William W. Stead, M.D.
Professor of Medicine and Biomedical Informatics
Associate Vice Chancellor for Health Affairs
Vande...
Road Map to the TalkRoad Map to the Talk
 Framework to guide thinking about alignment
of enterprise and IT strategies
 P...
Enterprise AlignmentEnterprise Alignment
 What technical barriers stand in our way?
 When will technical progress
solve ...
 Framework to guide thinking about alignment
of enterprise and IT strategies
Picking the purpose of IT in your business
...
Supply Chain & Revenue Cycle  Efficiency
– FTEs, – TimeAutomation
Management Decision Support  Strategy, Execution
IT ...
Time
High
Low
INFOUTILITY
Info. Value Shift
Source
Global
AVAILABILITY
I/T Value
Problems – Solutions – Results
• Correct Testing 1
– ICD9
– Imaging Advisor
Problems – Solutions – Results
• Correct Testing 2
– ICD9
– Imaging Advisor
Problems – Solutions – Results
• Correct Testing 3
– ICD9
– Imaging Advisor
pre-CPOE post-CPOE
Errorsper100Orders
2.2 1.3
30.1
0.2
6.8
0.1
0
5
10
15
20
25
30
35
Potential ADE's Medication Prescribin...
Potential ADEs
Duplicate therapy
Inappropriate dose
Inappropriate interval
Inappropriate route
Wrong drug
Allergy
Drug int...
Impact of Advanced Dosing onImpact of Advanced Dosing on
Potential ADE’sPotential ADE’s
7.3
13.9
2.2* 2.5*
0
2
4
6
8
10
12...
Clinical Decision SupportClinical Decision Support
 Costs
 Hardware, software, implementation
 24 hr receptionist cover...
 Framework to guide thinking about alignment
of enterprise and IT strategies
 Picking the purpose of IT in your business...
Technology TrendsTechnology Trends
 Convergence of media, computing and
communication technologies
 More natural user in...
Avoiding HypeAvoiding Hype
0
2
4
6
8
10
12
14
16
18
Yr 1 Yr 2 Yr 3
Information Technology
Software Development
PERFORMANCE Technical RealityTechnical...
Implications for Technical Approach
User Driven
 Communication
 Data Mining
 Visualization
Programmed
Workflow
Purpose Mechanism
Balance between
Human
& Technology
Efforts Impact on Process
Reproducibility Adaptability
Information Te...
 Framework to guide thinking about alignment
of enterprise and IT strategies
 Picking the purpose of IT in your business...
Work-arounds
System
Development
The Healthcare Non-systemThe Healthcare Non-system
System
Design
Practice
System
Design
Practice
Evidence Based System of CareEvidence Based System of Care
Pick Population
•...
System
Design
Practice
Individualize & Act
• Assess
• Order
• Results
Workflow
• People – Crew Training
• Process – Plans,...
Vignette from a System of CareVignette from a System of Care
 The clinician and patient are “on the same
page,” the appro...
Roles & Process ChangeRoles & Process Change
Evidence
Patient
Record
Synthesis
& Decision
Clinician
Clinician and Patient are PartnersClinician and Patient are Partners
Evidence
Patient
Record
Provider
Personalized
Knowled...
New Skills are NeededNew Skills are Needed
 Teamwork, problem solving and coaching
 Guiding a data-driven system of care...
Infrastructure Requirements ChangeInfrastructure Requirements Change
Information Islands
Discipline specific
information a...
 Framework to guide thinking about alignment
of enterprise and IT strategies
 Picking the purpose of IT in your business...
State of the Art 2006State of the Art 2006
 Life-Time Patient Record
 Remote Operation
 Continuous/Personalized Medicin...
Execution ChallengesExecution Challenges
 Aligning strategy and infrastructureAligning strategy and infrastructure
 Mana...
Research
Mission
2010
Informatics
Center
Process &
Infrastructure
Management
Decision
Support
Education
Mission
Clinical
M...
Pt. ID
Lab
Specimen
Plan
Patient to
Provider
Messaging
Widely
Available
Decision Symbols
Go-Live Date Symbols
Roadmap Symb...
Skills for All TimesSkills for All Times
 Comfort the patient
 Recognize patterns
 Know what you do not know
 Reflect ...
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  1. 1. William W. Stead, M.D. Professor of Medicine and Biomedical Informatics Associate Vice Chancellor for Health Affairs Vanderbilt University September 28, 2006 Picking an Enterprise TargetPicking an Enterprise Target Disclosures: McKesson distributes WizOrder as Horizon Expert Orders. I am a Director of Healthstream & Netsilica.
  2. 2. Road Map to the TalkRoad Map to the Talk  Framework to guide thinking about alignment of enterprise and IT strategies  Picking the purpose of IT in your business  Key trends in IT and Informatics that will bear on the art of the possible  One vision of how ready access to information might change health care in the near term  Status check
  3. 3. Enterprise AlignmentEnterprise Alignment  What technical barriers stand in our way?  When will technical progress solve the problem?  Is there a work around?  Will technology enable a new entrant to disrupt our business plan?  Will technology enable us to develop a new business model?  What is the purpose of technology in our business?
  4. 4.  Framework to guide thinking about alignment of enterprise and IT strategies Picking the purpose of IT in your business  Key trends in IT and Informatics that will bear on the art of the possible  One vision of how ready access to information might change health care in the near term  Status check Road Map to the TalkRoad Map to the Talk
  5. 5. Supply Chain & Revenue Cycle  Efficiency – FTEs, – TimeAutomation Management Decision Support  Strategy, Execution IT Strategy/Benefit FrameworkIT Strategy/Benefit Framework Remote Operation  Access Patient Centered Care  Quality, – Errors Context Sensitive Closed Loop – Errors Communication & Documentation – Errors, – Cost, – FTEs Clinical Decision Support  Quality, – Errors, – Utilization  EfficiencyUtilization of Scarce Resources
  6. 6. Time High Low INFOUTILITY Info. Value Shift Source Global AVAILABILITY I/T Value
  7. 7. Problems – Solutions – Results • Correct Testing 1 – ICD9 – Imaging Advisor
  8. 8. Problems – Solutions – Results • Correct Testing 2 – ICD9 – Imaging Advisor
  9. 9. Problems – Solutions – Results • Correct Testing 3 – ICD9 – Imaging Advisor
  10. 10. pre-CPOE post-CPOE Errorsper100Orders 2.2 1.3 30.1 0.2 6.8 0.1 0 5 10 15 20 25 30 35 Potential ADE's Medication Prescribing Errors Rule Violations Potts, A. et al. PEDIATRICS 2004;:113:59-63
  11. 11. Potential ADEs Duplicate therapy Inappropriate dose Inappropriate interval Inappropriate route Wrong drug Allergy Drug interaction Wrong units MPEs Weight not available Missing Information Illegible RVs Trailing zeros Abbreviation <0.001 <.001 .69 .39 .01 .07 .49 .49 <.001 <.001 <.001 <.001 <.001 <.001 <.001 <.001 Pre-CPOE (n = 6803) Post-CPOE (n = 7025) P Value 147 4 53 24 6 6 1 1 52 2049 22 1979 48 466 55 411 Total Number 2.2 0.06 0.78 0.35 0.09 0.09 0.01 0.01 0.76 30.1 0.32 29.09 0.71 6.8 0.81 6.04 Number Per 100 Orders 88 0 59 19 0 1 0 0 9 12 0 12 0 10 10 0 Total Number 1.3 0 0.84 0.27 0 0.01 0 0 0.13 0.2 0 0.17 0 Number Per 100 Orders Medication Drug Errors
  12. 12. Impact of Advanced Dosing onImpact of Advanced Dosing on Potential ADE’sPotential ADE’s 7.3 13.9 2.2* 2.5* 0 2 4 6 8 10 12 14 16 pre- post- Errorsper100Orders All orders Patients < 7 days *p value < 0.001Wright L, Gregory DF, Barr FE, Patel NR, Waitman LR. Impact of patient-specific decision support on medication errors in critically ill children. Critical Care Medicine. Society of Critical Care Medicine 35th Critical Care Congress San Francisco, CA, January 7-11, 2006. 33(12) Abstract Suppl:A12, December 2005
  13. 13. Clinical Decision SupportClinical Decision Support  Costs  Hardware, software, implementation  24 hr receptionist coverage  SWAT team during training & go-live  Pharmacist to reconcile multiple systems  Iterative development of content and process  Benefits  Appropriate utilization increases quality while reducing marginal cost  Quality improvement decreases downstream cost  Reduced error decreases LOS utilization, and risk management  Quality, safety and cost effectiveness increase market share
  14. 14.  Framework to guide thinking about alignment of enterprise and IT strategies  Picking the purpose of IT in your business Key trends in IT and Informatics that will bear on the art of the possible  One vision of how ready access to information might change health care in the near term  Status check Road Map to the TalkRoad Map to the Talk
  15. 15. Technology TrendsTechnology Trends  Convergence of media, computing and communication technologies  More natural user interfaces (voice & 3DVR)  Embedded sensors aware to person, place, time  Just-in-time data mining and simulation  Disruption of publication channels that limit access  Global/Best of Class content creation, organization to meet a purpose, mentoring during use  Faster, smaller, less expensive hardware
  16. 16. Avoiding HypeAvoiding Hype
  17. 17. 0 2 4 6 8 10 12 14 16 18 Yr 1 Yr 2 Yr 3 Information Technology Software Development PERFORMANCE Technical RealityTechnical Reality
  18. 18. Implications for Technical Approach User Driven  Communication  Data Mining  Visualization Programmed Workflow
  19. 19. Purpose Mechanism Balance between Human & Technology Efforts Impact on Process Reproducibility Adaptability Information Technology Tool KitInformation Technology Tool Kit Information Access Work Flow Automation Aggregation Data Mining Visualization Communication Work Lists Context Sensitive Decision Aids Data Processing & Knowledge Mgmt. Open Process Control Robotics T T/T T/T/T H/T H/H/T H/H/H H/T T/T/T
  20. 20.  Framework to guide thinking about alignment of enterprise and IT strategies  Picking the purpose of IT in your business  Key trends in IT and Informatics that will bear on the art of the possible One vision of how ready access to information might change health care in the near term  Status check Road Map to the TalkRoad Map to the Talk
  21. 21. Work-arounds System Development The Healthcare Non-systemThe Healthcare Non-system
  22. 22. System Design Practice System Design Practice Evidence Based System of CareEvidence Based System of Care Pick Population •Risk •Cost •Variability Pick Population •Risk •Cost •Variability Evidence •Research •Guidelines •Practice database Evidence •Research •Guidelines •Practice database Workflow • People – Crew Training • Process – Plans, Goals, Actions • Technology Tools – Advisors, Order Sets, Alerts Workflow • People – Crew Training • Process – Plans, Goals, Actions • Technology Tools – Advisors, Order Sets, Alerts Individualize & Act •Assess •Order •ResultsIndividualize & Act • Assess • Order • Results Feedback • Trigger/Sentinel Events • Process Outcome • Clinical Outcomes
  23. 23. System Design Practice Individualize & Act • Assess • Order • Results Workflow • People – Crew Training • Process – Plans, Goals, Actions • Technology Tools – Advisors, Order Sets, Alerts Evidence •Research •Guidelines •Practice database Feedback • Trigger/Sentinel Events • Process Outcome • Clinical Outcomes Pick Population •Risk •Cost •Variability Evidence Based System of CareEvidence Based System of Care
  24. 24. Vignette from a System of CareVignette from a System of Care  The clinician and patient are “on the same page,” the approach is standardized yet individualized  Complementary and alternative approaches to health improvement work in combination with scientific medicine  The patient is a full partner in tracking their progress and adapting course  The patient’s plan is updated proactively as standard of practice evolves
  25. 25. Roles & Process ChangeRoles & Process Change Evidence Patient Record Synthesis & Decision Clinician
  26. 26. Clinician and Patient are PartnersClinician and Patient are Partners Evidence Patient Record Provider Personalized Knowledge Base Patient
  27. 27. New Skills are NeededNew Skills are Needed  Teamwork, problem solving and coaching  Guiding a data-driven system of care  Privacy, confidentiality, security  Learning at “teachable moments”  Finding, assessing and applying ‘just in time’ information  Managing change
  28. 28. Infrastructure Requirements ChangeInfrastructure Requirements Change Information Islands Discipline specific information and records Task specific systems, each with its own record Each note stands on its own Common Information Aggregate information from all sources Provide views specific to experience and roles Link into role specific workflow tools
  29. 29.  Framework to guide thinking about alignment of enterprise and IT strategies  Picking the purpose of IT in your business  Key trends in IT and Informatics that will bear on the art of the possible  One vision of how ready access to information might change health care in the near term Status check Road Map to the TalkRoad Map to the Talk
  30. 30. State of the Art 2006State of the Art 2006  Life-Time Patient Record  Remote Operation  Continuous/Personalized Medicine  Industrial Engineering Models for Scheduling ResearchStandardof Care  Access to Medical Literature, Test Results, Transcription  Data Driven Practice Modification & Contracting  Supply Chain/JIT Inventory  Revenue Cycle Management Selective Use  Point of Care Systems  Patient Portals  Electronic Data Interchange (Direct)  Telemedicine Consultation  Clinical Trial Management
  31. 31. Execution ChallengesExecution Challenges  Aligning strategy and infrastructureAligning strategy and infrastructure  Managing discontinuous changeManaging discontinuous change  Building trustBuilding trust  Focusing organizational energyFocusing organizational energy  Leveraging intersectionsLeveraging intersections  Maximizing returnMaximizing return
  32. 32. Research Mission 2010 Informatics Center Process & Infrastructure Management Decision Support Education Mission Clinical Mission Direct Care Layer Support of Direct Care Layer Unit/Service/ Clinic Support Layer > > > > Informatics Center 5-Year Plan Major Project Groups Supporting Milestones > Curriculum Appropriate to a System of Care 20072005 2006 Breakthrough from Focused Interdisciplinary Research Team Medication Safety Best-of-Class Across Continuum of Care 20092008 Culture that Values Evidence Based, Individualized, Systematic Care Overview of RoadmapOverview of Roadmap
  33. 33. Pt. ID Lab Specimen Plan Patient to Provider Messaging Widely Available Decision Symbols Go-Live Date Symbols Roadmap SymbolsRoadmap Symbols High Level Goals Culture that Values Evidence Based, individualized, Systematic Care
  34. 34. Skills for All TimesSkills for All Times  Comfort the patient  Recognize patterns  Know what you do not know  Reflect the patient’s values  Observe the patient

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