Essential Components of an Electronic Medical Record

Essential Components of an Electronic Medical Record

Planning for the Successful Deployment of an Electronic Medical Record George Mason University College of Health and Human Services James L. Oakes, Jr., Principal Health Care Information Consultants LLC [email protected] Health Care Information Consultants, LLC James L. Oakes Thirty years in healthcare information systems and management engineering Extensive experience as an operating manager, vendor executive, and consultant Specializes in helping healthcare providers plan and optimize use of information resources, systems, and technology to improve clinical, operational, and financial outcomes Worked with return on investment methodologies and analysis for over 25 years and pioneered the use of healthcare-specific economic analysis of healthcare information technology, including financial, clinical, and decision support Developed and deployed healthcare value-based planning methodology for healthcare now adopted at a 600 bed regional medical center, a nationally known pediatric referral center, etc. Served as interim Chief Information Officer in 3 healthcare institutions in financial or operational turnarounds and provided CIO level leadership assistance and development in 12+ others Assisted in the development of a business case and pilot methodology for a community-wide health information exchange initiative (HIE) and currently working on planning and implementation options for a statewide HIE Co-authored the recently released book, Return on Investment for Healthcare: Maximizing the Value of Healthcare Information Technology (HIMSS 2003 book of the year) and advocates the development of a disciplined business case for technology investments Appeared on the Hospital Satellite Network and spoken at numerous professional conferences, including CPRI, HFMA and HIMSS on such issues as effective governance, value realization, and strategy alignment Holds a Bachelor of Industrial Engineering and a Master of Industrial Management Health Care Information Consultants, LLC The Press Cant Tell You What to Think, but They Can Tell You

What to Think About John Naisbitt Health Care Information Consultants, LLC HIMSS 18th Annual Leadership Survey Top Business Issues Facing Healthcare (2007 vs. 2006 Results) Figure 8 Improving Quality of Care 69% 36% 55% 51% 52% Patient (Customer) Satisfaction Medicare Cutbacks Increasing Need for Healthcare Services N/A 45% N/A Adoption of New Technology Demand for Capital 18% Availibility of Clinical Staff Decrease in Health Insurance Benefits 17% N/A 38% 29% 31% 29% 28% 2006 Results Health Care Information Consultants, LLC

2007 Results Life in the 21st Century Health Care Information Consultants, LLC Health Care Technology in the 21st Century Still predominately paper based Systems not interoperable Slow, expensive implementations Increasing public pressure to do something Continuing economic pressures Health Care Information Consultants, LLC Terms Defined EMR EHR CPOE IHE HIE RHIO EIEIO Health Care Information Consultants, LLC Why was the casualty rate so high in the civil war? Health Care Information Consultants, LLC State of the Industry - Reality Successful CPOE implementations are still rare Fully functioning EMRs are at least as rare Much of the information in the record will continue to be paper-based for years to

come A failure can cost the CIO his or her job Failure to act can cost his or her job Health Care Information Consultants, LLC Less than 4% of US Hospitals Using CPOE CPOE Hospitals Possible CPOE Hospitals Verified Cerner Millennium CliniComp Eclipsys SCM Eclipsys TDS Eclipsys XA Epic EpicCare GE Centricity IDX Carecast IDX LastWord McKesson Horizon MEDITECH C/S MEDITECH MAGIC Misys Patient1 Siemens Invision Custom 0 5 10 15 20 25 The yellow bar represents the number of hospitals verified in 2003 Health Care Information Consultants, LLC 30 35 1.3-1.8% US Hospitals w/MDs Entering >50% Orders Cerner Millennium <5% Orders Entered 5-50% Orders Entered >50% Orders Entered

CliniComp Eclipsys SCM Eclipsys TDS Eclipsys XA Epic EpicCare GE Centricity IDX Carecast IDX LastWord McKesson Horizon MEDITECH C/S MEDITECH MAGIC Misys Patient1 Siemens Invision Custom 0 5 10 15 20 IP Average: 54% MDs entering orders, with a very small percent (1.31.8%) entering >50% of the orders Health Care Information Consultants, LLC 25 30 HIMSS 18th Annual Leadership Survey Current IT Priorities (Within Next 12 Months) (2007 vs. 2006 Results) Figure 6 Reduce Medical Errors/Promote Patient Safety Replace/Upgrade Inpatient Clinical Systems 29% 48% 45%

Implement an EMR Business Continuity and Disaster Recovery Integrate Systems in Multi-Vendor Environment Connecting IT at Hospital and Remote Locations Process/Workflow Redesign Improve IS Departmental Services 54% 50% 48% 35% N/A 34% 27% 33% 36% 30% 35% 28% 26% 2006 Results Health Care Information Consultants, LLC 2007 Respondents HIMSS 18th Annual Leadership Survey Projected IT Priorities (Today vs. Next Two Years) Figure 7 Reduce Medical Errors/Promote Patient Safety Replace/Upgrade Inpatient Clinical Systems 33% Implement an EMR Business Continuity and Disaster Recovery Integrate Systems in Multi-Vendor Environment 25% 21% Connecting IT at Hospital and Remote Locations Process/Workflow Redesign

Improve IS Departmental Services 54% 35% 17% 32% 35% 48% 48% 34% 33% 26% 30% 24% 28% In Two Years Health Care Information Consultants, LLC Today HIMSS 18th Annual Leadership Survey Status of Electronic Medical Record Implementation (Comparison of 2007, 2006, and 2005 Results) Fully Operational System 18% 24% N/A 6% 4% 16% Developed Plan to Implement 8% No Plans Yet Don't Know 2005 Results

32% 37% 36% Installation Begun Signed Contract Figure 11 12% 24% 22% 17% 1% 1% 1% 2006 Results 2007 Results Health Care Information Consultants, LLC 42% 15 Health Care Information Consultants, LLC IT Strategy Alignment Future Short Term Increased Effectiveness Increased Efficiency Today Cost of Doing Business Necessary Evil Health Care Information Consultants, LLC Competitive Advantage

IT Planning Process The process used to develop the plan is comprised of nine phases, with each phase building from the information gathered in the previous phase. Phase 9 Phase 8 Phase 7 Phase 2 Phase 1 ROI Analysis Perform Current Environment Analysis Phase 5 Phase 3 Prepare IS Strategic Plan Develop Gap Analysis and IT Strategies and Initiatives Phase 6 Phase 4 Prepare Program Action Plan/ Tactical Plan Define Future State Conduct Needs Assessment Confirm Business Vision and Strategies Organize Project Health Care Information Consultants, LLC riv ers or t Su pp Bu sin

es sD IT Strategy IT Projects Plan IT Tactical Health Care Information Consultants, LLC rs ive Dr Information Technology St Strategy rategy & Portfolio s ct Initiatives re Di Business & Business and Clinical Initiatives Clinical et rk Ma FSLHC Strategy Strategy The planning process includes an assessment of the current state and defining a future state. The resulting gap analysis laid the foundation for the recommended IS strategies and tactical plans. Common Themes/Interviews Current MIS Environment Analysis IT Attributes Exercise

Strategies Tactical Plans EMR Adoption Model Operating Principles IS Goals IT Attributes Exercise IS Vision Davies Award Winners Analysis Health Care Information Consultants, LLC For Example A metropolitan community hospital Full service medical/surgical Busy emergency services Competitive environment Battle for market share Health Care Information Consultants, LLC Mission Statement and Vision Mission Statement We are a not-for-profit healthcare provider guided by the needs of our patients and community. We distinguish ourselves through service and clinical excellence, affiliations with the XXX and YYY, and stateof-the-art technology and facilities. We are committed to continuous improvement and appropriate use of resources. We create an environment that encourages the success and fulfillment of our physicians, staff, and volunteers. Vision ZZZ Hospital Healthcare System will set the standard for excellence in healthcare in the metropolitan region. Through our affiliations, we

aspire to provide world-class patient care, technology, and clinical research. Health Care Information Consultants, LLC Business and Market Drivers Development of services based on community need, market position, competitors positions, margin, recruitment, etc. Continuing shift from acute care to outpatient services Development of alternate physician practice models: Based on locale and structure of local health care market, and market forces (e.g. Number of practices, practice size, strengths and weaknesses of local hospitals, patient demographics, etc.) Objective of changing flow of patients and delivery of healthcare services Combat particular physician shortages Organizational alliances and partnership models Increasing expenditures (faster than general rate of inflation) State regulated revenues (70% regulated, 30% negotiated) and other regulatory requirements Health Care Information Consultants, LLC Business and Market Drivers Emphasis on quality, safety, expense control Focus on shortage of professional staff such as RNs and other clinical technicians Continuing capital constraints Consumer awareness, patient satisfaction, customer service Need for readily available clinical information Emphasis on Return on Investment (and more recently Value) as part of purchasing decision Balanced scorecard including non-financial (quantitative and qualitative) and financial measures Health Care Information Consultants, LLC

Key Strategies Demonstrate flexibility by promoting patient care and physician strategies: Traditional acute care Off campus services and joint services Increased focus on physician practices Develop stronger relationships with physicians and tie physicians into the organization Make it an easy place for physicians to practice; Endear physicians and improve MD satisfaction Demonstrated successes: Hospital-based physicians including Hospitals, Intensivists, Radiologists, Emergency Medicine, Anesthesiologists, etc. Specialty Care Medical Group Differentiate through program development where expertise and base exist Orthopedics (Joint program has doubled in volume since its inception) Trauma (County trauma center) Neurology and Neurosurgery (NIH protocol) Oncology (Focus on differentiation strategies) Open Heart Surgery Health Care Information Consultants, LLC Key Strategies Stabilize existing outpatient programs and partnerships and capitalize on new programs/partnerships/alignments Focus on quality and patient care Improve in State, JCAHO and other regulatory measures Advance existing and conduct new internal process improvement initiatives Medication reconciliation Patient throughput and turnaround ED to inpatient ICU to non-critical care units Recent implementation of observation status Improve patient satisfaction Health Care Information Consultants, LLC

Key Strategies Continue to develop human resource strategies to address personnel shortages and retain talent Recruitment Benefits and compensation Recognition and reward Make ZZZ an easy place to work Improve employee satisfaction Improve financial position Grow volumes Stabilize existing outpatient programs Advance partnering opportunities (e.g. XXX Promote image of smaller community hospital doing big hospital things Cross between smaller hospital and high tech Increase awareness of community outreach programs Continue development and execute campus enhancement program Health Care Information Consultants, LLC Start where you are.. Understand and document current environment Consider all applications Be prepared for surprises Health Care Information Consultants, LLC Current Information Systems Environment: Application Portfolio ACCESS Registration Enterprise Scheduling

Billing AR Electronic Claims Submission Electronic Claims Scrubber Collections Management Medical Necessity Denial Tracking ADT Eligibility ANCILLARY/DEPARTMENTAL Order Entry Electronic Payment Posting Medication Dispensing Med Admin (barcoding) Emergency Department Pharmacy Laboratory Radiology PACS Surgery Pathology

Microbiology Blood Bank Rehab (PT, OT, Sp) ICU Help Desk ADE Surveillance Quality Improvement Case Management Infection Control Disease Management ED Physician Documentation Anesthesiology EKG (Muse) Results Reporting Care Plans/ Pathways Interdisciplinary ClinDoc CPOE EMPI Patient Assessments MD Clinical Documenttation

Physician Access Clinical Decision Support Document Imaging ENTERPRISE RESOURCE PLANNING General Ledger Accounts Payable Budgeting/ Forecasting Fixed Assets Cost Accounting Time & Attendance Human Resources Payroll Materials Management Executive Support Decision Support Security Facilities Maintenance Cardiology

Incident Reporting Utilization Review Transport Dietary Endoscopy Report Writing Tumor Registry Radiation Oncology Employee Education Employee Health Physician Credentialing GSI PACS Trauma Registry Medical Library Call Center Nurse Call System Fund Raising (being replaced) CLINICAL Clinical Data Repository

REVENUE HIM Chart Management Coding Core Vendor Other Vendors Staff Scheduling Not Automated Partially Automated Health Care Information Consultants, LLC Abstracting Dictation & Transcription Todays Information Flow Patient/ Family View Admit Allergies Blood Panel Organization View Medications Process View Insurance Authorizatio n Technology View Health Care Information Consultants, LLC Progress Note

Develop a vision for the future. Phase in applications in a logical manner If moving towards a core vendor strategy, phase in as contracts expire Look for quick wins along the way Recognize that users must see continuing benefits to support a long term plan Be prepared to adapt plan as circumstances dictate Communicate, communicate, communicate! Health Care Information Consultants, LLC One Organizations Portfolio Leading to CPOE CPOE 18 + Months Problem Lists Care Plans 9 Months Integrated Monitors Today Outpatient Assessments Electronic EKG Results Online Results Universal Patient ID Document Imaging Clinical Alerts Ad-HOC Reporting

Patient Demographics Electronic Signature Case Mgmt. Dictation/ Transcription Order Management Common Order Sets Nursing Assessments Integrated Home Health Vital Signs I/Os 100% Codified Online MAR Medical Necessity Bar Code Radiology Health Care Information Consultants, LLC Operating Room Mgmt. Physician Remote Access

Scheduling LAB Pharmacy Tomorrows Information Flow Patient/ Family View Admit Organization View Blood Panel Allergies Progress Notes Medication s Insurance Authorizatio n Process View Technology View Health Care Information Consultants, LLC Single View of Virtual Patient Record Hospital ACCESS Registration Enterprise Scheduling Hospital ACCESS Registration ADT

Enterprise Scheduling Eligibility ANCILLARY/DEPARTMENTAL Pharmacy Pathology Laboratory Microbiology Help Desk Quality Improvement ADE Surveillance Incident Reporting Billing AR Electronic Claims Submission Electronic Claims Scrubber Collections Management Medical Necessity Denial Tracking REVENUE Order Entry Electronic

Payment Posting Med Admin (barcoding) Emergency Department Radiology PACS Surgery Rehab (PT, OT, Sp) ICU ED Physician Documentation Anesthesiology EKG (Muse) Case Management Infection Control Disease Management Cardiology Utilization Review Transport Dietary Endoscopy Report Writing Tumor

Registry Radiation Oncology Employee Education Employee Health Physician Credentialing GSI PACS Trauma Registry Medical Library Call Center Nurse Call System Fund Raising (being replaced) CLINICAL Clinical Data Repository MD Clinical Documenttation Clinical Decision Support EMPI Physician Access Document Imaging Electronic

Claims Scrubber Collections Management Eligibility Medical Necessity Denial Tracking Medication Dispensing REVENUE Order Entry Electronic Payment Posting Med Admin (barcoding) Emergency Department ED Physician Documentation Pharmacy Laboratory Radiology PACS Surgery Anesthesiology Pathology Microbiology Blood Bank

Rehab (PT, OT, Sp) ICU EKG (Muse) Quality Improvement Case Management Help Desk ENTERPRISE RESOURCE PLANNING Electronic Claims Submission ADT ANCILLARY/DEPARTMENTAL Patient Assessments Interdisciplinary ClinDoc CPOE Medication Dispensing Blood Bank Care Plans/ Pathways Results Reporting Billing AR Infection

Control Disease Management Accounts Payable ADE Surveillance Incident Reporting Utilization Review Transport Dietary Endoscopy Budgeting/ Forecasting Fixed Assets Cost Accounting Time & Attendance Report Writing Tumor Registry Radiation Oncology Employee Education Employee Health Physician

Credentialing Human Resources Payroll Materials Management Executive Support (being replaced) GSI PACS Trauma Registry Medical Library Call Center Nurse Call System Fund Raising Decision Support Security Facilities Maintenance Chart Management Coding Abstracting CLINICAL Clinical Data Repository Patient

Assessments Care Plans/ Pathways Interdisciplinary ClinDoc MD Clinical Documenttation Clinical Decision Support CPOE EMPI Physician Access Document Imaging General Ledger ENTERPRISE RESOURCE PLANNING Accounts Payable Budgeting/ Forecasting Fixed Assets Cost Accounting Time & Attendance Human Resources Payroll

Materials Management Executive Support Decision Support Security Facilities Maintenance Cardiology General Ledger HIM Results Reporting HIM Chart Management Coding Abstracting Dictation & Transcription Staff Scheduling Dictation & Transcription Staff Scheduling Physician Office Patients Long Term Care 33

Health Care Information Consultants, LLC Legend System yet to be Installed Sequenced or Simultaneous Installations System Operational Orange Indicates FY 08 Emphasis Electronic Medical Record Web-based Viewable Results** * Installed Quadramed Product **Planned Quadramed Product Computerized Provider Order Entry** Integrated Patient Web-based Monitors** Physician (OB, ICU, ER, Telemetry) Remote Access** Care Plans Problem Lists** Picture Archiving & Communication System (PACS) Patient-Centric Information Systems February 2007 Electronic Scheduling**

Outpatient Assessments** Clinical Alerts** McKesson HMI Electronic Electronic Document ED EKG Results Signature** Imaging/Storage Documentation Pyramis Quantim e-Sig** EDM* & Tracking T-System EV OB QS Sentinel Management Dictation/ Ad-HOC Reporting Transcription Crystal Reports Precyse Solutions Online Medication Administration Record** Nursing Assessments** Case Management MIDAS+ Vital Signs I/O** Utilization Review MIDAS+ OR Management ORSOS HealthNotes*, SpeechQ

Materials Management Dimension21 Clinics/Ambulatory /Physician NTierprise PM HealthmaticsEMR Patient Registration Affinity Reg* Order Mgt. Pathology Viewable Results MediSolutions AP Common Order Sets NTierprise HomeWorks, Mestamed Home Health Homeworks Radiology RMS Lab Medilab Order Mgmt* Transitional Care AccuCare Home Medical Equipment MestaMed Coding Quantim Coding* Homeworks Medical Record Management Affinity* MRI*, MRA*, MRC* Pharmacy

Affinity Pharmacy* Etreby Medical Billing & Necessity Collections Caremedic Affinity*, SSI, Medifax MestaMed, Homeworks, LMRP The FOUNDATION REQUIRED to make these components into a Fully Functional Electronic Medical Record includes the following: 1. Business Continuity Plans that provide for Redundant Storage and Communications to ensure constant availability of the systems 2. An adequate number of appropriate user devices connected to a Robust Infrastructure that provides data that is shared (interfaced or integrated) across the continuum of care 3. Common Identification of the Patient across the continuum of care 4. Adequate Technical Support to ensure continuous operation. Health Care Information Consultants, LLC Medware, Zirmed Things to keep in mind. You cant do everything at once Not all applications need to be state-of-the-art Paper will always be with us Value is in the mind of the beholder You must decide how far out on the bleeding edge your institution wants to be A well implemented system is more valuable than a snazzy one that is poorly implemented Health Care Information Consultants, LLC Understand Your Institutions Risk Profile The Healthcare Technology Adoption Life Cycle Traditional Technology Adoption CurveMainstream Mainstream Early Market

Market Market Chasm Health Care Information Consultants, LLC Skeptics Mainstream Conservatives Pragmatists Early Adopters Innovators Innovators Skeptics Radiology Pharmacy Automated Pathways EKG Lab EMR Physician Office Management Billing RFID PACS AI Voice Activated Systems Budgeting Credentialing

Time Health Care Information Consultants, LLC Differing Views of Value Business View Process View Application View Technology View Health Care Information Consultants, LLC Information View Hospital Automation Levels for % of Operating Budget 6% 5% 4% 3% 2% 1% 0% XXX MIS Actual Medium Automation State of the Art Low Automation Health Care Information Consultants, LLC High Automation Return on Investment is Essential The Economic Value Pathway $$$ $$ Traditional Healthcare Industry ROI

$ Enterprise Enterprise Level Level Financial Strategy Marketing Strategy Business Line Strategy Customer Service Strategy Process Process Level Level Work & Process Redesign Functional/Programmatic Transformation Tactical Tactical Level Level Incremental Improvement Automation Benefits (ie, cycle time reduction, FTE reduction, error elimination) Measurements have focused on tactical items, but should also focus on strategic goals. Broaden your focus: Can technology contribute to the bottom line? Health Care Information Consultants, LLC GSH & North Medical Records prints at GSH Results of Dictation/ Test Prints in Medical Records continuously Current Process for Mailing Dictation/ Test Results Monday through Friday GSH Cardiology & Radiology Department highlights physician name on results Results of Dictation/ Test

Prints in departments continuously Multiple pages stapled together Department highlights physician name on results Mailroom picks up every one hour Mailroom date stamps reports Reports sorted roughly into several piles by alphabet Multiple pages stapled together Mailroom picks up 2x/day GSH & North Lab results print at GSH Results printed in department Department matches all reports for each test, if applicable North Cardiology Results Medicenter North Conversion of Dictation/Test Results to Clinical Messaging Proposed May 2002 North Radiology Results

Results of Dictation/ Test Prints in department continuously Department highlights physician name on results Department highlights physician name Multiple pages stapled together by department Start At 3PM?? Dictation/ test results automatically print off in mailroom sorted alphabetically Mailroom pulls pulls off reports by grouping and places in envelopes with clear labels for addresses & sorts by weight Multiple pages stapled together Mailroom picks up reports 3-4x/day Each pile sorted into mail bins of specific letter Volunteer sorts alphabetically Volunteer prints off labels Stacks resorted within each letter alphabetically

Mailed to be weighted moved to next room, weighted and metered Picked up by presort at 4:30 pm Volunteer folds & stuffs envielopes End Mailroom prints off labels for each report Labels placed on envelopes Reports folded, stuffed in envelopes & labeled Reports picked up by mailroom 2x/ day Mail sorted by weight Mail sent to presort End Before After Health Care Information Consultants, LLC Sample Cost Data Cost over 5 Years (Rounded) $10,000,000 $15,000,000 Hardware 9% $900,000 $1,350,000

Software 45% $4,500,000 $6,750,000 Imp. 40% $4,000,000 $6,000,000 Int/Conv 6% $600,000 $900,000 Hospital A + B (1) $15,000,000 $22,000,000 $1,125,000 $1,687,500 $5,062,500 $7,593,750 $7,200,000 $10,800,000 $900,000 $1,350,000 $14,287,500 $21,431,250 Hospital A + B + C (2) $21,000,000 $31,000,000 $1,406,250 $2,109,375 $6,075,000 $9,112,500 $11,520,000 $17,280,000 $1,170,000 $1,755,000 $20,171,250

$30,256,875 Hospital A (1) Assumes: 25% increase in hardware, software; 80% increase in implementation; 50% increase in interfaces/conversions (2) Assumes: 25% increase in hardware; 20% increase in software; 60% increase in implementation; 30% increase in interfaces/conversions Health Care Information Consultants, LLC Process/Technology Maturity Evolution to Clinical Transformation Process Improvement Process Redesign Doing things differently Sketchy Operational Processes Doing the same effectiveness things quicker Joint IT & Process Data overload Technology install Redesign Little useful info separate from Individual heroes Process PI Automation Automate Transactions Info Silos Value Creation Health Care Information Consultants, LLC Clinical Transformation Doing different things Cross-organization

collaboration Strategic advantage Dynamic Partnering Tactical Plan (EMR) Q2 2007 Systems in Support of EMR 1 2 3 4.a. 4.b. 4.c. 5.a. 5.b. 6 7 8 9 10.a. 10.b. 11.a. 11.b. 12.a. 12.b. 12.b. 12.c. 12.d. 12.e. 13 14 15.a. 15.b. 16 17.a. 17.b. 17.c. M J Q3 2007

J A Q4 2007 S O N Q1 2008 D J F Vendor Decision Evaluate, Select and Implement EMPI Evaluate, Selection and Implement eMar Evaluate, Select and Implement RFID(Barcoding) Pilot Identify and Implement Other Areas Integrate with Pharmacy and CPOE Continue Roll-out of Clinical Documentation Applications: Patient Assessments, Interdisciplinary Documentation and Care Plans Implement Physician Documentation and Charting (Structured Templates) Evaluate, Select and Implement Care Management System Evaluate, Select and Implement Disease Management System Evaluate, Select and Implement Infection Control System Evaluate, Select and Implement Anesthesiology System Assess Surgery System Re-implement Surgery System (based on assessment findings in 10.a) Assess Document Scanning and Imaging System Implementation of Document Scanning and Imaging System (Pending assessment findings in 11.a) Evaluate and Selection of Portal Solution (All Views) Implement Clinician View Implement Employee View

Implement Patient View Implement Consumer View Implement Vendor View Evaluate, Select and Implement Laboratory Outreach System Evaluate, Select and Implement Clinical Decision Support System Assess Clinical Data Repository Implement Clinical Data Repository (Pending assessment findings in 17.a) Evaluate, Select and Integrate Patient Monitors and Smart-Pumps Reasessment of EMR Strategy/Prerequisite Systems for enterprise CPOE rollout CPOE Pilot CPOE Rollout Health Care Information Consultants, LLC Q2 2008 M A M Q3 2008 J J A Q4 2008 S O N S Tactical Plan (Non-clinical) Q2 2007 Non-Clinical Systems M J Q3 2007

J A Q4 2007 S O N Q1 2008 D J F Evaluate, Select and Implement Help Desk System Evaluate, Select and Implement Human Resources System Evaluate, Select and Implement Bed Management System Evaluate, Select and Implement Executive Support System Web Site Strategy Evaluate, Select and Implement Eligibility System Evaluate, Select and Implement Cost Accounting System?? Health Care Information Consultants, LLC Q2 2008 M A M Q3 2008 J J A Q4 2008 S

O N S Tactical Plan (Services) Q2 2007 Services M J Q3 2007 J A Q4 2007 S O N Q1 2008 D J F MIS Staff Certifications/Training: Applications and Technical Project Management PrimerStaff Training: Applications, Technical and Clinical Informatics Staff Process Documentation Primer Training: Applications and Clinical Informatics Staff Departmental IT Support Certifications/Training Incorporate Required Competencies (Certifications/Training Requirements) into Job Descriptions and Performance Evaluation Process

Assess Training Center Needs (Space, hardware, software) and Enhance Center (Based on Findings) Develop and Implement MIS Cross Training Program Develop Vendor Relations Plan Health Care Information Consultants, LLC Q2 2008 M A M Q3 2008 J J A Q4 2008 S O N S Tactical Plan (Technical Infrastructure) Q2 2007 Technical Infrastructure M J Q3 2007 J A Q4 2007 S O

N Q1 2008 D J F Replace Deficient Equipment: Fire Suppression Systems Replace Deficient Equipment: HVAC Replace Deficient Equipment: UPS Replace Deficient Equipment: Racking Equipment Execute Data Resilience Plan SUBTASKS Develop MIS Facilities Maintenance Policies and Procedures Develop Network Closet Maintenance Policies and Procedures (Including Ownership and Accountability Policies and Procedures) Develop Plan for and Implement Closet Rewiring Evaluate, Select and Implement New Telephone System Develop Plan for Relocation of Non-Data Center Based SystemsImpact to DataAnalysis Center Develop Infrastructure Policies and Procedures (Incorporate as part of Project Costing) Evaluate, Select and Implement Select Network Management System Health Care Information Consultants, LLC Q2 2008 M A M Q3 2008 J

J A Q4 2008 S O N S Tactical Plan (Governance) Q2 2007 Governance M J Q3 2007 J A Q4 2007 S O N Q1 2008 D J F M Develop IS Steering Committee Charter Develop Policies and Procedures: IS Planning Develop Policies and Procedures: Investment Prioritization Develop Policies and Procedures: Vendor Selection Develop Policies and Procedures: Major

Project Structure and Implementation (Mandatory components to include Charter, Executive Sponsor, Scope, and Workplan; other components may include ROI Analysis and Success Metrics) Reassess IS Strategic Plan Establish Advanced Clinical Systems Governance Structure Health Care Information Consultants, LLC Q2 2008 A M Q3 2008 J J A Q4 2008 S O N S Tactical Plan (Information Use/Workflow) Q2 2007 Information Use/Workflow M J Q3 2007 J A Q4 2007 S

O N Q1 2008 D J F Standardize Use of Technology Applications Develop policies and procedures to incorporate workflow analysis as part of system implementations Develop polocies to allocate sufficient hours of training for staff users and incorporate into job descriptions STRATEGY FOR PARTNERSHIPS/JOINT VENTURES, ETC? Health Care Information Consultants, LLC Q2 2008 M A M Q3 2008 J J A Q4 2008 S O N S Tactical Plan (Culture/Organization) Q2 2007

Culture/Organization M J Q3 2007 J A Q4 2007 S O N Q1 2008 D J F Migrate to More Accountable IS Culture: Implement Organizational Changes Develop IS Customer Service Culture: Develop Service Level Agreements Develop IS Customer Service Culture: Develop Operational Support Structure in support of IS-User Department Support Model (Charter, Responsibilities, Performance, SLA Expectations) Develop and Implement Physician Engagement Strategy Evaluate customer service training programs to enhance/instill customer service attitude Health Care Information Consultants, LLC Q2 2008 M A M Q3 2008 J

J A Q4 2008 S O N S A few words about governance Good governance wont guarantee a successful project, but Poor governance will almost certainly doom a project Health Care Information Consultants, LLC Governance Defined Exercising authority or control over the decision to utilize resources in the pursuit of organizational objectives or strategies. Health Care Information Consultants, LLC IT Governance Goals Create a fast, flexible and effective process Strategically align decision-making and accountability Be selective and apply the best thinking within the organization so not all decisions are sent through governance Measure IT performance and value Health Care Information Consultants, LLC IT Governance Fits Into Overall Enterprise Governance Enterprise Governance Mission Vision

Values Strategic Plan Leadership Management & Control Human Resource Governance Financial Governance IT Governance IT Governance is an organized framework of roles, responsibilities, policies & methods used to guide, direct & manage IT resources IT Governance is an extension of Enterprise Governance, not an island function delegated to IT department Effective IT Governance requires executive-level involvement & participation by stakeholders Health Care Information Consultants, LLC Sources of Projects Strategic Business Initiatives IT Vision and Plan Dept Initiated Requests Maintenance & Upgrades ISSC Role Requested $ CFO CEO

input ISSC Prioritization Available $ Other IT Routine IT Other Strategic Initiatives Must Have Defer Cancel 12 Month IT Plan Resources Project Plans Project Budgets CPOE Executive Sponsors and ISSC Membership Responsibilities: g oin g On le Ro 12 Month Project Portfolio Set objectives & policy Measure performance & business value Cascade strategy, policy & goals throughout organization Facilitate communication Establish clear accountabilities Manage risk Remove barriers Improve processes, organization structure & knowledge Health Care Information Consultants, LLC

Four Ares Strategic question: In line with vision Consistent with business principles Contributing to strategic objectives Are we doing the right things? Architecture question: In line with architecture Consistent with principles Are we doing them the Consistent with other right way? initiatives Are we getting the benefits? Are we getting them done well? Health Care Information Consultants, LLC Value question: Understanding of expected benefits Accountability for realization Relevant metrics Benefits realization process Delivery question: Management, Delivery, change mgt Resources to deliver Required technology Required capabilities Governance Map Executive Governance Executive Council IS Strategic Governance Information Systems Steering Committee

IS Management Senior Mgmt. Team IT Department Liaisons IT Operations IT Staff Project Teams Health Care Information Consultants, LLC Areas for Action Systems Governance Services Technical Infrastructure Information Use/Workflow Culture/Organization Health Care Information Consultants, LLC Technology is just a matter of using the right wrench to pound in the correct screw Health Care Information Consultants, LLC

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