Effective IT Implementation in Health Care

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Effective IT Implementation in Health
Care Patient Safety and National Resource Center
Annual Conference June 2005 Donald Crandall, MD,
FACS
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Trinity Health Our Communities

• Sixth largest tax-exempt health system in the
  United States
• Operating revenues of 5.3 billion
• 44,000 FTEs
• 7,582 physicians 95 private practice community
  hospital based
• 45 hospitals (29 owned and 16 managed)

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Project Genesis Is . . .

• Trinity Healths leading-edge initiative to
  transform the way we deliver care and improve
  patient safety
• Our vision to unite state-of-the-art computer
  information systems with best-practice business
  processes across Trinity in three areas
• Clinical
• Revenue Cycle
• Supply Chain

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Project Genesis Will Transform the Delivery of
Health Care. . .

• Improve Quality of Care and Safety
• Improve Clinical and Operational Processes
• - Redesign more than 300 clinical and business
  processes
• Touch Almost Every Employee and Physician in
  Trinity Health

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Primary Clinical and Business Applications (as of
2001)Tool Diversity ? Process Diversity ?
Variable Performance
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Primary Clinical and Business Applications
(2008)Best Practices Consistent Tools
Operational Excellence
Eastern Division
Western Division
Mt.
Silver
Columbus,
Port
Clemens,
Ann Arbor,
Battle
Grand
Muskgeon,
South
Dubuque,
Mason
Sioux City,
Fresno,
Operating Units
Spring, MD
OH
Huron, MI
MI
Pontiac, MI
Livonia, MI
MI
Creek, MI
Rapids, MI
MI
Bend, IN
Clinton, IA
IA
City, IA
IA
Boise, ID
CA
McKesson
Revenue Management

Registration

HealthQuest
HealthQuest

STAR
STAR
STAR
Patient Accounting

Cerner Profile
Cerner Profile
Medical Records
PeopleSoft and Lawson
ERP

General Ledger

Payroll/Human

Resources

A/P
Materials

Management
Cerner
Clinical Systems

Clinician Order
Management

Results Reporting

ADEs

Clinical
Documentation

Laboratory

Pharmacy

Surgery Management

Radiology
xCare.net (E-merge) / TIBCO / Internal Development
Integration Tools

DSS

EMPI
TIBCO
Web Foundation
Shaded
denotes core systems

• Completed
• To be Completed within 6 months
• Active Implementations

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Scope Computer Systems

• CLINICAL
  (Cerner/Millenium)
• Power Chart - Orders and results
• Clin Doc - Clinical documentation
• PharmNet - Pharmacy
• FirstNet Emergency Dept.
• RadNet Radiology Dept.
• SurgiNet Operating Room
• Inet ICU
• Profile - HIM application
• EMPI
• CPOE
• Electronic Record
• - Clinical functions by pt. type
• - Current clinical
• documentation forms

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Investment

• Capital
• 180 million capital investment in clinical and
  revenue cycle systems
• 30 million capital investment in supply chain
  systems
• Operations
• Process redesign
• Training
• Go-live and post-go-live support
• Increased depreciation

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Transformation 1 Part Technology 2 Parts
Culture Work Process
Transformation
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Getting there Implementation Readiness

• Implementation Readiness
• Process Requires 20-24 Months
• People
• Culture and implementation strategy
• Manage organizational change and resistance to
  change
• Training competency testing
• Communication
• Process
• More than 300 discrete processes affected by
  implementation
• Process maps (current future gap)
• Technology
• Infrastructure
• Wireless network and device deployment
• Redundancy
• Response time

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Example Readiness Process Timeline(Months prior
to Go-Live)
Design Confirmation (-13)
Preliminary Design (-20)
Detailed Design (-15)
Core Build (-10)
Core System Test (-7)
Integration Test (-3))
Activation (-0-)
Project Definition (-22 months prior to G0-Live)
Systems Readiness one iteration per system
QA
QA
QA
Site Specific System Build
Operational Testing Training (OTT)
Operational Impact Analysis (OIA)
Current State Analysis (CSA)
Operational Build (OB)
Hospital System Readiness (one iteration per site)
QA
QA
Operational Testing and Training
Baseline Materials Development
Building / Sustaining Alignment
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Readiness Structure

• Office of Project Management
• Project Genesis Steering Team
• Clinical Executive Oversight Group
• Revenue Enhancement Oversight Group
• Supply Chain Oversight Group
• Clinical Rules Oversight Group
• Benefits Management Office
• Knowledge Management Steering Committee
• Clinical Information Oversight Group
• Physician Advisory Group
• Facilitated Decision Making Process

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Trinity Health Major IS Projects as of May 2005
FY06
FY07
FY08
FY05

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Project Genesis Planned Metrics

• Metrics (measured before go-live and then after
  go-live) Implementations beginning in July 2004
  will be tracked these categories
• Clinical
• Safety
• Financial
• Patient and Employee Satisfaction
• Operational/Productivity

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Examples of Actual and Planned Metrics

• Clinical
• CPOE orders placed online
• CPOE of physicians using system
• Improvements in clinical indicators
• e.g. Beta Blockers ACE inhibitors Aspirin for
  AMI, LVF assessment, pneumococcal vaccination,
  misidentification rate
• Medication time to first dose for STAT orders
• Procedure/order turn-around time (pharmacy, lab,
  radiology orders)
• Duplicate orders
• Incomplete charts

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Additional Planned Metrics

• Safety
• Medication errors and ADEs resulting in
  intervention
• Rate of identification of errors
• Finance
• Reduction in bad debt
• Reduction in operational write-offs
• Percentage of clean claims
• Satisfaction
• Nursing satisfaction and retention
• Patient satisfaction
• Operations
• Staffing and productivity levels
• Physician and nursing time studies

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ADE Benefits

• Statistically Significant Reductions in
• Severity adjusted mortality (7.4 percent)
• Severity adjusted length of stay (2.4 percent)
• Pharmacy department and variable drug cost
  reductions (18 million)
• 25,000 physician drug orders changed

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Physician COPE Results
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Project Genesis Clinical Results

• Major Learning Realizing clinical benefits of
  transformational change is a function of time
• Stage 0 Mobilize or prepare for implementation
• Stage 1 Digitize or install the enabling
  information technology
• Stage 2 Stabilize not only the technology but
  also the myriad clinical processes that have been
  redesigned
• Stage 3 Analyze the impact of the
  transformational change on organizational metrics
• Stage 4 Realize clinical benefits (quality,
  safety, satisfaction, productivity, financial) at
  MO level
• Stage 5 Optimize clinical benefits by leveraging
  MO learnings across the system

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