Dignity Health: Implementation of an EHRAlliance Bridging Acute and AmbulatoryCareRaymond LoweSenior Director Enterprise C...
Objective• This session will provide a unique learning opportunity focusing on  the Dignity Health $1.8B implementation pr...
Dignity Health                 3
Who is Dignity Health• Dignity Health, headquartered in San Francisco, Calif., provides  integrated, patient and family ce...
Who is Dignity Health•   Assets: $13.1 billion•   Net Operating Revenue: $10.6 billion•   General Acute Patient Care Days:...
Our Vision A vibrant, national health care system known for service, chosenfor clinical excellence, standing in partnershi...
The Quality Chasm“Between the health care we have and thecare that we could have lies not just a gap, buta chasm.”Institut...
Responding to the Call • There is compelling evidence that there are great   opportunities to redefine healthcare   – To r...
A Bridge to Better Care                          9
EHR AllianceProgram OverviewRay LoweSenior Director, IT Acute Care Strategy
Dignity Health Has Multiple Strategic InitiativesExecuting In Parallel    Fiscal               FY12                 FY13  ...
What is Clinical Standardization and Why is it Beneficial?Standardization is the process of decreasing unnecessary   varia...
From Standardization to Better OutcomesFrom EVIDENCE                           To BEST PRACTICES                          ...
Board Approved FY2013 Schedule
Lessons Learned EHRAcute Implementation
6 Keys to Project Success•    Effective Collaboration                           •    High Standards/Value on Excellence   ...
SUCCESS…• The EHR Implementation will only be successful if all  of us are successful doing our part. – “If you could get ...
Communication A solid communication plan should be built, executed and monitored with  adjustments as needed Communicati...
Communication and Performance through Change                                            The Performance Dip               ...
Governance Strong governance and leadership is needed from the start Governance process should support having the diffic...
Trust and Culture                            Best Practice                                  Infrastructure      Enterprise...
Key Areas of Focus• Project Resources: – Ensure resources have the proper skill set (project and facility)• Project Manage...
Key Areas of Focus Testing • Sufficient number of testing cycles and time for each cycle • Test systems available for thi...
Key Areas of Focus Go-Live Planning, Execution and Transition   Begin go-live planning early in the process and conduct ...
Clinical Integration
What is Clinical Integration (CI)?                CI System                                                Quality Metrics...
Key Clinical Integration Capabilities: Technical Tiers                 Communications                                     ...
Key Clinical Integration Capabilities:Core IT ComponentsCommunications                    Patient Portal                  ...
Transforming Data withAnalytics
Opportunities and Challenges       Opportunities                   Challenges•   Evidence Based Medicine   • Managing Data...
The transformation journey                             31
Transformation• Improving outcomes and point of care decisions – Analyze the patient population – Supporting diagnosis and...
Example Quality Metrics Dashboard                                    33
Questions?
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iHT² Health IT Summit in Beverly Hills 2012 - Raymond Lowe Case Study “Dignity Health: Implementation of an EHR Alliance Bridging Acute and Ambulatory Care"

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Case Study "Dignity Health: Implementation of an EHR Alliance Bridging Acute and Ambulatory Care"

This session will provide a unique learning opportunity focusing on the Dignity Health $1.8B implementation program to meet horizon 2020 as we transform healthcare. The initiative encompassed a 42 hospital health IT implementation in the acute care setting. Mr. Lowe will also review the challenges associated with governance and review lessons Learned from the project.

Learning Objectives:

∙ Key implementation points
∙ Integration with Ambulatory strategies for a full market approach
∙ What’s next – business intelligence

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  • RayEither speak to this was original and mention changes that impact St. Joseph’s; or drop in new.“Need for Speed”
  • QualityProviders are rewarded for collective outcomesCollective measurement drives better care coordinationBetter care coordination improves qualityCost Population focus means providers take holistic, long viewProviders only rewarded if they lower cost growthThis creates incentives for providers to find cost savingsBetter care coordination also reduces costShift from encounter-focused to patient-focused
  • iHT² Health IT Summit in Beverly Hills 2012 - Raymond Lowe Case Study “Dignity Health: Implementation of an EHR Alliance Bridging Acute and Ambulatory Care"

    1. 1. Dignity Health: Implementation of an EHRAlliance Bridging Acute and AmbulatoryCareRaymond LoweSenior Director Enterprise Clinical ImplementationsEHR AllianceOctober 24, 2012 Email: Raymond.lowe@dignityhealth.org
    2. 2. Objective• This session will provide a unique learning opportunity focusing on the Dignity Health $1.8B implementation program to meet horizon 2020 as we transform healthcare. The initiative encompassed a 42 hospital health IT implementation in the acute care setting. Review the challenges associated with governance and review lessons Learned from the project.• Learning Objectives: ∙ Key implementation points ∙ Clinical Integration with Ambulatory strategies ∙ What’s next – business intelligence 2
    3. 3. Dignity Health 3
    4. 4. Who is Dignity Health• Dignity Health, headquartered in San Francisco, Calif., provides integrated, patient and family centered care to more than six million people annually.• We are the fifth largest health system in the nation with 10,000 physicians and 55,000 employees across Arizona, California, and Nevada.• Dignity Health is committed to delivering compassionate, high- quality, affordable health care services with special attention to the poor and underserved. 4
    5. 5. Who is Dignity Health• Assets: $13.1 billion• Net Operating Revenue: $10.6 billion• General Acute Patient Care Days: 1.8 million• Community Benefits and Care of the Poor: $1.4 billion• Acute Care Beds: 8,800• Skilled Nursing Beds: 800• Acute Care Hospitals: 40• Clinics/Ancillary Care Centers: 150• Medical Foundations: 11• Active Physicians: 10,000• Total Employees: 55,000 5
    6. 6. Our Vision A vibrant, national health care system known for service, chosenfor clinical excellence, standing in partnership with patients,employees and physicians to improve the health of allcommunities served. 6
    7. 7. The Quality Chasm“Between the health care we have and thecare that we could have lies not just a gap, buta chasm.”Institute of Medicine Crossing the Quality Chasm: A New Health System for the 21stCentury. Janet M. Corrigan, Molly S. Donaldson, Linda T. Kohn, eds. Washington, D.C.National Academy Press. 2001 7
    8. 8. Responding to the Call • There is compelling evidence that there are great opportunities to redefine healthcare – To reduce clinical errors – To improve clinical and cost outcomes – To improve reliability on delivery of best practices • Crossing the chasm will require: – Putting advanced decision making tools in the hands of care providers – Treating the creation and exchange of information as an integrated system – Standardize key processes around evidenced based best practices 8
    9. 9. A Bridge to Better Care 9
    10. 10. EHR AllianceProgram OverviewRay LoweSenior Director, IT Acute Care Strategy
    11. 11. Dignity Health Has Multiple Strategic InitiativesExecuting In Parallel Fiscal FY12 FY13 FY14 FY15 FY16 Year Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Acute EHR (Cerner & Meditech) Ambulatory EMR (Allscripts & Mobile MD) EHR Meaningful Use Stages 1-3 Meaningful Revenue Cycle Standardization (Siemens & Artiva) Use HIPAA 5010 Revenue Cycle ICD-10 (Various Vendors) Lean Process Transformation Compliance Compliance DeadlinesTransformational Care
    12. 12. What is Clinical Standardization and Why is it Beneficial?Standardization is the process of decreasing unnecessary variation to improve quality and efficiency outcomes of care – Processes done the same way every time decrease mistakes and oversights – Processes done the same way each time become more efficient – Reliability increases; events or steps in a process are more predictableKey component of clinical transformation – Facilitate the measurement of quality, safety and service outcomes – Improve operational and clinical quality outcomes – Increase the speed of a “sustainable” deployment – Decrease the cost of ongoing support – Decrease cost of care 12
    13. 13. From Standardization to Better OutcomesFrom EVIDENCE To BEST PRACTICES To OUTCOMES Order Sets Standards Outcomes Top 80% of all Dignity Health Clinical Decision Support Ace-Inhibitor on discharge Admissions Therapeutic Guidance Beta-Blocker on discharge (by vol and cost) Lipid therapy compliance Ace-Inhibitor Reminder Platelet inhibitor AAA Repair - Postop Beta-Blocker Reminder Reduction in adverse drug events Acute Renal Failure - Adult Admit HMG CoA Reductase Inhibitor Reminder Influenza Vaccine compliance AMI ED Evaluation Platelet aggregation Inhibitor Reminder Pneumococcal Vaccine compliance Appendectomy - Postop Admission Risk Assessment Tool Smoking Cessation education Asthma Adult Admit Short acting Rapid-Release Nifedipine Alert Craniotomy - Postop Reductions in LOS / OI Influenza Vaccine Reminder Reduction in preventable falls Critical Care Management Pneumococcal Vaccine Reminder Diabetes - Inpatient care Reduction in preventable skin Smoking Cessation Education Reminder breakdown DKA - Adult Admit Drug-Lab interactions PCI -Postprocedure PNA PCP - Adult Admit Drug-Drug interactions TIA - Adult Admit Drug-Allergy interactions Total Hip Knee Replacement - Postop Adverse event surveillance TURP - Postop Delayed discharge surveillance UGIB - Adult Admit Fall Risk assessment - alert Unstable Angina NSTEMI - Adult Admit Skin Breakdown risk assessment - alert UTI - Adult Vaginal Hysterectomy - Postop Unstable Angina NSTEMI - Adult Admit 13
    14. 14. Board Approved FY2013 Schedule
    15. 15. Lessons Learned EHRAcute Implementation
    16. 16. 6 Keys to Project Success• Effective Collaboration • High Standards/Value on Excellence – It takes everyone – Be the example that everyone else wants to follow – Break down the barriers (IT, Clinical, Revenue Cycle, Physicians, Vendors) – Communicate, communicate, communicate• Culture of Transparency • Emphasis on Community and Culture – Create an environment that supports issues – Medical Center will continue providing care reporting and escalation long after the days of EHR implementation have come and gone – Transparency facilitates information flow─ both up and down• Sound Structure and Governance • Focus on Process vs. Product – Work toward a common vision – In projects of this scale, individuals can’t fix every problem. But everyone can work to – Execute within project structure create pathways for healthy resolution of – Fine tune as you go (always learn) issues 16
    17. 17. SUCCESS…• The EHR Implementation will only be successful if all of us are successful doing our part. – “If you could get all the people in an organization rowing in the same direction, you could dominate any industry, in any market, against any competition, at any time.”- Patrick Lencioni 17
    18. 18. Communication A solid communication plan should be built, executed and monitored with adjustments as needed Communication needs to occur at all levels • Communicate the shared vision • Communicate decisions, as well as the logic behind those decisions • Communication plans for both facility and project team • Communicate accomplishments • If people don’t talk it out, they will act it out 18
    19. 19. Communication and Performance through Change The Performance Dip Organizational Change Initiative Complete Uninformed Business Performance Informed Optimism Optimism/ Uncertainty Denial Anger Acceptance Testing Pessimism Despair/ Skepticism Time 19
    20. 20. Governance Strong governance and leadership is needed from the start Governance process should support having the difficult conversations and making difficult decisions Interdisciplinary governance committees need to exist and must include facility managers and directors • Solid decision-making process that supports timely, sound decisions and eliminates waffling on previous decisions • Leadership has to be onboard for the governance to be effective • The project team and facility need to hear the vision from leadership 20
    21. 21. Trust and Culture Best Practice Infrastructure Enterprise Guidance People Process Technology Human Resources Enterprise Governance Dignity Health Organizational Effectiveness “The What” and “The How” Information Technology Change Acceleration Transformational Care Process Implementation Project Team, EHR Physician Champion, Enterprise Physician Informaticist Escalations for Implementation Program Director, Director Clinical Informatics, Executive Sponsor Enterprise Guidance Management Decision Group People Process Technology Clinical Informaticists MPAG (Multidisciplinary Local IT/FSO Leadership EHR Physician Champion Phyisican Advisory Group) Facility IT Site Director Facility Super Users CPIC (Process Project Infrastructure Accountability Key Department Leaders Improvement Committees) Resources Transformational Care Implementation Program Director, EHR Physician Champion, Director Clinical Informatics, Executive Escalations for Sponsor Enterprise Guidance Facility Executive Steering Committee Executive Sponsor CEO, COO, CFO, CNE, VPMA IT Site Director Escalations for Feedback Enterprise Guidance EHR Physician Champion Director Clinical Informatics EHR Alliance Cerner Engagement LeaderNSSA Facility Governance Model Implementation Program Director 9/17/2012 EHR Alliance Senior Directors 21
    22. 22. Key Areas of Focus• Project Resources: – Ensure resources have the proper skill set (project and facility)• Project Management – Strong project team structure, including a clear chain of command and authority should be in place – Clearly-defined issues management and escalation process supported by all team members and leadership • Strong document management and version control solution should be used • Structured and consistent team meetings 22
    23. 23. Key Areas of Focus Testing • Sufficient number of testing cycles and time for each cycle • Test systems available for third-party applications • Issues tracking, reporting and documented re-testing/regression testing Training  Set expectation on training percentage required for go live … and stick to it  Provide opportunities for practice  Develop a training domain strategy, including a fully built-out, tested environment containing enough data for successful training 23
    24. 24. Key Areas of Focus Go-Live Planning, Execution and Transition  Begin go-live planning early in the process and conduct multidisciplinary team review meetings until all details of the cutover are identified – Conduct a mock-live event – Leverage production support resources and prepare for transition – Reach out to sister hospitals for go-live support – Go-live command center team should be properly trained; need good issues triage and tracking processes in place – Plan for ongoing optimization efforts well in advance of live event 24
    25. 25. Clinical Integration
    26. 26. What is Clinical Integration (CI)? CI System Quality Metrics – Population and disease managementHospital Physician Quality Metrics & Cost Savings – Better coordination improves quality of care – Population focus means business model Governance takes holistic view of wellness Financial or Risk Sharing Shared – Model promotes rewards for improved Savings and Risks quality and lower cost of patient care (riskCare Coordination sharing model)  Creates incentives for providers to find cost savings  Increases care coordination  Reduces overall costs  Shifts from encounter-focused to patient-focused care Sharing clinical data at the CI level, across the team, promotes an Patient emphasis on care coordination and taking a long-term, holistic view of wellness. 26
    27. 27. Key Clinical Integration Capabilities: Technical Tiers Communications Quality Metrics Information Reporting Analytics & Reports Data Integration, Data Integration Management, & Aggregation Workflow, Data Extraction & Data Acquisition Collection from Multiple Clinical & Financial Systems 27
    28. 28. Key Clinical Integration Capabilities:Core IT ComponentsCommunications Patient Portal Provider Portal Secure Patient – Provider Secure Provider-Provider Clinical Decision Management PHI / Messaging Messaging Support (CDS) Personal Health Record (PHR) Clinical Information DeliveryAnalytics & Reports Quality Metric Analysis & ReportingData Integration Match Patient’s Data Match Providers & Patient EMPI & Provider EMPI Data Integration, Conforming, Normalization, & StandardizationData Acquisition Clinical Data Repository Extract Clinical Data Extract Clinical Data Extract Claims Data (Internal Systems) External Systems (Rx, Labs, etc.) (Internal /External Systems) 28
    29. 29. Transforming Data withAnalytics
    30. 30. Opportunities and Challenges Opportunities Challenges• Evidence Based Medicine • Managing Data Complexity• Improved Treatments • Ensuring patient Confidentiality• Intervene earlier • Changing Medical Practices • Avoiding False negatives 30
    31. 31. The transformation journey 31
    32. 32. Transformation• Improving outcomes and point of care decisions – Analyze the patient population – Supporting diagnosis and research – Active diagnosis – Point of care Decisoning – Create values and the potential to improve outcomes. 32
    33. 33. Example Quality Metrics Dashboard 33
    34. 34. Questions?

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