Effective IT Implementation in Health Care

1. Effective IT Implementation in Health Care Patient Safety and National Resource Center Annual Conference June 2005 Donald Crandall, MD, FACS

2. 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)

4. 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

5. 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

6. Primary Clinical and Business Applications (as of 2001)Tool Diversity  Process Diversity  Variable Performance

7. Primary Clinical and Business Applications (2008)Best Practices +Consistent Tools = Operational Excellence Eastern Division Western Division Mt. Silver Columbus, Port Clemens, Ann Arbor, Battle Grand Muskgeon, South Dubuque, Mason Sioux City, Fresno, Operating Units Spring, MD OH Huron, MI MI Pontiac, MI Livonia, MI MI Creek, MI Rapids, MI MI Bend, IN Clinton, IA IA City, IA IA Boise, ID CA McKesson Revenue Management Registration HealthQuest HealthQuest STAR STAR STAR Patient Accounting Cerner Profile Cerner Profile Medical Records PeopleSoft and Lawson ERP General Ledger Payroll/Human Resources A/P Materials Management Cerner Clinical Systems Clinician Order Management Results Reporting ADEs Clinical Documentation Laboratory Pharmacy Surgery Management Radiology xCare.net (E-merge) / TIBCO / Internal Development Integration Tools DSS EMPI TIBCO Web Foundation Shaded = denotes core systems • = Completed • = To be Completed within 6 months • = Active Implementations

8. 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

9. Investment • Capital • $180 million capitalinvestment 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

10. Transformation: 1 Part Technology + 2 Parts Culture & Work Process Transformation:

11. 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

12. Example: Readiness Process Timeline(Months prior to Go-Live) Design Confirmation (-13) Project Definition (-22 months prior to G0-Live) Preliminary Design (-20) Detailed Design (-15) Core Build (-10) Core System Test (-7) Integration Test (-3)) Activation (-0-) Systems Readiness [one iteration per system] QA QA QA Site Specific System Build Current State Analysis (CSA) Operational Impact Analysis (OIA) Operational Testing & Training (OTT) Operational Build (OB) Hospital System Readiness (one iteration per site) QA QA Operational Testing and Training Baseline Materials Development Building / Sustaining Alignment

13. Readiness Structure • Office of Project Management • Project Genesis Steering Team • Clinical Executive Oversight Group • Revenue Enhancement Oversight Group • Supply Chain Oversight Group • Clinical Rules Oversight Group • Benefits Management Office • Knowledge Management Steering Committee • Clinical Information Oversight Group • Physician Advisory Group • Facilitated Decision Making Process

14. Port Huron May 2003 Mason City July 2005 Oakland J/A/S 2006 South Bend J/A/S 2007 Sioux City September 2005 Ann Arbor O/N/D 2006 Fresno O/N/D 2007 Muskegon July 2004 Grand Rapids October 2004 Dubuque J/F/M 2006 Clinton J/F/M 2007 Columbus J/F/M 2008 Battle Creek February 2005 Livonia J/F/M 2006 Silver Spring A/M/J 2007 Macomb April 2005 Boise A/M/J 2006 Completed In Process Not Started Trinity Health Major IS Projects as of May 2005 FY06 FY07 FY08 FY05

15. 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

16. Examples of Actual and Planned Metrics • 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

17. Additional Planned Metrics • Safety • Medication errors and ADEs resulting in intervention • Rate of identification of errors • Finance • Reduction in bad debt • Reduction in operational write-offs • Percentage of clean claims • Satisfaction • Nursing satisfaction and retention • Patient satisfaction • Operations • Staffing and productivity levels • Physician and nursing time studies

18. 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

19. Physician COPE Results

20. 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