0

Partnership and Alignment: Critical Steps to Maximize Speed and Execution

William Holland, MD

VP and Chief Medical Informatics Officer

Banner Health

November 13, 2016

2

3

The Banner Operating Model

• Integrated governing process• Single Board of Directors

• Centralized management structure

• Centralized corporate functions

• Designed to achieve results• Enhance clinical quality

• Affordable cost model

• Patient/member experience

• Alignment from strategy through initiatives• Drives common strategy from senior leaders down through entire organization

• Allows IT leaders to tightly align technology strategies with Banner strategy

• Aligns IT sub-strategies and tactics across IT operations

Banner’s Operating

Model

4

ED

Pulmonary

Palliative Care

NICU/Newborn

Neurosciences

Critical Care

Behavioral Health

Anesthesia

Pediatrics

Women’s Health

Long-term Care

Medical Imaging

Primary Care

Hospital Medicine

Cardiology

Nephrology

Surgery

Pharmacy & Therapeutics

Infectious Disease

CV Surgery

Oncology

Ortho

Care Management

Council

5

Evidence Based Practices

• Medical Imaging for Dx Community

Acquired Pneumonia

• Chlorhexidine Alcohol for Surgical Skin

Preparation

• Seprafilm Use in Cesarean Sections

• Knee High SCDs and TEDs

• Early Sepsis Identification

• Acute Respiratory Distress Syndrome

(ARDS)

• Delirium

• Newborn Hypoglycemia Screening &

Mgmt

• Medical Imaging for Peds Appendicitis

• Large/Small Bowel Surgical Care

• Diagnosis of Diarrheal Disease

• Pooling of Bronchoscopy respiratory

specimens

• Diagnosis of Coccidioidomycosis by

Seriological Means

• Diagnosis of Clostridium difficile

Associated Diarrhea

• Elective Deliveries Prior to 39 Weeks

• Behavioral Health Medical Clearance

• Ventilated Patient Management (oral

care, sedation)

• CT Scan in ED for Atraumatic Headache

• Dysphagia Management for peds

patients

• Subcutaneous Insulin

• Readmission Risk Assessment and

Management

• Pediatric Sepsis

• Enhancing Progression of Labor

• Indwelling Catheters in Laboring

patients

• Pharmacy Drug Level/Lab Monitoring

Service

• Appropriate Use of PPI’s (Proton

Pump Inhibitors)

• DKA Hyperglycemic Crisis

• Moderate-Severe EtOH-Substance

Withdrawal

• Pediatric Bronchiolitis

• Pediatric Fevers

• Adult Implantable Automatic Cardio-

Defibrillators (ICD’s)

• Epoetin-Adult

• Orthopedic Care for Total Knees,

CPMs, Cold Therapy

• Anesthesia Administration

• Post Partum Hemorrhage

• Early Warning System for Adult

Patients

• ED Pulmonary Embolism Rule-Out

Criteria (PERC)

• ED Discharge Transition

• ED Acute paint management

• Midline Sternotomy – Post Operative

Management-Adult

• Point of Care Chest Ultrasonography

• Developmental Screening for Peds

• Acute Blood Loss

• ED Chronic Pain

• T Dap Vaccine

• Use of BMP

• Nitrous Oxide

• Reducing Postoperative Pulmonary

Complications

• Ambulatory Diabetes Care

• Hepatic Encephalopathy Patient

Management

• Syncope

• ED Ischemic Stroke tPA

• Scorpion Envenomations

• ED to Critical Care Admissions

• Intra Op Goal Directed Therapy

• PET Scan

• Admin Intravenous Contrast Media

• Vertebroplasty

• Pre-Term Labor

• Ambulatory Lower Back Pain

• Insulin Drip Transition Post Cardiac

Surgery

• Palliative Sedation

• Chorioaminonitis Management

2012–Top 5 Health System Clinical

Quality

2010-2011 - Top 10 Health System

(Thomson Reuters)

2010 - 2011 Top 25 Connected

Facilities in US

(Health Imaging & IT Magazine)

2010 & 2011- Top 10 of the Top

100 Integrated Healthcare Systems

in the US(SDI & Modern Healthcare Magazine)

2010 - One of Arizona’s Most

Admired Companies

(Business Magazine & Best

Companies AZ)

2009 & 2010 - Top 100 best

technology innovators in US(Information Week 500)

2007 - 2010 Best Places to Work

winner

(Business Journal & Best Companies

AZ)

2011 -2012 Best Hospitals (US News/World Report)

2011 Top Leadership Team in

HealthCare(Health Leaders Media)

Truven Health Analytics

15 Top Health Systems 2013

Partial List of Banner Awards

Banner’s Vision 2020

Acute Hospital

Company

Clinical Quality

Company

Population Health

Management Company

8

9

Payson Banner Hospital

27

Acute PowerChartMaternity Units

Increased Anesthesia OR’s

340

Ambulatory Providers

41 Urgent Cares myBanner Portal

120

Case Managers

8

Registries

2 Banner MD Anderson Oncology

Optimization

100

Provider Acquisitions

2 Tucson Banner Hospitals

800 Ambulatory Providers

Research Stage 3 Domain Upgrades

Home Health MACRA/MIPS Interoperability PowerChart Touch

Focus

10

CLinical INformatics Integration Council

11

Ambulatory - Our MoonShot

• Change Management• Cultural, Workflow, Patient/Consumer

• Merging of Ambulatory and Acute• Optimization, Transitions of care

• Availability of skilled resources• Speed vs. Quality• Regulatory• Data migration• Interfaces• Growth, Acquisitions• Revenue

Projected Ambulatory Implementations 2015

0

50

100

150

200

250

300

350

June July August September October November December

Providers (Projected)

Clinics

Specialties

Actual Ambulatory Implementations 2015

0

50

100

150

200

250

300

350

June July August September October November December

Providers (Actual)

Providers (Projected)

Clinics

Specialties

Implementations 2015 and 2016

0

200

400

600

800

1000

1200

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Providers (Actual)

Providers (Projected)

Clinics

17

18

19

Org Chart

William Holland

VP, CMIO

Scott Sharples

Physician Informaticist

Dana Kosmala

Physician Informaticist

Cornel Antonescu

Physician Informaticist

Deborah Bonnell

Senior Director Meaningful Use Program

William Holland

VP, CMIO

Scott Sharples

Physician Informaticist

Ken Schaefer

Physician Informaticist

Dennis Swearingen

Physician Informaticist

Nitin Bhosale

Physician Informaticist

Dana Kosmala

Physician Informaticist

Michael Radtke

Physician Informaticist

Cornel Antonescu

Physician Informaticist

Umar IqbalInformatics Fellow

Y2

Edward Maddela

Informatics Fellow Y2

Andrew Muth

Informatics Fellow Y1

Christopher Hollweg

Informatics Fellow Y1

Jennifer LyonPhysician

Alignment Executive (Cerner)

Cathy Patterson

Senior Healthcare Executive (Cerner)

Chris LewisDirector Physician

Alignment (Cerner)

Deborah BonnellSenior Director

Meaningful Use Program

Team

• Informatics Fellows• Cerner Physician Informatics Alignment• Projected Growth

William Holland

VP, CMIO

Scott Sharples

SD Ambulatory and Population Health Informatics

Ken Schaefer

Physician Informaticist

Dennis Swearingen

Physician Informaticist

Nitin BhosalePhysician Informaticist

Projected GrowthSpecialty Workgroup Analyst

Dana Kosmala

SD User Experience , Optimization, and Consumer Informatics

Michael RadtkePhysician Informaticist

Lisa ChanPhysician Informaticist(Tucson Conversion)

Kevin ReillyPhysician Informaticist(Tucson Conversion)

Projected Growth

Urgent Care/Retail Informaticist

Projected Growth

Lights On Analyst

Cornel Antonescu

SD Clinical Decision Support and Academic Informatics

Umar IqbalInformatics Fellow Y2

Edward Maddela

Informatics Fellow Y2

Andrew MuthInformatics Fellow Y1

Christopher Hollweg

Informatics Fellow Y1

Jennifer Lyon

Physician Alignment Executive (Cerner)

Cathy Patterson

Senior Healthcare Executive (Cerner)

Chris LewisDirector Physician Alignment

(Cerner)

Deborah Bonnell

Senior Director Meaningful Use Program

Team

• Tucson Project Informaticists• Informatics Fellows• Cerner Physician Informatics Alignment• Projected Growth

23

All-In Approach

Strategic Initiative

Informatics &Medical Group

Co-leads

Stakeholders driving design

Cerner at the table

24

Weekly Project Status Dashboard

Project: Ambulatory / Registration

Banner Health

Week Of: 3/16/2015 - 3/20/2015

Metric Status Owner Summary / Impact Action Plan / Next Meeting

Overall Yellow Dr. Holland/Scott

1. Project plan, in process and a lot of progress have been made and will continue to be made until

the plan is complete for phase 1, once that is complete we will start on phase 2. 2. Improve

communication and visibility. Control messaging. 3. Schedule oversight meetings. 5. Continue

daily agile project management meetings. Twice week status meetings

Training and Education Green Jenny Training and Education Plan is not defined. Training/Support proposals received. Making final

determination.

Banner Meeting on March 30th. Decision made by

Tuesday March 24th. Banner looking to partner

with Cerner for training and support.

Domain Strategy Yellow Rhonda / Ruby/Stephen

Engaged Banner in domain discussions regarding PCM acute build in AZA. (Refer to Maternity note).

Received communication from Banner their plan to replicate AZA build in their other domains.

'Draft domain strategy for AZA phase 1 and phase 11 posted in project portal.

1) Cerner team is met Wed, March 18th to

continue the internal domain planning discussion.

Final plan will be reivewed and proposed to

Banner IT on Friday, March 20th

2) Wkly Domain Meeting with Brad, Rhonda, and

Stephen

3)Next Wed this should be back on track to green

for Phase 1ICD10 Yellow Ruby ICD 10 Testing taking place in AZA Domain

Change Management Green Clay -Met with Clay from the Banner team to get a Change Management plan in place.

-Proposal will be put together on Monday.

Communication Green Toni Initial communication plan is completeFollow up Meeting scheduled for next Thursday,

March 26th

Hardware - Mainframe Green RhondaCerner Fitness Team and Brad Likes team are meeting weekly to review and plan for additional

ambulatory users. Final Report is due out March 30th

Reporting YellowCorey, Suzi, Michael

Paris

Need to identify all reporting that currently is currently used in Banner. Clinical, Rev Cycle, Practice

Management and other reports This might not be needed day 1

Hardware - Front End Devices Yellow Natalie List is provided to Cerner.

Meeting scheduled for next Monday, March 23rd.

Hardware list should be provided to Cerner by

David on Friday 3/20. Natalie working with Stacy

to get a schedule for on site hardware

assessment for the week of 3/30. Should have

schedule by EOD 3/20 from Banner.

1. HIMS / 2. Document

ManagementYellow

1. Christine/Carla 2.

Christine/Carla

BMG / HIMS / IT have not agreed on a final plan for document scanning and management. For

Cerner Ambulatory project we should proceed with what clinics are currently doing.

1. Follow Up meeting scheduled for Friday, March

20th. Sync with Kathy on weekly calls. 2.

Document Hierarchy still an issue, Tuesday the

24th

Data Migration – Vendor A Red Katherine/ Matt/Laura

Data Migration is a risk at this point especially for Phase 1 getting information into the charts is a risk

at this point.. Banner Health not getting the data from their current vendor until May 1st is a risk at

this point for our June 15 go live. Images/Documents will not be available at go live. What is our

plan? Extended read only access to Vendor A? Manual abstractors,, printing? Full day meeting to

capture this worflow.

Meeting 3/20 to discuss additional concerns and

what really plan A is or what plan B (manual

abstraction)

Plan Needed for gap data

Plan needed for images

Needing to figure out which data set will actually

be in for phase 1

Cerner and Banner meeting in PHX 3/30 to go

over test extract.

Expected transition to yellow: Possibly May 1

Data Migration – Vendor B Red Katherine/ Matt /Laura Planning for Phase II underway – no finalized

Data Migration call March 20th. For Vendor B to

Cerner meeting on 3/17/2015 and possibly moving

forward with contract at that time. Looking to set

up time when Matt and Laura Expected transition

to yellow: Closer to JunePatient Portal Yellow Jeff Planning in progress for Phase II

EMPI Yellow Christine EMPI clean up action plan needed EMPI action plan to be completed by Friday

25

26

26

27

ADKAR Approach

28

Touch Points

29

Texting, Mobile App, Survey

30

31

Clinic Report Card

32

SWAT Team

Goals:

• Week 1 - % of Order/documentation signed off

• Week 2 – Optimize Ordering workflow

• Week 3 – Optimize Documentation workflow

• Week 4 – Optimize Chart Review/Other workflow

• Week 5 – Final push

Lights On

35

37

Additional Banner Health Sessions

Tuesday, November 15 Start Time End Time Location Presenter

One System Focus: Implementation & Ongoing Support

Governance11:30 AM 12:30 PM KCCC 2100-2013C William Holland, MD VP, Chief Medical Informatics Officer

Effective Change Management: Techniques for

Successful adoptive change3:00 PM 4:00 PM KCCC 2200-2201 Clay Taylor Change Management Director

Wednesday, November 16 Start Time End Time Location Presenter

Implementing a proactive customer support system 11:30 AM 12:30 PM KCCC 2500 - 2504 A Laurina Jarvis, RN,MSHI Clinical Informatics Director

Managing populations: Banner's holistic approach 12:30 PM 1:30 PM KCCC 2500 - 2505 B Jodi Erpelding, RN Clinical Informatics Program Director

Banner Health training and adoption 12:30 PM 1:30 PM KCCC 2200 - 2211 Courtney Hitzhusen Learning Architect

The State of Patient Engagement & Health IT 12:30 PM 1:30 PM KCCC 2100 - 2102 B Ed Clarke, MDChief Medical Officer, Az Eastern Division - Banner

Medical Group

Prescription Intelligence using SMART 4:15 PM 5:15 PM KCCC 3500 - 3501 E Nathan Spence Pharmacy Informatics

Turning goals into outcomes with Work Queue

Management4:15 PM 5:15 PM KCCC 2100 - 2101 Jason Bickford, MCSE Department Applications Director