Case Study: Building an Effective Governance Model

Sameer Badlani, MD, FACPChief Medical Information Officer

June 11th , 2014

About the University of Chicago Medicine

Established in 1927

Located on the Southside of Chicago in Hyde park

Approximately 600 beds

9500 employees

700 + physicians

900 + residents and fellows

1500 + nurses

Epic Implementation

2009 - CPOE - 2009

2011 - Inpatient, Stork, Transplant, Beacon, OpTime - 2011

2012 - Ambulatory, AIMS - 2012

2014 – MyChart, CareLink, CareEverywhere, Bar Coding & Epic 2014 Upgrade

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Objectives

• Define Governance

• Why do we need it

• Creating and Implementing

• Assessing effectiveness

• Iterative improvement

• Future work

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Define Governance

IT governance (ITG) is defined as the processes that ensure the effective and efficient use of IT in enabling an organization to achieve its goals. (Source: Gartner)

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Define Governance

IT governance (ITG) is defined as the processes that ensure the effective and efficient use of IT in enablingan organization to achieve its goals. (Source: Gartner)

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Define Governance

IT governance (ITG) is defined as the processes that ensure the effective and efficient use of IT in enablingan organization to achieve its goals. (Source: Gartner)

More:-

- Transparent

- Timely

- Seamless

- Equitable

- Measurable

- Iterative

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Why do we need it

• Health IT Spending to Top $34 Billion in 2014

(Healthcare Informatics Aug 2013)

• % of total IT Budget/ Total Hospital Expense Overall in 2011 was 4.87% up from 2.77 % in 2010

( HIMSS 2012 Annual Report)

• Organizations' IT spending expected to keep growing

( Modern Healthcare Feb 2014)

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Why do we need it

• Volume to Value Based Contracts

• ACA/ ACO

• PQRS

• MU Stage 2

• Managed Medicaid

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Why do we need it

• ROI

• Clinical Efficiency

• Analytics

• Big Data

• Are you using what you have already?

• Survival

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Creating and Implementing

• Iterative model refined every year for the last four years

• Broken into 40 hour plus and below 40 hour projects

• Approved by the IS steering, Clinical Chairs Committee, Practice Plan Board

• Socialized extensively and exhaustively before final implementation

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UCM IS Governance: Portfolio Committees

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COLT(Epic Program )

Portfolio

Hospital Operations

Portfolio

Administrative Operations

Portfolio

Enterprise Informatics

and Analytics Portfolio

Infrastructure Portfolio

Information ExchangePortfolio

UCM IS Governance |

Executive IS Steering Committee

AmbulatoryPortfolio

Group

InpatientPortfolio

Group

Practice Management

EHR/EpicCareAmbulatory

OB/GYN(Stork)

Oncology(Beacon)

Transplant(Phoenix)

Perioperative Tools

MedicationTools

EHR/EpicCareInpatient

HIMTools

EHR Advisory Group

• Co-Chairs – VP, Amb Care Serv, CMIO

• Members:

• Executive VP, Practice & Bus Dev

• 2 MD Practice Directors TBD

• Director, Ambulatory Access

• Director, Ambulatory Operations

• CMIO

• ACMO, Quality

• ACMO, Clinical Effectiveness

• VP – Pt Safety/Risk/Compliance

• Ambulatory Practice Administrators

• Director, IS Epic Program

• Asst Director, IS Epic Ambulatory

12Clinical & Operational Leadership Team

Ambulatory Portfolio Membership 1/17/2012

• Co-Chairs – CMIO, CNO

• Members:

• ACMO, Quality

• ACMO, Clinical Effectiveness

• VP, Pt Safety/Risk/Compliance

• 2 Medical Practice Directors

• VP, Pharmacy

• VP, Procedural Services

• Anesthesia Physician Sponsor

13Clinical & Operational Leadership Team

Inpatient Portfolio Membership 1/17/2012

UCM IS Portfolio Management: High Level Process for 40 hour plus requests

14UCM IS Governance |

Project Request

submitted to VP or above

for authorization to progress to

Portfolio Comm

Portfolio Comm

reviews and

prioritizes or denies request

Portfolio Comm

representatives

communicate outcome

to requestor

IS reviews prioritized

projects for resourcing

and proj execution timeline

Prioritized projects

executed

Portfolio Comm

monitors realization of business

value

15UCM IS Governance |

Scoring Model for Prioritization

Category Impact Score Description Weight

Patient Safety

4 - Severe Impact Immediate high risk patient safety issue with no workflow fix and/or Critical event - liability claim

83 - High Impact Immediate high risk patient safety issue with available workflow fix and/or Documented near miss

2 - Medium Impact Risk/Suspected safety issue

1 - Low Impact Potential low risk patient safety issue with available workaround

0 - No Impact No Impact

Compliance

4 - Severe Impact Clear CMS or Joint Commission mandate with no exceptions (within 30 days impact)

63 - High Impact UCMC Policy Standard or CMS/JC mandate with 60 day plus date of impact

2 - Medium Impact UCMC Standard of Care

1 - Low Impact UCMC "nice to have"

0 - No Impact No Impact

Strategic Goal

4 - Severe Impact Organizational AOP goal or CEO Inititiave

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3 - High Impact VPs, CNO, CMO, CMIO, aCMO, CIO, CCO initiative

2 - Medium Impact Director/Department Quality Chief level initiative

1 - Low Impact Single department goal and/or less than 25 users

0 - No Impact No Impact

Efficiency/Productivity

4 - Severe Impact >250 users and/or daily issue

43 - High Impact >100 users and/or weekly issue

2 - Medium Impact >10 users and/or monthly issue

0 - No Impact No Impact

Revenue Impact

4 - Severe Impact More than $1M

43 - High Impact Between $500k and $1M2 - Medium Impact Between $100k and $500k

1 - Low Impact Less than $100k

0 - No Impact No Impact

Scholarly Impact

3 - High Impact Enterprise wide research/education project or initiative

42 - Medium Impact Research/Education project for multiple departments, facilities and/or areas of care

1 - Low Impact Single department Research/Education project

0 - No Impact No Impact

• Review projects before meeting with stakeholder for clarity and operational readiness

• Validate score and remind committee it is to lend some objectivity to a subjective process

• Focus on not only approval and prioritization but resolution of issues for ongoing work

• Communicate bandwidth issues well in advance

• Create top ten list not in an order of importance

• High-threshold to stop a project inflight

• Communicate, communicate and hold accountable

Best Practices

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Under 40 Hours

• Requests collected through various intake mechanisms including but not limited to

• Help desk complaints

• Sub portfolio groups

• Emails to CMIO

• Offshoots from unrelated discussions

• Every clinical section has designated SMEs• Refreshed every year

• Monitored for response time and collaborative spirit

• Counted towards service to institution in the promotion criteria

• Can delegate but have to be final sign off

• Operational units have designated director level point of contacts

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Under 40 Hours

• Racked and stacked per Director of Epic applications

• Resource allocation closely monitored and balanced with demands for over 40 hour bucket

• CMIO and medical directors for informatics act as liaisons to mitigate escalation and resolution

• Criteria• Do you still need it?

• How are you functioning now?

• How will this impact your process

• How will you measure roi?

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Assessing effectiveness

• Monitor turn around time

• Check in with institutional leaders, influencers ( including constipators)

• End user feedback around transparency, turnaround time

• Gut sense

• Close the loop on operational readiness and ROI

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• 316 Clarity Report Requests & Updates

• 1,812 Scheduled Classroom Hours

• Application Changes, Updates and Support:

• 3,797 Service Desk Tickets Resolved

• 2,098 Application Change Controls

• More than 150 projects delivered (> 40 hours)

Epic Application Support FY13 Summary

20Epic Optimization Status Summary |

33%

55%

12%Ambulatory

Inpatient

Other

2%

21%

76%

1% 0%MEANINGFUL USE

NHP

OPERATIONAL

PHOENIX

RESEARCH

0 200 400 600 800

Other

Nurses

Providers

Assessing effectiveness

• Be able to tie in every project to annual operating and strategic goals

• Do we have a line of sight for projects requested by me and my direct reports

• Assess resource utilization between • RUN

• GROW

• TRANSFORM

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Iterative improvement

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Future work

• Online dashboard

• Outreach and communication

• Translate paradigm to Clinical and Business Intelligence Initiatives

• Involve more front line users in process and decision making

• Share and Learn

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