challenges and successes in implementing a health it strategy

Challenges and Successes in

Implementing a Health IT Strategy

October 5th, 2006Rich Pollack M.S. CPHIMSS FHIMSSVP and CIO, VCU Health System

Overview

Planning Strategy 2003 Effort at VCUHS Effective Governance Competition for Capital Demand Management Internal IT barriers Communication Leadership Alignment 2006 Re-Visioning

Strategic Planning Process

Rich Pollack, MS CPHIMSS FHIMSSS

Major components of an IT Strategic Plan

Assessment Vision formulation IT implications of the vision Plan development

Educate the key players on the need for and possibilities resulting from a IT strategic planning process

1. Apply an accepted model such as CAM (component alignment model)

2. Create a set of “planning categories”

Assessment

InformationTechnologies

ExternalEnvironment

Non-controllable Components

MissionOrganizational

Infrastructure andProcesses

ITInfrastructure and

Processes

Controllable Components

Expanded CAM Model

BusinessStrategy

ITStrategy

Alignment

IT Strategic PlanBusiness Plan

Alignment

MedicalScientificAdvances

Prototypical Planning Categories Mission, business strategy, organizational

infrastructure, external environment

Risk partners

IT infrastructure and emerging information technologies

Patients, family and the community

Providers

Education and research

Perform the assessment phase Utilize subcommittees to organize and document

information within the planning categories

Gather information through administration of questionnaires and interviews, as needed

Develop a Vision of the Future Utilize the subcommittees to organize

information within the planning categories

Key Foci

Expanding the market segment through closer linkages with physicians facilitated by technology

Offer the patient community concierge level convenience via unique web portals, IVR and other patient centered innovations. Embrace the coming tide of “consumer-directed healthcare”

Understand the bottlenecks and redundancy in the patient flow process. How can a workflow enabled EMR break through those?

Enhancement of the revenue cycle as a byproduct of improved on-line documentation

Develop a Vision for the Future Key Foci (cont.)

Could an EMR and CPOE make a significant and measurable contribution to crafting a “high quality – high safety” patient environment?

Detail the productivity to be gained by new mobile communication tools like Vocera, RFID tagging and Blackberry’s

Is there a need and support for using data mining to analyze practice variation and the effective use of “order sets” and “protocols”

Determine what level of system availability is required for the critical clinical systems measured against the corresponding infrastructure costs

Specify the I.T. implications of the Vision

?

Consider the possibilities of process redefinition and re-engineering in conjuncture with I.T. deployment

Referral Registration Scheduling Intake Diagnosis/treatment Order entry/results reporting Etc.

Develop the Plan

Current and future environments

Current application portfolio

I.T. governance and organizational structure

Strategic goals Strategic objectives

Tactical objectives Timeframes Resource requirements Financial requirements Value to be received Prioritization and

demand management process

Summary of the IT Strategic Plan

November 17, 2003

DRAFT

VCUHS has been an industry leader in its use of Information Technology, with automation support for virtually every function.

At this point, many of the key clinical, financial and administrative systems are reaching end of life and must be replaced.

The purpose of the IT Strategic Planning process is to develop a plan for the use of Information Technology over the next three years. It will define:

How IT will be managed

What technologies will be deployed to support VCUHS’ needs

The Strategic Plan will help to ensure that the greatest value is gained from VCUHS’ IT investments.

VCUHS IT Governanceand Demand Management

IT Governance: StructureThe first step in any IT planning and budgeting is defining the governance structure that will manage the process. The major components of the proposed IT Governance structure are illustrated below:

IT SteeringCommittee

CustomerIT Liaisons

IT Staff

IT Management

Clinical

Financial

Admin.

MCVP

VCUHS DepartmentArea

VCUHSExecutive

Management

VA Premier

IT WorkingGroups

IT/DepartmentCoordinatingCommittee

IT Governance: Capital Budgeting and Department Specific IT Projects Departmental projects will affect the VCUHS IT operational or technical

environment, and are likely to need central IT resources to implement, integrate and support their initiatives.

These projects should follow the same approval process as an IT capital project, with early central IT involvement to review the requirements of the new system, regardless of the source(s) for capital funding.

The new IT Governance process – with its focus on customer service – should alleviate departmental concerns about central IT’s involvement.

In addition, the IT Steering Committee will provide a forum for discussing departmental initiatives and their impact on VCUHS as a whole.

IT Steering CommitteeDuring the Visioning Session, participants developed a set of guidelines for the IT Steering Committee that will confirm its central role in IT Planning and Budgeting. The guidelines include:

VCUHS IT Governance: IT Steering Committee

Membership – VCUHS, MCVP, Faculty, Research, VCU,

School of Medicine, Active Working Group Representation

Appointed by VCUHS Executive Management/CEO

Responsibilities –

• Has final authority for IT project approval

• Implements the IT Vision and Guiding Principles

• Develops IT project prioritization process and resolves conflicting priorities

• Ensures appropriate focus on Clinical, Research and Education initiatives

• Reviews strategic initiatives and associated business cases

• Approves and allocates annual IT Capital and Operating Budgets

• Endorses initiative staffing and other resource allocations

• Monitors progress and communicates IT activities to the VCUHS organization

IT SteeringCommittee

CustomerIT Liaisons

IT Staff

IT Management

Clinical

Financial

Admin.

MCVP

VCUHS DepartmentArea

VCUHSExecutive

Management

VA Premier

IT WorkingGroups

IT/DepartmentCoordinatingCommittee

Competition for Capital

1.New construction and renovation

2.Replacement of clinical equipment (beds, monitors, Xray etc)

3. Investment in I.T.

Determine estimated resources

required to implement each project

Apply resource estimates

beginning at the top of the

prioritized list and continuing

thru full (reasonable)

consumption of

resources and somewhat beyond

Present prioritized list with resource demand management

Applying Resource Demand Management

Resources

# of Pro

jects

Resource Saturation

1

4

Scores forEach Project

Final Scores

Weights forEach Criterion

Final List

Post-ScoringBalancing

Phasing

PlatformImplications

Intangibles

Dependencies

ImplementationPhasing

Scored List

Weightsand

Scoring

3

BusinessEconomics

ValueProposition

Strategic FitBusinessFeasibility

2

Short List

Phasing ofProjects Resource

Allocation

Phasing ofServices

CriteriaGates

Long List

Process Key Components Prioritization Level

Project Prioritization – Components

Cla

rian L

ab

Test

ing R

eso

urc

es

IS D

esk

top S

vcs

.

IS P

rogra

mm

er

Analy

st

IS I

nte

rface

Analy

st

IS P

roje

ct M

anagem

ent

VisicuLawson UpgradeCampus Wide Network RefreshInternal and External Network FirewallsHospice ApplicationProVation InterfacesRiley Phase VCancer HospitalActive Directory 2003Cloverleaf Upgrade and Server ExpansionContribution ManagementHealthcare InsightsDisaster RecoveryServer Refresh - CarewebHost Based Intrustion Detection

Resource Demand Management Applied to Prioritized List

Example

System Development and Review ProcessIdentify

SystemInitiative

Assess Feasibility

Cost/Benefits

ConductProject Review

Add to IT Plan

InitiateProject

• Initiatives are submitted for review to the IT Steering Committee (ITSC) via a formal request process

•Department and IT must jointly evaluate all projects to ensure that needed integration and network connectivity will be available and that on-going support needs are budgeted

•The ITSC will add projects to the IT Strategic Plan only upon the committee’s approval

To commence a project:

•User department management must be committed as project sponsors

• IT and user staff must be available

•Funds must be available

• IT and the user departments share responsibility for identifying systems initiatives

Recommended thresholds for Steering Committee approval:

Demand Management Process

Cost > $100,000?

• Initiative presented to Steering Committee for review and approval• Informational copy of Capital Budget presented to Steering Committee

Yes

Requires >6 man-months

of Central IT staff support? Requires

Interfaces? Introduces a cross-

departmentalSystem?

Requires network

connectivity and/orwide availability

across the institution?

NoYes

No

No

No

Yes

Yes

Yes

Initiative must be funded from disposable

IT or departmentalfunds

No

Has similar functionality to an existing

system?

New Projects

Annual Departmental

Capital Budgets

No

Yes

VCUHS IT Vision

VCUHS Strategic ThemesVCUHS Strategic Themes

VCUHS MissionVCUHS Mission

VCUHS VisionVCUHS Vision

VCUHS IT VisionVCUHS IT Vision

The VCUHS Information Technology organization views data as a strategic asset and is committed to providing information that is accurate, timely, secure, and available to those who need it.

Electronic Medical Record: Improve Patient Safety by providing advanced clinical systems and an

Electronic Medical Record for the VCUHS physicians and clinicians. Access: Support ready access to appropriate information for patients, clinicians, employees, and management.

Operational Support: Provide information systems that support the clinical and business functions of VCUHS for efficient operations, performance improvement, and financial viability.

Research and Education: Support the patient care, research and educational goals of the VCU community.

Connectivity: Provide the framework, infrastructure, and standards for secure, high speed access, processing, and communications.

The VCUHS Information Technology organization views data as a strategic asset and is committed to providing information that is accurate, timely, secure, and available to those who need it.

Electronic Medical Record: Improve Patient Safety by providing advanced clinical systems and an

Electronic Medical Record for the VCUHS physicians and clinicians. Access: Support ready access to appropriate information for patients, clinicians, employees, and management.

Operational Support: Provide information systems that support the clinical and business functions of VCUHS for efficient operations, performance improvement, and financial viability.

Research and Education: Support the patient care, research and educational goals of the VCU community.

Connectivity: Provide the framework, infrastructure, and standards for secure, high speed access, processing, and communications.

Enterprise Planning & GovernanceIT Infrastructure

Rev CycleERP

Decisions through use of Information

Supply Chain

Clinical Applications

Finance Applications

CIS

Enterprise Level Applications

HR Applications

I have seen the enemy, and he is us !

(Walt Kelly, in the comic strip Pogo)

Recognize and address the internal ITbarriers Immature project management – skills, process

and organization Weak infrastructure – “rocky foundation” Lack of vendor commitment and involvement –

“MIA syndrome” Inwardly focused and insular – need to look

outside for ideas and solutions HIMSS, Gartner, Advisory Board etc Trade press, white papers, vendors, consultants Networking with other provider organizations

Communicate the plan and build support

And constantly update it (living document)!

The Electronic Medical The Electronic Medical Record (EMR)Record (EMR)

• Patient Demographics

• Laboratory Results

• Radiology Diagnostic Imaging Results - (Stentor)

• Transcription Results (Medquest & Dragon)

•Operative Notes/ Discharge Summaries

• Limited Notes (Voice to Text Dictation)

• Cardiac Cath & Pulmonary Lab Results

• Orders • Ambulatory – Labs, Radiology, Admit• Inpatient - All• Easyscript• Caresets & Practice Guidelines

• Medication Documentation - Inpatient• Patient Education & Discharge Information

• Allergies, Heights, Weights

• Problem & Procedure Lists

• Dietician, Social Work & Respiratory Therapy Notes

• OR Process Redesign

• Progress Notes & H&Ps

• Transcribed Documentation (Non Medquest)

• Nursing Assessments & Documentation

• Research Documentation

• Printed Results – Endoscopy, Vascular, Heart Station, Peds Pulmonary

• IPOC

• Referral Letters/Consult Notes

• Flowsheets – Vital Signs & I&O

• Consents & Operative Notes

• Discharge Summaries

Year 2006

40 % of key chart components on-line



• Diagnostic Imaging Results - (Stentor)

• Transcription Results (Medquest)

•Operative Notes

•Discharge Summaries

• Cardiac Cath Results

• Orders • Ambulatory -All• Inpatient - All• Easyscript• Caresets & Practice Guidelines

• Medication Documentation - Inpatient• Patient Education & Discharge Information

• Dietician Notes

• Social Work Notes

• Respiratory Therapy Notes

• OT/PT/RT Notes

• Ambulatory EHR Phase 1

• Progress Notes & H&Ps

• Transcribed Documentation (Non Medquest)

• Nursing Assessments & Documentation

• IPOC

• Referral Letters/Consult Notes

• Anesthesia/Operative Reports

Year

2007


• Flowsheets – Vital signs and I & O

• Consents

• Printed Results – Heart Station

• Miscellaneous Documents






•Operative Notes




• Medication Documentation – Inpt & Outpatient• Patient Education & Discharge Information

• Nurse & Physician Documentation

• Dietician, Social Work, Respiratory Therapy, & OT/PT/RT Notes

• Interdisciplinary Plan of Care (IPOC)

• Ambulatory Phase 1

• Ambulatory Visit & Consult Notes

• Charge Capture from Documentation

• INET (Critical Care Documentation & Machine Interfaces)



Year 2008

• Printed Results – Heart Station

• Flowsheets – Vital Signs & I&O

• Consents






•Operative Notes




• Medication Documentation – Inpatient & Outpatient• Patient Education & Discharge Information•Nurse & Physician Documentation

• Dietician, Social Work, Respiratory Therapy, & OT/PT/RT Notes

• Interdisciplinary Plan of Care (IPOC)

• Ambulatory Rules & Alerts

• Ambulatory Visit & Consult Notes

• INET (Critical Care Documentation & BMDI)



Year 2009& Beyond


Align the Leadership and build support

Why is getting to an agreed strategy so hard?

Leadership Alignment: Seize “educational moments” with individual

leaders or groups – correct mis-perceptions Provide honest and consistent message Create an atmosphere of trust and transparency Search for “common ground” Control expectations or they’ll control you Pursue small wins along the way to establish

credibility

Unrealistic Expectations:

Re-Visioning – Summer 2006 A cross section of 5 senior clinical leaders

engage in an off-site retreat facilitated by the CIO

Used a vendor best practice site visit as the catalyst for direction setting

Evaluated remaining EMR initiatives for importance and effort

Positioned those initiatives across a 3 year planning horizon