Sentara

1
Sentaras Road to an EMR

• Virginia HIMSS Chapter
• Annual Conference
• October 17, 2008

2
Agenda

• Overview of eCare
• Results So Far
• Key Lessons Learned
• Discussion

3
Sentara Healthcare

• 120-year not-for-profit mission
• 7 hospitals
• 10 long term care/assisted living centers
• Extended stay hospital
• 350-physician medical group
• 350,000-member health plan
• School of Health Professions
• 2.4B total operating revenues
• 2.8B total assets
• .55B cash reserves net of long term debt

2/6/2014
4
Sentara eCare

• Epic EMR
• A shared medical record for patients across the
  continuum of care
• Process Redesign
• Re-evaluate and optimize all major processes
• Complementary Technology
• Barcoding
• Document Management
• Device Integration

5
Total Cost of Ownership Benefits (10 years)

• Summary Costs/Benefits
• Total cost of ownership 237 M
• Less Physician subscription fees ( 20
  M)
• Less cost of replacing non-supported systems
  ( 80 M)
• Net cost of ownership 137 M
• Annual benefits once fully implemented
• - Hospitals 30.0 M
• - Post-Acute 2.7 M
• - Health Plan 2.8 M
• Total 35.5 M
• Phased-in 10 year value of benefits
  253 M
• Net Costs/Benefits 116 M
• Internal Rate of Return (IRR) 12.3

6
Results So Far

• ( Why we are slightly credible)

7
Hospital Implementations

• Have Successfully implemented and stabilized two
  hospitals and three associated EDs.
• Hospital 1 with 1 ED
• Two phase implementation
• Phase 1 February 2008 (Clin Doc / Results)
• Phase 2 June 2008 Computerized Physician Order
  Management (CPOM)
• Maintaining gt80 CPOM
• Hospital 2 with 2 EDs
• Big Bang Implementation
• September 2008
• gt80 CPOM at Go Live

8
Medical Records / Scanning

• Accomplishments
• Scanning volume continues to decline 38
• 16,722 images scanned vs. 27,000 at go-live
• Scanning started in PASS (PAT)
• Pre-surgical documentation available
• On time performance 98 (index within 30 minutes)
• Pharmacy order scanning reduction 94
• 500 orders /day vs. 30 orders /day
• Same day Scanning and indexing endo procedure
  images
• Sentara rocks!

9
Ambulatory Practices

• At Year End 2008
• - 40 practice locations live
• - 200 providers
• Primary Specialty
• - 1000 staff members
• - 1400 devices

The physician implementation team brings one
practice live every 10 days.
10
SLH ROI Business Case Benefits
1.4 Million Budgeted for 2008
eCare Benefit Benefit
- Reduce Length of Stay/ Reduced ADEs 366,886
- Increase Outpatient Procedures 40,205
- Increase Unit Efficiency/ Retention of RNs 211,763
- Reduce Transcription Expense 193,472
- Reduce Med Records Supply Costs 89,835
- Reduce Inappropriate Admissions 5,850
- Reduced Pharmacist Order Entry 53,780
Total 961,791
April through August Cumulative Benefits
Feb 23 Go Live
10
11
Sentara Medical Group

• As of Q2, 2008
• Transcription Expense Reduced by 120,000
• Supply Expense Reduced by 50
• The following statistics will also be tracked
• against the business case
• Reimbursement improvements
• Storage cost reduction
• Medical records labor reduction
• Malpractice claims and premiums reduction

12
Havent Seen This Yet
13
Key Lessons Learned

• Operations Must Lead
• Training and Support
• Tell the Truth
• This Never Ends (Optimization)
• Change Management

14
Operations Must Lead

• This is NOT an IT Project
• You Own It
• Design, Implementation and Achieving Benefits
• Administration
• Clinical Staff
• Physicians

15
Physician Governance eCare Project Team
Integration
16
Training and Support

• Training and Support
• Training is Mandatory for All
• Medical Staff Mandated Training for MDs
• Support from Administration for clinical staff
  training
• Pre/Post Go Live Support
• On Site
• Superusers Operations Owns This!
• Pre-Go Live 11 Sessions / Personalization
• Dedicated MD Help Desk
• Remote Access to Desktop
• Initially 24/7/365 Coverage
• No Phone Tree!

17
This Never Ends (Optimization)

• Develop a focused approach to achieve the
  following (in priority order)
• Implement
• Stabilize
• Optimize
• Achieve eCare business case
• Leverage eCare to achieve additional benefits
• Leverage optimization program to look for
  non-eCare opportunities

18
Tell the Truth

• The Good, The Bad, and The Ugly
• Set REALISTIC expectations up front
• Disruption
• Lost Productivity
• Impact on Customer Service
• Time required to train and practice
• Costs and benefits
• The Trough of Disillusionment
• Staffing Backfill (for Superusers)
• Errors and Safety Events

19
Change Management

• Its NOT about the Technology!!!
• Attitude Not Aptitude
• Transparency
• Control / Influence
• Strong Communication Plan
• Circles of Influence
• Be Patient
• Embrace the Skeptics / Manage the Disruptive
• There is no Perfection

20
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