OUR HEAD IS IN THE CLOUDS WHILE
OUR FEET ARE STUCK IN THE MUD: THE NEED FOR APPLICATION
CONSOLIDATIONJohn Kravitz, MHA, CHCIO, CIO, Geisinger Health System
Todd Hatton, MHSA, CHCIO, ACIO, Saint Luke’s Health System
William Reed, FCHIME, LFHIMSS, Huntzinger Management Group
Agenda
• Topic and Panelist Introductions
• Learning Objectives
• The Geisinger Perspective
• The Saint Luke’s Perspective
• Panel Q&A
Topic Introduction
• The ability to aggressively pursue cloud-based service is inhibited by the heterogeneity of most organizations’ application portfolios
• Question – How can rigorous application consolidation address this issue, enabling the exploitation of the benefits cloud-based services offer?
Learning Objectives
• Identify the extent application heterogeneity exists within organizations
• Identify the economic benefit of consolidating applications
• Explore the potential impact application consolidation can have on cloud-based services
• Discuss approaches for an application assessment with the intent to consolidate
Panelists Introduction
• John Kravitz, MHA, CHCIO, CIO, Geisinger Health System
• Todd Hatton, MHSA, CHCIO, ACIO, Saint Luke’s Health System
The Geisinger Perspective
• Established an IT Governance process which includes application rationalization.▪Governance process will provide a complete
review of new system requests.
▪Need to identify the problem to solve, not bring forward a solution.
▪Rationalization of IT Application Portfolio is a critical component of this process.
IT Strategy for Application Consolidation
• Geisinger IT supports nearly 1,700 software assets.
• Need to eliminate our Best of Breed environment, moving to an integrated environment▪ Reduces complexity of environment, reducing cost
to support
▪ Simplify the infrastructure – eliminate mainframes
▪ Simplifies the environment – less support cost
▪ Reduces cost of supporting multiple disparate computer platforms
IT Strategy for Application Consolidation – Example
Epic Module License Implementation Maintenance Personnel Cost
Removed
Billing $6,220,039 $10,879,552 $611,845 $1,680,000 $3,785,896
Radiology $ 860,000 $ 2,488,575 $107,796 Same $ 651,141
Laboratory $3,112,000 $ 4,500,000 $303,000 $500,000 $1,050,000
Cardiology $ 551,570 $ 3,500,000 $ 53,000 Same staff $ 243,075
Bed Mgmt. $ 250,000 $ 30,000 $ 35,000 Same staff $ 531,322
Outpatient Pharmacy $ 573,825 $ 2,435,300 $ 55,087 $160,000 $ 684,400
Utilization Mgmt $ 539,777 $ 705,840 $134,795 Same staff $1,884,000*
Summary $12,107,211 $24,439,267 $1,300,523 $2,340,000 $8,829,834
* 3.5 Year ROI
Hosting in the Cloud
• Goal is to host 50% or more of our applications in the Cloud by 2020.
• Value of the Cloud:▪Cost transparency
➢Requesting party will have full visibility and accountability for cost of their application(s)
▪Security – Cloud providers providing the highest level of security protection
▪Opportunities: AWS, Google Cloud, Azure, etc.
SLHS Perspective
• Highlights from IT Guiding Principles:
• Pursue core vendors to support across enterprise
• Follow model build, avoiding customization
• Deploy generally available software
• IT Steering Committee to provide oversight / governance
• Execute on projects and IT Service Delivery
5-year plan to consolidate to a single EMR platform
1 EMR
12 Inpatient Clinical
13 Ambulatory Clinical
8 Critical Access Clinical
5 Ambulatory Rev Cycle
7 Inpatient Rev Cycle
3 Critical Access Rev Cycle
Inefficiencies in IT
Variation in servers, client software, support staff
Business continuity across all systems
Security hardening and auditing
Inefficiencies in Operations
Growth limited by over burdened IT
Patient safety due to variation of software in use
Lack of adoption / optimization
Analysis of patient populations increasingly complex
• Innovation vs. Scale
• Speed to market vs. Stability
SLHS Consolidation Plan
Move to the Cloud is Not a Guiding Principle
• Resilience against loss of service
• Ability to pass the appropriate security audit
• Supports larger strategic goal of IT Infrastructure
1. IT Governance and Project Sponsorship
Strong, unified governance process for making IT decisions requires discipline and a consistent and ongoing commitment by SLHS executives. Technology change initiatives will be owned and driven by operational/clinical leadership. Clear and consistent prioritization process in place.
2. Overall Vendor Strategy
Pursue integrated, core vendors (e.g., Epic, ERP solution) to support functions across the enterprise (vs. cluster of core vendors).
• Core vendor: integrated architecture and data base; cross continuum and all locations; includes physician, nursing and ancillary workflow.
• Consolidate systems where feasible.• Structures in place to say “no” to local desires at the expense of the greater good.• Assume the integrated vendor product will be the system of choice unless a business case demonstrates a clear and
compelling reason to consider an alternative solution.• Understand there will be requests to go outside core vendors’ product lines, including considerations for funding and
supporting interim solutions until a core vendor is able to support a specialized need. In these instances, SLHS will implement processes to ensure justification, accountability and adjudication.
3. System Ownership and Support
Subsequent to initial implementation, system support responsibilities will be shared by the Information Services and User Departments.
4. Core System Design
Focus on enterprise-wide process and system designs shared by all departmental/business/clinical units and service lines whenever possible. Leverage vendor-recommended model configurations and avoid customization wherever possible.
5. Resource Focus Shift the focus of our internal resources to designing and implementing new solutions from support and enhancement of applications that will be replaced. Explore discrete outsourcing opportunities to improve effectiveness, reduce cost sand/or enhance skills.
6. Risk Profile and Innovation
Deploy generally available software. SLHS will be a fast follower in most areas and an innovator in very high value areas (without putting organization at risk).
7. Reliability Standards
Appropriate financial investments will be made in reliable infrastructure and business recovery processes; these investments will be prioritized; (not all applications are equal).
IT Guiding Principles: Summary