Simon Samaha discusses aligning EHR implementations with care delivery transformations. Traditional EHR implementations focus on technology activation, but value-based implementations address people, processes, and technology together to realize benefits. Transformations require multi-year journeys, not single implementations. EHRs can support transformations by enabling predictive analytics, integrated technologies, and new care models, but only if implementations are guided by a value proposition and roadmap that considers financial, clinical, and operational impacts. Risks to implementations include financial losses, quality issues, and user dissatisfaction if transformations and EHRs are not properly aligned.
Enabling Step Change in your PPM Maturity - Vince Hines | Project Challenge, ...Wellingtone
The State of Project Management is the largest annual piece of research of its kind in the UK. Published by Wellingtone and involving hundreds of organisations it provides deep insight into the state of our industry.
Vince will combine this data with practical advice on how your organisation can use this knowledge to enable a step change in your project and portfolio management maturity. You will gain rich industry data and thought provoking practical advice from this entertaining presentation.
Most of the agile framework focus on delivery part and provide no guidance on project initiation part. What are right questions to ask when we are in very first meeting with the sponsor? How to guide the sponsor through a process of converting high level business idea into a vision and go about chartering exercise? How to effectively conduct project initiation workshop and start with a discovery exercise that sets the scene for a project and produces an initial backlog? These are some of the concerns addressed in this presentation.
Adrian Pyne
Agile project governance
Successful change - good culture and governance matter
APM Governance Specific Interest Group Conference
London, 06 Oct 2016
The team at TOPP TI is pleased to bring to you PRESTO Change Management, a one-of-a-kind project management tool built on the know-how of our talented team of consultants, most of whom spent the majority of their careers in business transformation environments
Enabling Step Change in your PPM Maturity - Vince Hines | Project Challenge, ...Wellingtone
The State of Project Management is the largest annual piece of research of its kind in the UK. Published by Wellingtone and involving hundreds of organisations it provides deep insight into the state of our industry.
Vince will combine this data with practical advice on how your organisation can use this knowledge to enable a step change in your project and portfolio management maturity. You will gain rich industry data and thought provoking practical advice from this entertaining presentation.
Most of the agile framework focus on delivery part and provide no guidance on project initiation part. What are right questions to ask when we are in very first meeting with the sponsor? How to guide the sponsor through a process of converting high level business idea into a vision and go about chartering exercise? How to effectively conduct project initiation workshop and start with a discovery exercise that sets the scene for a project and produces an initial backlog? These are some of the concerns addressed in this presentation.
Adrian Pyne
Agile project governance
Successful change - good culture and governance matter
APM Governance Specific Interest Group Conference
London, 06 Oct 2016
The team at TOPP TI is pleased to bring to you PRESTO Change Management, a one-of-a-kind project management tool built on the know-how of our talented team of consultants, most of whom spent the majority of their careers in business transformation environments
Joanne Bradshaw
Challenges of blending waterfall and agile in transformation projects
Successful change - good culture and governance matter
APM Governance Specific Interest Group Conference
London, 06 Oct 2016
The intention of this presentation is to give a very quick overview of what the agile methodologies entail and what the impact of a transformation to agile could have on an organisation.
This presentation discusses frequently confusing areas of Perform Integrated Change Control, Change Management is one of the important topics of PMP and this presentation with video will help test takers in marking many questions right.
Software Quality Dashboard Benchmarking StudyJohn Carter
Software metrics best practices from a benchmarking assignment that indicates how software metrics are reported to management and used to drive behavior. We learned how leading companies used dashboards to report on quality progress and improvement results. We found the best organizations focused on the vital few metrics but also had automated systems with the ability to drill down on metrics at the divisional and team levels. In addition, the best normalized the metrics by number of customers or complexity. They systematically used root cause analysis to analyze bugs in the field. The SW Quality metrics often went beyond the strict definition of quality in that they also measured release predictability and feature expectations. Finally, the best companies used external benchmarks to set their quality targets.
Governance of agile Software projectsby an automated KPI Cockpit in the CloudpliXos GmbH
Governance of agile Software projectsby an automated KPI Cockpit in the Cloud
Presentation of Dr. Udo Wilski, CTO and Member of Board
at the Swiss IT Sourcing Forum in Zuerich, 2012
Support of project by pliXos
VersionOne Gartner PPM Presentation 2014: Journey to Value - The PPM/Agile In...VersionOne
Lee Cunningham, director, enterprise agile enablement for VersionOne, shared insight into “The Journey to Value – The PPM/Agile Integration” at the Gartner PPM & IT Summit. Lee works with organizations around the globe, providing guidance in the development of business agility through enterprise alignment.
It is very important for a project to implement a robust project change request process to help manage succesful delivery.
This presentation provides an overview of the 5 core steps of the project change control process.
Ideal for a PMO or project team looking to implement their own change control process.
Deliver on time and improve communication with the business to minimize project failure.
Your Challenge
The Agile evangelists are having trouble converting others to the Agile philosophy.
Your team is facing pressure to deliver projects in a smaller time frame. The Waterfall approach is causing projects to go over budget, misunderstanding of project owners’ expectations, and late delivery to the end-customer.
Projects that get implemented successfully may be susceptible to problems as the software gets older and crucial changes are too expensive.
A consolidation roadmap that is based on an easy-to-implement method will ease the burden on resource and infrastructure maintenance.
Our Advice
Critical Insight
Agile is not suitable for all organizations, or all projects. Carefully select pilot projects that have the greatest chance of success and determine the right requirements or risk significant cost overruns to fix problems or roll back development.
An Agile rollout may require peripheral projects to be accelerated.
Agile will modify internal roles and processes. Get ready for change management.
Impact and Result
Agile will improve communication and transparency between teams and stakeholders, which will lead to higher quality products and fluid team dynamics.
The success of the Agile pilot should be used to build the case for an organizational-wide deployment.
In order for your organization to stay competitive, it must place focus on delivering projects at a quicker pace with the right features.
Making Work Product-Centric: A Journey at Nationwide Insurance | Tasktop Conn...Tasktop
Over the last 18 months, Enterprise Digital at Nationwide Insurance experimented with an end to end agile approach to better integrate IT delivery and business activities in the commercial and mobile spaces. Customers are demanding products quicker, and we as a company must find ways to compress the timeline required to deliver the features customers seek to remain competitive. At the end of the second phase of this transition, which comprised just one team, we found a 64% decrease in lead time from discovery to analysis and a 20% decrease in lead time from analysis to implementation. This end to end model stressed co-location of business and IT and working together as one cross-functional team to continuously plan, integrate, and deliver value to our customers. We made the value stream work visible from idea to implementation and organized it in product-centric value streams with the goal of standardizing customer experiences regardless of whether the customer is interacting with our company via web or mobile. This standardization allowed for maximum reusability of requirements, code, and automation, and decreased variances with and the frequency of estimating. In the end to end model, poly-skilling was stressed across both roles and technologies so that all team members had the flexibility to pick up and work on any card at any point in the flow. This, coupled with the team’s use of the tools necessary to implement dev ops capabilities, allowed us to be more responsive to the customer.
Kristen Biddulph
Scrum Master, CSM, CSPO, CAL1 - Nationwide Insurance
Kristen has led software delivery teams over the last 4 years across Nationwide’s Digital assets for Sales, Identity Management, Servicing, and Mobile. Her current focus is on providing solutions to aid high performance teams in their product-centric journeys.
Tasktop Connect 2018
connect.tasktop.com
www.tasktop.com
Keys to Successful Cohabitation: Governance and Autonomous TeamsDevOps.com
Our release management processes and teams are there to try to protect us from failure and disaster, but when we want to accelerate our velocity, they can seem to get in the way. Current best practices that optimize value streams move toward smaller, autonomous teams who are responsible for every aspect of delivery and risk management. But how can we do that without compromising our governance and introducing risk?
Join Helen Beal, a self-described ‘DevOpsologist’ at Ranger4 and Jeff Keyes, VP of Product at Plutora, to learn about:
Why autonomous teams and centralized governance can live together;
How organizations evolve to release frequently and safely on demand;
What happens to release managers in a decentralized model;
The technology that supports us in making risk-informed decisions.
A good overview of Agile Values and Principles, Framework and Methodologies, as well as guidance as to when to utilize Waterfall vs. Agile Project Management, and how to avoid potential pitfalls in Agile Adoption.
Joanne Bradshaw
Challenges of blending waterfall and agile in transformation projects
Successful change - good culture and governance matter
APM Governance Specific Interest Group Conference
London, 06 Oct 2016
The intention of this presentation is to give a very quick overview of what the agile methodologies entail and what the impact of a transformation to agile could have on an organisation.
This presentation discusses frequently confusing areas of Perform Integrated Change Control, Change Management is one of the important topics of PMP and this presentation with video will help test takers in marking many questions right.
Software Quality Dashboard Benchmarking StudyJohn Carter
Software metrics best practices from a benchmarking assignment that indicates how software metrics are reported to management and used to drive behavior. We learned how leading companies used dashboards to report on quality progress and improvement results. We found the best organizations focused on the vital few metrics but also had automated systems with the ability to drill down on metrics at the divisional and team levels. In addition, the best normalized the metrics by number of customers or complexity. They systematically used root cause analysis to analyze bugs in the field. The SW Quality metrics often went beyond the strict definition of quality in that they also measured release predictability and feature expectations. Finally, the best companies used external benchmarks to set their quality targets.
Governance of agile Software projectsby an automated KPI Cockpit in the CloudpliXos GmbH
Governance of agile Software projectsby an automated KPI Cockpit in the Cloud
Presentation of Dr. Udo Wilski, CTO and Member of Board
at the Swiss IT Sourcing Forum in Zuerich, 2012
Support of project by pliXos
VersionOne Gartner PPM Presentation 2014: Journey to Value - The PPM/Agile In...VersionOne
Lee Cunningham, director, enterprise agile enablement for VersionOne, shared insight into “The Journey to Value – The PPM/Agile Integration” at the Gartner PPM & IT Summit. Lee works with organizations around the globe, providing guidance in the development of business agility through enterprise alignment.
It is very important for a project to implement a robust project change request process to help manage succesful delivery.
This presentation provides an overview of the 5 core steps of the project change control process.
Ideal for a PMO or project team looking to implement their own change control process.
Deliver on time and improve communication with the business to minimize project failure.
Your Challenge
The Agile evangelists are having trouble converting others to the Agile philosophy.
Your team is facing pressure to deliver projects in a smaller time frame. The Waterfall approach is causing projects to go over budget, misunderstanding of project owners’ expectations, and late delivery to the end-customer.
Projects that get implemented successfully may be susceptible to problems as the software gets older and crucial changes are too expensive.
A consolidation roadmap that is based on an easy-to-implement method will ease the burden on resource and infrastructure maintenance.
Our Advice
Critical Insight
Agile is not suitable for all organizations, or all projects. Carefully select pilot projects that have the greatest chance of success and determine the right requirements or risk significant cost overruns to fix problems or roll back development.
An Agile rollout may require peripheral projects to be accelerated.
Agile will modify internal roles and processes. Get ready for change management.
Impact and Result
Agile will improve communication and transparency between teams and stakeholders, which will lead to higher quality products and fluid team dynamics.
The success of the Agile pilot should be used to build the case for an organizational-wide deployment.
In order for your organization to stay competitive, it must place focus on delivering projects at a quicker pace with the right features.
Making Work Product-Centric: A Journey at Nationwide Insurance | Tasktop Conn...Tasktop
Over the last 18 months, Enterprise Digital at Nationwide Insurance experimented with an end to end agile approach to better integrate IT delivery and business activities in the commercial and mobile spaces. Customers are demanding products quicker, and we as a company must find ways to compress the timeline required to deliver the features customers seek to remain competitive. At the end of the second phase of this transition, which comprised just one team, we found a 64% decrease in lead time from discovery to analysis and a 20% decrease in lead time from analysis to implementation. This end to end model stressed co-location of business and IT and working together as one cross-functional team to continuously plan, integrate, and deliver value to our customers. We made the value stream work visible from idea to implementation and organized it in product-centric value streams with the goal of standardizing customer experiences regardless of whether the customer is interacting with our company via web or mobile. This standardization allowed for maximum reusability of requirements, code, and automation, and decreased variances with and the frequency of estimating. In the end to end model, poly-skilling was stressed across both roles and technologies so that all team members had the flexibility to pick up and work on any card at any point in the flow. This, coupled with the team’s use of the tools necessary to implement dev ops capabilities, allowed us to be more responsive to the customer.
Kristen Biddulph
Scrum Master, CSM, CSPO, CAL1 - Nationwide Insurance
Kristen has led software delivery teams over the last 4 years across Nationwide’s Digital assets for Sales, Identity Management, Servicing, and Mobile. Her current focus is on providing solutions to aid high performance teams in their product-centric journeys.
Tasktop Connect 2018
connect.tasktop.com
www.tasktop.com
Keys to Successful Cohabitation: Governance and Autonomous TeamsDevOps.com
Our release management processes and teams are there to try to protect us from failure and disaster, but when we want to accelerate our velocity, they can seem to get in the way. Current best practices that optimize value streams move toward smaller, autonomous teams who are responsible for every aspect of delivery and risk management. But how can we do that without compromising our governance and introducing risk?
Join Helen Beal, a self-described ‘DevOpsologist’ at Ranger4 and Jeff Keyes, VP of Product at Plutora, to learn about:
Why autonomous teams and centralized governance can live together;
How organizations evolve to release frequently and safely on demand;
What happens to release managers in a decentralized model;
The technology that supports us in making risk-informed decisions.
A good overview of Agile Values and Principles, Framework and Methodologies, as well as guidance as to when to utilize Waterfall vs. Agile Project Management, and how to avoid potential pitfalls in Agile Adoption.
ALPE Taxcom SAP Component. Legally Significant E-Documents from SAP ERP throu...Mikhail Kalyabin
ALPE consulting designed a solution of integration with EDO “Taxcom – DocLines”. Using this solution you will be able to prepare documents in your SAP ERP system, to sign them with digital signature, to send documents to your contractor, to get an answer from contractor and to update the status of document.
It is not a surprise that the whole world is getting more and more digital, but it is important to acknowledge, that so are the tax authorities in requirements they now set froth towards taxpayers.
OECD’s model of SAF-T files (followed by Polish JPK, Lux FAIA or Lithuanian i.SAF) and many other forms of more or less standardized types of electronic audit files are currently being required all over Europe. In the other corner huge amount of businesses struggling to make their ERP capturing all transactions in VAT compliant manner.
Feeling lost and overwhelmed with all the mixture of IT and tax regulations? We hope the attached slide deck would give you an overview of the topic.
IAB Internet Advertising Revenue report 2014 - April 2015Margarita Zlatkova
An industry survey conducted by PwC and sponsored
by the Interactive Advertising Bureau (IAB).
Conducted by PricewaterhouseCoopers LLP (“PwC”) on an ongoing basis, with results released quarterly, the “IAB Internet Advertising Revenue Report” was initiated by the Interactive Advertising Bureau (IAB) in 1996. This report utilizes data and information reported directly to PwC, publicly available online corporate data, and information provided by online ad selling companies.
Sleeping Lion Business Improvement Toolkit 2017 Sarah Duncan
Sleeping Lion business improvement toolkit including 50 straightforward techniques in the following areas:
10 tools to help build a robust brand
10 tools to help understand your customers and build greater loyalty
10 tools to help reinvigorate your marketing
10 tools to help build an amazing team
10 tools to help build a more ethical business
10 tools to help with brainstorming for the future
És una mesura de govern pionera a l’Estat que pretén garantir la cohesió social i la protecció dels drets humans. El document ha estat debatut i consensuat en un procés que ha implicat una vuitantena de persones entre experts en drets humans i discriminació, tècnics municipals i entitats socials i de la comunitat musulmana.
Capita offers the benefit of enormous experience in
supporting organisations to deliver better financial
services. From translation services to customer management, find out how our knowledge and expertise can help your business succeed.
The healthcare industry is seeing a surge in project management growth to support the number of initiatives driven by federal legislation and movements to patient centered care, evidence based medicine, and establishing centers of excellence. These projects typically impact a variety of departmental areas – from IT, to administration, to a clinical setting, resulting in a variety of challenges to successfully deliver on these critical projects.
Strategic Application of IT for Performance Improvement in hospital industry_...DrDevTaneja1
Hospital industry has been laggard in using IT tools to improve Performance Management.
The hospital industry must move beyond Transaction Reporting HMIS to Performance Improvement Tools like Visual Analysis Business Intelligence
Hospital industry must use IT spending as a Strategic Resource to optimize business outcomes & productivity
Aligning Healthcare Organizations: Lessons in improved Quality and Efficiency...Nathan Ives
Aligning Healthcare Organizations describes how best practices in measuring organizational performance in the nuclear power industry can be applied to healthcare providers facing the daunting challenge of concurrently increasing production, efficiency, and quality while reducing operating costs.
Electronic health record (EHR) implementations can be operationally invasive and can have significant financial implications. Organizations may see a reduction in net revenue, an increase in accounts receivable days and a slowdown in cash collections. With several NJ providers in the process of moving to an Epic HIS and EHR environment, preserving net revenue, maintaining consistent cash and ensuring accurate financial reporting should be among the provider’s primary conversion goals. We have worked with several providers throughout the country who have undergone a recent Epic conversion and thought it would be beneficial to share conversion lessons learned from these providers. A consistent phrase in the Epic conversion world is ”Big Bang,” indicating that every module that’s been purchased is implemented at the same time. The conversion timeline is an eighteen month journey and has been described as a conversion like no other. More and more providers are moving towards the “Single Billing Office” (SBO) solution, meaning hospital, physician and potentially other entities such as home health appear on a single statement. This alone is a significant change for hospital providers.
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
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.
Hospital and Healthcare System Strategic Planning and Financial ForecastingAxiom EPM
Given the level of uncertainty in the healthcare industry and all of the external factors that impact healthcare provider organizations today, strategic planning has become an increasingly complex function. The process is no longer a simple financial forecasting exercise. Instead, it has evolved into a more integrated financial and operational planning activity that touches the entire organization. The process of defining a multi-year financial forecast is now predicated on the modeling of individual business initiatives focused on cost reduction or revenue growth. These slides present four factors vital to establishing more agile strategic planning models. You'll learn techniques to incorporate financial and service line-based analytics to enable efficient ‘what-if’ modeling, scenario analysis and initiative-based modeling and tracking.
Convert with Confidence: Barriers and Benefits of the EHR Switchathenahealth
Is your current electronic health record not working the way you want it to? Switching to a new system can be difficult without the right partner with the knowledge and support to help.
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
How can cost management and complete charge capture protect and enhance the margin?
In this webinar, we will look at 2024 margin pressures likely to impact your organization’s financial resiliency. This presentation will also share how organizations can move from Fee-for-Service to Value; bringing Cost to the forefront.
Benefits Management: the essential ingredient for change, 10 Jan 2017. Southampton
Transformational change is here to stay.
We are living in an era of continuous transformation where standing still is simply not an option in today’s ultra-competitive and constantly changing business environments.
This presentation describes the key drivers and management imperatives for successful transformational change in organisations. It shows how placing Benefits Management at the heart of change management directly addresses and enables success.
In the main there are two key attributes of the Benefits Management methodology that help deliver successful business change.
The first is a flexible framework which can be easily embedded across the entire organisational change structure. This provides powerful change management capabilities that focus on delivering the desired end results and outcomes for the business.
Secondly and arguably most importantly, is the need to focus on the decision makers and data owners within the organisation. They are responsible for driving the change and associated benefits forward. This applies equally to; the senior responsible owner, the business change manager and benefit owners.
Benefits Management done well will naturally draw people into the change process and can achieve game-changing results. It does this by fostering in people; joined-up thinking, good communications, readiness for change and a culture of shared goals and objectives.
Today’s market drivers for constant business change don’t offer the luxury of choice.
If there is new technology or a threat to our current or aspired market objectives, then organisations must rise to the change challenge or accept the inevitable consequences such as reduced market share or business failure.
If directed to cut costs or do more for less, it should be done intelligently. Benefits management is essentially about making sure that the organisation has an unrelenting focus on delivering business value and not just traditional time, cost and quality outputs.
In the real world, it’s about people and winning the hearts and minds of the people, that will deliver true success.
On the theme of benefits management, the presentation impressed the need for measurable improvement but not at all costs. One of the challenges of benefits management is to identify which benefits are the ones to address, and not just because they happen to be measurable!
Several useful frameworks and tools are recommended and referenced in the presentation.
The presenters were Neil White, Chair of APM Benefits Management SIG and Merv Wyeth, Secretary.
See also: http://bit.ly/2iykbXX
Value-based payments research study - Availity 2014Availity
Dive into the latest research study from Availity, and learn more about provider attitudes toward value-based payment models. Get an overview of current-state physician reimbursement, find out current and expected adoption levels, learn administrative and operational challenges that are barriers to further adoption, and discover physician attitudes toward outcomes and cost savings.
Final Project Implementation Assessment of Electronic Health .docxtjane3
Final Project:
Implementation Assessment of Electronic Health Record.
Objective
:
For this assignment, you will create the assessment to implement the new HER in a Health care setting. The assessment phase is foundational to all other EHR implementation steps, and involves determining if the practice is ready to make the change from paper records to electronic (EHRs), or to upgrade their current system to a new certified version. You will be encourage to choose a Community Health Center or a Doctor’s Office. The Assessment is designed because our world has been radically transformed by digital technology – smart phones, tablets, and web-enabled devices have transformed our daily lives and the way we communicate. Medicine is an information-rich enterprise. A greater and more seamless flow of information within a digital health care infrastructure, created by electronic health records (EHRs), encompasses and leverages digital progress and can transform the way care is delivered and compensated. With EHRs, information is available whenever and wherever it is needed.
The Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act of 2009, represents the Nation’s first substantial commitment of Federal resources to support the widespread adoption of EHRs. As of August 2012, 54 percent of the Medicare- and Medicaid-eligible professionals had registered for the
meaningful use incentive program
.
The paper will be 8 pages long. More information and due date will provide in the assignments link.
ASSIGNMENT GUIDELINES (2 points /10%):
The
assessment
should look at the current state of the practice:
Are administrative processes organized, efficient, and well documented?
Are clinical workflows efficient, clearly mapped out, and understood by all staff?
Are data collection and reporting processes well established and documented?
Are staff members computer literate and comfortable with information technology?
Does the practice have access to
high-speed internet connectivity
?
Does the practice have access to the financial capital required to purchase new or additional hardware?
Are there clinical priorities or needs that should be addressed?
Does the practice have specialty specific requirements?
Through the Regional Extension Centers (RECs), we’ve learned that these questions and assessment tools provide a good understanding of the current state of the practice and can help identify key goals for improvement. Often, these goals relate to patient quality, patient satisfaction, practice productivity and efficiency, improved quality of work environment, and most important to the overall goal – improved health care.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1.
Introduction (5 points / 25%)
Offer an abstract that provide a brief outlook of the proposal and explaining in your own words what is meant by a Electronic H.
These slides use concepts from my (Jeff Funk) course entitled Biz Models for Hi-Tech Products to analyze the business model for ConnexionAsia’s health insurance product. This product provides a one-step health service for employers that enables employees to choose from multiple providers and make tradeoffs between different types of insurance coverage and wellness programs. Employees can use their health care benefits for wellness programs (e.g., fitness) and other preventative health care in addition to the traditional health care insurance. By enabling employees to be more proactive in their health care, ConnexionAsia’s health insurance product can provide employers with healthier employees, reduced sick leave, and lower health care costs in the long run. It makes money through its wellness products, consultation services, and the sale of data.
Develop a 5-7 page implementation plan addressing the various factors.docxrosaliaj1
Develop a 5-7 page implementation plan addressing the various factors critical to the successful deployment of the new or upgraded telehealth technology that was the focus of the previous two assessments. Introduction Technology continues to move at an accelerated pace, and the delivery of health care is shifting from office-based environments to the home. For this reason, health care organizations must be at technology's cutting edge in order to remain competitive in today's environment. Integrating the daily activities of patients into the health care continuum will improve the quality of care that is provided and enable more holistic care. This assessment provides an opportunity for you to develop an implementation plan that addresses the various factors critical to the successful deployment of the new or upgraded telehealth technology that was the focus of your previous assessments. Preparation Based on the positive reactions and feedback from stakeholders with regard to the proposed telehealth technology, executive leaders have decided to move forward with implementation of this telehealth solution and have asked you to develop the implementation plan. To prepare for the assessment, you are encouraged to reflect on the factors critical to the successful deployment of the new or upgraded telehealth technology and on how such technology would be implemented in your organization or practice setting. In addition, you are encouraged to become familiar with the Systems Development Life Cycle (SDLC) process for successfully implementing information systems or a change model for technology use that you think best supports your technology implementation ideas. Refer to the suggested readings, supplemented, as desired, by your own research. You may also wish to:
· Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete.
· Review the , which includes questions to consider and additional guidance on how to successfully complete the assessment.. Requirements Develop a technology implementation plan that supports the vision for safe, high-quality health care in your organization or practice setting. Complete the simulation. The implementation plan requirements, outlined below, correspond to the grading criteria in the Implementation Plan Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed. The Guiding Questions: Implementation Plan document, linked above, provides additional considerations that may be helpful in completing your assessment. In addition, be sure to note the requirements below for document format and length and for citing supporting evidence.
· Assess the adequacy of existing telehealth technology infrastructure in your organization or practice setting.
· Assign tasks and responsibilities for deploying the new or upgraded telehealth technology.
· Develop an implementation sch.
2. PwC
With you today
2
PricewaterhouseCoopers LLC
300 Madison Avenue
New York, NY 10017
simon.samaha@us.pwc.com
Simon Samaha, MD
Principal Client Services
Co-lead- Care Delivery
Transformation Practice
Health Industries Advisory
3. PwC
Goal for today: what we are seeing in the market?
Alignment between EHR implementation and Transformation
• TCO vs Value Based Implementation
• Transformation discipline
• Using professional services
3
4. PwC
Table of contents
4
What are we seeing in the market: Implementation vs.
Transformation
How do we define Value Based Implementation?
How are transformation and EHR
aligning?
Using Professional services
1
3
4
2
5. PwC
What are we hearing?
• Was unable to deliver and show
value beyond a smooth go live
Client CIO
Go Live went on time, on
budget and on scope; CEO not
happy
“
• Addressed technology in
isolation of People and Process,
but more important there was no
value proposition but TCO which
included software related benefit
realization
”
5
Our clients need
optimization help after go live,
in revenue growth,
productivity, physician
productivity, governance, and
other operational challenges
“
”
Vendor Executive
1-Implementation vs Transformation
6. PwC
Typical Business Case:
Technology Acquisition Cost
+ EHR Implementation Cost
+ Software/Hardware Maintenance Cost
= Total Cost of Ownership (TCO)
Typical TCOs lack consideration for
care delivery transformation needed
during and post go live
Value-Based Business Case:
Technology Acquisition Cost
+ EHR Implementation Cost
+ Software/Hardware Maintenance Cost
+ Care Delivery Transformation
+ Post-Implementation Transformation
= Total Investment
+ Value Realized
= Net Benefit
A new starting point? TCO vs. Value Based Implementation
Starting with the business case
6
1-Implementation vs Transformation
7. PwC
How is Value-Based Implementation (VBI)
different from ROI
ROI VBI
•Justifies initial investment
•Rarely used post-implementation
•Drives benefits realization
•Scope extends beyond system activation
•Typically based on operational metrics –
•FTE reduction
•Patient Satisfaction
•Value realized is based on strategic & measureable
value –
•Cost of care reduction
•Patient retention
Vs.
7
1-Implementation vs Transformation
8. PwC
Bu
EHR implementations have failed to deliver value
because there has been no focus on value creation
Go Live
Focus
Value-
Based
Focus
Features &
Functions
Scope Time
Line
Technology
Implementation
Identify
Value
Budget
Validate
Value
Drive Value
with
Transformation
Budget
Care
Transformation
Implementation
A Value-Based Implementation focuses on achieving value
rather than just system “activation”
Traditional implementation vs. Value based focus
8
1-Implementation vs Transformation
9. PwC
Selection Implementation Go Live
Value
Proposition
Execution Sustainability
Value Based Implementation requires a
transformation approach
Best perceived system
based on features and
functions
PMO driven focusing
on Scope, Timeline
and Budget
Success = System go
live with limited if any
downfalls
EHR Implementation
Determine value to be
achieved.
Execute changes in
People, Process and
Technology
Assure value created
is achieved and
sustained
Transformation
Achieving a transformation through an EHR implementation requires
both, question is how are these 2 aligned and synchronized?
Value realized
= TCO +/-
Implementatio
n benefits
Value realized
= Value
proposition +
sustainability
9
1-Implementation vs Transformation
10. PwC
Transformation : eliminate non
value added functions
New Care Delivery Model: Patient
focused affinity & democratization of
care
Customer Relationship Management
Precision medicine
Virtual visits
Operationalization: put in place
Operating model
Call centre
Service line implementation
Scope of practice analysis
Technology: EHR implementation/
standardization
Optimization: get the most
Team-based “continuity of care”
design
Physician Enterprise enhancement
Cross department scheduling
EHR optimization
Enterprise interoperability
The road to Care Delivery Transformation is a journey, not a
destination
Customer
Engagement
Margin
Management
Clinical
Integration
Workforce
Transition
Predictive
Analytics
Integrated
Technology
Services: A staged approach
10
2- Value based implementation
11. PwC
Tomorrow’s organization will need six broad capabilities to
enable a value based care delivery model
Predictive Analytics
Adaptable models, machine learning, new and informed data sources, using data to predict and guide financial and clinical
outcomes, agile responses to quality and risk pressure
Clinical Integration
Connection and integration of clinical and revenue cycle operations, aligning with strategic intent, going beyond population
management and aligning the network
Customer Engagement
Personalized, transparent, convenient, and on-demand
Margin Management
Standard and efficient operations, shared service models, contract management, convergent practices, supports quality and risk
based reimbursement models
Workforce Transition
Organizational alignment, Integration of clinical and revenue cycle resources, improved critical thinking skills, new staffing models
Integrated Technology across the Continuum of Care
Appropriate use of workflow driven technologies that minimize human intervention to drive results, easy access to data for all
stakeholders
11
2- Value based implementation
12. PwC
EHR Before
Transformation
Transformation
Before EHR
EHR &
Transformation
When it comes to aligning EHR implementations and
transformation, what are the perceived pros & cons?
12
Technology platform available for
transformation
Focus and align with overall
Transformation
Full synchrony and ability to cover
People, Process and Technology
Implementation not in line with
Transformation, and risk of re-
implementation
Technology platform not available
for transformation
Too complex to handle, HIT
vendors typically recommend and
push for a transformation after
2- Value based implementation
13. PwC
Let us take an example: Physician productivity
• Typical concern is around physician
adoption and impact on physician workflow
• EHR scope focuses on different but related
areas
• Physician: ease of use, screen design,
adoption, workflow
• Registration: ease of registration
• Back end: proper billing
• We do see in benefit realization increase or
no decrease in productivity
• In most instances we see decrease in some a
25% decrease for > 6 months
• What drives this disconnect are:
• Lack of true value proposition
developed but rather ability of a
system that may or may not be
sufficient to solve the problem
• Focus is still on activation first and
benefit later
Pre-
encounter
Post-
encounter
Encounter
• Proper deployment
• Understand supply-
demand
• Front end
• Back end
• Patient engagement
• Patient reactivation
• Throughput
• Predictability of
schedules and
experience
* Covered or at least partially addressed by EHR
• Governance
• Incentives
• Operations
13
2- Value based implementation
14. PwC
How are transformation and EHR
implementations aligning?
Determine
Value
Proposition
Develop a
Roadmap
Align scope &
timeline between
EHR and
Transformation
Implement EHR
under
transformation
discipline
Manage
Risk
•Develop a corporate
wide value proposition
•Validate and determine
feasibility
•Ideation and details of
current and future state
•Stakeholder buy in
•Risk and sustainability plan
•Scope
•Sequence
•Budget
•KPI and realization
•Common oversight
•Maintain overall PMO with
a subset on EHR
•Embed risk
management and
controls based on
future state
14
3- Aligning Transformation and Implementation
EMR implementation
begins
Transformation begins
15. PwC
Cost of care: identifying variability by service line
$-
$1
$2
$3
$4
$5
$6
$7
Millions
Value of variability by service lines based on Medicare FFS data
Source: Medicare FFS Data
15
Determine
Value Prop
Align
Scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
17. PwC
Roadmap
Access
• Current state: we offer centralized and cross
departmental access
• Future state: we will perform predictive scheduling on
all of our primary care, OB, Peds PC, and chronic
disease patients. We will also offer virtual visit based on
predictive outreach to the patient and family
• Stakeholders: physicians, centralized access, Revenue
cycle, Risk management
• Financial impact:
- Increase in patient affinity xxMM$
• Sustainability plan:
- KPI: n of patient with predictive call/(n of patients with
predictive call + n of patient with patient/family initiated
call)
• Risk:
- Reimbursement
- Cost of care increase/excess utilization
EHR implications:
• Rules and data for predictive scheduling
• Rules for virtual v/s real encounter
• Virtual visit type and reimbursement
• Virtual visit workflow and EHR intake
• Patient access to EHR for data and digital (device
entry)
• Rules for follow up on patients after a virtual
encounter
• Quality controls for virtual visits
Centralized Access
Cross departmental
scheduling
Predictive Scheduling
Virtual visit
Current state
Future state
17
Determine
Value Prop
Align
Scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
18. PwC
Roadmap
Pharmacy Stewardship Program
• Current state: we have a strong P&T committee
addressing clinical indication
• Future state: we will increase the scope to include
pharmaco-economic decision, and use medication
profile as one of the drivers of care management
• Stakeholders: physicians, pharmacy, P&T, Finance,
Population health
• Financial impact:
- Decrease cost of care for patients with annual medication
cost > $1,000
• Sustainability plan:
- KPI: Expected v/s actual cost.
- Change in P&T governance model
• Risk:
- Impact of change of governance
- Physician adoption
- Impact on research
- Conflict with disease based care management
EHR implications:
• Cost and pharmaco-economic embedded in
medication profile
• Rules and Alerts
• Medication profile registries
• Medication profile care management workflow
• Rules and alerts specific for overlapping clinical
conditions
• Pharmacist workflow
Clinical P&T
Add Pharmaco-economic
decision
Use medication profile as one of
the drivers care management
Current state
Future state
18
Determine
Value Prop
Align
Scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
19. PwC
Roadmap
Order Set Usage
• Current state: we use admission order sets to drive
standardization of care and educate our students and
residents on proper care and best practices
• Future state: we will use order sets to test the
knowledge level of our students and residents
• Stakeholders: students, residents, fellows, physicians,
research , residency program directors,
• Financial impact:
- Precursor to better clinical education effectiveness
• Sustainability plan:
- Measure knowledge and impact of interventions
- Feedback from residents and students
• Risk:
- Slow down ordering process
- Physician adoption
EHR implications:
• Design of order set
• Capture usage and usage time
• Develop or partner for knowledge testing material
• Embed knowledge testing for residents and students
• Capture results and link to educational interventions
• Report on usage behavior and create a learning
analytics tool
Standardized admission
order set
Embed knowledge
assessment in order sets
Current state
Future state
19
Determine
Value Prop
Align
Scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
20. PwC
Align & implement: methodology
20
Readiness Implement Activate Go Live
IT/EHR
Roadmap Transform Sustain
Transformation
Develop Plan Test Mitigate
Risk
Assurance
Determine
Value Prop
Align
Scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
21. PwC
Align & implement: Value based transformation
benefits
21
Determine
Value Prop
Align
scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
Guided by
purpose & vision
and enables Financial
Excellence
which leads to
Physician Alignment
and Team Satisfaction
Vision: highest quality comprehensive continuum of integrated health care
Purpose: increase excellence in care and advance transformative efforts with
their unified voice
through the Value of
Integration
that creates a better
Patient Experience
Drive Care Excellence
• Enhanced care delivery and coordination due to access to single longitudinal
patient record across the care continuum
• Higher clinical efficiency
• Reduced errors and redundancies
• Decreased mortality rates , readmissions, and LOS
• Management of the health of the population: one record, one outcome
• Improved access to providers according to clinical and personal need
• Improved use of technology infrastructure due to integration, usability,
reliability, and stability
• Ease of access to “patient’s complete story”
• Enhanced workforce: resource optimization and team-based care model
• Increased standardization in workflows and processes: assessments,
treatments, preventive services and follow-up care
• Reduced cost: pricing, cost per case etc.
• Enhanced profitability through margin management
1
2
3
4
5 • Enhanced experience of “consistent”, coordinated” and “integrated” care
• Increased consumer participation
• Improved choice
• Enhanced safety of care and services
22. PwC
Putting controls in place: What can go wrong with
an EHR transition…
22
Program
ManagementTechnology
Financial &
Compliance
Clinical &
OperationalOrganizational
RISK EXAMPLES
Patient Care/Experience: Negative clinical outcomes, sentinel/reportable events, and patient dissatisfaction
Economic Risk: Cash flow declines, gross and net receivables increases, increase in DNFB days and amounts, regulatory billing noncompliance (i.e.
fines and penalties), increase in charity care, contractual allowances, and bad debt expense
Financial Statement Risk: EHR sub-ledgers not reconciling to G/L, treasury clearing accounts not reconciled or reconciled with significant balances,
unusual contractual allowance and charity/bad debt fluctuations, and negative audit opinion due to deficient controls impacting bond rating
•Impact of organizational
culture
•Users don’t understand
or struggle to use the
system
•Difficulty recruiting and
retaining staff
•Cost overruns result in
project going over
budget, time and scope
•Cybersecurity/ Privacy
violations
•Patient access challenges
•Increased Patient and
Provider dissatisfaction
•Quality care
compromised due to
unintended
consequences or
omissions
•Workflows not
operational, aligned
and/or conducive to end
users
•Challenge to produce
official medical records
•System doesn’t function
as intended, inaccurate
or incomplete billing
•Revenue cycle
implications and cash
flow disruptions
•Segregation of Duties
violations
•Fraud or financial
statement integrity issues
•Regulatory non-
compliance (e.g.
Meaningful Use)
•System is not available
when needed
•Interoperability:
Interfaces don’t
accurately or completely
exchange information
•Insecure configuration
resulting in data breach
•Access is not restricted or
based on user roles
•Lack of resilience
•Data integrity issues
•Workflow disruptions
•Changes to system are
not managed
•System is not
implemented on time or
on budget
•Ineffective or inadequate
training of physicians
and clinicians or front
line
Determine
Value Prop
Align
Scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
23. PwC
And What Can Be Done to Prevent it…
End-to-end Process, Risk, and Control workflow design/assessment and
recommendations
Assessment of Governance and Project Management
Control testing and remediation, with resiliency planning and validation
Key regulatory compliance controls integration
Key clinical care and patient safety controls integration
Technology Assurance (e.g. change control and application access controls assessment )
External and internal reporting process assessments of interfaces from EHR
Financial process and related controls testing of design and effectiveness for those
processes impacted from the EHR implementation (e.g. Revenue, A/R and Treasury)
Subsequent go-live implementation reviews and legacy system(s) cutover
To mitigate risk, a risk assurance focused project team will
assist the organization with oversight activities to include, but
not limited to:
23
Determine
Value Prop
Align
Scope
Transform
with EHR
Manage
Risk
Develop a
Roadmap
24. PwC
Engaging professional services: different models at
different stages
Three Types of
Service
Before Selection
During
implementation
After Go Live
Implementation
Typically staff augmentation
providing additional staff to
support implementation and
configuration
Selection & TCO Staff augmentation
Transformation
Senior level with expertise in
EHR and Clinical
Transformation help in aligning
transformation and EHR
implementation
Value proposition and
alignment
Kick off transformation
Support transformation Transition
Risk Assurance
Mostly focusing on revenue cycle,
financial controls, research
compliance
Develop baseline
assessment
Test and assure good
controls
Assure good transition
24
4- Engaging professional services
25. PwC
Value
•Aligned IT Strategy
•System Selection
•Implementation Planning
•Readiness Assessment
•Total Cost of Ownership
•Project Management
•Interim Management
•Application Expertise
•Training Strategy
•Virtual Testing Center
•Standardization
•Evidence based practice
•Clinical Documentation
•Process Redesign
•Revenue Cycle
•System Optimization
•Benefits Realization
•Adoption
•Clinical Informatics
•In Flight Health Check
•Risk & Controls Audit
•Regulatory Compliance
•Data Integrity
•Continuous Improvement
Planning Implementation Transformation Optimization Evaluation
Value is generated by coupling care delivery transformation with technology
implementations to create a sustainable future operating model
Governance Structure, Scope & Decision-Making
Change Management & Communication
Physician & User Adoption
Engaging professional services
25
4- Engaging professional services
26. PwC
Some are using risk based models with professional
services
25% 15%
15% 45%
System Transform
Milestone
Outcomes
40% 60%
40%
60%
Develop component of @Risk based on value
proposition and organizational readiness
26
4- Engaging professional services
27. PwC
Key takeaways
27
01
02
03
04
Focus on a value
proposition before starting
an EHR program
Assign a clinical executive
to own the value based
EHR program
Look at internal
controls right at the
beginning
01
02
03
04
Underestimate the
important of transformation
Forget to drive clinical
ownership of value drivers
Dos Don’ts
Approach EHR as a technology
play
Partner with trusted advisors who
focus on transformation, not
implementation
Forget to understand what value
drivers are behind the EHR program
e.g. service lines