IT Transformation Tim Tarnowski & Vince Willoughby

March 2013

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Disclosure

Tim Tarnowski, CIO Vince Willoughby, Strategy Development

Has no real or apparent

conflicts of interest to report.

© 2013 HIMSS

Learning Objectives

• Define the process to align IT strategies with medical and business strategies

• Explain one approach on how IT Governance can prioritize potential IT investments against medical and business metrics

• Describe how UK HealthCare transformed their IT function by using a framework to define Key Attributes of a World Class IT Organization

UK HealthCare Overview

Lexington, Kentucky March 2013

University of Kentucky Lexington, Kentucky

Ranked No. 1 Hospital in Kentucky Nationally ranked in the top 50 for Orthopaedics

6

Ranked high-performing in 10 specialties

Cancer › Diabetes & Endocrinology › Ear, Nose & Throat › Gastroenterology › Geriatrics › Gynecology › Nephrology › Neurology & Neurosurgery › Pulmonology › Urology

UK HealthCare

• Academic Medical Center

• State, Not for Profit

• Three Hospitals

• 80+ Sub Specialty Clinics

• 1,500 Physicians

• 8,000 Employees

• Key Statistics: – 825 Beds – 34,453 Discharges – 448,673 O/P Visits

Five Focus Areas

• Strengthen Subspecialties

• Expand Geographic Reach

• Improve Cost Effectiveness

• Patient Safety & Satisfaction

• Maintain Financial Strength

Information Technology

• 200+ FTEs

• Hybrid FTE Model: – Central – De-Central

• Best of Breed

Dedicated to Patient Care Hospitals

• UK Albert B. Chandler Hospital • UK Good Samaritan Hospital • Kentucky Children’s Hospital

Outpatient Services • Kentucky Clinic • UK Polk-Dalton Clinic • Kentucky Clinic South • UK Family Care Center • 80 specialized clinics • 150 outreach programs

Six Healthcare Colleges • Dentistry • Health Sciences • Medicine • Nursing • Pharmacy • Public Health

Areas of Excellence • Gill Heart Institute • Kentucky Children’s Hospital • Kentucky Neuroscience Institute • Markey Cancer Center • Maternal-Fetal Medicine Program • Orthopaedic Surgery & Sports Medicine • UK Transplant Center

Benchmark on Discharges

3,200

4,200

5,200

6,200

7,200

8,200

9,200

10,200

2004 Q1 2004 Q3 2005 Q1 2005 Q3 2006 Q1 2006 Q3 2007 Q1 2007 Q3 2008 Q1 2008 Q3 2009 Q1 2009 Q3 2010 Q1 2010 Q3 2011 Q1 2011 Q3 2012 Q1 2012 Q3

UK HealthCare Median Teaching Hospital

75th Percentile Teaching Hospital 25th Percentile Teaching Hospital

UK HealthCare - Benchmarked against COTH Median Teaching Hospital

Shaded area includes Good Samaritan & Chandler

Our Strategic Priorities

IT will be a fundamental organizer in relationship development and making

improvements to care delivery. Michael Karpf, MD

EVPHA, UK HealthCare June 2011

IT Transformation Using World Class

IT Attributes UK HealthCare, Lexington, Kentucky

March 2013

2009 Current State Assessment

• Internal Data Collection/Information Gathering – Nov/Dec-08 Interview Summary – I.T. Staff Survey (73% Response Rate) – I.T. Senior Management Group Reviews – Walkthrough I.T. Areas – Feedback from Colleagues/Peers – Customer Satisfaction Survey

• External Advisory Services

– Review 2007 I.T. Assessment/Strategic Plan – Participated in Benchmarking – Analyze/Benchmark I.T. Structure

Current Healthcare IT Industry Trend

Source: Healthcare Advisory Board, Innovation Center, 2010

The Challenges – Evolution of HIT

Source: Healthcare Information Systems, Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4

Focus Decade Computing Type

Billing 1960 Mainframe

Clinical 1970 Minicomputer

Billing/Clinical 1980 Computer for Masses

Healthcare Reform 1990 Internet

Healthcare Reform, ACO, Medical Home,

etc. 2000 to Today HIT Arrives

Customer • I.T. is Critical to Success of UK

HealthCare

• Need “Enterprise” Focus & Integration

• Current Level of I.T. Services is Sub-Standard

• Lacking Overall Strategies/Plan

• Upcoming Major I.T. Projects

IT Staff • Silos/Lack of Teamwork

• Fragmented Org. Structure

• Confusing Roles & Resp.

• Lacking Tools & Methods

• Not Addressing Low Performers

• Poor Communication

• Reactive/Not Proactive

• Weak Infrastructure

Conclusions of 2009 Current State Assessment (CSA)

Future State Needs – From 2009 CSA

• Industry is Rapidly Transforming

• I.T. is Critical to Success of UK HealthCare

• Prepare to Meet Healthcare Industry Trends – Immediate Tactical Plans for Major I.T. Projects – Improved I.T. Governance – High Performing I.T. Function

• Overall I.T. Vision, Strategies & Roadmap

I.T. Assessment Conclusions (Updated 2010)

Source: Healthcare Information Systems, Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4

Focus Decade Computing Type

Billing 1960 Mainframe

Clinical 1970 Minicomputer

Billing/Clinical 1980 Computer for Masses

Healthcare Reform 1990 Internet

Healthcare Reform, ACO, Medical Home,

etc. 2000 to Today HIT Arrives

Performance Excellence,

Improvement & Value Creation

Forecast 2010 + Always On Computing

Concept: Our Anticipated Focus Areas 2010 +

Transformational Change Denial

� Confusion � Apathy � Numbness � “If I ignore this, it will go away.” � “Yeah, right, they’ve said this

before.”

Commitment � Teamwork � Satisfaction � Clear focus and plan � “Sign me up!” � Acceptance

Resistance � Anger & Fighting � Withdrawal � Can’t sleep at night � “I gave my all and look what I

get.” � “I don’t like it.” � Loss of morale, productivity and

communication

Exploration � Brainstorming new ideas � Frustration � Have a lot to do � Trouble focusing � Open to new things � “How can we do things

differently?”

Source: Unknown

Transformational Change – “White to Blue”

Totally Transform Our DNA: • Gradual Process • Allows Acclimation • Organized/Documented Transition • Walkthrough Changes Over Periods of Time • Repeated Messages & Themes • Learning Cycles

Transformational Change Directly Addressing the Tough Issues

is the Work of Leadership •Maintaining Status Quo/Avoiding the Issues

•Appears to be Easier in the Short Term •Outdated Job Descriptions •Lack of Infrastructure Investments •Immature Methods, Tools, Processes

•Creates Very Difficult Long Term Issues

•We Are Here •Very Uncomfortable

•Leading Transformational Change is Very Hard Work

Transformational Change – Year One Roadmap

Topic Current State First 4 Months Middle 4 Months Last 4 Months Future State Acclimation New Employee • Orientation, SuperVISION

Session • Meet Key Customers • Tour/Visit Common

Conference Rooms & Buildings

• Discuss How Obtain Health Services

• Meet Key Customers • Meet Key Customers

• New Exec. Director Acclimated

Assessment of Operations, Processes, Methods, Tools

Inconsistent Methods & Processes

• Review Operations, Policies & Procedures

• Learn Current Processes, Methods, Tools

• Clear & In-Depth Understanding of Current State

• Assessment First Draft, Opportunities for Improvement, Options-Pros-Cons-Recommend

• Initial Recommendations • Initial Goals • Final Assessment • Draft of Performance

Scorecard, Service Level Agreements

• Establish Rounding Process & Schedule for Key Customers and Staff

• Obtain Approval for Recommendations & Goals

• Road Map to World Class I.T. Service Delivery

• Final Performance Scorecard

• Implement Rounding for Key Customers

• Improvement Method as Std. Operations & Measurement Scorecard

• Scheduled Rounding with Key Customers

• Professional IT Operations Methods (ITIL, SLAs, etc.)

• World Class I.T. Service Delivery

• Improve UK HealthCare HR Fragmented

Structure, Unclear Roles & Responsibilities

• Meet Staff • Review Job Descriptions

(JAQs), Roles & Responsibilities

• Develop Organization Structure

• Participate in Shaping I.T. Restructuring

• Market Wage Survey • Career Ladders • Succession Plans • Development Plans • Lean Training

• Lean Training Program for Areas of Responsibility

• Organization Structure • HR Programs • Improvement Method

Development Program • Internship Program

Budget Current Budget • Learn Capital & Operating Budgets

• Identify Cost Savings • Implement Cost Savings • Cost Savings

Projects Projects Managed Differently to Varying Degrees of Success

• Review Key Projects • Collect Inventory of

Projects in Area of Responsibility

• Work with PMO to Record all Projects in PMO Registry

• All Projects Managed Through PMO & In PMO Registry

Sep – Dec 2010

World Class IT Attributes

• Service Strategies • IT Governance • World Class Attributes • Passport • IT Strategies

Used by Permission; Corporate Executive Board, Key Attributes of the World-Class Information Technology Organization.

Add Reference

IT Transformation Using World Class Attributes

USING WORLD CLASS ATTRIBUTES: • Provides a Framework for a New Team • Creates a Common Language • Good Tool to Build Teamwork

ADDITIONAL COMMENTS: • This is One Approach • Other Frameworks Can Be Used • Pick Something & Stick With It

IT Alignment

UK HealthCare, Lexington, Kentucky March 2013

• Aligned ITSP Interview Teams with Org Chart

• Questions: • Strategies • Activities • How Can IT Help?

Eight IT Strategies

• Foundation for IT Approaches

• Very Long Term

IT Strategic Plan

• Service Strategies • IT Governance • World Class Attributes • Passport • IT Strategies

IT Strategic Plan

• Service Strategies • Ambulatory Services

Strategy

• What Ambulatory Services is Doing

• How IT Can Help

Benefits of IT Alignment

MAIN BENEFIT: • Ensure IT Investments are Directly Contributing to

Medical & Business Strategies

ADDITIONAL BENEFITS: • Align Strategic Plans (IT & Business) • Market Your IT Function • IT Governance Participation/Ownership

IT Governance Prioritization Process

UK HealthCare, Lexington, Kentucky March 2013

Add Reference

•World Class I.T. Service Delivery

•Data as Strategic Asset

•Usability •Interoperability •EMR

•Always On Computing

•Growth/Outreach •Unified Comm.

IT Governance

Project Priorities Data Warehouse Infrastructure & Security Service Requests

•Usability •EMR

Physician IT Advisory

MD Documentation

Clinical Decision Support

IMPACT (Improving Pt. Care

Using IT)

IT Governance

ONEList – Demand Management

ONEList – Rate vs. Signature Metrics

ITG

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# Ref Request Name 807 519 73 817 127 Totals by 1 1 Patient Access & Registration/Revenue Cycle 9 9 0 9 9 36 2 40 Ambulatory EMR (Single Patient Record) 9 3 3 3 9 27 3 174 Central Telemetry monitoring (cockpit) 9 9 0 9 0 27 4 4 Closed Loop Barcode Med Administration 9 9 0 9 0 27 5 5 CPOE-OR-Co-Path/SCM 9 9 0 9 0 27 6 155 Intraoperative CPOE (SCM Orders to OR) 9 9 0 9 0 27 7 6 Intrapartum utilization of GE 9 9 0 9 0 27 8 193 BCMA-Bar Coded Medication Administration 9 9 0 9 0 27 9 181 Co-location Data Center Space 3 3 0 9 9 24 10 14 Core Measure / NSI Hardwiring 9 3 3 9 0 24 11 11 Develop Data Center Strategy 9 3 0 3 9 24 12 3 Develop Integration Engine Strategy 9 3 0 9 3 24 13 15 EMR Completion 9 3 3 9 0 24 14 13 Order set clean up 9 3 3 9 0 24

IT Exec. Council Rating:0 = No Impact1 = Little Impact3 = Moderate Impact9 = Significant Impact

IT Governance Rating:L = LowM = MediumC = Critical

ONEPage – Executive Summary

How will requested item relate to signature metrics?

ITSP – How IT Can Help 10 Year Funding Model

Sample Amounts

Project Name FY13 FY14Single Patient Record $0 $0Remote Clinic Access 0 100Referring Physician Access 0 0Clinic and Building Growth 0 250Standardization of Clinic Systems 0 0Practice Management System 0 0Patient Access 0 0Role-based System Access 0 0Standardized Model Clinics 0 50 GRAND TOTAL $400

FY14 FY15 $0 $0

100 100 0 0

250 250 0 0

0 0 0 500

0 0 50 50

$400 $900

Benefits of IT Governance Prioritization

MAIN BENEFIT: • IT Governance Decides Which IT Investments Meet

Medical and Business Strategies.

ADDITIONAL BENEFITS: • IT Governance Participation/Ownership • Organize Approved/Unapproved Requests

Results

UK HealthCare, Lexington, Kentucky March 2013

Assoc. V.P. & CIO Tim Tarnowski

I.T. Portfolio Mgt Executive Director

Michelle Cassin

CMIO Carol Steltenkamp, MD

Applications Executive Director

Doris Miller

Technology Executive Director

Mark Eimer

I.T. Security Director Doug Fee

Architects: Michelle Gerding

Ben Nicholls

Strategy Analyst: Vince Willoughby

I.T. Service Line Director - COM

Steve Welch

UK HealthCare IT Leadership Structure January 2013

Informatics Executive Director

Cecilia Page

Assoc. V.P. & CIO Tim Tarnowski

I.T. Portfolio Mgt Executive Director

Michelle Cassin

CMIO Carol Steltenkamp, MD

Applications Executive Director

Doris Miller

Technology Executive Director

Mark Eimer

Select & Implement

(PMO)

Stabilize &

Transition (All)

Support (Apps, Tech, Security)

Stra

tegy

&

Arc

hite

ctur

e

Optimize (Informatics)

Innovate (Innovation)

I.T. Security Director Doug Fee

Architects: Michelle Gerding

Ben Nicholls

Strategy Analyst: Vince Willoughby

I.T. Service Line Director - COM

Steve Welch

UK HealthCare IT Leadership Structure January 2013

Informatics Executive Director

Cecilia Page

IT Team Composition

83%

17%

Leadership 2010

48% 49%

3% Leadership 2011

94%

6%

All Staff 2010

65%

33%

2%

All Staff 2011

UK HealthCare External UK

97%

3%

All Staff 2009

97%

3%

Leadership 2009

Results: IT Governance Top Priorities

Assessment

IT Transformation

New Hospital

Community Hosp.

Ambulatory EMR

Data Center

ARRA/MU

ICD-10/Regulatory

ITG Top Priority 2009 2010 2011 2012 2013

Rollout Selection

Move Apps

http://ukhealthcare.uky.edu/IT/

Passport for Our Improvement Journey

Passport for Our Improvement Journey

UK HealthCare IT Capital Spend (2002 – 2012) & Forecast (2013 – 2023) (Figures in $000s)

TCO Avg. $43M

Capital Avg. $26M

Lessons Learned

UK HealthCare, Lexington, Kentucky March 2013

Lessons Learned • Restructuring:

– Does Not Equal Team Building – Challenge to Maintain Service Delivery While In Process – Need to Develop Common Language/Understanding

• Customer Demand Always > IT Supply – Critical Success Factors are:

• ONEList • Customers Prioritize Requests Against Signature Metrics

• Customer Turnover Impacts Priorities

• Over Communication is NOT Possible

Lessons Learned • IT Strategic Plan:

– Help Areas Without Documented Strategies – Alignment is a Very Difficult & Repetitive Process

• World Class Attributes

– Multiple Years to Build – Establishes a Common Language/Understanding

• IT is All About the TEAM

“Transformation without work and pain, without suffering, without a sense of loss is just an illusion of true change.”

Source: Cross Roads, by William Paul Young

Thank You! Tim.Tarnowski@uky.edu

Vincent.Willoughby@uky.edu

www.ukhealthcare.uky.edu www.ukhealthcare.uky.edu/IT

March 2013