Sajid Ahmed presented on the implementation of an EHR system at Martin Luther King Jr Community Hospital on a limited budget and tight timeline. The hospital was established through a public-private partnership between LA County and UCLA. Key strategies for successful implementation included aligning the culture, processes and people; allowing the processes to drive the EHR design rather than the other way around; and focusing on the hospital's mission when facing challenges. Through extensive planning and vendor management, the EHR went live on time and on budget to support the hospital's opening.

1. Sajid Ahmed, CHCIO
Chief Information and Innovation Officer
November 4 2015
Martin Luther King, Jr Hospital:
Maximum Implementation with
Limited Resources
A Startup Hospital Goes All In
on Time and on Budget

2. Martin Luther King, Jr. Community Hospital Page 2
Session Objectives
• Learn to apply MLK-LA's implementation
strategies and multi-factorial experience with
limited resources and time to large scale
implementations, new hospitals, and new
services.
• Learn the examples and issues of designing an
EHR as a tool during an evolving and changing
organization
• Demonstrate how people, processes, and systems
need to work together to succeed

3. Martin Luther King, Jr. Community Hospital Page 3

4. Martin Luther King, Jr. Community Hospital Page 4

5. Martin Luther King, Jr. Community Hospital Page 5
"Once we rid ourselves of
traditional thinking we can get
on with creating the Future."
— James Bertrand

6. Martin Luther King, Jr. Community Hospital Page 6
Vision
To be a leading model of innovative, collaborative
community healthcare.
Mission
The mission of Martin Luther King, Jr. Community Hospital
is to provide compassionate, collaborative, quality care
and improve the health of our community.
Values
• Caring, Collaboration, Accountability, Respect, Excellence
Mission, Vision, and Values

7. Martin Luther King, Jr. Community Hospital Page 7
A private, non-profit, safety net hospital
providing high quality, collaborative care
for South Los Angeles and surrounding
communities in partnership with the
County of Los Angeles, University of
California and other community providers
Identity Statement

8. Martin Luther King, Jr. Community Hospital Page 8
Hospital History
Date Milestone
August, 2007 MLK-Harbor, a 461-bed acute care hospital operated by Los
Angeles County in South Los Angeles closes; the County maintains
a commitment to re-establish hospital services on MLK campus
October, 2007 South Los Angeles Preservation Fund signed into law; ensures
funding for new Hospital
Spring, 2008 County approaches Governor Schwarzenegger and the Regents of
the University of California for assistance with re-opening Hospital
November, 2009 UC approves plan to work with County and State to re-open the
Hospital. Terms of re-opening:
• County and UC would work together to form a wholly
independent, nonprofit 501(c)(3) entity which would open and
operate new Hospital
• Hospital to focus on providing community-based medicine
• Hospital to contract with UC for the provision of “key services”

9. Martin Luther King, Jr. Community Hospital Page 9
Hospital History
Date Milestone
April, 2010 County and UC jointly sponsor AB2599 to ensure long-term
financial viability of the new Hospital; AB 2599 signed by Governor
on September 23, 2010
July, 2010 County and UC sign Coordination Agreement . UC will assist with:
• Hiring the Hospital’s Chief Medical Officer
• Development of the Hospital’s Graduate Medical Education
program
• Development of hospital-based physician services
• Development of the Hospital’s quality and performance
improvement programs
• Assistance with other pre-opening activities that require
physician expertise
July, 2010 MLK-LA formed as a new nonprofit entity; Board members are
appointed by the County and UC
April, 2014 Board of Supervisors approve lease and funding agreement

10. Martin Luther King, Jr. Community Hospital Page 10
The New MLK Community Hospital
A Public/Private Partnership
Governance:
County Board of Supervisors
Governance:
Board of Regents
MLKCH Foundation
Coordination
Agreement
IGT and Indigent Care Funds
MLK, Jr. Community Hospital
Governance:
Community Board
Non-Profit 5013c
Building Lease
LA County
UC, UCLA
Fundraising

11. Martin Luther King, Jr. Community Hospital Page 11
MLKCH Clinical Services
Licensed Bed Type Total
Medical/Surgical 93
Intensive Care 20
Obstetrics 18
Total Licensed Beds 131
Other Licensed Services Total
Nursery - Bassinets 11
Emergency Department 21
Fast Track Stations 8
Operating Rooms 4
C-Section Rooms 1
Post-Anesthesia Care
Unit
12
Scope of Inpatient Services to
be Provided by the Hospital
 Anesthesiology
 Cardiology
 Emergency Services
 Gastroenterology
 General Medicine
 General Surgery
 Infectious Diseases
 Neurology
 Obstetrics & Gynecology
 Ophthalmology
 Orthopedics
 Otolaryngology
 Pathology
 Radiology
 Pulmonary Medicine
 Urology

12. Martin Luther King, Jr. Community Hospital Page 12
Key Demographics
• 1.35 million residents;
46.0% age 15-44 years
• 70.4% Hispanic, 22.7%
Black
• 64.6% of household
incomes less than $50,000
Large portions of the
service area are Health
Professional Shortage
Areas (“HPSA”) and/or
Medically Underserved
Areas (“MUA”), indicating
a deficit of primary care
physicians. Physician
shortages exist across
most medical and surgical
specialties.
Service Area Overview

13. Martin Luther King, Jr. Community Hospital Page 13
Projected Payer Mix – 2015*
Medicare
10%
Medi-Cal FFS
24%
Medi-Cal managed care
39%
Medicare dual-eligible
2%
Uninsured
23%
Commercial
2%
*Based on ADC

14. Martin Luther King, Jr. Community Hospital Page 14
The New MLKCH: An Innovative, Integrated Care Strategy
Los Angeles County
Ambulatory Clinics
Shared Professional Staff
MLK Medical Campus
Innovation
Hub/HealthCare
Transformation
Medical Groups/IPAs
UCLA and community-
based providers
Community-based
Providers, FQHCs
Care Coordination
Shared Data
Partnering Hospitals
Tele-ICU/TeleHealth
Pre-Post Acute
Providers
Home Visits
Prevention, Education, and Wellness Partners
Learning Center, Wellness Center

15. Martin Luther King, Jr. Community Hospital Page 15

16. Martin Luther King, Jr. Community Hospital Page 16
Patient
California
Hospital
Med
Center
St. Francis
Hospital
LAC DHS
Rancho
Harbor
LAC USC
UCLA
Clinical
Leadership
Quality
Telehealth
Hospital
Partners
Community
Partners
Physician
Partners
Alta Med
HCLA
IPA
Alta Med
IPA
Global
IPA
Home
Health,
DME, Rx
Payor Partners
Health-
Net
Medi-
care
Anthem
Medical
Groups
SPA 6
MLK
Campus
Public
Health
Centinela
Hospital
LA County
Molina
Indep.
Physicians
DHS
MLK OC
Blue
Shield
Long-Term
Care
Other
Community
Partners
Associ-
ations
CBOs
Govn’t
Agen-
cies
MLKCH Care Partners in Population Health Improvement
SNF
Applecare
IPA
Care
First
Omnicare
IPA
Social
Services,
Transport
Gardena
Memorial
DHS MH
Urgent
Care
MediCal
LA Care
CHLA
Brand
New
Day
Health
Care
Partners
Angeles
IPA
EHS IPA
Talbert
Medical
Group
Preferred
IPAMolina
LBMMC
DMH
Hawkins
CFC
IPA
MOB
SSC
8 FQHCs

17. Martin Luther King, Jr. Community Hospital Page 17
MLKCH’s Collaborative Care System (EHR) and Portals
for Patients, Providers and Health Plans/IPAs
• Uses a fully integrated Cerner EHR designed with care management for
every patient with real-time critical data into the clinician workflow
• Patient’s health record will issue alerts to providers of possible health risks
direct to MLK’s Care Phones (iPhones)
Portals
• Patient Portal: Provides secure messaging, lab results, eVisits, and
appointment scheduling between your patients and providers with Cerner
Patient Portal.
• Physician/Provider Portal: Provides health information on the providers’
patient(s), view only into the MLKCH’s EHR System
• Health Plan/IPA Portal: Provides daily real time census on a health plans’
members or IPA patients currently admitted at MLKCH and any relevant
medical status notes

18. Martin Luther King, Jr. Community Hospital Page 18

19. Martin Luther King, Jr. Community Hospital Page 19

20. Martin Luther King, Jr. Community Hospital Page 20
• Evaluated, selected, tested and integrated over 20 software packages
• Negotiated, contracted and managed over 36 vendors
• Integrated 57 unique medical device types into the our EHR (CCS), making this
implementation the largest device integration ever in Cerner history
• Designed and implemented over 55 EHR modules
• Project Managed over 134 interfaces
• Architected, engineered, installed, configured and tested over 1,000 unique hardware
items in our Data Center and technical rooms, equipment closets and on the floors
• Designed, configured, deployed and supported an IP-based phone system for over 500
users as well as the analog backup system
• Defined, configured and deployed over 700 desktops, laptops and phones
• Added cabling and 193 wireless access points to support a high density network
connectivity throughout the hospital
• Installed, tested and delivered Interactive Patient Care system in over 100 patient rooms
• Held competitive bids for Health IT outsourcing. Reviewed, selected, negotiated and on-
boarded CareTech. Hired key IT Director positions internally
• Developed over 53 policies and procedures
 Continuing to project manage and operate the hospital command center for licensing,
Joint Commission and a successful hospital opening!
What We Accomplished to date….

21. Martin Luther King, Jr. Community Hospital Page 21
Design, Innovation and Culture…

22. Martin Luther King, Jr. Community Hospital Page 22
Getting the Gears of Change Aligned
Culture
Process
People

23. Martin Luther King, Jr. Community Hospital Page 23
Getting the Gears of Change Aligned
Culture
Process
People
“Give us your current orders, processes,
policies and procedures and we will build
your EHR.”
Problem: We didn’t have any
(And, by the way, we have no department
directors, managers, or physician staff to
participate)
(And we have an absolute no-can-fail deadline)

24. Martin Luther King, Jr. Community Hospital Page 24
Startup:
• Consultants, Consultants, Consultants = $$$
• Extensive Roadmap and pre-planning
• Subject matter experts (SME’s) = $$$
How do People Come Together…People

25. Martin Luther King, Jr. Community Hospital Page 25
Down the Roadmap:
• Project management
– Get the right people on the bus
– Make the hard decisions on who is best for the job
– There was no time to start over
• On boarding the permanent hires
– Balancing flexibility between the expertise they bring
to the table and avoiding letting every new hire from
changing everything to mirror their old way
How do People Come Together…People

26. Martin Luther King, Jr. Community Hospital Page 26
Approaching the completion:
• Down sizing the consultants
– Varying the overlap (transition); do you have a competent
hire in place?
• Looking for your super users
• Training new hires en mass
• Onboarding all new physician staff (beyond the EHR)
How do People Come Together…People

27. Martin Luther King, Jr. Community Hospital Page 27
The EHR could not drive policy and procedure
• The paradox of building out the EHR before P&P
• Continuous change management with checks and
balances
• Designated individuals with clinical and technical
expertise communicating both sides of the processes
The Process needs to drive the EHRProcess

28. Martin Luther King, Jr. Community Hospital Page 28
Rapid Design vs Method M
• Synopsis of Rapid Design and Method M
• “The best laid plans…”
– You can’t be rigid
• Endless effort to “break the silos”
• Changing the roadmap on the fly
– Examples (we were more than a Greenfield…)
Process
What were lessons learned in the Cerner
Process

29. Martin Luther King, Jr. Community Hospital Page 29
• Re focusing on the mission and cause at hand
– Dave Logan’s “Tribal Leadership”
– Helping each other to a higher level
• When stressed, people revert to what they knew first
– The learning curve(s)
• Understand different communication styles
– “Crucial Conversations”
Nurturing a Culture of Values and
Leadership
Culture

30. Martin Luther King, Jr. Community Hospital Page 30
• Creating buy in after-the-fact
– 100% usage, no choice, no alternative
• Moving forward:
– “Refinement and enhancement” ( Not do-over and “fix”)
– An EHR is an never ending story, never complete
• Trust and Communication
– Setting expectations to match reality
Creating a Culture of Values and
Leadership
Culture

31. Martin Luther King, Jr. Community Hospital Page 31
Its not the technology’s ability
to work, but the peoples
ability to work the technology
People, Processes, and Systems:
Laurie Lipton
On, 2008

32. Martin Luther King, Jr. Community Hospital Page 32
Lessons Learned

33. Martin Luther King, Jr. Community Hospital Page 33

34. Martin Luther King, Jr. Community Hospital Page 34

35. Martin Luther King, Jr. Community Hospital Page 35
Questions and Answers

36. Martin Luther King, Jr. Community Hospital Page 36
Thank you!
Sajid Ahmed, CIIO, sahmed@mlkch.org