effective it implementation in health care patient safety and national resource center annual...
TRANSCRIPT
Effective IT Implementation in Health Care
Patient Safety and National Resource Center Annual ConferenceJune 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 Health’s 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
Eastern Division Western Division
Operating UnitsSilver Spring, MD
Columbus, OH
Port Huron, MI
Mt. Clemens, MI Pontiac, MI Livonia, MI
Ann Arbor, MI
Battle Creek, MI
Grand Rapids, MI
Muskegon, MI
South Bend, IN Clinton, IA
Dubuque, IA
Mason City, IA
Sioux City, IA Boise, ID Fresno, CA
Patient Administration
Registration
Patient Accounting
Medical Records
DRG Grouper 3M 3M Quadramed 3MQuadraMed
3M
APC/APG Grouper HSS HSS
Enterprise Resource Planning (ERP)
General Ledger People Soft Global People Soft People Soft
Payroll/Human Resources
GEACCeridian
GEAC
A/P
Materials Management
Cost Accounting
Self Developed (Analysis & DSS)
TSI Mainframe TSI Mainframe TSI AS400
Self Developed (Analysis & DSS)
TSI AS400
Self Developed (Analysis & DSS)
Contract Management
SARMCMcKesson HBOC
Clinical Systems
Physician Order Management
Eclipsys
Order EntryHBOC STAR
SMS MedSeries 4
HBOC Plus 2000
HBOC Series
SMS MedSeries4 HBOC STAR HBOC STAR
Results ReportingIn-house/3M CWS CWS Cerner In-House
ADEs
Clinical Documentation
EclipsysHBOC Care
ManagerTDS
HBOC Care Manager
TDS EclipsysLifeServ Petronics
LaboratoryHBOC STAR
Cerner Pathnet
Cerner Pathnet
Sunquest ClassicHBOC ALG
Classic Cerner Millenium
Classic ClassicCerner Pathnet
Cerner Millenium
United Clinical Labs Sunquest
Cerner Millenium Sunquest
HBOC STAR
Pharmacy HospitalCerner
MsMedsCerner
MsMedsCerner
MsMedsHBOC Series
Cerner MsMeds
Cerner MsMeds
Cerner MsMeds
Cerner MsMeds
HBOC STARCerner
MsMedsCerner
MsMedsCerner
MsMedsCerner
MsMedsMediware WORX
Surgery Management
RES-Q Healthcare Omni-server
Omni-server
Patient Scheduling HBOC Pathways HBOC Pathways HBOC Pathways
RadiologyHBOC STAR
IDXADAC MARS II
HBOC Series
ADAC MARS II
HBOC STARADAC MARS II
Per-Se'Consort
HBOC STAR
Transcription Softmed Dolbey Softmed Dolbey Softmed Medrite Softmed Dictaphone Softmed SARMC Softmed
HBOC STAR
SMS Med Series4
HBOC
SMS Med Series4
Medline Systems
Global
SMS Med Series4
HBOC Plus 2000 HBOC
Series
TDS TDS
SMS Med Series4
SMS MedSeries
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HBOC STAR
HBOC
SMS Med Series4
Per-Se'ORSOS
HBOC STAR
HBOC
HBOC Health-Quest
SMS Med Series4
HBOC Health-Quest
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Primary Clinical and Business Applications (2008)Best Practices + Consistent Tools = Operational Excellence
Eastern Division Western Division
Operating UnitsSilver Spring, MD
Columbus, OH
Port Huron, MI
Mt. Clemens, MI Pontiac, MI Livonia, MI
Ann Arbor, MI
Battle Creek, MI
Grand Rapids, MI
Muskgeon, MI
South Bend, IN Clinton, IA
Dubuque, IA
Mason City, IA
Sioux City, IA Boise, ID
Fresno, CA
Revenue Management
Registration
Patient Accounting
HealthQuest HealthQuest
Medical Records Cerner Profile Cerner Profile
ERP
General Ledger
Payroll/Human Resources
A/P
Materials Management
PeopleSoft and Lawson
Clinical Systems
Clinician Order Management
Results Reporting
ADEs
Clinical Documentation
Cerner
Laboratory
Pharmacy
Surgery Management
Radiology
Integration Tools
DSS
EMPI
xCare.net (E-merge) / TIBCO / Internal Development
Web FoundationTIBCO
Shaded = denotes core systems
STAR STAR STAR
= Completed = To be Completed within 6 months = Active Implementations
McKesson
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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
Culture/workprocess
Technology
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)
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]
Hospital System Readiness(one iteration per site)
QA QA QA
Design Confirmation
(-13)
Operational Testing & Training(OTT)
Operational Impact
Analysis(OIA)
Operational Build(OB)
Current State Analysis(CSA)
QA QA
Baseline Materials Development
Building / Sustaining Alignment
Operational Testing and Training
Site Specific System Build
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Readiness Structure
Office of Project ManagementProject Genesis Steering TeamClinical Executive Oversight GroupRevenue Enhancement Oversight GroupSupply Chain Oversight GroupClinical Rules Oversight GroupBenefits Management OfficeKnowledge Management Steering CommitteeClinical Information Oversight GroupPhysician Advisory GroupFacilitated Decision Making Process
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Trinity Health Major IS Projects as of May 2005
FY05 FY06 FY07
South BendJ/A/S 2007
FresnoO/N/D 2007
ColumbusJ/F/M 2008
FY08
OaklandJ/A/S 2006
Ann ArborO/N/D 2006
ClintonJ/F/M 2007
Silver SpringA/M/J 2007
Completed
In Process
Not Started
Port HuronMay 2003
MuskegonJuly 2004
Grand RapidsOctober 2004
Battle CreekFebruary 2005
MacombApril 2005
Mason CityJuly 2005
DubuqueJ/F/M 2006
LivoniaJ/F/M 2006
BoiseA/M/J 2006
Sioux CitySeptember 2005
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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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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
Examples of Actual and Planned Metrics
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Safety• Medication errors and ADEs resulting in intervention• Rate of identification of errorsFinance• Reduction in bad debt• Reduction in operational write-offs• Percentage of clean claimsSatisfaction• Nursing satisfaction and retention• Patient satisfactionOperations• Staffing and productivity levels• Physician and nursing time studies
Additional Planned Metrics
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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
Battle Creek 19-Apr 20 21 22 23Total CPOE Saturation 56.97 61.68 61.85 62.77 70.12Total CPOE Participation 66.67 73.27 68.27 66.98 57.89
Grand Rapids 19-Apr 20 21 22 23Total CPOE Saturation 79.88 73.89 79 79.04 78.11Total CPOE Participation 77.06 72.81 71.63 73.87 51.05
Macomb Beginning April 30th 19-Apr 20 21 22 23Total CPOE Saturation Total CPOE Participation
Muskegon 19-Apr 20 21 22 23Total CPOE Saturation 3.89 5.71 8.14 6.74 7.66Total CPOE Participation 11.46 9.71 13.27 10.53 11.25
Port Huron 19-Apr 20 21 22 23Total CPOE Saturation 19.07 22.03 18.3 22.5 16.54Total CPOE Participation 23.61 22.95 28.57 21.88 24.44
11-May Total Average64.01 1437.56 62.5071.56 1549.98 67.39
11 Total Average78.89 1792.23 77.9274.54 1578.9 68.65
11 Total Average63.4 696.28 58.02
64.04 647 53.92
11 Total Average8.36 161.39 7.02
12.38 244.35 10.62
11 Total Average21.04 382.11 16.6125.37 525.75 22.86
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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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