caBIG® Clinical Information Suite

Deployment Approach

September 29, 2010

Philip Gelda

Ekagra Software Technologies

29/29/2010 2

Agenda/Overview

• Introduction of deployment team• Goals of caBIG® Clinical Information Suite• Role of deployment team• Deployment approach• Deployment process and engagement• Adaptation and adoption deployment options• Wrap-Up – next steps

3

Deployment Team Experience

• Adam Welsh – Deployment Customer Relationship Manager (CRM)– Over 15 years of health information technology experience across a diversity

of domains– Successful leader and manager of systems implementations in the health

domain across Federal and private-sector health systems, health plans, bio-pharmaceutical companies and health agencies

– Particular expertise in information technology strategy and health IT stakeholder management and facilitation

• Gregory Thompson, MD, MSc – Deployment Subject Matter Expert– Over 20 years of health care experience including clinical practice in Internal

Medicine– Served as Chief of Ambulatory Care for the Veterans Administration, Steering

Committee Chair for CPRS implementation, and consulting medical informaticist

– Training includes a fellowship and Master's degree in Biomedical Informatics

9/29/2010

4

Deployment Team Experience

• Jeff Couch – Deployment Senior Software Engineer– Enterprise System and Data Integration Architect with over 10 years of

experience in health care systems integration for industry leading clients including Mayo Medical Laboratories, University of Virginia Medical Center, Centers for Disease Control, and State of Florida Department of Health

– Experienced leader that provides strategic guidance to clients and delivers tactical solutions that ensure client success

• Karen Hall – Deployment Analyst– 23 years in health care, including both Ambulatory and Hospital settings,

participating in a variety of roles with an emphasis on training and implementation

– Knowledge of both the clinical and revenue cycle workflows

• Shannon Brown – Deployment Technical Writer– Skilled technical writer with knowledge of health care and Federal HIT efforts,

including standards harmonization and the NHIN– Coordinated and managed the publication of health standards interoperability

specifications and has conducted literature reviews on the costs, benefits, and impacts of electronic health record implementation in various care settings

9/29/2010

59/29/2010 5

Goals and Success Criteria caBIG® Clinical Information Suite Project

caBIG® Clinical Information Suite currently defined goals:• Provide software components and specifications which will enable ambulatory

oncology stakeholders to:– Provide access to and utilization of integrated information and coordinated system interactions

across the Translational Medicine Continuum– Work more effectively within the broader research and oncology care environments– Help meet meaningful use criteria

caBIG® Clinical Information Suite current success criteria:• Clinical Community Adaptation or Adoption

– Business Capabilities and/or Reference Implementation will be used in a daily production setting

• Service Specification Adoption by Industry– Industry consumption of platform independent level specifications

• Adoption by the Open Health Tools (OHT) or Commercial Vendor Communities– Business Capabilities and/or Reference Implementation consumption

5

69/29/2010 6

Scope and supporting characteristics

The overall caBIG® Clinical Information Suite project has defined core scope elements and characteristics for meeting short-term goals and realizing long-term goals and success criteria:• Research/Treatment Setting

– Focus on oncology research and care delivered in an ambulatory setting

• Business capabilities– Address only oncology-specific capabilities that yield high value and/or describe

interactions that need to be specified for business capabilities

• Deployment Scenarios– Scope to be informed by deployment at several community cancer centers (NCCCP

sites)

• Standards– Focus on relevant set of standards necessary for effective, integrated oncology-

extensions

6

79/29/2010 7

Deployment Support for caBIG® Clinical Information Suite

Role of the Deployment Team• Determining and planning how a

site can adapt, adopt and share data

• Providing a feedback loop from the sites to overall requirements activities

• Driving successful market penetration of oncology extensions by collaborating with vendors of EMR/EHRs

• Supporting, in a wide range of roles, the execution of site deployment

7

Objectives of the Deployment Team• Demonstrating how oncology-extended

services can best serve the complex needs of oncology settings through:

• Adapting oncology extension services by integrating or deploying the service specifications into an existing (defined) environment

• Adopting an oncology-extended EHR by adoption of the service specifications and reference implementation in concert with an EHR platform implementation

89/29/2010 8

Deployment Approach

99/29/2010 9

A Readiness-based Assessment Approach• Develop a baseline model for assessing the site-level

feasibility of each deployment option

• The baseline will define the requirements to successfully execute a given deployment option

• The Deployment team will be primarily an outward facing team and the bulk of our activities will involve:

– Processes– Personnel– Technology– Organizational structure

9

109/29/2010 10

Deployment Approach

• Process:– Understanding current procedures and the development of new

procedures to be used during and after the implementation are critical success factors

– In a phased implementation, procedures will change several times. We will prepare adopters for such changes from inception to avoid any surprises

– We will integrate site specific business workflows into the training process for the new oncology extension service

119/29/2010 11

Deployment Approach

• People:– Leadership from all departments that will use/integrate with oncology

extensions must participate and bring their expertise to the process

– Deployment should be led by clinical staff

– A “core team” must be assembled to make decisions, provide direction and ultimately be responsible for the success

– Training , education and communication with staff are critical success factors

– Provide single point of contact for site – Customer Relationship Manager

11

129/29/2010 12

Deployment Approach

• Technology:– Operations workflow and processes will be the key drivers supported

by technology

– Work with Billings Clinic’s infrastructure group to ensure oncology-extended EHR technology aligns and integrates with enterprise systems and solutions

12

139/29/2010 13

Deployment Process & Engagement with the Billings Clinic Cancer Center

149/29/2010 14

Keys to Successful Deployment

• Smaller and targeted discussion around readiness and needs

• Precise and agreed upon definitions of Billings Clinic’s deployment options

• Detailed deployment test use cases/scenarios for the selected deployment option

• Focus on critical gaps in IT systems for oncology care that are addressed by caBIG® Clinical Information Suite

• Focus on achievable milestones

• Identify interim goals that can be achieved successfully, early in the project

14

159/29/2010 15

Deployment Process – Slide 1

• Requirements and Planning– Site business process mapping (can use prior documentation if valid)– Document site specific requirements– Develop deployment scenarios and map to business process map– Deployment team is the site’s advocate on the project– Deliver and review use cases and site-specific requirements for final

review with site

• Readiness Assessment– Capabilities (Process, People and Technology)– Review of assessment with site

15

169/29/2010 16

Deployment Process – Slide 2

• Site Deployment Plan and Architecture– Define deployment architecture for IT systems– Specify integration of systems with oncology-extended EHR– Data Sharing Plan and Architecture– Deliver and review site integration and deployment plans with site for

final input and approval

16

179/29/2010 17

Deployment Process – Slide 3

• Deployment– Confirm infrastructure– QA and testing with site

• Beta Test• User Acceptance Testing

– Training– Support– Go-live– Production and on-going support

• The Deployment team will work with the site through each step and be on-site to support throughout the process

18

Adaptation Deployment Options

Option Description Benefits Needs

Specification Adaptation

Integration of service specifications into existing EHR platform

•Seamless integration of oncology extensions into homogenous system•Long term vendor support•Process redesign, training and change management are part of overall EHR management

•Committed vendor relationship and support•Homogeneous EHR environment

Standalone Services Adaptation

Oncology services are deployed independently from an EHR

•Less impact on personnel and non-IT resources•Timelines can be shorter•Process redesign, change management and training only needed for given services

•Technology environment that can support independent modules•Services-oriented IT systems

Bolt-on Services Adaptation

Extension modules “bolted-on” to existing EHR platform(s) via interfaces

•Requires less vendor support and doesn’t require system reconfiguration•Provides oncology extension into existing IT environment•Supports integrated patient record with oncology extension

•Interface and data mapping activities can be complex•Change management, process redesign, training extends beyond oncology extension

9/29/2010 18

19

Adoption Deployment Options

Option Description Benefits Needs

Reference Implementation Adoption

Deployment of reference implementation EHR with associated oncology extensions

•Open source EHR reduces reliance on vendor support for long term support•Oncology extensions tightly integrated with reference implementation•Suite of oncology extensions in process of development •Can manage EHR environment to directly meet site needs

•Technology support in long term is managed by the facility•Significant change management, process redesign and training needs•Adequate site level IT support and resources•Site level resource intensity can be high

9/29/2010 19

209/29/2010 20

Partnership with the Billings Clinic Cancer Center

• Listen

• Understand

• Communicate

• Help to improve oncology workflow with oncology extensions

• Help to support improvement in patient care

20

219/29/2010 21

Wrap Up – Next Steps

• Questions

• Breakout sessions

21