Patient Record Business Acquistion Projects Tactical Initiatives Cerner PathNet Implementations HBOC Star Implement. & Upgrades Trendstar/Quantum Implementations CyCare 3000 Implementations Imaging/Optical Storage Projects CIS Electronic Claims Support Magic Implementation Consort Mammography System Labor & Delivery Point of Care Optical Radiology Archive Respiratory Therapy System

Business and I/S Strategy Linkage

Program Management Performance

Sample Performance IndicatorsSample Results Indicators

43

Help Desk Analytics

Incidents/Call Volume/Hospital Survey Scores

70.5

75.6

81.484.4 84.8

87.4 87.4

50.652.7

64.5

2123.6

21.3

26.925

27

33.1

9 10.3 8.9 8 6.68.2

48.3

52.4

42.4

49.8

8.4

0

10

20

30

40

50

60

70

80

90

Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 Sep-01 Mar-02

Period

Nu

mb

er

Hospital Scores

Total Calls / 100

Total BHS Incidents / 100

Hospital Incidents / 100

Jun-01

44

Actual IT Growth

1998 2005

• Applications• Employees and Physicians• Data Lines to Hospitals• Servers• Devices• Storage• Interfaces• IS Employees

19015,00045Mbs600+

20,85142 TB

81140

908,000

1.5Mbs22

9,277500 GB

32105

11187

29002600125

820015333

% IncrBHS IS

2173 Avg. Concurrent Sessions (Oracle)850 transactions per second on Horizon Patient Folder 100,000 Scanned Images per Day (HPF)500 Backups per Day Including 4+ Terabytes of DataBHS Internet had 2,355,230 Page Views in AprilImplementing SAN Technology in Hospital Computer Rooms (8TB Baseline)500+ Wireless Access Points Deployed at BHS13,608 Switch Ports Deliver a Total of 2.4Tb/s of Throughput (45Mbps to Data Center)

45

Representative Investment in IT

$16

$19

$7

$42

$17

$6

$31

$11

9.1%

28.1%

21.8%

14.0%

23.4%

0.8%

24.0%

15.1%

$0

$5

$10

$15

$20

$25

$30

$35

$40

$45

BHS IDS #1 IDS #2 IDS #3 IDS #4 IDS #5 IDS #6 IDS #7

Ann

ual I

/S C

apita

l Inv

estm

ent (

$M)

0%

5%

10%

15%

20%

25%

30%

I/S C

apita

l as

% o

f Ove

rall

Cap

ital

Capital $ Capital %

$1.1B $1.2B $682M $450M $2.5B $831M $752M

1996-97 figures

$850M

46

Representative Investment in IT

$12

$24

$14$17

$7

$71

$18$15

2.4%

1.8%

3.3%

2.0%

3.5%

2.5%2.3%

0.2%$0

$10

$20

$30

$40

$50

$60

$70

$80

BHS IDS #1 IDS #2 IDS #3 IDS #4 IDS #5 IDS #6 IDS #7

Ann

ual I

/S O

pera

ting

Expe

nse

($M

)

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

I/S O

pera

ting

as %

of O

vera

ll O

pera

ting

Operating $ Operating %

1996-97 figures

$1.1B $1.2B $682M $450M $2.5B $831M $752M$850M

47

VALUE

Prove Value by UnderstandingBusiness Alignment, Consumer Demands

Physician Needsand

Showing it Every Step of the Way

48

1993 IT Strategic PlanGOAL I.

Electronic Medical RecordGOAL I.

Electronic Medical Record

Objectives• Automate Documentation System• Electronic Capture, Storage, and Provision

of Information• Automate Selected Archived Patient

Records and Transcribed Reports• Establish Electronic Community Medical

Record• Evaluate Transport of Images

GOAL II.Decision-Making

GOAL II.Decision-Making

Objectives• Establish Clinical/Operational Database• Establish Analytical Database/Data

Warehouse• Provide End User Access to all

Databases• Evaluate Clinical/Physician Workstation

GOAL III.Productivity/Resource

Management

GOAL III.Productivity/Resource

ManagementObjectives• Support Paperless Process for Materials and

Supplies• Evaluate Automated Scheduling• Enhance Physician Access System• Enhance Quality Resource/Utilization Review• Acquire Human Resources and Time Entry

System and Replace Payroll Systems• Provide Internet Access• Purchase Niche Applications• Provide User Friendly Office Automation• Continued Deployment/Acquisition of

Technology Infrastructure

Three GoalsThree Goals

49

1997 & 2006 Perceived System Value

50

Cardiology ICU/CCURehab Therapies

NutritionSocial ServicesRespiratory

Outside Records

Admin.

Consents

Nurses NotesVitals/IO

LaboratoryAssessmen

ts /Plans

ImagingPathology

Face Sheet H&P ConsultsOperative

Report

Progress Notes

OR/ Anesth /RR

Physician

Orders

ERAdmission

MAR

Fully automated

Automation in ProgressNot automated

Current State of the BHSComputerized Medical Record

2006 EMR Capability

51

Ordering

39%

Transcribing

12%

Preparing

11%

Administering

38%

Leape LL et al. Systems analysis of adverse drug events. JAMA 1995;274:35-43.

Understand Consumer’s Perspective

Where Medication Errors Occur

What the Public Perceives

IOM Report stated 44,000 – 98,000 people killed each year as a result of errors in hospitals

52

• Impossible to keep current on all journals

• Don’t want “cookbook medicine”

• Single Sign-On

• Easy integrated access

• Someone else to key it in

• Reduced hassle

• Standardization on my data

PAN (Physician Access Network)

Understand Physician’s Perspective

53

Additional Payer Perspective

Prevalence of ADEs

Cost of ADEs

4.7

277

$4,685

$1.3M

Preventable ADEs per

1,000 Patient Days

Annual Preventable ADEs for 300-Bed Hospital

Cost per Preventable

ADE

Annual Preventable ADEs Costs for 300-Bed

Hospital

BHS Estimates

$4,685

Cost per Preventable

ADE

Annual Costs of

Preventable ADEs

$7-7.5M

340K patient days/year1,598 preventable ADE’s

54

CPOEPardon Our Dust !

It’s MessyIt’s Messy

Vision of WhyVision of Why

Trust the Trust the MissionMission

Focus/RallyFocus/Rally

CommunicationCommunication

Culture PointCulture Point “ “Progress” is Good ! Progress” is Good ! (Right?)(Right?)

55

Change Requires… What?

Recognition of the commitment to clinical transformation

Clinical Transformation – a comprehensive and structured approach to achieving clinical excellence through the use of reengineered work processes, evidence-based medicine and information technologies.

Just don’t lose your focus!

56

Order Sets: Approach the Lions with Care

Joel McAlduff, M.D.

Senior Medical Informatics Analyst

Banner Health

Single and multiple hospital systems all face the same challenge; how to standardize physician order sets across the organization. The goals are laudable; reduce variation, base orders on clinical evidence, and reduce costs due to standardized care and supplies.

Yet physicians resist “cookbook medicine” that limits their ability to base care on their experience and clinical knowledge.

How can organizations meet the needs of patients and clinicians? How can systems balance the need for detailed information with the clinician’s need to rapidly move through orders online?

57

Bedside Meds AdministrationNursing Workflow

- With AcuDose & Admin/Rx

= AdminRx = AcuDose

58

Project ManagementEfficiency!

StatisticsSeveral years ago we measured the cost for implementing computer systems at BHS and compared this to a national average.

Statistics for projects:

Non-Healthcare National Average

1997

2000

2003

2004

1

1

1

1

1997

For Every Capital $

1

For Every Capital $

Total Operating and Capital Expenditure

5

3

2.85

2.12

2-3

Total Operating and Capital Expenditure

BHS HealthcareAverage

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Publications

Innovation in PACS Abstract: Vol. 10 •Issue 4 • Page 20. Innovation in PACS. A historic view of PACS reveals how da Vinci's artistic renderings have brought us to where we are today, and where we may be tomorrow.By Al Barea and Shannon Davis. Staff have heard a favorite expression of ours: "A picture is worth a thousand words. The message ha...

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Publications

Vet Your VendorVENDOR MANAGEMENTThe software industry is unstable. The economy is shaky. And your software company could be sold or go broke tomorrow. That's why you need the knowledge and tools to analyze and evaluate present and potential software vendors. BY MERIDITH LEVINSON

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Publications

The Art of the Shmooze - PROJECT POLITICS - the importance of ...

There, they met up with their host, the man who had provided their tickets, Alfred Barea, CIO of Louisville, Ky.-based Baptist Healthcare and then-member of ...www.cio.com/archive/041502/shmooze.html

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Publications

Winning the Talent Wars by Bruce Tulgan.

Baptist Healthcare System and Mr. Barea are featured in chapter three, pages 72 - 74.In Winning the Talent Wars, Bruce shares what he has learned and taught at the front lines of the war for talent, a war that many see as the single most important challenge business faces in the twenty-first century. Based on five years of research about the character and proclivities of the swelling free-agent labor force, Bruce also brings to the table valuable, never-before-published stories about how managers at some of America's most influential corporations are quietly coming up with innovative solutions