Pella Regional Health Center

1
Pella Regional Health Center

• Health Information System Selection

2
Organizational Overview

• Licensed for 47 acute care beds
• 109-bed long-term care unit (24-bed dementia
  unit)
• Emergency and urgent care departments
• Occupational health clinic
• Five family health clinics (Pella, Bussey, Sully,
  Monroe and Knoxville)
• Specialty clinics
• Hospital-based dialysis unit

3
Organizational Overview

• Surgical Services
• Rehabilitative services
• Hospice
• Home Health
• 100-bed residential care facility
• Independent living campus

4
A New Vision

• To establish a fully integrated enterprise-wide
  information system encompassing clinical and
  financial applications which are tied to a
  patient-centric database enabling data to flow to
  authorized customers through internal and
  external networks.

5
Potential Derailment

• Negotiated with a single vendor
• Unable to reach an affordable price
• Ongoing concern with respect to the perceived
  level of risk

6
Revived the search process!
7
Back to Basics

• Which vendor and products?
• How much should be spent?
• The nursing process in IS?

8
Existing Vendors/Applications
9
Existing Vendors/Applications
10
Diagnosis

• Ineffective Communication related to multiple
  silos of data

11
Silos of Data

• Redundant processes
• Less than optimal patient safety
• Labor intensive data analysis and reporting

12
Diagnosis

• Management of Therapeutic Regimen, Challenging
  Community

13
Multiple Systems (Including a Paper-based
Medical Record)

• Patient-specific data not readily accessible
• Shadow charts created within departments
• Labor intensive for IS staff
• Maximum value NOT derived from individual systems

14
Dispel the Myths

• We will find the perfect system
• If you build it - they will come!
• Implementing a new HIS will automatically solve
  organizational inefficiencies
• Mass consensus and enthusiasm for a vendor will
  be the key indicator for the right choice

15
Overall Approach(Source Dr. Leo Black, Mayo
Clinic Jacksonville)

• There are choices to be made
• Choice 1
• Start with the big picture and later
• develop individual programs
• OR
• Start with individual programs and later try
  to link them

16
Choice 1

• Start with the big picture and later develop
  (enhance) individual programs.
• Data center design and build
• Migrate current functionality to new HIS
• Enterprise-wide order entry with focus toward
  point-of-care medical necessity checking
• Enterprise-wide EMR for resulting

17
Overall Approach(Source Dr. Leo Black, Mayo
Clinic Jacksonville)

• Choice 2
• Go predominantly with one vendor
• OR
• Go with best of breed

18
Choice 2

• Go predominately with one vendor.
• Minimize interfaces
• Similar look and feel across the enterprise
• Ultimately achieve maximum utilization of
  functionality
• Sound Easy?

19
Which Vendor?

• Consultant
• Request for information and request for proposal
• Current state was evaluated
• Written report submitted
• Functional specifications provided by consultant
  and sent to relevant departments

20
Lessons Learned

• Interview several consulting firms and evaluate
  their methods for facilitating your selection
  process
• Pose questions that uncover a one size fits all
  approach
• Identify potential conflicts of interest
• Request references of similar organizations
  conduct conference calls to solicit their
  experience and satisfaction

21
Lessons Learned

• Define deliverables and establish realistic
  expectations
• Maintain leadership a consultant will never
  know your organization as well as you, nor will
  they lead you to the perfect system!

22
Best of Breed Sirens
23
Identify Health Information System (HIS) Vendors

• Retrieved the 2003 HIMSS Conference Exhibitor
  List
• Quick scan of websites to identify health
  information system vendors
• Categorized vendors

24
HIS Vendor Offerings

• Created a table to identify the clinical
  components of each vendors HIS
• Eight vendors provided registration, scheduling,
  clinical data repository, order management,
  clinical documentation, laboratory, medical
  imaging, pharmacy and health information
  management

25
Potential Vendors

• Cerner
• CPSI
• Dairyland
• Epic

• Keane
• McKesson
• MediTech
• Siemens

26
Overall Approach(Source Dr. Leo Black, Mayo
Clinic Jacksonville)

• Choice 3
• View this as an isolated project/function
• OR
• View this as part of an overall
  institutional strategy

27
Information Technology Portfolio
Strategic
Informational
Transactional
Infrastructure
28
Information Technology Portfolio
Business integration Business flexibility Reduced
IT costs Standardization
Infrastructure
29
Information Technology Portfolio
Process the basic, repetitive transactions
Developed to cut costs, often by substituting
capital for labor, or handle higher volumes
25 40 return on investment The more money
invested in transaction information technology,
the stronger the impact on performance
successful in creating business value Low risk
Transactional
30
Information Technology Portfolio
Informational
Provides the information for managing and
controlling the organization
Must derive the right to realize a business
value Can lead to superior quality and premium
pricing
31
Information Technology Portfolio
Strategic
Increased sales Competitive advantage Market
positioning Innovative services
Inherently risky 50 fail Some spectacular
successes 2- to 3- year lead
32
Overall Approach(Source Dr. Leo Black, Mayo
Clinic Jacksonville)

• Choice 4
• Is a positive financial return very important
  in the near term?
• OR
• Is financial return of lower importance than
  other goals?

33
Estimating Return on Investment (ROI)

• Financial return was deemed important and
  necessary, but a long-term view was utilized.
• Literature review completed
• Vendor estimates reviewed
• Potential line items identified, linked with
  literature citations and issues for consideration

34
Line Items within ROI

• Gain in patient volumes within out-patient
  clinics
• Gain in surgical net revenue
• Reduction in file clerk positions in HIM
• Reduction in labor costs associated with charge
  entry
• Avoidance of inappropriate/redundant orders
• Reduced denials

35
Line Items within ROI

• Increase in-patient charge capture
• Increase out-patient charge capture
• Reduction in paper forms and supplies
• Reduction in labor costs associated with data
  collection/analysis
• Reduction in labor costs related to pharmacy
  billing
• Decreased nursing overtime