Case Study: Building an
Effective Governance Model
Sameer Badlani, MD, FACP
Chief Medical Information Officer
June 11th , ...
About the University of Chicago Medicine
Established in 1927
Located on the Southside of Chicago in Hyde park
Approximatel...
Objectives
• Define Governance
• Why do we need it
• Creating and Implementing
• Assessing effectiveness
• Iterative impro...
Define Governance
IT governance (ITG) is defined as the processes that
ensure the effective and efficient use of IT in ena...
Define Governance
IT governance (ITG) is defined as the processes that
ensure the effective and efficient use of IT in ena...
Define Governance
IT governance (ITG) is defined as the processes that
ensure the effective and efficient use of IT in ena...
Why do we need it
• Health IT Spending to Top $34 Billion in 2014
(Healthcare Informatics Aug 2013)
• % of total IT Budget...
Why do we need it
• Volume to Value Based Contracts
• ACA/ ACO
• PQRS
• MU Stage 2
• Managed Medicaid
8
Why do we need it
• ROI
• Clinical Efficiency
• Analytics
• Big Data
• Are you using what you have already?
• Survival
9
Creating and Implementing
• Iterative model refined every year for the last four years
• Broken into 40 hour plus and belo...
UCM IS Governance: Portfolio Committees
11
COLT
(Epic Program )
Portfolio
Hospital
Operations
Portfolio
Administrative
Ope...
• Co-Chairs – VP, Amb Care Serv, CMIO
• Members:
• Executive VP, Practice & Bus Dev
• 2 MD Practice Directors TBD
• Direct...
• Co-Chairs – CMIO, CNO
• Members:
• ACMO, Quality
• ACMO, Clinical Effectiveness
• VP, Pt Safety/Risk/Compliance
• 2 Medi...
UCM IS Portfolio Management: High Level Process for 40 hour plus requests
14UCM IS Governance |
Project
Request
submitted ...
15UCM IS Governance |
Scoring Model for Prioritization
Category Impact Score Description Weight
Patient Safety
4 - Severe ...
• Review projects before meeting with stakeholder for clarity and operational readiness
• Validate score and remind commit...
Under 40 Hours
• Requests collected through various intake mechanisms
including but not limited to
• Help desk complaints
...
Under 40 Hours
• Racked and stacked per Director of Epic applications
• Resource allocation closely monitored and balanced...
Assessing effectiveness
• Monitor turn around time
• Check in with institutional leaders, influencers ( including constipa...
• 316 Clarity Report Requests & Updates
• 1,812 Scheduled Classroom Hours
• Application Changes, Updates and Support:
• 3,...
Assessing effectiveness
• Be able to tie in every project to annual operating and strategic goals
• Do we have a line of s...
Iterative improvement
22
Future work
• Online dashboard
• Outreach and communication
• Translate paradigm to Clinical and Business Intelligence Ini...
24
Upcoming SlideShare
Loading in …5
×

Health IT Summit Chicago 2014 Case Study: Building an Effective Gorvernance Model with Sameer Badlani, MD, FACP, CMIO, Asst Professor, Section of Hospital Medicine, The University of Chicago Medicine and Biological Sciences

1,209 views

Published on

Sameer Badlani, MD, FACP
Chief Medical Information Officer
Assistant Professor, Section of Hospital Medicine
The University of Chicago Medicine and Biological Sciences
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.

Health IT Summit Chicago 2014 Case Study: Building an Effective Gorvernance Model with Sameer Badlani, MD, FACP, CMIO, Asst Professor, Section of Hospital Medicine, The University of Chicago Medicine and Biological Sciences

  1. 1. Case Study: Building an Effective Governance Model Sameer Badlani, MD, FACP Chief Medical Information Officer June 11th , 2014
  2. 2. About the University of Chicago Medicine Established in 1927 Located on the Southside of Chicago in Hyde park Approximately 600 beds 9500 employees 700 + physicians 900 + residents and fellows 1500 + nurses Epic Implementation 2009 - CPOE - 2009 2011 - Inpatient, Stork, Transplant, Beacon, OpTime - 2011 2012 - Ambulatory, AIMS - 2012 2014 – MyChart, CareLink, CareEverywhere, Bar Coding & Epic 2014 Upgrade 2
  3. 3. Objectives • Define Governance • Why do we need it • Creating and Implementing • Assessing effectiveness • Iterative improvement • Future work 3
  4. 4. Define Governance IT governance (ITG) is defined as the processes that ensure the effective and efficient use of IT in enabling an organization to achieve its goals. (Source: Gartner) 4
  5. 5. Define Governance IT governance (ITG) is defined as the processes that ensure the effective and efficient use of IT in enabling an organization to achieve its goals. (Source: Gartner) 5
  6. 6. Define Governance IT governance (ITG) is defined as the processes that ensure the effective and efficient use of IT in enabling an organization to achieve its goals. (Source: Gartner) More:- - Transparent - Timely - Seamless - Equitable - Measurable - Iterative 6
  7. 7. Why do we need it • Health IT Spending to Top $34 Billion in 2014 (Healthcare Informatics Aug 2013) • % of total IT Budget/ Total Hospital Expense Overall in 2011 was 4.87% up from 2.77 % in 2010 ( HIMSS 2012 Annual Report) • Organizations' IT spending expected to keep growing ( Modern Healthcare Feb 2014) 7
  8. 8. Why do we need it • Volume to Value Based Contracts • ACA/ ACO • PQRS • MU Stage 2 • Managed Medicaid 8
  9. 9. Why do we need it • ROI • Clinical Efficiency • Analytics • Big Data • Are you using what you have already? • Survival 9
  10. 10. Creating and Implementing • Iterative model refined every year for the last four years • Broken into 40 hour plus and below 40 hour projects • Approved by the IS steering, Clinical Chairs Committee, Practice Plan Board • Socialized extensively and exhaustively before final implementation 10
  11. 11. UCM IS Governance: Portfolio Committees 11 COLT (Epic Program ) Portfolio Hospital Operations Portfolio Administrative Operations Portfolio Enterprise Informatics and Analytics Portfolio Infrastructure Portfolio Information Exchange Portfolio UCM IS Governance | Executive IS Steering Committee Ambulatory Portfolio Group Inpatient Portfolio Group Practice Management EHR/EpicCare Ambulatory OB/GYN (Stork) Oncology (Beacon) Transplant (Phoenix) Perioperative Tools Medication Tools EHR/EpicCare Inpatient HIM Tools EHR Advisory Group
  12. 12. • Co-Chairs – VP, Amb Care Serv, CMIO • Members: • Executive VP, Practice & Bus Dev • 2 MD Practice Directors TBD • Director, Ambulatory Access • Director, Ambulatory Operations • CMIO • ACMO, Quality • ACMO, Clinical Effectiveness • VP – Pt Safety/Risk/Compliance • Ambulatory Practice Administrators • Director, IS Epic Program • Asst Director, IS Epic Ambulatory 12Clinical & Operational Leadership Team Ambulatory Portfolio Membership 1/17/2012
  13. 13. • Co-Chairs – CMIO, CNO • Members: • ACMO, Quality • ACMO, Clinical Effectiveness • VP, Pt Safety/Risk/Compliance • 2 Medical Practice Directors • VP, Pharmacy • VP, Procedural Services • Anesthesia Physician Sponsor 13Clinical & Operational Leadership Team Inpatient Portfolio Membership 1/17/2012
  14. 14. UCM IS Portfolio Management: High Level Process for 40 hour plus requests 14UCM IS Governance | Project Request submitted to VP or above for authorization to progress to Portfolio Comm Portfolio Comm reviews and prioritizes or denies request Portfolio Comm representati ves communicat e outcome to requestor IS reviews prioritized projects for resourcing and proj execution timeline Prioritized projects executed Portfolio Comm monitors realization of business value
  15. 15. 15UCM IS Governance | Scoring Model for Prioritization Category Impact Score Description Weight Patient Safety 4 - Severe Impact Immediate high risk patient safety issue with no workflow fix and/or Critical event - liability claim 8 3 - High Impact Immediate high risk patient safety issue with available workflow fix and/or Documented near miss 2 - Medium Impact Risk/Suspected safety issue 1 - Low Impact Potential low risk patient safety issue with available workaround 0 - No Impact No Impact Compliance 4 - Severe Impact Clear CMS or Joint Commission mandate with no exceptions (within 30 days impact) 6 3 - High Impact UCMC Policy Standard or CMS/JC mandate with 60 day plus date of impact 2 - Medium Impact UCMC Standard of Care 1 - Low Impact UCMC "nice to have" 0 - No Impact No Impact Strategic Goal 4 - Severe Impact Organizational AOP goal or CEO Inititiave 5 3 - High Impact VPs, CNO, CMO, CMIO, aCMO, CIO, CCO initiative 2 - Medium Impact Director/Department Quality Chief level initiative 1 - Low Impact Single department goal and/or less than 25 users 0 - No Impact No Impact Efficiency/Productivity 4 - Severe Impact >250 users and/or daily issue 4 3 - High Impact >100 users and/or weekly issue 2 - Medium Impact >10 users and/or monthly issue 0 - No Impact No Impact Revenue Impact 4 - Severe Impact More than $1M 4 3 - High Impact Between $500k and $1M 2 - Medium Impact Between $100k and $500k 1 - Low Impact Less than $100k 0 - No Impact No Impact Scholarly Impact 3 - High Impact Enterprise wide research/education project or initiative 4 2 - Medium Impact Research/Education project for multiple departments, facilities and/or areas of care 1 - Low Impact Single department Research/Education project 0 - No Impact No Impact
  16. 16. • Review projects before meeting with stakeholder for clarity and operational readiness • Validate score and remind committee it is to lend some objectivity to a subjective process • Focus on not only approval and prioritization but resolution of issues for ongoing work • Communicate bandwidth issues well in advance • Create top ten list not in an order of importance • High-threshold to stop a project inflight • Communicate, communicate and hold accountable Best Practices 16
  17. 17. Under 40 Hours • Requests collected through various intake mechanisms including but not limited to • Help desk complaints • Sub portfolio groups • Emails to CMIO • Offshoots from unrelated discussions • Every clinical section has designated SMEs • Refreshed every year • Monitored for response time and collaborative spirit • Counted towards service to institution in the promotion criteria • Can delegate but have to be final sign off • Operational units have designated director level point of contacts 17
  18. 18. Under 40 Hours • Racked and stacked per Director of Epic applications • Resource allocation closely monitored and balanced with demands for over 40 hour bucket • CMIO and medical directors for informatics act as liaisons to mitigate escalation and resolution • Criteria • Do you still need it? • How are you functioning now? • How will this impact your process • How will you measure roi? 18
  19. 19. Assessing effectiveness • Monitor turn around time • Check in with institutional leaders, influencers ( including constipators) • End user feedback around transparency, turnaround time • Gut sense • Close the loop on operational readiness and ROI 19
  20. 20. • 316 Clarity Report Requests & Updates • 1,812 Scheduled Classroom Hours • Application Changes, Updates and Support: • 3,797 Service Desk Tickets Resolved • 2,098 Application Change Controls • More than 150 projects delivered (> 40 hours) Epic Application Support FY13 Summary 20Epic Optimization Status Summary | 33% 55% 12% Ambulatory Inpatient Other 2% 21% 76% 1% 0% MEANINGFUL USE NHP OPERATIONAL PHOENIX RESEARCH 0 200 400 600 800 Other Nurses Providers
  21. 21. Assessing effectiveness • Be able to tie in every project to annual operating and strategic goals • Do we have a line of sight for projects requested by me and my direct reports • Assess resource utilization between • RUN • GROW • TRANSFORM 21
  22. 22. Iterative improvement 22
  23. 23. Future work • Online dashboard • Outreach and communication • Translate paradigm to Clinical and Business Intelligence Initiatives • Involve more front line users in process and decision making • Share and Learn 23
  24. 24. 24

×