Challenges and Successes in Implementing a Health IT Strategy

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Challenges and Successes inImplementing a Health
IT Strategy

• October 5th, 2006
• Rich Pollack M.S. CPHIMSS FHIMSS
• VP and CIO,
• VCU Health System

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Overview

• Planning Strategy
• 2003 Effort at VCUHS
• Effective Governance
• Competition for Capital
• Demand Management
• Internal IT barriers
• Communication
• Leadership Alignment
• 2006 Re-Visioning

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Strategic Planning Process

• Rich Pollack, MS CPHIMSS FHIMSSS

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Major components of an IT Strategic Plan

• Assessment
• Vision formulation
• IT implications of the vision
• Plan development

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Educate the key players on the need for and
possibilities resulting from a IT strategic
planning process
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1. Apply an accepted model such as CAM
(component alignment model)2. Create a set of
planning categories
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Expanded CAM Model
Assessment
InformationTechnologies
MedicalScientificAdvances
ExternalEnvironment
Non-controllable Components
Alignment
Controllable Components
Mission
OrganizationalInfrastructure and Processes
ITInfrastructure and Processes
Alignment
BusinessStrategy
IT Strategy
IT Strategic Plan
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Prototypical Planning Categories

• Mission, business strategy, organizational
  infrastructure, external environment
• Risk partners
• IT infrastructure and emerging information
  technologies
• Patients, family and the community
• Providers
• Education and research

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Perform the assessment phase

• Utilize subcommittees to organize and document
  information within the planning categories
• Gather information through administration of
  questionnaires and interviews, as needed

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Develop a Vision of the Future

• Utilize the subcommittees to organize information
  within the planning categories
• Key Foci
• Expanding the market segment through closer
  linkages with physicians facilitated by
  technology
• Offer the patient community concierge level
  convenience via unique web portals, IVR and other
  patient centered innovations. Embrace the coming
  tide of consumer-directed healthcare
• Understand the bottlenecks and redundancy in the
  patient flow process. How can a workflow enabled
  EMR break through those?
• Enhancement of the revenue cycle as a byproduct
  of improved on-line documentation

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Develop a Vision for the Future

• Key Foci (cont.)
• Could an EMR and CPOE make a significant and
  measurable contribution to crafting a high
  quality high safety patient environment?
• Detail the productivity to be gained by new
  mobile communication tools like Vocera, RFID
  tagging and Blackberrys
• Is there a need and support for using data mining
  to analyze practice variation and the effective
  use of order sets and protocols
• Determine what level of system availability is
  required for the critical clinical systems
  measured against the corresponding infrastructure
  costs

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Specify the I.T. implications of the Vision

• ?

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Consider the possibilities of process
redefinition and re-engineering in conjuncture
with I.T. deployment

• Referral
• Registration
• Scheduling
• Intake
• Diagnosis/treatment
• Order entry/results reporting
• Etc.

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Develop the Plan

• Tactical objectives
• Timeframes
• Resource requirements
• Financial requirements
• Value to be received
• Prioritization and demand management process

• Current and future environments
• Current application portfolio
• I.T. governance and organizational structure
• Strategic goals
• Strategic objectives

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DRAFT

• Summary of the IT Strategic Plan
• November 17, 2003

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• VCUHS has been an industry leader in its use of
  Information Technology, with automation support
  for virtually every function.
• At this point, many of the key clinical,
  financial and administrative systems are reaching
  end of life and must be replaced.
• The purpose of the IT Strategic Planning process
  is to develop a plan for the use of Information
  Technology over the next three years. It will
  define
• How IT will be managed
• What technologies will be deployed to support
  VCUHS needs
• The Strategic Plan will help to ensure that the
  greatest value is gained from VCUHS IT
  investments.

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VCUHS IT Governanceand Demand Management
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IT Governance Structure
The first step in any IT planning and budgeting
is defining the governance structure that will
manage the process. The major components of the
proposed IT Governance structure are illustrated
below
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IT Governance Capital Budgeting and Department
Specific IT Projects

• Departmental projects will affect the VCUHS IT
  operational or technical environment, and are
  likely to need central IT resources to implement,
  integrate and support their initiatives.
• These projects should follow the same approval
  process as an IT capital project, with early
  central IT involvement to review the requirements
  of the new system, regardless of the source(s)
  for capital funding.
• The new IT Governance process with its focus on
  customer service should alleviate departmental
  concerns about central ITs involvement.
• In addition, the IT Steering Committee will
  provide a forum for discussing departmental
  initiatives and their impact on VCUHS as a whole.

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VCUHS IT Governance IT Steering Committee
IT Steering Committee During the Visioning
Session, participants developed a set of
guidelines for the IT Steering Committee that
will confirm its central role in IT Planning and
Budgeting. The guidelines include

• Membership
• VCUHS, MCVP, Faculty, Research, VCU, School of
  Medicine, Active Working Group Representation
• Appointed by VCUHS Executive Management/CEO

• Responsibilities
• Has final authority for IT project approval
• Implements the IT Vision and Guiding Principles
• Develops IT project prioritization process and
  resolves conflicting priorities
• Ensures appropriate focus on Clinical, Research
  and Education initiatives
• Reviews strategic initiatives and associated
  business cases
• Approves and allocates annual IT Capital and
  Operating Budgets
• Endorses initiative staffing and other resource
  allocations
• Monitors progress and communicates IT activities
  to the VCUHS organization

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Competition for Capital

1. New construction and renovation
2. Replacement of clinical equipment (beds,
   monitors, Xray etc)
3. Investment in I.T.

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Applying Resource Demand Management
Resource Saturation

• Determine estimated resources
• required to implement each project
• Apply resource estimates
• beginning at the top of the
• prioritized list and continuing
• thru full (reasonable)
• consumption of
• resources and somewhat beyond
• Present prioritized list with resource demand
  management

Resources


of Projects
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Project Prioritization Components
Process
Key Components
Prioritization Level
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Resource Demand Management Applied to Prioritized
List
Resource Available
Example
Nearing saturation could experience
availability issues
Insufficient resources
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System Development and Review Process
Identify System Initiative
Assess Feasibility Cost/Benefits
Conduct Project Review
Add to IT Plan
Initiate Project

• Department and IT must jointly evaluate all
  projects to ensure that needed integration and
  network connectivity will be available and that
  on-going support needs are budgeted

• To commence a project
• User department management must be committed as
  project sponsors
• IT and user staff must be available
• Funds must be available

• The ITSC will add projects to the IT Strategic
  Plan only upon the committees approval

• Initiatives are submitted for review to the IT
  Steering Committee (ITSC) via a formal request
  process

• IT and the user departments share responsibility
  for identifying systems initiatives

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Demand Management Process

• Recommended thresholds for Steering Committee
  approval

Cost gt 100,000?
New Projects

• Requires
• gt6 man-months
• of Central IT
• staff support?

No
Requires Interfaces?
No
Introduces a cross- departmental System?
No
Yes
No
Yes
Yes
Yes
Has similar functionality to an existing system?
Requires network connectivity and/or wide
availability across the institution?
No
Initiative must be funded from disposable IT or
departmental funds
No
Yes
Yes
Annual Departmental Capital Budgets

• Initiative presented to Steering Committee for
  review and approval
• Informational copy of Capital Budget presented to
  Steering Committee

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VCUHS IT Vision

• The VCUHS Information Technology organization
  views data as a strategic asset and is committed
  to providing information that is accurate,
  timely, secure, and available to those who need
  it.
• Electronic Medical Record Improve Patient Safety
  by providing advanced clinical systems and an
  Electronic Medical Record for the VCUHS
  physicians and clinicians.
• Access Support ready access to appropriate
  information for patients, clinicians, employees,
  and management.
• Operational Support Provide information systems
  that support the clinical and business functions
  of VCUHS for efficient operations, performance
  improvement, and financial viability.
• Research and Education Support the patient care,
  research and educational goals of the VCU
  community.
• Connectivity Provide the framework,
  infrastructure, and standards for secure, high
  speed access, processing, and communications.

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I have seen the enemy, and he is us !(Walt
Kelly, in the comic strip Pogo)
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Recognize and address the internal ITbarriers

• Immature project management skills, process and
  organization
• Weak infrastructure rocky foundation
• Lack of vendor commitment and involvement MIA
  syndrome
• Inwardly focused and insular need to look
  outside for ideas and solutions
• HIMSS, Gartner, Advisory Board etc
• Trade press, white papers, vendors, consultants
• Networking with other provider organizations

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Communicate the plan and build support

• And constantly update it (living document)!

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The Electronic Medical Record (EMR)
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Year 2006

• Progress Notes HPs
• Transcribed Documentation (Non Medquest)
• Nursing Assessments Documentation
• Research Documentation
• Printed Results Endoscopy, Vascular, Heart
  Station, Peds Pulmonary
• IPOC
• Referral Letters/Consult Notes
• Flowsheets Vital Signs IO
• Consents Operative Notes
• Discharge Summaries

• Patient Demographics
• Laboratory Results
• Radiology Diagnostic Imaging Results - (Stentor)
• Transcription Results (Medquest Dragon)
• Operative Notes/ Discharge Summaries
• Limited Notes (Voice to Text Dictation)
• Cardiac Cath Pulmonary Lab Results
• Orders
• Ambulatory Labs, Radiology, Admit
• Inpatient - All
• Easyscript
• Caresets Practice Guidelines
• Medication Documentation - Inpatient
• Patient Education Discharge Information
• Allergies, Heights, Weights
• Problem Procedure Lists
• Dietician, Social Work Respiratory Therapy
  Notes
• OR Process Redesign

40 of key chart components on-line
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Year 2007

• Research Documentation
• Flowsheets Vital signs and I O
• Consents
• Printed Results Heart Station
• Miscellaneous Documents

• Patient Demographics
• Laboratory Results
• Diagnostic Imaging Results - (Stentor)
• Transcription Results (Medquest)
• Operative Notes
• Discharge Summaries
• Cardiac Cath Results
• Orders
• Ambulatory -All
• Inpatient - All
• Easyscript
• Caresets Practice Guidelines
• Medication Documentation - Inpatient
• Patient Education Discharge Information
• Dietician Notes
• Social Work Notes
• Respiratory Therapy Notes
• OT/PT/RT Notes
• Ambulatory EHR Phase 1

60 of key chart components on-line

• Progress Notes HPs
• Transcribed Documentation (Non Medquest)
• Nursing Assessments Documentation
• IPOC
• Referral Letters/Consult Notes
• Anesthesia/Operative Reports

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Year 2008

• Patient Demographics
• Laboratory Results
• Diagnostic Imaging Results - (Stentor)
• Transcription Results (Medquest)
• Operative Notes
• Discharge Summaries
• Cardiac Cath Results
• Orders
• Ambulatory -All
• Inpatient - All
• Easyscript
• Caresets Practice Guidelines
• Medication Documentation Inpt Outpatient
• Patient Education Discharge Information
• Nurse Physician Documentation
• Dietician, Social Work, Respiratory Therapy,
  OT/PT/RT Notes
• Interdisciplinary Plan of Care (IPOC)
• Ambulatory Phase 1
• Ambulatory Visit Consult Notes

75 of key chart components on-line

• Miscellaneous Documents
• Research Documentation

• Printed Results Heart Station
• Flowsheets Vital Signs IO
• Consents

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Year 2009 Beyond

• Patient Demographics
• Laboratory Results
• Diagnostic Imaging Results - (Stentor)
• Transcription Results (Medquest)
• Operative Notes
• Discharge Summaries
• Cardiac Cath Results
• Orders
• Ambulatory -All
• Inpatient - All
• Easyscript
• Caresets Practice Guidelines
• Medication Documentation Inpatient
  Outpatient
• Patient Education Discharge Information
• Nurse Physician Documentation
• Dietician, Social Work, Respiratory Therapy,
  OT/PT/RT Notes
• Interdisciplinary Plan of Care (IPOC)
• Ambulatory Rules Alerts
• Ambulatory Visit Consult Notes

• Research Documentation
• Miscellaneous Documents

95 of key chart components on-line
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Align the Leadership and build support

• Why is getting to an agreed strategy so hard?

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Leadership Alignment

• Seize educational moments with individual
  leaders or groups correct mis-perceptions
• Provide honest and consistent message
• Create an atmosphere of trust and transparency
• Search for common ground
• Control expectations or theyll control you
• Pursue small wins along the way to establish
  credibility

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Unrealistic Expectations
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Re-Visioning Summer 2006

• A cross section of 5 senior clinical leaders
  engage in an off-site retreat facilitated by the
  CIO
• Used a vendor best practice site visit as the
  catalyst for direction setting
• Evaluated remaining EMR initiatives for
  importance and effort
• Positioned those initiatives across a 3 year
  planning horizon