Read Slide 1 text version

Implementing Electronic Health Records

May 20, 2011

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Objectives

· Describe Bon Secours and ConnectCare · Discuss ConnectCare accomplishments and alignment with BSHSI strategic goals · Discuss rollout methodology, timeline, and structure · Discuss implementation lessons learned

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Objectives

· Describe Bon Secours and ConnectCare · Discuss ConnectCare accomplishments and alignment with BSHSI strategic goals · Discuss rollout methodology, timeline, and structure · Discuss implementation lessons learned

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Bon Secours Health System Inc.

The Mission of Bon Secours Health System is to bring compassion to health care and to be Good Help to Those in Need®, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church.

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Bon Secours Health System Inc.

Headquartered in Marriottsville, Maryland, Bon Secours Health System is a $2.9 billion not-for-profit Catholic health system that owns, manages or joint ventures 18 acutecare hospitals, one psychiatric hospital, five nursing care facilities, four assisted living facilities and 14 home care and hospice programs. More than 21,000 Bon Secours employees help people in seven states, primarily on the East Coast.

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In 2006....

Bon Secours Health System committed to the Implementation of ConnectCare (CC)

ConnectCare was identified as one of the key strategies to achieve the goal ,,delivering clinical excellence

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In the beginning

The focus of the ConnectCare implementation was considered to be the build and rollout of an inpatient record and the build out of an ambulatory electronic medical record.

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ConnectCare is more than an EMR

DIAGNOSTIC CENTER CLINIC HOME

PROCEDURE CENTER

PRE-HOSPITAL

ACUTE CARE HOSPITAL POST ACUTE CARE HOME

ConnectCare is the infrastructure that connects our patients and providers across the continuum

Epic remains the number one ranked KLAS EMR System

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Original Plan

$150 Million over five years

· · · · · · · · · ·

Pharmacy w/bar coding Inpatient Documentation Inpatient Orders Limited HIM functionality Clinical Documentation Computerized Physician Order Entry Ambulatory Record (build only) Document Management ASAP/ED Clinical Data Repository

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Expansion of Scope

· · · · · · · · · · · · Revenue Cycle ($26 M) Ambulatory ($13 M) Revenue Cycle complexities ($9 M) MyChart (Patient Portal) EPIC CareLink (Portal for non-credentialed providers) Optime (OR) Radiant (Radiology) Care Everywhere (Integration with other Epic CIS) Stork (OB) Beacon (Oncology) Capsule (Integration w/medical devices) Kiosks (Richmond Check-in)

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Projects, Upgrades, and Enhancements

· In addition to the expanded scope we have taken;

­ Two Major Epic Upgrades ­ Preparing to take Epic 2010 Upgrade in January 2012 ­ 1,031 enhancements from Local Markets completed (1,408 requested) ­ 65 Project requests from Local Markets (17 completed)

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Care Everywhere MyChart Activations

Supporting Medical Home Model Framework for interoperability

EpicCare Link

Enabling read only access to Independent referring physicians

Inpatient & Ambulatory Record

Bon Secours Health System Connections

Revenue Cycle

The "I" Connection

Iphone, Ipad, Ipod

Registries

Improving Health Status Building Volumes and Market Share

Independent Physician Record

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ConnectCare is now live in:

·South Carolina

·Virginia

·New York

·Kentucky

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Objectives

· Describe Bon Secours and ConnectCare · Discuss ConnectCare accomplishments and alignment with BSHSI strategic goals · Discuss rollout methodology, timeline, and structure · Discuss implementation lessons learned

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"I urge lower costs without harming any hair on any patient's head. It's a stark, clear reality...Our healthcare system, in its current form, is not up to that job. We cannot, with our current system of care, give Americans the care that they need and want and deserve." Donald Berwick, MD Director, Center for Medicare & Medicaid

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The maturity and use of the CC inpatient record has allowed us to achieve HIMSS Stage 6 status, which puts us in the top 4.5% of US Hospitals

­ Benefits are being realized ­ Created the clinical and operational infrastructure for the future

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Lessons learned from other stage six health systems

· As Stage 6 hospitals become more experienced and proficient with their EMR applications, they will achieve even greater benefits and value · Once Stage 6 is accomplished, IT budgets are transformed (become lower). But hospitals still implementing major EMR applications require much higher capital to extend the EMR capabilities. · We are currently at the peak of the lifecycle costs for our systems. We are supporting the old systems, and building, implementing, supporting the new system. · Average ratio of IT capital to IT operating budget for Stage 6 hospitals is 30% post implementation * · The average duration for all facilities to achieve Stage 6 starting from the EMR launch was seven years.

* During implementation, we are 50% range

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Connecting with our employed physicians

· Bon Secours Employed Physicians

­ 200 physicians budgeted ­ 280 physicians will be live on ConnectCare at fiscal year end

· Delivering better value with improved care and lower costs:

­ ­ ­ ­ ­ ­ Reduced transcription costs Reduced duplicate orders E-prescribing incentives (2% of Medicare payments for 2010) Improved coding Decreased risk of medication errors Efficiencies driven by electronic refills and appointments via MyChart

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Connecting with our independent physicians

· ConnectCare is expanding to our communities' independent physicians

­ Independent EMR pilot June 2011

· Bon Secours Richmond clinical data is available to community physicians through the MedVirginia portal · In the near future we will be able to connect with community physicians via record exchange through Care Everywhere · Paper-based and non-affiliated physicians can connect via EpicCare link which provides read only access to independent referring physicians

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Connecting with our patients

· Through MyChart patients have controlled access to the same medical information their providers use. The self-serve functionality reduces costs and increases satisfaction ­ 13,421 MyChart Patients Activated as of April 13, 2011 · This functionality is essential for us to meet our commitment to accountable care. · In order to be successful patients must take an active role in their care and have a means to do so. · To be successful our physician networks need to provide preventative healthcare.

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ConnectCare supports Long-Term Strategy

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With all that has been accomplished since 2006, are we achieving our SQP Goals?

You bet....

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Ambulatory Benefit Realization Metric Results - 2011

ConnectCare Ambulatory Dashboard LIVE PRACTICES, LOCATIONS, and PROVIDERS MARCH 2011

Medical Home Model/ConnectCare Early Benefits Reductions in No Show Rates at Medical Home Practices RN Navigator & Reduced Readmissions seen for: CHF GI Bleed Pneumonia RN Navigator Activity: 11/10 ­ 2/11

Market

Hampton Roads Kentucky Richmond Totals:

# Practices

13 5 35 53

# Locations

17 5 49 71

# Providers

44 16 141 201

MYCHART UTILIZATION : 12,809 Active Users (March 2011) 11,624 Active Users (December 2010) 3,047 Active Users (July 2010) 250 Active Users (March 2010)

E-PRESCRIBING: 83,790 prescriptions/194 providers (March 2011) 65,333 prescriptions/150 providers (December 2010) 55,000 prescriptions/123 providers (July 2010) ERx Bonus: 2% of Medicare payments for FY10

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A Real Success Story

Since the initial go-live in 2008, look at what St. Francis Greenville has accomplished...

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Greenville Benefits Realized

Mortality and Complication Rate Trending

2.50% 1.99% 2.00% 1.78% 1.60% 1.50% 1.57% 1.27% 1.15% 1.18%

8.00% 7.80% 7.76% 7.72%

Readmission Rate

1.88%

7.60% 7.40% 7.20% 6.95% 7.00% 6.80% 7.52%

1.00%

0.50%

6.60% 6.40%

0.00% Mortality Rate Jan-Dec 2007 Jan-Dec 2008 Jan-Dec 2009 Complication Rate Jan-Aug 2010

Jan-Dec 2007

Jan-Dec 2008

Jan-Dec 2009

Jan-Aug 2010

Readmission Rate

Physician Engagement

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Percentile in Respective Database

98 96 94 92 90 88 86 FY07 Place to Practice Medicine FY08 Quality of Care (PRC) FY09 FY10

Overall MD Engagement (Gallup)

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Greenville Benefits Realized

Variable Cost/Case Trending

$5,800 $5,700 $5,600 $5,500 $5,400 $5,300 $5,200 $5,100 $5,000 $4,900 $4,800 $4,700 Jan-Dec 2007 Jan-Dec 2008 Jan-Dec 2009 Jan-Aug 2010 3.90 3.80 Jan-Dec 2007 Jan-Dec 2008 ALOS Jan-Dec 2009 Jan-Aug 2010 4.40 4.60

ALOS Trending

4.54 4.44

$5,663

4.50

$5,427

Days

4.30 4.20 4.10

$5,097 $5,051

4.15 4.06

4.00

Variable Cost/Case

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Summary of Greenville Benefits Realized*

· ED net revenue per visit increase of $200

­ SFD 45,000 visits FY10 ­ SFE 35,000 visits FY10

· Mortality and complications have declined (21% and 37% respectively) · Adjusted length of stay down 10.6% · Variable cost/case has decreased more than $600 · Readmission rates declined 7.6% · Medication errors decreased · Physician satisfaction remained high · Through March, Operating Margin is exceeding both budget and prior year performance. Actual YTD is 55% better than budget and 102% better than prior year.

* Appendix B

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Other benefits

· Savings from elimination of legacy systems - $6M+ per year · Meaningful Use payments

­ $13M in FY11 ­ $90M overall

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Registry Care 2010-2011

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Potential Mammograms

· Number of unique women seen ages 50-74: 31,438 · Total ordered:10,702 · Total resulted in CCare:9,587 · Number of mammograms potentially missed: 21,851 · Hypothetical screening of 20,000 results in ~200 CA diagnosis

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Diabetic Patient Follow-up Appointments

· Total poorly controlled diabetics:13,519 · Total missed quarterly follow up:10,994 (81%)

· Diabetic defined as having DM on problem list. Poor control defined as a A1C>7, BMI>35, BP>140/90, or LDL>100 · # uncontrolled DM patients by problem list: 8,890 · # patients with A1c>7 with or without DM on problem list: 18,693

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Objectives

· Describe Bon Secours and ConnectCare · Discuss ConnectCare accomplishments and alignment with BSHSI strategic goals · Discuss rollout methodology, timeline, and structure · Discuss implementation lessons learned

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Guiding Principles

· We shall ...

­ make decisions that are patient-centric, improve quality and safety, and enhance the patient/caregiver experience. ­ commit to standardization so that system-wide benefits will be realized. ­ adopt leading clinical practices based on evidence and national practice standards. ­ be appropriately involved and accountable for the transformation required to achieve a successful implementation. ­ dedicate the necessary resources to support an optimized system for sustainable transformation to achieve the best patient experience.

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Focused Design ("DBVs")

Prep Session

Determine the right session structure to facilitate discussion, identify the right participants and collect the right tools (i.e. current state workflows, forms, order sets etc) Design future state workflows Design build content Facilitate discussions to ensure strong decisions are made Document all decisions, issues, open items and training points Review "what worked" and "what needs to be done differently" for the next sessions Validate content and/or build with participants Structure and communicate decisions Build content into system Write test scripts Test scenarios and confirm expected results Finalize future workflows and decision templates

Follow Up

Analyze

Build

...repeat as often as needed

Validate

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DBV Progression integrated, and DBV sessions begin more broadly focused and highly

progress to more application specific topics.

Highly Integrated Application Specific

Integrated Topics · Some topics cross more than one application and need a more diverse group to discuss, design and make decisions · Examples of Integrated Topics and "who" would be involved in the DBV Session:

­ Allergies · Clin Doc, Orders, ED, ADT, HIM, OpTime, Epic Rx, Ambulatory Teams involved (one of these teams would take the lead on preparing and leading the discussion) Advance Directives & Consents · Clin Doc, Orders, ED, ADT, HIM, OpTime, Epic Rx, Ambulatory Teams involved (one of these teams would take the lead on preparing and leading the discussion)

Application Specific Topics · Some topics are more specific to an application and require a more focused group of participants to discuss, design and make decisions · Examples of Application Specific Topics and "who" would be involved in the DBV Session:

­ Nursing Documentation (i.e. Initial Assessment, Sign Out Reports, Flowsheets) · RN's from specialty areas, ED, OpTime · May include RT Payment Posting · Billing Office · Corporate Accounting

­

­

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DBV Participants

Each Local System will identify their "Subject Matter Experts" in the DBV sessions....

· Qualifications: ­ Broad understanding of current clinical practices and processes ­ Regarded as leaders among peers · Comfortable representing general opinions of clinician/end-user community · Trusted by peers to act as representative ­ "Out of the box" thinkers Expectations: ­ Actively Participate in DBV sessions as assigned ­ Actively Participate in workflow redesign

·

­

­ ­ ­ ­ ­ ­ ­

Actively Participate in design of build and content

Available for consultation and validation on off weeks (non-DBV session weeks) Communicates with peers in home hospital/site to obtain collaborative decisions, manages and follows-up on any assigned issues Brings knowledge of decisions to sites Serve as a "voice" for your department, specialties, or service area Participate in training development, including script development, review and content development Support site go-lives Own and support the decisions made in the Collaborative DBV's

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Iterative Design Approach Progression

Iterative Design Sessions ­ Workflow and SpecialtyBuild Focused: Foundation Design Sessions

Integrated Topics Across Teams Sessions fully/partially integrated as required by topic

Integrated System/Process Validation and Testing

· Clinical Scenario Workflows Validation · Integrated System Testing

Scheduling ADT/Reg Order Entry

Documentation & Content

HIM Radiology

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Apr-07

Jul-07

Oct-07

Jan-08

BSHSI ­ Enterprise Foundation Build for Clinical Applications

Implementation Roll-out Schedule

Apr-08 Jul 08 Oct 08 Jan 09 Apr 09 Jul 09 Oct 09 Jan 10 Apr 10 Jul 10 Oct 10 Jan 11 Apr 11 Jul 11 Oct 11 Jan 12 Apr 12 Jul 12 Oct 12 Jan 13

Apr 13

Jul 13

Oct 13

Ambulatory Pilot Richmond

-live t Go Pilo Live R CD

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Richmond Ambulatory Rollouts

Ambulatory Pilot Hampton Roads

Go IV Ph live

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Hampton Rds Ambulatory Rollouts

St. Francis Greenville

Ambulatory Pilot NY Charity

Apr 1 2010

-liv Go III Ph

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e -liv t Go Pilo ive RL

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Memorial Regional Medical Center Richmond Community Hospital Ent. Build for Rev Cycle

Richmond Acute Rollouts

Upgrade to Summer 2009

St. Marys Hospital

Aug 2010 Nov 2010 Mary Immaculate Mar 2011 Maryview Jul 2011 DePaul Oct 2011 Mar 2012 St. Anthony Jul 2012 Oct 2012

St. Francis

Hampton Roads Acute Rollouts

Upgrade to Summer 2010

Good Sam

Local Systems

New York Charity Acute Rollouts

Baltimore Charity Hampton Roads Kentucky

Ambulatory Michigan

BS Community

2007 - 2013

ConnectCare Rollout Plan

Updated 07-09-09

Upgrade to Summer 2011

Kentucky Acute Rollout

Our Lady of Bellefonte

Mar 2013 Jul 2013

Baltimore Upgrade to Summer 2012

Richmond South Carolina

St. Francis Greenville

Oct 2013

TODAY

Apr 07

Jul 07

Oct 07

Jan 08

Apr 08

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High-Level Roll-out Schedule

Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11

CD

e liv otG lo Pi ive L R

Ambulatory Pilot Richmond BSHSI ­ Enterprise Foundation Build for Clinical Applications

Continued Richmond Ambulatory Rollouts

Ambulatory Pilot Hampton Roads

CD

liv otG lo Pi Live R e

Continued Hampton Roads Amb Rollouts

Ph

Ph

IV Ph -live Go

CD R ve -li Go

St. Francis Greenville

ve -li Go II

ve -li Go III

e -liv Go lot Pi

Memorial Regional Medical Center

Local System

Richmond Community Hospital

Baltimore Charity Hampton Roads

Enterprise Build for Rev Cycle

e liv oG

Kentucky

Ambulatory Michigan

St. Marys Hospital

Richmond South Carolina

Upgrade to Spring 2008 Completed Upgrade to Summer 2009

ve -li Go

St. Francis

ConnectCare Rollout Plan

06-01-09

DRAFT

TODAY

Apr-07

Jul-07

Oct-07

Jan-08

Apr-08

Jul-08

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Jan-09

Apr-09

Jul-09

Oct-09

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Jan-11

Apr-11

Jul-11

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ConnectCare Team

Facility Executive Team ConnectCare BSHSI Leadership Team (Enterprise)

Executive Sponsors

Facility ConnectCare Coordinators Steering Committee Workgroup Team Leads

ConnectCare

Project Director

Bon Secours Virginia ConnectCare Team

ConnectCare BSHSI (Enterprise) Team

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The BSV Core Work Groups

Information Technology

Facility Construction Staffing/Training

Clinical Workflow

Communications

Physician Adoption

Clinical Content

Revenue Cycle

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ConnectCare Navigation Chart

January February / March April / May

Project & Facility Org Structure

Physician Adoption and VPMA Strategy & Planning

Construction & Device Walk-thru Validations

Preliminary Scope Analysis

Kick-off

Steering Committee & Workgroups Begin

Scope by Dept & Site Visits

Knowledge Transfer Summits (Clinical & Rev Cycle)

Leadership Workshop #1 Understanding the Journey

Initiation and Planning Activities

January December / November / October September / August

Facility Demo Days Begin Leadership Workshop #3 Preparing the Staff

Physician On-Line Training Available

Physician & Staff Training Begins

Credentialed Trainer Training Begins

Class Reg. in HealthStream Begins

Computer & Device Installations Begin

SU , CT & Physician Kick-offs

Physician Ambassador Workshop ­ Understanding the Journey

Job Roles, Functions and Description Reviews Begin

Leadership Workshop #2 Staffing/ Training

Leadership Workshop #4 Key Workflows

Training Go-Live Readiness

Draft

User Acceptance Testing Leadership Workshops Getting Ready for Go-Live Weekly Series Login Days & Dress Rehearsals

Engagement 45 ­ 90+ days post Go-Live

Leadership Workshop #5 Revenue Cycle/ Charging

Clinical & Operational Department Simulations

Computer, Device and Access Validations

March

Go-Live

Support and Stabilization Phase (4-6 Weeks)

April

Optimization Phase Begins

May

Draft

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Readiness Checklist

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Objectives

· Describe Bon Secours and ConnectCare · Discuss ConnectCare accomplishments and alignment with BSHSI strategic goals · Discuss rollout methodology, timeline, and structure · Discuss implementation lessons learned

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BSR Lessons Learned

· · · Strong Executive Leadership commitment, support, and consistent involvement is key to success Agreement and Commitment to a blended market and facility based implementation strategy and approach Clear understanding and definition of departmental scope ­ roles and responsibilities, particularly with registration and charging, clear understanding of handoff process e.g. PAT/ OR scheduling

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BSR Lessons Learned (Cont...)

· Departments and units that are most successful, emphasized the importance of end-user participation in all additional/alternative training strategies More attention and emphasis on complex and strategic workflows, i.e. phases of care Strong commitment to a blended staff and physician training model that includes completion of online learning, classroom and specialty based training

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·

·

BSR Lessons Learned (Cont...)

· Provide a proactive support model ­ 1 on 1 support, physician peer group support, support staff that are MDs Validation of all printing and adequate hardware deployment in advance of go live enhances the success of go-live Adoption of ConnectCare is more effective and occurs sooner in areas that have skilled zone coverage support and where workflows are well understood

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·

·

Enterprise Lessons Learned

·

· ·

Scope Change management

Better structured to manage new functionality Not as well prepared to manage new locations

· · · ·

·

Meaningful Use adjustments Pay it forward ­ i.e., printing expertise Security complexities ­ roles, processes Clinical Transformation for optimization

Stalling of benefit realization without infrastructure

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Long Term Support: Epic Lessons Learned

· Business and operational involvement is inversely proportional to application support needs · Clinical applications require a higher level of support than non-clinical applications · As geographic disparity increases so will your staffing numbers · Support staff need to have project management skills in addition to technical or clinical backgrounds

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Effective implementation in a challenging fiscal environment

·Drive to focused benefit realization ·Recommit to standardized design, build, and implementation · Inpatient, employed ambulatory, independent ambulatory · Roll-out schedule · Leaner and meaner · Lower support & training/user ratios · Self reliance · Minimize use of consultants · Inter-LS support · Local market credentialed trainers and super users ·Physician Support Model

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Five Stages of Benefit Realization

Stage I: Prepare for Success Stage II: Turn On Bedrock Functionality Stage III: Integration "Go-Live" Stage IV: Optimization Stage V: Transformation

Driving utilization of physician order sets & nursing protocols while understanding workflows.

2010 Kentucky Baltimore Charity

One clinical data repository to enable one patient ­ one record

Starting to use ConnectCare.

Molding what we do currently into the best it can be.

Reaching a new level of excellence

Charity Hampton Roads

BS Richmond

St. Francis - SC

2011

Kentucky Baltimore

Charity Hampton Roads

Kentucky Baltimore

BS Richmond

St. Francis - SC

2012

Charity Hampton Roads

BS Richmond

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The Benefits Journey has just Begun

The drive to improvement requires a partnership between the Local Markets and the Enterprise and an understanding that driving benefits requires dedicated resources and focus

The partnership has begun...

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Clinical Informatics

Our Bridge to Achieve the Extraordinary Experience of Care

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Progression towards transformation focused informatics strategy

Planned Optimization

Implementation

Transformation

Clinical-Business Intelligence Strategy

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Informatics Partnership Model

Collaborate to Accelerate Transformation

Local System Executive Leaders and Boards

BQIC and EMT

BSHSI Clinical Operations Steering Committee

BSHSI Clinical Collaborative

Informatics Partnership

Local Market Informatics/ Transformation Steering Committees

System Wide Learning Communities

Critical Work from EMT/Board/SQP

Learning Communities

Clinical LS Service Transformation Line work Metrics

Clinical-Business Intelligence Team Data Analytics, Data Validation, Reporting Standards (Under Development)

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ConnectCare Implementation Schedule

Sequential Timeline

Revised 3/2/2011

Oct-10 Jan-11 Apr-11 Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13

SF-Rich

Mar 2011 OLBH July 2011 2010 Upgrade Jan 2012

Radiology Sunset Date and Radiant Rollout begins with Hampton Roads

Mary Immaculate & Radiant begins

April 2012

Maryview/HV

DePaul/VB

Nov 2012

Good Sam ASAP

Feb 2011

Good Samaritan

Jan 2013 St. A BSCH

Local System

Baltimore Charity Hampton Roads Kentucky Michigan Ambulatory Richmond South Carolina

June 2013

Baltimore

Sept/ Oct 2013 Sept 2013

St. Francis (rev cycle & Radiant)

Va. Practices ­ GO Live 26 phy Ky Practices GO Live­ 23 phy Va. Practices Go Live ­ 34 phy Ky Practices GO Live ­ 14 phy

Va. Practices Go Live­ 35 phy Ky Practices GO Live­ 23 phy

Independent Pilot ­ 5 phy

ICD10 Go Live and Support Starts

Oct-13

Aug 2012

Oct-10

Jan-11

Apr-11

Jul-11

Oct-11

Jan-12

Apr-12

Jul-12

Oct-12

Jan-13

Apr-13

Jul-13

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Questions?

Laishy Williams-Carlson [email protected]

Jeff Pearson [email protected]

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