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Challenges and Successes in
Implementing a Health IT Strategy
October 5th, 2006
Rich Pollack M.S. CPHIMSS FHIMSS
VP and CI...
Page 2
Overview
 Planning Strategy
 2003 Effort at VCUHS
 Effective Governance
 Competition for Capital
 Demand Manag...
Strategic Planning Process
Rich Pollack, MS CPHIMSS FHIMSSS
Page 4
Major components of an IT Strategic
Plan
 Assessment
 Vision formulation
 IT implications of the vision
 Plan d...
Educate the key players on the
need for and possibilities
resulting from a IT strategic
planning process
1. Apply an accepted
model such as CAM
(component alignment
model)
2. Create a set of
“planning categories”
Page 7
Assessment
Information
Technologies
External
Environment
Non-controllable Components
Mission
Organizational
Infrast...
Page 8
Prototypical Planning Categories
 Mission, business strategy, organizational
infrastructure, external environment
...
Page 9
Perform the assessment phase
 Utilize subcommittees to organize and document
information within the planning categ...
Page 10
Develop a Vision of the Future
 Utilize the subcommittees to organize
information within the planning categories
...
Page 11
Develop a Vision for the Future
 Key Foci (cont.)
 Could an EMR and CPOE make a significant and measurable
contr...
Specify the I.T. implications of
the Vision
?
Page 13
Consider the possibilities of process
redefinition and re-engineering in
conjuncture with I.T. deployment
 Referr...
Page 14
Develop the Plan
 Current and future
environments
 Current application
portfolio
 I.T. governance and
organizat...
Summary of the IT Strategic Plan
November 17, 2003
DRAFT
Page 16
 VCUHS has been an industry leader in its use of Information
Technology, with automation support for virtually ev...
VCUHS IT Governance
and Demand Management
Page 18
IT Governance: Structure
The first step in any IT planning and budgeting is defining the governance structure that...
Page 19
IT Governance: Capital Budgeting and
Department Specific IT Projects
 Departmental projects will affect the VCUHS...
Page 20
IT Steering Committee
During the Visioning Session, participants developed a set of guidelines for the IT Steering...
Competition for Capital
1.New construction and renovation
2.Replacement of clinical equipment
(beds, monitors, Xray etc)
3...
Page 22
 Determine estimated resources
required to implement each project
 Apply resource estimates
beginning at the top...
Page 23
1
4
Scores for
Each Project
Final Scores
Weights for
Each Criterion
Final List
Post-
Scoring
Balancing
Phasing
Pla...
Page 24
ClarianLab
TestingResources
ISDesktopSvcs.
ISProgrammerAnalyst
ISInterfaceAnalyst
ISProjectManagement
Visicu
Lawso...
Page 25
System Development and Review Process
Identify
System
Initiative
Assess
Feasibility
Cost/Benefits
Conduct
Project
...
Page 26

Recommended thresholds for Steering Committee approval:
Demand Management Process
Cost >
$100,000?
• Initiative ...
Page 27
VCUHS IT Vision
VCUHS Strategic ThemesVCUHS Strategic Themes
VCUHS MissionVCUHS Mission
VCUHS VisionVCUHS Vision
V...
Page 28
I have seen the enemy, and
he is us !
(Walt Kelly, in the comic strip Pogo)
Page 29
Recognize and address the internal IT
barriers
 Immature project management – skills, process
and organization
 ...
Communicate the plan
and build support
And constantly update it (living
document)!
Page 31
The Electronic Medical Record (EMR)The Electronic Medical Record (EMR)
Page 32
• Patient Demographics
• Laboratory Results
• Radiology Diagnostic Imaging Results -
(Stentor)
• Transcription Res...
Page 33
• Patient Demographics
• Laboratory Results
• Diagnostic Imaging Results - (Stentor)
• Transcription Results (Medq...
Page 34
• Patient Demographics
• Laboratory Results
• Diagnostic Imaging Results - (Stentor)
• Transcription Results (Medq...
Page 35
• Patient Demographics
• Laboratory Results
• Diagnostic Imaging Results - (Stentor)
• Transcription Results (Medq...
Align the Leadership
and build support
Why is getting to an agreed strategy so
hard?
Page 37
Leadership Alignment:
 Seize “educational moments” with individual
leaders or groups – correct mis-perceptions
 ...
Page 38
Unrealistic Expectations:
Page 39
Re-Visioning – Summer 2006
 A cross section of 5 senior clinical leaders
engage in an off-site retreat facilitate...
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  • <number>
    System replacement is required to ensure VCUHS’ continued leadership.
    For example, the CIS project will replace the 20+ year old clinical system, thereby placing VCUHS back in the top 5% of university health systems in the use of clinical information technology.
  • <number>
    After the consolidation of IT, most of the funding for IT capital investments was included in the IT capital budget; however, some departments developed their own capital funding sources to supplement IT funding for department-specific projects.
  • <number>
    Ask Dr. Tatum to comment on how decisions will actually be made and enforced
  • <number>
    Formal processes for planning and budgeting IT initiatives help ensure that IT investments are appropriately evaluated to support the needs of an organization.
    Most successful health care organizations have developed formal processes for planning and budgeting IT initiatives. These processes allow all aspects of a system request to be evaluated at the appropriate level of management, thereby ensuring that IT investments support the needs of the organization.
    In the absence of a formal process, IT investment decisions are made without fully understanding the impact or benefits of an initiative.
    A formal IT initiative approval process will help VCUHS to address issues of:
    Prioritization
    Organizational commitment
    Sponsorship
    Oversight of information technology initiatives
    While the IT Strategic Plan is an important first step, the absence of a formal IT investment approval process negatively impacts IT’s ability to meet VCUHS' critical information systems needs.
    The following is a proposed process for IT initiative approval:
    Identify System Initiative
    Assess Feasibility Cost/Benefits
    Visioning Session participants recommended that a formal IT capital request process be developed for initiatives that are submitted to the IT Steering Committee.
    The capital request criteria may include items such as:
    Maturity of the technology
    Alignment with VCUHS strategic priorities
    Feasibility
    Operational impact
    Fit with current VCUHS IT technologies and infrastructure
    Total Cost of Ownership (TCO) reflecting acquisition, implementation, and lifetime maintenance and support for the requested system
    Return on Investment (ROI)
    Conduct Project Review
    Projects that do not exceed the thresholds must be funded out of available IT or departmental capital and operating funds. The departments at VCUHS frequently have access to grant or other funding for research, which often require IT work.
    The use of departmental funding provides flexibility for IT projects.
    Add to IT Plan
    All IT groups, both central and decentralized, will collaborate with the Working Group and User Department(s) to develop a detailed implementation plan for the project that will address:
    Project management
    IT and departmental staffing
    External staffing
    Software and hardware requirements
    On-going support staffing
    Technology needs
    Initiate Project
    Based on the detailed implementation plan, IT will organize the project team and initiate the work on the project. Key requirements for project start up are:
    The commitment of User Department management as project sponsors and managers;
    The availability of IT and User staff to work on the project; and
    The availability of budgeted capital and operating funding to pay for the acquisition, implementation and on-going support of the system.
  • <number>
    The Visioning Session participants recommended that IT initiatives be divided into two classes – projects that require IT Steering Committee approval and those that do not.
    They recommended that these thresholds be set based on the cost and resources required to implement the initiatives, such as:
    Cost greater than $100,000
    Requires more than 6 man-months of central IT staff support
    Requires interfaces
    Introduces a cross-departmental system
    Requires wide availability across the institution
  • <number>
  • <number>
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  • <number>
  • Transcript of "Challenges and Successes in Implementing a Health IT Strategy ..."

    1. 1. Challenges and Successes in Implementing a Health IT Strategy October 5th, 2006 Rich Pollack M.S. CPHIMSS FHIMSS VP and CIO, VCU Health System
    2. 2. Page 2 Overview  Planning Strategy  2003 Effort at VCUHS  Effective Governance  Competition for Capital  Demand Management  Internal IT barriers  Communication  Leadership Alignment  2006 Re-Visioning
    3. 3. Strategic Planning Process Rich Pollack, MS CPHIMSS FHIMSSS
    4. 4. Page 4 Major components of an IT Strategic Plan  Assessment  Vision formulation  IT implications of the vision  Plan development
    5. 5. Educate the key players on the need for and possibilities resulting from a IT strategic planning process
    6. 6. 1. Apply an accepted model such as CAM (component alignment model) 2. Create a set of “planning categories”
    7. 7. Page 7 Assessment Information Technologies External Environment Non-controllable Components Mission Organizational Infrastructure and Processes IT Infrastructure and Processes Controllable Components Expanded CAM Model Business Strategy IT Strategy Alignment IT Strategic PlanBusiness Plan Alignment Medical Scientific Advances
    8. 8. Page 8 Prototypical Planning Categories  Mission, business strategy, organizational infrastructure, external environment  Risk partners  IT infrastructure and emerging information technologies  Patients, family and the community  Providers  Education and research
    9. 9. Page 9 Perform the assessment phase  Utilize subcommittees to organize and document information within the planning categories  Gather information through administration of questionnaires and interviews, as needed
    10. 10. Page 10 Develop a Vision of the Future  Utilize the subcommittees to organize information within the planning categories  Key Foci  Expanding the market segment through closer linkages with physicians facilitated by technology  Offer the patient community concierge level convenience via unique web portals, IVR and other patient centered innovations. Embrace the coming tide of “consumer-directed healthcare”  Understand the bottlenecks and redundancy in the patient flow process. How can a workflow enabled EMR break through those?  Enhancement of the revenue cycle as a byproduct of improved on-line documentation
    11. 11. Page 11 Develop a Vision for the Future  Key Foci (cont.)  Could an EMR and CPOE make a significant and measurable contribution to crafting a “high quality – high safety” patient environment?  Detail the productivity to be gained by new mobile communication tools like Vocera, RFID tagging and Blackberry’s  Is there a need and support for using data mining to analyze practice variation and the effective use of “order sets” and “protocols”  Determine what level of system availability is required for the critical clinical systems measured against the corresponding infrastructure costs
    12. 12. Specify the I.T. implications of the Vision ?
    13. 13. Page 13 Consider the possibilities of process redefinition and re-engineering in conjuncture with I.T. deployment  Referral  Registration  Scheduling  Intake  Diagnosis/treatment  Order entry/results reporting  Etc.
    14. 14. Page 14 Develop the Plan  Current and future environments  Current application portfolio  I.T. governance and organizational structure  Strategic goals  Strategic objectives  Tactical objectives  Timeframes  Resource requirements  Financial requirements  Value to be received  Prioritization and demand management process
    15. 15. Summary of the IT Strategic Plan November 17, 2003 DRAFT
    16. 16. Page 16  VCUHS has been an industry leader in its use of Information Technology, with automation support for virtually every function.  At this point, many of the key clinical, financial and administrative systems are reaching end of life and must be replaced.  The purpose of the IT Strategic Planning process is to develop a plan for the use of Information Technology over the next three years. It will define:  How IT will be managed  What technologies will be deployed to support VCUHS’ needs  The Strategic Plan will help to ensure that the greatest value is gained from VCUHS’ IT investments.
    17. 17. VCUHS IT Governance and Demand Management
    18. 18. Page 18 IT Governance: Structure The first step in any IT planning and budgeting is defining the governance structure that will manage the process. The major components of the proposed IT Governance structure are illustrated below: IT Steering Committee Customer IT Liaisons IT Staff IT Management Clinical Financial Admin. MCVP VCUHS Department Area VCUHS Executive Management VA Premier IT Working Groups IT/Department Coordinating Committee
    19. 19. Page 19 IT Governance: Capital Budgeting and Department Specific IT Projects  Departmental projects will affect the VCUHS IT operational or technical environment, and are likely to need central IT resources to implement, integrate and support their initiatives.  These projects should follow the same approval process as an IT capital project, with early central IT involvement to review the requirements of the new system, regardless of the source(s) for capital funding.  The new IT Governance process – with its focus on customer service – should alleviate departmental concerns about central IT’s involvement.  In addition, the IT Steering Committee will provide a forum for discussing departmental initiatives and their impact on VCUHS as a whole.
    20. 20. Page 20 IT Steering Committee During the Visioning Session, participants developed a set of guidelines for the IT Steering Committee that will confirm its central role in IT Planning and Budgeting. The guidelines include: VCUHS IT Governance: IT Steering Committee Membership –  VCUHS, MCVP, Faculty, Research, VCU, School of Medicine, Active Working Group Representation  Appointed by VCUHS Executive Management/CEO Responsibilities – • Has final authority for IT project approval • Implements the IT Vision and Guiding Principles • Develops IT project prioritization process and resolves conflicting priorities • Ensures appropriate focus on Clinical, Research and Education initiatives • Reviews strategic initiatives and associated business cases • Approves and allocates annual IT Capital and Operating Budgets • Endorses initiative staffing and other resource allocations • Monitors progress and communicates IT activities to the VCUHS organization IT Steering Committee Customer IT Liaisons IT Staff IT Management Clinical Financial Admin. MCVP VCUHS Department Area VCUHS Executive Management VA Premier IT Working Groups IT/Department Coordinating Committee
    21. 21. Competition for Capital 1.New construction and renovation 2.Replacement of clinical equipment (beds, monitors, Xray etc) 3.Investment in I.T.
    22. 22. Page 22  Determine estimated resources required to implement each project  Apply resource estimates beginning at the top of the prioritized list and continuing thru full (reasonable) consumption of resources and somewhat beyond  Present prioritized list with resource demand management Applying Resource Demand Management Resources # of Projects Resource Saturation
    23. 23. Page 23 1 4 Scores for Each Project Final Scores Weights for Each Criterion Final List Post- Scoring Balancing Phasing Platform Implications Intangibles Dependencies Implementation Phasing Scored List Weights and Scoring 3 Business Economics Value Proposition Strategic Fit Business Feasibility 2 Short List Phasing of Projects Resource Allocation Phasing of Services Criteria Gates Long List Process Key Components Prioritization Level Project Prioritization – Components
    24. 24. Page 24 ClarianLab TestingResources ISDesktopSvcs. ISProgrammerAnalyst ISInterfaceAnalyst ISProjectManagement Visicu Lawson Upgrade Campus Wide Network Refresh Internal and External Network Firewalls Hospice Application ProVation Interfaces Riley Phase V Cancer Hospital Active Directory 2003 Cloverleaf Upgrade and Server Expansion Contribution Management Healthcare Insights Disaster Recovery Server Refresh - Careweb Host Based Intrustion Detection Resource Demand Management Applied to Prioritized List Example
    25. 25. Page 25 System Development and Review Process Identify System Initiative Assess Feasibility Cost/Benefits Conduct Project Review Add to IT Plan Initiate Project •Initiatives are submitted for review to the IT Steering Committee (ITSC) via a formal request process •Department and IT must jointly evaluate all projects to ensure that needed integration and network connectivity will be available and that on-going support needs are budgeted •The ITSC will add projects to the IT Strategic Plan only upon the committee’s approval To commence a project: •User department management must be committed as project sponsors •IT and user staff must be available •Funds must be available •IT and the user departments share responsibility for identifying systems initiatives
    26. 26. Page 26  Recommended thresholds for Steering Committee approval: Demand Management Process Cost > $100,000? • Initiative presented to Steering Committee for review and approval • Informational copy of Capital Budget presented to Steering Committee Yes Requires >6 man-months of Central IT staff support? Requires Interfaces? Introduces a cross- departmental System? Requires network connectivity and/or wide availability across the institution? No Yes No No No Yes Yes Yes Initiative must be funded from disposable IT or departmental funds No Has similar functionality to an existing system? New Projects Annual Departmental Capital Budgets No Yes
    27. 27. Page 27 VCUHS IT Vision VCUHS Strategic ThemesVCUHS Strategic Themes VCUHS MissionVCUHS Mission VCUHS VisionVCUHS Vision VCUHS IT VisionVCUHS IT Vision The VCUHS Information Technology organization views data as a strategic asset and is committed to providing information that is accurate, timely, secure, and available to those who need it.  Electronic Medical Record: Improve Patient Safety by providing advanced clinical systems and an Electronic Medical Record for the VCUHS physicians and clinicians.  Access: Support ready access to appropriate information for patients, clinicians, employees, and management.  Operational Support: Provide information systems that support the clinical and business functions of VCUHS for efficient operations, performance improvement, and financial viability.  Research and Education: Support the patient care, research and educational goals of the VCU community.  Connectivity: Provide the framework, infrastructure, and standards for secure, high speed access, processing, and communications. The VCUHS Information Technology organization views data as a strategic asset and is committed to providing information that is accurate, timely, secure, and available to those who need it.  Electronic Medical Record: Improve Patient Safety by providing advanced clinical systems and an Electronic Medical Record for the VCUHS physicians and clinicians.  Access: Support ready access to appropriate information for patients, clinicians, employees, and management.  Operational Support: Provide information systems that support the clinical and business functions of VCUHS for efficient operations, performance improvement, and financial viability.  Research and Education: Support the patient care, research and educational goals of the VCU community.  Connectivity: Provide the framework, infrastructure, and standards for secure, high speed access, processing, and communications. Enterprise Planning & Governance IT Infrastructure Rev Cycle ERP Decisions through use of Information Supply Chain Clinical Applications Finance Applications CIS Enterprise Level Applications HR Applications
    28. 28. Page 28 I have seen the enemy, and he is us ! (Walt Kelly, in the comic strip Pogo)
    29. 29. Page 29 Recognize and address the internal IT barriers  Immature project management – skills, process and organization  Weak infrastructure – “rocky foundation”  Lack of vendor commitment and involvement – “MIA syndrome”  Inwardly focused and insular – need to look outside for ideas and solutions  HIMSS, Gartner, Advisory Board etc  Trade press, white papers, vendors, consultants  Networking with other provider organizations
    30. 30. Communicate the plan and build support And constantly update it (living document)!
    31. 31. Page 31 The Electronic Medical Record (EMR)The Electronic Medical Record (EMR)
    32. 32. Page 32 • Patient Demographics • Laboratory Results • Radiology Diagnostic Imaging Results - (Stentor) • Transcription Results (Medquest & Dragon) •Operative Notes/ Discharge Summaries • Limited Notes (Voice to Text Dictation) • Cardiac Cath & Pulmonary Lab Results • Orders • Ambulatory – Labs, Radiology, Admit • Inpatient - All • Easyscript • Caresets & Practice Guidelines • Medication Documentation - Inpatient • Patient Education & Discharge Information • Allergies, Heights, Weights • Problem & Procedure Lists • Dietician, Social Work & Respiratory Therapy Notes • OR Process Redesign • Progress Notes & H&Ps • Transcribed Documentation (Non Medquest) • Nursing Assessments & Documentation • Research Documentation • Printed Results – Endoscopy, Vascular, Heart Station, Peds Pulmonary • IPOC • Referral Letters/Consult Notes • Flowsheets – Vital Signs & I&O • Consents & Operative Notes • Discharge Summaries Year 2006 40 % of key chart components on-line
    33. 33. Page 33 • Patient Demographics • Laboratory Results • Diagnostic Imaging Results - (Stentor) • Transcription Results (Medquest) •Operative Notes •Discharge Summaries • Cardiac Cath Results • Orders • Ambulatory -All • Inpatient - All • Easyscript • Caresets & Practice Guidelines • Medication Documentation - Inpatient • Patient Education & Discharge Information • Dietician Notes • Social Work Notes • Respiratory Therapy Notes • OT/PT/RT Notes • Ambulatory EHR Phase 1 • Progress Notes & H&Ps • Transcribed Documentation (Non Medquest) • Nursing Assessments & Documentation • IPOC • Referral Letters/Consult Notes • Anesthesia/Operative Reports Year 2007 • Research Documentation • Flowsheets – Vital signs and I & O • Consents • Printed Results – Heart Station • Miscellaneous Documents 60 % of key chart components on-line
    34. 34. Page 34 • Patient Demographics • Laboratory Results • Diagnostic Imaging Results - (Stentor) • Transcription Results (Medquest) •Operative Notes •Discharge Summaries • Cardiac Cath Results • Orders • Ambulatory -All • Inpatient - All • Easyscript • Caresets & Practice Guidelines • Medication Documentation – Inpt & Outpatient • Patient Education & Discharge Information • Nurse & Physician Documentation • Dietician, Social Work, Respiratory Therapy, & OT/PT/RT Notes • Interdisciplinary Plan of Care (IPOC) • Ambulatory Phase 1 • Ambulatory Visit & Consult Notes • Charge Capture from Documentation • INET (Critical Care Documentation & Machine Interfaces) • Miscellaneous Documents • Research Documentation Year 2008 • Printed Results – Heart Station • Flowsheets – Vital Signs & I&O • Consents 75 % of key chart components on-line
    35. 35. Page 35 • Patient Demographics • Laboratory Results • Diagnostic Imaging Results - (Stentor) • Transcription Results (Medquest) •Operative Notes •Discharge Summaries • Cardiac Cath Results • Orders • Ambulatory -All • Inpatient - All • Easyscript • Caresets & Practice Guidelines • Medication Documentation – Inpatient & Outpatient • Patient Education & Discharge Information •Nurse & Physician Documentation • Dietician, Social Work, Respiratory Therapy, & OT/PT/RT Notes • Interdisciplinary Plan of Care (IPOC) • Ambulatory Rules & Alerts • Ambulatory Visit & Consult Notes • INET (Critical Care Documentation & BMDI) • Research Documentation • Miscellaneous Documents Year 2009 & Beyond 95 % of key chart components on-line
    36. 36. Align the Leadership and build support Why is getting to an agreed strategy so hard?
    37. 37. Page 37 Leadership Alignment:  Seize “educational moments” with individual leaders or groups – correct mis-perceptions  Provide honest and consistent message  Create an atmosphere of trust and transparency  Search for “common ground”  Control expectations or they’ll control you  Pursue small wins along the way to establish credibility
    38. 38. Page 38 Unrealistic Expectations:
    39. 39. Page 39 Re-Visioning – Summer 2006  A cross section of 5 senior clinical leaders engage in an off-site retreat facilitated by the CIO  Used a vendor best practice site visit as the catalyst for direction setting  Evaluated remaining EMR initiatives for importance and effort  Positioned those initiatives across a 3 year planning horizon
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