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Partnership and Alignment: Critical Steps to Maximize Speed and Execution
William Holland, MD
VP and Chief Medical Informatics Officer
Banner Health
November 13, 2016
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The Banner Operating Model
• Integrated governing process• Single Board of Directors
• Centralized management structure
• Centralized corporate functions
• Designed to achieve results• Enhance clinical quality
• Affordable cost model
• Patient/member experience
• Alignment from strategy through initiatives• Drives common strategy from senior leaders down through entire organization
• Allows IT leaders to tightly align technology strategies with Banner strategy
• Aligns IT sub-strategies and tactics across IT operations
Banner’s Operating
Model
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ED
Pulmonary
Palliative Care
NICU/Newborn
Neurosciences
Critical Care
Behavioral Health
Anesthesia
Pediatrics
Women’s Health
Long-term Care
Medical Imaging
Primary Care
Hospital Medicine
Cardiology
Nephrology
Surgery
Pharmacy & Therapeutics
Infectious Disease
CV Surgery
Oncology
Ortho
Care Management
Council
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Evidence Based Practices
• Medical Imaging for Dx Community
Acquired Pneumonia
• Chlorhexidine Alcohol for Surgical Skin
Preparation
• Seprafilm Use in Cesarean Sections
• Knee High SCDs and TEDs
• Early Sepsis Identification
• Acute Respiratory Distress Syndrome
(ARDS)
• Delirium
• Newborn Hypoglycemia Screening &
Mgmt
• Medical Imaging for Peds Appendicitis
• Large/Small Bowel Surgical Care
• Diagnosis of Diarrheal Disease
• Pooling of Bronchoscopy respiratory
specimens
• Diagnosis of Coccidioidomycosis by
Seriological Means
• Diagnosis of Clostridium difficile
Associated Diarrhea
• Elective Deliveries Prior to 39 Weeks
• Behavioral Health Medical Clearance
• Ventilated Patient Management (oral
care, sedation)
• CT Scan in ED for Atraumatic Headache
• Dysphagia Management for peds
patients
• Subcutaneous Insulin
• Readmission Risk Assessment and
Management
• Pediatric Sepsis
• Enhancing Progression of Labor
• Indwelling Catheters in Laboring
patients
• Pharmacy Drug Level/Lab Monitoring
Service
• Appropriate Use of PPI’s (Proton
Pump Inhibitors)
• DKA Hyperglycemic Crisis
• Moderate-Severe EtOH-Substance
Withdrawal
• Pediatric Bronchiolitis
• Pediatric Fevers
• Adult Implantable Automatic Cardio-
Defibrillators (ICD’s)
• Epoetin-Adult
• Orthopedic Care for Total Knees,
CPMs, Cold Therapy
• Anesthesia Administration
• Post Partum Hemorrhage
• Early Warning System for Adult
Patients
• ED Pulmonary Embolism Rule-Out
Criteria (PERC)
• ED Discharge Transition
• ED Acute paint management
• Midline Sternotomy – Post Operative
Management-Adult
• Point of Care Chest Ultrasonography
• Developmental Screening for Peds
• Acute Blood Loss
• ED Chronic Pain
• T Dap Vaccine
• Use of BMP
• Nitrous Oxide
• Reducing Postoperative Pulmonary
Complications
• Ambulatory Diabetes Care
• Hepatic Encephalopathy Patient
Management
• Syncope
• ED Ischemic Stroke tPA
• Scorpion Envenomations
• ED to Critical Care Admissions
• Intra Op Goal Directed Therapy
• PET Scan
• Admin Intravenous Contrast Media
• Vertebroplasty
• Pre-Term Labor
• Ambulatory Lower Back Pain
• Insulin Drip Transition Post Cardiac
Surgery
• Palliative Sedation
• Chorioaminonitis Management
2012–Top 5 Health System Clinical
Quality
2010-2011 - Top 10 Health System
(Thomson Reuters)
2010 - 2011 Top 25 Connected
Facilities in US
(Health Imaging & IT Magazine)
2010 & 2011- Top 10 of the Top
100 Integrated Healthcare Systems
in the US(SDI & Modern Healthcare Magazine)
2010 - One of Arizona’s Most
Admired Companies
(Business Magazine & Best
Companies AZ)
2009 & 2010 - Top 100 best
technology innovators in US(Information Week 500)
2007 - 2010 Best Places to Work
winner
(Business Journal & Best Companies
AZ)
2011 -2012 Best Hospitals (US News/World Report)
2011 Top Leadership Team in
HealthCare(Health Leaders Media)
Truven Health Analytics
15 Top Health Systems 2013
Partial List of Banner Awards
Banner’s Vision 2020
Acute Hospital
Company
Clinical Quality
Company
Population Health
Management Company
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Payson Banner Hospital
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Acute PowerChartMaternity Units
Increased Anesthesia OR’s
340
Ambulatory Providers
41 Urgent Cares myBanner Portal
120
Case Managers
8
Registries
2 Banner MD Anderson Oncology
Optimization
100
Provider Acquisitions
2 Tucson Banner Hospitals
800 Ambulatory Providers
Research Stage 3 Domain Upgrades
Home Health MACRA/MIPS Interoperability PowerChart Touch
Focus
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CLinical INformatics Integration Council
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Ambulatory - Our MoonShot
• Change Management• Cultural, Workflow, Patient/Consumer
• Merging of Ambulatory and Acute• Optimization, Transitions of care
• Availability of skilled resources• Speed vs. Quality• Regulatory• Data migration• Interfaces• Growth, Acquisitions• Revenue
Projected Ambulatory Implementations 2015
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100
150
200
250
300
350
June July August September October November December
Providers (Projected)
Clinics
Specialties
Actual Ambulatory Implementations 2015
0
50
100
150
200
250
300
350
June July August September October November December
Providers (Actual)
Providers (Projected)
Clinics
Specialties
Implementations 2015 and 2016
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200
400
600
800
1000
1200
Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Providers (Actual)
Providers (Projected)
Clinics
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Org Chart
William Holland
VP, CMIO
Scott Sharples
Physician Informaticist
Dana Kosmala
Physician Informaticist
Cornel Antonescu
Physician Informaticist
Deborah Bonnell
Senior Director Meaningful Use Program
William Holland
VP, CMIO
Scott Sharples
Physician Informaticist
Ken Schaefer
Physician Informaticist
Dennis Swearingen
Physician Informaticist
Nitin Bhosale
Physician Informaticist
Dana Kosmala
Physician Informaticist
Michael Radtke
Physician Informaticist
Cornel Antonescu
Physician Informaticist
Umar IqbalInformatics Fellow
Y2
Edward Maddela
Informatics Fellow Y2
Andrew Muth
Informatics Fellow Y1
Christopher Hollweg
Informatics Fellow Y1
Jennifer LyonPhysician
Alignment Executive (Cerner)
Cathy Patterson
Senior Healthcare Executive (Cerner)
Chris LewisDirector Physician
Alignment (Cerner)
Deborah BonnellSenior Director
Meaningful Use Program
Team
• Informatics Fellows• Cerner Physician Informatics Alignment• Projected Growth
William Holland
VP, CMIO
Scott Sharples
SD Ambulatory and Population Health Informatics
Ken Schaefer
Physician Informaticist
Dennis Swearingen
Physician Informaticist
Nitin BhosalePhysician Informaticist
Projected GrowthSpecialty Workgroup Analyst
Dana Kosmala
SD User Experience , Optimization, and Consumer Informatics
Michael RadtkePhysician Informaticist
Lisa ChanPhysician Informaticist(Tucson Conversion)
Kevin ReillyPhysician Informaticist(Tucson Conversion)
Projected Growth
Urgent Care/Retail Informaticist
Projected Growth
Lights On Analyst
Cornel Antonescu
SD Clinical Decision Support and Academic Informatics
Umar IqbalInformatics Fellow Y2
Edward Maddela
Informatics Fellow Y2
Andrew MuthInformatics Fellow Y1
Christopher Hollweg
Informatics Fellow Y1
Jennifer Lyon
Physician Alignment Executive (Cerner)
Cathy Patterson
Senior Healthcare Executive (Cerner)
Chris LewisDirector Physician Alignment
(Cerner)
Deborah Bonnell
Senior Director Meaningful Use Program
Team
• Tucson Project Informaticists• Informatics Fellows• Cerner Physician Informatics Alignment• Projected Growth
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All-In Approach
Strategic Initiative
Informatics &Medical Group
Co-leads
Stakeholders driving design
Cerner at the table
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Weekly Project Status Dashboard
Project: Ambulatory / Registration
Banner Health
Week Of: 3/16/2015 - 3/20/2015
Metric Status Owner Summary / Impact Action Plan / Next Meeting
Overall Yellow Dr. Holland/Scott
1. Project plan, in process and a lot of progress have been made and will continue to be made until
the plan is complete for phase 1, once that is complete we will start on phase 2. 2. Improve
communication and visibility. Control messaging. 3. Schedule oversight meetings. 5. Continue
daily agile project management meetings. Twice week status meetings
Training and Education Green Jenny Training and Education Plan is not defined. Training/Support proposals received. Making final
determination.
Banner Meeting on March 30th. Decision made by
Tuesday March 24th. Banner looking to partner
with Cerner for training and support.
Domain Strategy Yellow Rhonda / Ruby/Stephen
Engaged Banner in domain discussions regarding PCM acute build in AZA. (Refer to Maternity note).
Received communication from Banner their plan to replicate AZA build in their other domains.
'Draft domain strategy for AZA phase 1 and phase 11 posted in project portal.
1) Cerner team is met Wed, March 18th to
continue the internal domain planning discussion.
Final plan will be reivewed and proposed to
Banner IT on Friday, March 20th
2) Wkly Domain Meeting with Brad, Rhonda, and
Stephen
3)Next Wed this should be back on track to green
for Phase 1ICD10 Yellow Ruby ICD 10 Testing taking place in AZA Domain
Change Management Green Clay -Met with Clay from the Banner team to get a Change Management plan in place.
-Proposal will be put together on Monday.
Communication Green Toni Initial communication plan is completeFollow up Meeting scheduled for next Thursday,
March 26th
Hardware - Mainframe Green RhondaCerner Fitness Team and Brad Likes team are meeting weekly to review and plan for additional
ambulatory users. Final Report is due out March 30th
Reporting YellowCorey, Suzi, Michael
Paris
Need to identify all reporting that currently is currently used in Banner. Clinical, Rev Cycle, Practice
Management and other reports This might not be needed day 1
Hardware - Front End Devices Yellow Natalie List is provided to Cerner.
Meeting scheduled for next Monday, March 23rd.
Hardware list should be provided to Cerner by
David on Friday 3/20. Natalie working with Stacy
to get a schedule for on site hardware
assessment for the week of 3/30. Should have
schedule by EOD 3/20 from Banner.
1. HIMS / 2. Document
ManagementYellow
1. Christine/Carla 2.
Christine/Carla
BMG / HIMS / IT have not agreed on a final plan for document scanning and management. For
Cerner Ambulatory project we should proceed with what clinics are currently doing.
1. Follow Up meeting scheduled for Friday, March
20th. Sync with Kathy on weekly calls. 2.
Document Hierarchy still an issue, Tuesday the
24th
Data Migration – Vendor A Red Katherine/ Matt/Laura
Data Migration is a risk at this point especially for Phase 1 getting information into the charts is a risk
at this point.. Banner Health not getting the data from their current vendor until May 1st is a risk at
this point for our June 15 go live. Images/Documents will not be available at go live. What is our
plan? Extended read only access to Vendor A? Manual abstractors,, printing? Full day meeting to
capture this worflow.
Meeting 3/20 to discuss additional concerns and
what really plan A is or what plan B (manual
abstraction)
Plan Needed for gap data
Plan needed for images
Needing to figure out which data set will actually
be in for phase 1
Cerner and Banner meeting in PHX 3/30 to go
over test extract.
Expected transition to yellow: Possibly May 1
Data Migration – Vendor B Red Katherine/ Matt /Laura Planning for Phase II underway – no finalized
Data Migration call March 20th. For Vendor B to
Cerner meeting on 3/17/2015 and possibly moving
forward with contract at that time. Looking to set
up time when Matt and Laura Expected transition
to yellow: Closer to JunePatient Portal Yellow Jeff Planning in progress for Phase II
EMPI Yellow Christine EMPI clean up action plan needed EMPI action plan to be completed by Friday
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ADKAR Approach
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Touch Points
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Texting, Mobile App, Survey
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Clinic Report Card
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SWAT Team
Goals:
• Week 1 - % of Order/documentation signed off
• Week 2 – Optimize Ordering workflow
• Week 3 – Optimize Documentation workflow
• Week 4 – Optimize Chart Review/Other workflow
• Week 5 – Final push
Lights On
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Additional Banner Health Sessions
Tuesday, November 15 Start Time End Time Location Presenter
One System Focus: Implementation & Ongoing Support
Governance11:30 AM 12:30 PM KCCC 2100-2013C William Holland, MD VP, Chief Medical Informatics Officer
Effective Change Management: Techniques for
Successful adoptive change3:00 PM 4:00 PM KCCC 2200-2201 Clay Taylor Change Management Director
Wednesday, November 16 Start Time End Time Location Presenter
Implementing a proactive customer support system 11:30 AM 12:30 PM KCCC 2500 - 2504 A Laurina Jarvis, RN,MSHI Clinical Informatics Director
Managing populations: Banner's holistic approach 12:30 PM 1:30 PM KCCC 2500 - 2505 B Jodi Erpelding, RN Clinical Informatics Program Director
Banner Health training and adoption 12:30 PM 1:30 PM KCCC 2200 - 2211 Courtney Hitzhusen Learning Architect
The State of Patient Engagement & Health IT 12:30 PM 1:30 PM KCCC 2100 - 2102 B Ed Clarke, MDChief Medical Officer, Az Eastern Division - Banner
Medical Group
Prescription Intelligence using SMART 4:15 PM 5:15 PM KCCC 3500 - 3501 E Nathan Spence Pharmacy Informatics
Turning goals into outcomes with Work Queue
Management4:15 PM 5:15 PM KCCC 2100 - 2101 Jason Bickford, MCSE Department Applications Director