That Was Then This Is Now….. Healthcare IT and Operations in the Era of Healthcare Reform One System’s Journey 1

That Was ThenThis Is Now…..

Healthcare IT and Operations in the Era of Healthcare Reform

One System’s Journey

1

UMass Memorial Health Care

• 7 Hospital System• Clinical Partner to UMass

Medical School • 13,500 employees• 3,000 registered nurses• Approximately 1,600

physicians• 1,111 beds• $1.4b in Annual Revenue• ~60,000 discharges• ~1,000,000 outpatient visits




physicians• 1,111 beds• $1.4b in Annual Revenue• ~60,000 inpatients• ~1,000,000 outpatients

















Meditech

Meditech

Siemens Soarian

Allscripts / IDX

University

MemorialHahnemann

CommunityMedical Group

ClintonHospital

HealthAllianceHospital

Wing MemorialHospital

Medical Group

MarlboroughHospital

Private Medical Practice A

Private Medical Practice C

Private Medical Practice B

Current Information Systems Evolved Historically

AffiliatedHospital

History

• Period of underfunding IT (2000- 2004)– Aging infrastructure, reliability challenges– Paper-based system

• Significant bright spots– Electronic ICU across all hospitals– One community hospital has lead EMR efforts– Commitment to ambulatory EMR in 2007– Recognized quality leader in numerous areas– Excellent operational statistics (through shear effort)

• Recognition of need to modernize IT systems9

ChallengingEnvironmental Factors

• Declining Reimbursement• Universal Coverage• State and National IT Requirements - HITECH• Payment Reform

– Bundled payment– Accountable Care Organizations (ACO’s)– Quality & Outcomes

• Coordination of Care• Redefinition of Relationships

– Competitor vs Partner

• Privacy and Security Issues

10

Cost Shifting vs Cost Reduction

11

Kilday Presentation at HFMA Enterprise Performance Management Meeting February 12, 2010

Health Alliance

Clinton

Wing

Marlborough

Private MedicalPractices

UMMMC Providers

• PATIENT CENTERED

• Safety

• Quality

• Service excellence

• Distributed care

• Right service

• Right place

• Right time

• Clinically Efficient

• Operationally Efficient

• Interoperability of information

• PATIENT CENTERED

• Safety

• Quality

• Service excellence

• Distributed care

• Right service

• Right place

• Right time

• Clinically Efficient

• Operationally Efficient

• Interoperability of information

The Patient

OtherServices•In-Home•Hospice•PT / OT

The Vision

CMG

12

Providers

ProvidersProviders

Providers

Providers

Providers

IT Systems Overhaul

• Advantages– Senior leadership & board commitment– Learn from experiences of the “pioneers”– Financial commitment

• Disadvantages– Time pressures– Culture– Financial reality– Breadth of effort (inside system & across community)

13

University

MemorialHahnemann


ClintonHospital



Medical Group

MarlboroughHospital




Existing Bright Spots

Siemens Soarian

Allscripts / IDX

University

MemorialHahnemann


ClintonHospital



Medical Group

MarlboroughHospital




The Future Includes More - Allscripts

Siemens Soarian

Allscripts / IDX

Allscripts / Soarian Scheduling (pilot)

Allscripts MyWay

University

MemorialHahnemann


ClintonHospital



Medical Group

MarlboroughHospital




The Future Includes More - Siemens Soarian

Siemens Soarian

Allscripts / IDX


Allscripts MyWay


Siemens Soarian

Allscripts / IDX

University

MemorialHahnemann


ClintonHospital



MarlboroughHospital

Initiate & dbMotion



Medical Group


Allscripts MyWay

Initiate & dbMotion Tie Everything Together

Approach• Focus on operations, not IT• Selection process (priority of selection criteria)

– First: Execution and delivery of operational results– Second: Total cost of ownership (7 year focus)– Third: Feature/function

• Contracting– Operational improvements built into contracts– Deliver results, not software

• Detailed cost/benefit analysis– Internal and External costs– Benefits tied to delivery of operational improvements

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Total Cost of OwnershipBoth Implementation and Post-Live

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20


21


22

Focus on Benefits Realization

23


24


25


26

Implementation Timeline

27

Legend: Planning

HW/SW

Education

Design

Implementation

Deploy

Post Live Support/Transition/Continued Rollout

O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M

1 Capital Implementation Timeline 50 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 UMASS Medical Center 48 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

3 Phase 1 - Corporate Design with UMass 0

4 Technology/Infrastructure/Environment 15

5 Hardware/Software Deliveries 10 Upgrade UpgradeTest UpgradeTest

6 Soarian Financial Education 3

7 Soarian Clinical Education 3

8 Business process reengineering 12

9 Corporate model design 12

10 Soarian Base Access/Fin/Orders/HIM 22 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Version Upgrade Version Upgrade

11 Siemens Pharmacy/MAK 22 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Version Upgrade Version Upgrade

12 Soarian Base Clinicals/I&O/Assessments* 22 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Version Upgrade Version Upgrade

13 Soarian Adv. Clinicals/Care Plans/Coordination 20 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Version Upgrade

14 Soarian CPOE Implementation 20 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Version Upgrade

15 Soarian CPOE Roll-out 13 1 1 1 1 1 1 1 1 1 1 Version Upgrade

16 Soarian Sched/Prac Mgt 12 1 1 1 1 1 1 1 1 1 1 1 1

17 Soarian ED/Oncology/Surgery 12 1 1 1 1 1 1 1 1 1 1 1 1

18

19 Phase 2 - Clinton and Marlborough Rollout 0

20 Entity Gap to Corporate Design 3


22 Hardware/Software Deliveries 2 UpgradeTest

23 Soarian Base Access/Fin/Orders/HIM 7 Version Upgrade

24 Siemens Pharmacy/MAK 7 Version Upgrade

25 Soarian Base Clinicals/I&O/Assessments* 7 Version Upgrade

26 Soarian Adv. Clinicals/Care Plans/Coordination 7 Version Upgrade

27 Soarian CPOE Implementation & Roll Out 8 Version Upgrade

28 Soarian Optional 0

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30 Phase 3 - Wing Roll Out 0








38 Soarian CPOE Implementation 12 Version Upgrade


40

41 Phase 4- Retrofit HealthAlliance


43 Upgrade/Corporate Model Design/Entity Gap 4


45 Soarian Base Access/Fin/Orders/HIM 9

46 Siemens Pharmacy/MAK 9

47 Soarian Base Clinicals/I&O/Assessments* 9

48 Soarian Adv. Clinicals/Care Plans/Coordination 9

49 Soarian CPOE 9


Siemens Draft Implementation Timeline

FY 09 FY 10 FY 11 FY 12 FY 13

Enter HITECH……..

28

Focus on Ultimate GoalStructure Process Outcomes

29

Incentive $ - Penalties $$$

30

Glaser Presentation at HFMA Enterprise Performance Management Meeting February 12, 2010

How does this affect our timeline?

31

Legend: Planning

HW/SW

Education

Design

Implementation

Deploy




















18











29











40









49 Soarian CPOE 9



FY 09 FY 10 FY 11 FY 12 FY 13

How does this affect our timeline?Do it fast, but do it right…..

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Legend: Planning

HW/SW

Education

Design

Implementation

Deploy




















18











29











40









49 Soarian CPOE 9



FY 09 FY 10 FY 11 FY 12 FY 13

After reading most of the regulations and just finishing a conference call with the VHA on the subject I would offer the following thought.

Installing an EHR just to get stimulus dollars will turn out to make as much sense as having children just to get a tax break.

R. Hal Baker, MD, FACPVP & CIOWellSpan Health45 Monument Rd.York, PA717-812-7850

After reading most of the regulations and just finishing a conference call with the VHA on the subject I would offer the following thought.

Installing an EHR just to get stimulus dollars will turn out to make as much sense as having children just to get a tax break.

R. Hal Baker, MD, FACPVP & CIOWellSpan Health45 Monument Rd.York, PA717-812-7850

HIE - Vision for Connected Healthcare

• Enable high-quality, patient-centric care by making all relevant information about a patient available at the point-of-care, irrespective of organization, geography or care setting.

Connected Healthcare Solution Stack

Value

Scope of Information Sharing

EMR at the point of care

Connect organizations

Uniquely identify patients and providers

Aggregate and harmonize

Seamless access

Traditional Approach to Sharing Data – Central Repository

dbMotionClinical

Repository& Portal

dbMotionClinical

Repository& Portal

EnterpriseMaster PatientIndex

EnterpriseMaster PatientIndex

UMass MemorialHealth Care

UMass MemorialHealth Care

ExternalOrganization

ExternalOrganization

LocalApplications

LocalApplications

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33

22

11

22

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Send data to UMass Memorial so we can put it in our systems in case it’s needed

We store, aggregate and use the data

Data, information, or service provided back to external organization

Challenge – What Data to Share?

36

UMass Memorial Health CareUMass Memorial Health CareIndependent

Medical GroupIndependent

Medical Group

Shared Patients

Wing MemorialWing MemorialHospitalHospital

Wing MemorialWing MemorialHospitalHospital

UMass MemorialUMass MemorialMedical CenterMedical Center

UMass MemorialUMass MemorialMedical CenterMedical Center

MarlboroughMarlboroughHospitalHospital

MarlboroughMarlboroughHospitalHospital

ClintonClintonHospitalHospital

ClintonClintonHospitalHospital

Health AllianceHealth AllianceHospitalHospital

Health AllianceHealth AllianceHospitalHospital

OutsideOutsideOrganizationOrganization

OutsideOutsideOrganizationOrganization

John Smith123 Main StreetAnywhere USA

G: 96000005

U: 1234

M: M7766

C: 9883-2

H: 7765A

W: D-33338

O: 555555

John Smith123 Main StreetAnywhere USA

G: 96000005

U: 1234

M: M7766

C: 9883-2

H: 7765A

W: D-33338

O: 555555

The Patient HubThe Patient Hub

EnterpriseMaster PersonIndex

EnterpriseMaster PersonIndex

CommunityCommunityMedicalMedical

GroupGroup

CommunityCommunityMedicalMedical

GroupGroup

UMass MemorialHealth Care Community

AllscriptsMyWay

Ambulatory EMR

CommunityPortal

Acute andAmbulatory

EMR

InitiateEMPI

AllscriptsEnterprise

Any other EMR

Any other EMR

Private Medical Group or IPAAffiliated Hospital Organization

Independent Physicians

CommunityEMPI

Meditech

Soarian

WingMeditech

UMass Memorial HealthcareMany locations, 1600+ providers, 1 connection

What we need to offerFor Providers with an EMR

• Data Delivery– their data about their patients– selected UMMHC data about their patients– delivered and place in their EMR as desired

• Access to everything when they want it– portal access

• Bi-directional orders and results– order communication across EMR’s

What we need to offer For Providers without an EMR

• Allscripts MyWay• Different EMR than Allscripts Enterprise used by

UMMHC– specifically designed for the smaller practice (< 5 physicians)

• Offered by Allscripts as UMMHC’s preferred EMR for private physicians– per month subscription fee with no upfront setup or implementation

fees– full EMR, integrated practice management, ePrescribing, electronic

claims submission– includes three days of additional on-site training, one day of

customization, and full interoperability with UMMHC

Summary – Keys to the Future

• Cost Reduction• Variability Reduction• Information Sharing

– “Connected Healthcare”

• Strategic Partnerships

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Summary – Keys to the Future

• Cost Reduction• Variability Reduction• Information Sharing

– “Connected Healthcare”

• Strategic Partnerships

42

Thank You.

Questions?

Documents

That Was Then This Is Now….. Healthcare IT and Operations in the Era of Healthcare Reform One System’s Journey 1