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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 2
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”
Page 3
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
Page 4
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
Page 5
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
Page 6
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?
Page 7
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
Page 8
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
Self Developed (Analysis & DSS)
TSI AS400
Self Developed (Analysis & DSS)
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
Page 10
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
Page 11
1999 – 2009 Outcomes (cont.)
Copyright 2008 Trinity Health – Novi, Michigan INTERNAL13
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%
Page 13
2010+ - Where do we go from here?
Healthcare Environmental Challenges
Trinity Health Strategic Imperatives
Key IS Focus Areas for the Next Decade
Strategic Scrabble!
Page 14
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
Page 15
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
Page 16
Solidifying Gains:GSSP – Genesis Safety and Simplification Program
Copyright 2008 Trinity Health – Novi, Michigan INTERNAL6
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
Page 17
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
Page 18
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
Page 19
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
Page 20
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.
Page 21
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 22
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
Page 23
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
Page 24
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
Page 25
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
Page 26
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
Page 27
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
Page 28
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