IT Transformation                                       Tim Tarnowski & Vince Willoughby                                  ...
Conflict of Interest Disclosure           Tim Tarnowski, CIOVince Willoughby, Strategy Development        Has no real or a...
Learning Objectives• Define the process to align IT strategies with  medical and business strategies• Explain one approach...
UK HealthCare  Overview   Lexington, Kentucky       March 2013
University of Kentucky     Lexington,      Kentucky
Ranked No. 1 Hospital in Kentucky                  Nationally ranked in the top 50 for Orthopaedics                Ranked ...
Information    UK HealthCare                 Five Focus Areas                                                             ...
Dedicated to Patient CareHospitals                                   Outpatient Services•   UK Albert B. Chandler Hospital...
Benchmark on Discharges                         UK HealthCare - Benchmarked against COTH Median Teaching Hospital10,200 9,...
Our Strategic Priorities IT will be a fundamental organizer inrelationship development and making    improvements to care ...
IT TransformationUsing World Class   IT Attributes UK HealthCare, Lexington, Kentucky           March 2013
2009 Current State Assessment• Internal Data Collection/Information Gathering   –   Nov/Dec-08 Interview Summary   –   I.T...
Current Healthcare IT Industry Trend            Source: Healthcare Advisory Board, Innovation Center, 2010
The Challenges – Evolution of HIT       Focus           Decade                        Computing Type       Billing        ...
Conclusions of 2009 Current State Assessment (CSA)           Customer                               IT Staff• I.T. is Crit...
Future State Needs – From 2009 CSA• Industry is Rapidly Transforming• I.T. is Critical to Success of UK HealthCare• Prepar...
I.T. Assessment Conclusions (Updated 2010)          Focus                    Decade                         Computing Type...
Transformational ChangeDenial                                 CommitmentConfusion                              TeamworkApa...
Transformational Change – “White to Blue”      Totally Transform Our DNA:• Gradual Process• Allows Acclimation• Organized/...
Transformational Change                 Directly Addressing the Tough Issues                      is the Work of Leadershi...
Transformational Change – Year One Roadmap      Topic       Current State             First 4 Months               Middle ...
World Class IT Attributes           •       Service Strategies           •       IT Governance           •       World Cla...
Add Reference
IT Transformation Using World Class AttributesUSING WORLD CLASS ATTRIBUTES:• Provides a Framework for a New Team• Creates ...
IT AlignmentUK HealthCare, Lexington, Kentucky          March 2013
• Aligned ITSP Interview  Teams with Org Chart• Questions:  • Strategies  • Activities  • How Can IT Help?
Eight IT Strategies• Foundation for IT  Approaches• Very Long Term
IT Strategic Plan•   Service Strategies•   IT Governance•   World Class Attributes•   Passport•   IT Strategies
IT Strategic Plan• Service Strategies  • Ambulatory Services    Strategy  • What Ambulatory    Services is Doing  • How IT...
Benefits of IT AlignmentMAIN BENEFIT:• Ensure IT Investments are Directly Contributing to  Medical & Business StrategiesAD...
IT GovernancePrioritization Process   UK HealthCare, Lexington, Kentucky             March 2013
Add Reference
IT Governance                                                 IT                                             Governance   ...
ONEList – Demand Management
ONEList – Rate vs. Signature Metrics                                                                                      ...
ONEPage – Executive Summary    How will requested item relate to signature metrics?
ITSP – How IT Can Help 10 Year Funding Model Project Name                        FY13                                     ...
Benefits of IT Governance PrioritizationMAIN BENEFIT:• IT Governance Decides Which IT Investments Meet  Medical and Busine...
ResultsUK HealthCare, Lexington, Kentucky          March 2013
UK HealthCareIT Leadership Structure                                        Assoc. V.P. & CIO                             ...
UK HealthCareIT Leadership Structure                                            Assoc. V.P. & CIO                         ...
IT Team Composition All Staff 2009       All Staff 2010                           All Staff 2011                          ...
Results: IT Governance Top PrioritiesITG Top Priority    2009    2010       2011   2012          2013AssessmentIT Transfor...
http://ukhealthcare.uky.edu/IT/
Passport for Our Improvement Journey
Passport for Our Improvement Journey
UK HealthCare IT Capital Spend (2002 – 2012) & Forecast (2013 – 2023)                          (Figures in $000s)         ...
Lessons Learned UK HealthCare, Lexington, Kentucky           March 2013
Lessons Learned• Restructuring:   – Does Not Equal Team Building   – Challenge to Maintain Service Delivery While In Proce...
Lessons Learned• IT Strategic Plan:  – Help Areas Without Documented Strategies  – Alignment is a Very Difficult & Repetit...
“Transformation without workand pain, without suffering,without a sense of loss is justan illusion of true change.”       ...
Thank You!  Tim.Tarnowski@uky.eduVincent.Willoughby@uky.edu www.ukhealthcare.uky.eduwww.ukhealthcare.uky.edu/IT       Marc...
UK HealthCare IT Transformation HIMSS 2013
UK HealthCare IT Transformation HIMSS 2013
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UK HealthCare IT Transformation HIMSS 2013

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UK HealthCare, an Academic Medical Center in Lexington, KY, highlights of a recent transformation of the Information Technology function. Topics covered include IT Assessment, IT Mission, Vision and Values, IT Governance, IT Strategic Plan and IT Balanced Scorecard. By Tim Tarnowski & Vince Willoughby, March 2013

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UK HealthCare IT Transformation HIMSS 2013

  1. 1. IT Transformation Tim Tarnowski & Vince Willoughby March 2013DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
  2. 2. Conflict of Interest Disclosure Tim Tarnowski, CIOVince Willoughby, Strategy Development Has no real or apparent conflicts of interest to report. © 2013 HIMSS
  3. 3. Learning Objectives• Define the process to align IT strategies with medical and business strategies• Explain one approach on how IT Governance can prioritize potential IT investments against medical and business metrics• Describe how UK HealthCare transformed their IT function by using a framework to define Key Attributes of a World Class IT Organization
  4. 4. UK HealthCare Overview Lexington, Kentucky March 2013
  5. 5. University of Kentucky Lexington, Kentucky
  6. 6. Ranked No. 1 Hospital in Kentucky Nationally ranked in the top 50 for Orthopaedics Ranked high-performing in 10 specialties Cancer › Diabetes & Endocrinology › Ear, Nose & Throat › Gastroenterology › Geriatrics › Gynecology › Nephrology › Neurology & Neurosurgery › Pulmonology › Urology6
  7. 7. Information UK HealthCare Five Focus Areas Technology• Academic Medical • Strengthen • 200+ FTEs Center Subspecialties • Hybrid FTE Model:• State, Not for Profit • Expand Geographic – Central Reach – De-Central• Three Hospitals • Improve Cost • Best of Breed• 80+ Sub Specialty Effectiveness Clinics • Patient Safety &• 1,500 Physicians Satisfaction• 8,000 Employees • Maintain Financial• Key Statistics: Strength – 825 Beds – 34,453 Discharges – 448,673 O/P Visits
  8. 8. Dedicated to Patient CareHospitals Outpatient Services• UK Albert B. Chandler Hospital • Kentucky Clinic• UK Good Samaritan Hospital • UK Polk-Dalton Clinic• Kentucky Children’s Hospital • Kentucky Clinic SouthAreas of Excellence • UK Family Care Center• Gill Heart Institute • 80 specialized clinics • 150 outreach programs• Kentucky Children’s Hospital• Kentucky Neuroscience Institute Six Healthcare Colleges• Markey Cancer Center • Dentistry• Maternal-Fetal Medicine Program • Health Sciences• Orthopaedic Surgery & Sports Medicine • Medicine• UK Transplant Center • Nursing • Pharmacy • Public Health
  9. 9. Benchmark on Discharges UK HealthCare - Benchmarked against COTH Median Teaching Hospital10,200 9,200 8,200 7,200 6,200 5,200 4,200 Shaded area includes Good Samaritan & Chandler 3,200 2004 Q1 2004 Q3 2005 Q1 2005 Q3 2006 Q1 2006 Q3 2007 Q1 2007 Q3 2008 Q1 2008 Q3 2009 Q1 2009 Q3 2010 Q1 2010 Q3 2011 Q1 2011 Q3 2012 Q1 2012 Q3 UK HealthCare Median Teaching Hospital 75th Percentile Teaching Hospital 25th Percentile Teaching Hospital
  10. 10. Our Strategic Priorities IT will be a fundamental organizer inrelationship development and making improvements to care delivery. Michael Karpf, MD EVPHA, UK HealthCare June 2011
  11. 11. IT TransformationUsing World Class IT Attributes UK HealthCare, Lexington, Kentucky March 2013
  12. 12. 2009 Current State Assessment• Internal Data Collection/Information Gathering – Nov/Dec-08 Interview Summary – I.T. Staff Survey (73% Response Rate) – I.T. Senior Management Group Reviews – Walkthrough I.T. Areas – Feedback from Colleagues/Peers – Customer Satisfaction Survey• External Advisory Services – Review 2007 I.T. Assessment/Strategic Plan – Participated in Benchmarking – Analyze/Benchmark I.T. Structure
  13. 13. Current Healthcare IT Industry Trend Source: Healthcare Advisory Board, Innovation Center, 2010
  14. 14. The Challenges – Evolution of HIT Focus Decade Computing Type Billing 1960 Mainframe Clinical 1970 Minicomputer Billing/Clinical 1980 Computer for Masses Healthcare Reform 1990 Internet Healthcare Reform,ACO, Medical Home, 2000 to HIT Arrives etc. Today Source: Healthcare Information Systems, Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4
  15. 15. Conclusions of 2009 Current State Assessment (CSA) Customer IT Staff• I.T. is Critical to Success of UK • Silos/Lack of Teamwork HealthCare • Fragmented Org. Structure• Need “Enterprise” Focus & Integration • Confusing Roles & Resp.• Current Level of I.T. Services is • Lacking Tools & Methods Sub-Standard • Not Addressing Low Performers• Lacking Overall Strategies/Plan • Poor Communication• Upcoming Major I.T. Projects • Reactive/Not Proactive • Weak Infrastructure
  16. 16. Future State Needs – From 2009 CSA• Industry is Rapidly Transforming• I.T. is Critical to Success of UK HealthCare• Prepare to Meet Healthcare Industry Trends – Immediate Tactical Plans for Major I.T. Projects – Improved I.T. Governance – High Performing I.T. Function• Overall I.T. Vision, Strategies & Roadmap
  17. 17. I.T. Assessment Conclusions (Updated 2010) Focus Decade Computing Type Billing 1960 Mainframe Clinical 1970 Minicomputer Billing/Clinical 1980 Computer for Masses Healthcare Reform 1990 Internet Healthcare Reform, ACO, Medical Home, 2000 to HIT Arrives etc. Today Source: Healthcare Information Systems,Concept: Our Anticipated Focus Areas 2010 + Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4 Performance Excellence, Always On Improvement & Value Forecast 2010 + Computing Creation
  18. 18. Transformational ChangeDenial CommitmentConfusion TeamworkApathy SatisfactionNumbness Clear focus and plan“If I ignore this, it will go away.” “Sign me up!”“Yeah, right, they’ve said this Acceptancebefore.”Resistance ExplorationAnger & Fighting Brainstorming new ideasWithdrawal FrustrationCan’t sleep at night Have a lot to do“I gave my all and look what I Trouble focusingget.” Open to new things“I don’t like it.” “How can we do thingsLoss of morale, productivity and differently?”communication Source: Unknown
  19. 19. Transformational Change – “White to Blue” Totally Transform Our DNA:• Gradual Process• Allows Acclimation• Organized/Documented Transition• Walkthrough Changes Over Periods of Time• Repeated Messages & Themes• Learning Cycles
  20. 20. Transformational Change Directly Addressing the Tough Issues is the Work of Leadership•Maintaining Status Quo/Avoiding the Issues •Appears to be Easier in the Short Term •Outdated Job Descriptions •Lack of Infrastructure Investments •Immature Methods, Tools, Processes •Creates Very Difficult Long Term Issues •We Are Here •Very Uncomfortable•Leading Transformational Change is Very Hard Work
  21. 21. Transformational Change – Year One Roadmap Topic Current State First 4 Months Middle 4 Months Last 4 Months Future StateAcclimation New Employee • Orientation, SuperVISION • Meet Key Customers • Meet Key Customers • New Exec. Director Session Acclimated • Meet Key Customers • Tour/Visit Common Sep – Dec 2010 Conference Rooms & Buildings • Discuss How Obtain Health ServicesAssessment of Inconsistent • Review Operations, • Initial Recommendations • Obtain Approval for • Improvement Method asOperations, Methods & Policies & Procedures • Initial Goals Recommendations & Goals Std. Operations &Processes, Processes • Learn Current Processes, • Final Assessment • Road Map to World Class Measurement ScorecardMethods, Tools Methods, Tools • Draft of Performance I.T. Service Delivery • Scheduled Rounding • Clear & In-Depth Scorecard, Service Level • Final Performance with Key Customers Understanding of Current Agreements Scorecard • Professional IT State • Establish Rounding • Implement Rounding for Operations Methods • Assessment First Draft, Process & Schedule for Key Key Customers (ITIL, SLAs, etc.) Opportunities for Customers and Staff • World Class I.T. Service Improvement, Options- Delivery Pros-Cons-Recommend • Improve UK HealthCareHR Fragmented • Meet Staff • Market Wage Survey • Lean Training Program for • Organization Structure Structure, • Review Job Descriptions • Career Ladders Areas of Responsibility • HR Programs Unclear Roles & (JAQs), Roles & • Succession Plans • Improvement Method Responsibilities Responsibilities • Development Plans Development Program • Develop Organization • Lean Training • Internship Program Structure • Participate in Shaping I.T. RestructuringBudget Current Budget • Learn Capital & Operating • Identify Cost Savings • Implement Cost Savings • Cost Savings BudgetsProjects Projects • Review Key Projects • Work with PMO to Record • All Projects Managed Managed • Collect Inventory of all Projects in PMO Registry Through PMO & In PMO Differently to Projects in Area of Registry Varying Degrees Responsibility of Success
  22. 22. World Class IT Attributes • Service Strategies • IT Governance • World Class Attributes • Passport • IT StrategiesUsed by Permission; Corporate Executive Board, Key Attributes of the World-Class Information Technology Organization.
  23. 23. Add Reference
  24. 24. IT Transformation Using World Class AttributesUSING WORLD CLASS ATTRIBUTES:• Provides a Framework for a New Team• Creates a Common Language• Good Tool to Build TeamworkADDITIONAL COMMENTS:• This is One Approach• Other Frameworks Can Be Used• Pick Something & Stick With It
  25. 25. IT AlignmentUK HealthCare, Lexington, Kentucky March 2013
  26. 26. • Aligned ITSP Interview Teams with Org Chart• Questions: • Strategies • Activities • How Can IT Help?
  27. 27. Eight IT Strategies• Foundation for IT Approaches• Very Long Term
  28. 28. IT Strategic Plan• Service Strategies• IT Governance• World Class Attributes• Passport• IT Strategies
  29. 29. IT Strategic Plan• Service Strategies • Ambulatory Services Strategy • What Ambulatory Services is Doing • How IT Can Help
  30. 30. Benefits of IT AlignmentMAIN BENEFIT:• Ensure IT Investments are Directly Contributing to Medical & Business StrategiesADDITIONAL BENEFITS:• Align Strategic Plans (IT & Business)• Market Your IT Function• IT Governance Participation/Ownership
  31. 31. IT GovernancePrioritization Process UK HealthCare, Lexington, Kentucky March 2013
  32. 32. Add Reference
  33. 33. IT Governance IT Governance •World Class I.T. Service Delivery Physician IT Infrastructure &Project Priorities Data Warehouse Service Requests Advisory Security•Growth/Outreach •Data as Strategic •Usability •Usability •Always On•Unified Comm. Asset •EMR •Interoperability Computing •EMR MD Clinical Decision IMPACT (Improving Pt. Care Documentation Support Using IT)
  34. 34. ONEList – Demand Management
  35. 35. ONEList – Rate vs. Signature Metrics e n l lenc dati o e ty l enc p act Safe y Exce m enIT Exec. Council Rating: IT Governance Rating: xcel ienc th I m0 = No Impact L = Low l ity & re ecom ice E Effi c emi c1 = Little Impact M = Medium l Sco Gr ow3 = Moderate Impact C = Critical Qua Serv R Acad9 = Significant Impact Tota ITG# Ref Request Name 807 519 73 817 127 Totals by1 1 Patient Access & Registration/Revenue Cycle 9 9 0 9 9 362 40 Ambulatory EMR (Single Patient Record) 9 3 3 3 9 273 174 Central Telemetry monitoring (cockpit) 9 9 0 9 0 274 4 Closed Loop Barcode Med Administration 9 9 0 9 0 275 5 CPOE-OR-Co-Path/SCM 9 9 0 9 0 276 155 Intraoperative CPOE (SCM Orders to OR) 9 9 0 9 0 277 6 Intrapartum utilization of GE 9 9 0 9 0 278 193 BCMA-Bar Coded Medication Administration 9 9 0 9 0 279 181 Co-location Data Center Space 3 3 0 9 9 2410 14 Core Measure / NSI Hardwiring 9 3 3 9 0 2411 11 Develop Data Center Strategy 9 3 0 3 9 2412 3 Develop Integration Engine Strategy 9 3 0 9 3 2413 15 EMR Completion 9 3 3 9 0 2414 13 Order set clean up 9 3 3 9 0 24
  36. 36. ONEPage – Executive Summary How will requested item relate to signature metrics?
  37. 37. ITSP – How IT Can Help 10 Year Funding Model Project Name FY13 FY14 FY14 FY15 Single Patient Record $0 $0 $0 $0 Remote Clinic Access 0 100 100 100 Referring Physician Access 00 00 Clinic and Building Growth 0 250 250 250 Standardization of Clinic Systems 00 00 Practice Management System 00 00 Patient Access 00 0 500 Role-based System Access 00 00 Standardized Model Clinics 050 50 50 GRAND TOTAL $400 $400 $900 Sample Amounts
  38. 38. Benefits of IT Governance PrioritizationMAIN BENEFIT:• IT Governance Decides Which IT Investments Meet Medical and Business Strategies.ADDITIONAL BENEFITS:• IT Governance Participation/Ownership• Organize Approved/Unapproved Requests
  39. 39. ResultsUK HealthCare, Lexington, Kentucky March 2013
  40. 40. UK HealthCareIT Leadership Structure Assoc. V.P. & CIO CMIO Tim Tarnowski Carol Steltenkamp, MDJanuary 2013 I.T. Service Line Director - COM Steve Welch Architects: I.T. Portfolio Mgt Applications Technology Executive I.T. Security Director Informatics Executive Michelle Gerding Executive Director Executive Director Director Doug Fee Director Ben Nicholls Michelle Cassin Doris Miller Mark Eimer Cecilia Page Strategy Analyst: Vince Willoughby
  41. 41. UK HealthCareIT Leadership Structure Assoc. V.P. & CIO CMIO Tim Tarnowski Carol Steltenkamp, MDJanuary 2013 I.T. Service Line Director - COM Steve Welch Architects: I.T. Portfolio Mgt Applications Technology Executive I.T. Security Director Informatics Executive Michelle Gerding Executive Director Executive Director Director Doug Fee Director Ben Nicholls Michelle Cassin Doris Miller Mark Eimer Cecilia Page Strategy Analyst: Vince Willoughby Support (Apps, Tech, Security) Architecture Strategy & Stabilize Select & & Implement Optimize (Informatics) Transition (PMO) (All) Innovate (Innovation)
  42. 42. IT Team Composition All Staff 2009 All Staff 2010 All Staff 2011 2% 3% 6% 33% 65% 97% 94%Leadership 2009 Leadership 2010 Leadership 2011 17% 3% 3% 49% 48% 97% 83% UK HealthCare UK External
  43. 43. Results: IT Governance Top PrioritiesITG Top Priority 2009 2010 2011 2012 2013AssessmentIT TransformationNew HospitalCommunity Hosp.Ambulatory EMR Selection RolloutData Center Move AppsARRA/MUICD-10/Regulatory
  44. 44. http://ukhealthcare.uky.edu/IT/
  45. 45. Passport for Our Improvement Journey
  46. 46. Passport for Our Improvement Journey
  47. 47. UK HealthCare IT Capital Spend (2002 – 2012) & Forecast (2013 – 2023) (Figures in $000s) TCO Avg. $43M Capital Avg. $26M
  48. 48. Lessons Learned UK HealthCare, Lexington, Kentucky March 2013
  49. 49. Lessons Learned• Restructuring: – Does Not Equal Team Building – Challenge to Maintain Service Delivery While In Process – Need to Develop Common Language/Understanding• Customer Demand Always > IT Supply – Critical Success Factors are: • ONEList • Customers Prioritize Requests Against Signature Metrics• Customer Turnover Impacts Priorities• Over Communication is NOT Possible
  50. 50. Lessons Learned• IT Strategic Plan: – Help Areas Without Documented Strategies – Alignment is a Very Difficult & Repetitive Process• World Class Attributes – Multiple Years to Build – Establishes a Common Language/Understanding• IT is All About the TEAM
  51. 51. “Transformation without workand pain, without suffering,without a sense of loss is justan illusion of true change.” Source: Cross Roads, by William Paul Young
  52. 52. Thank You! Tim.Tarnowski@uky.eduVincent.Willoughby@uky.edu www.ukhealthcare.uky.eduwww.ukhealthcare.uky.edu/IT March 2013

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