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April 11, 2005 The information herein is confidential and proprietary to INFOHEALTH Management Corp. 1

Providing IT solutions to the healthcare industry.

We manage healthcare with you.

111 E. Wacker Drive, Suite 1050

Chicago, IL 60601

p: 312.321.1638

f: 312.321.0128

www.infohealth.net

Journey Through a Legacy System Landscape

Mark A. FarrowMark A. FarrowDirector, Information & Communication Technologies, HHSDirector, Information & Communication Technologies, HHS

Account DirectorAccount Director


Our family of hospitals

Hamilton General Hospital Henderson General Hospital Chedoke Hospital McMaster University Medical Centre McMaster Children’s Hospital Juravinski Regional Cancer Centre

All brought together by a series of mergersAll brought together by a series of mergers


The region we serve

South Central Ontario


HHS At-a-glance

Number of Beds: 1,039 ER visits: 107,587 Admissions: 41,089 Cancer Clinic

– Number of new patients per year: 7,000– Active patients receiving care: 18,000– Outpatient Visits per year: 180,000


Major Programs and Services

Cardiac and Vascular Program

Neurosciences and Trauma Program

Digestive Diseases High-risk Obstetrics and

gynecology Paediatrics Acquired Brain Injury Prosthetics and Orthotics Children’s Exercise and

Nutrition Program

Oncology (Cancer care) Orthopedics Rehabilitation Palliative Care Nuclear Medicine Critical care Infectious Diseases Diagnostic Imaging Emergency Medicine General surgery


Post Merger Challenges

Combination of non-integrated systems Multiple best-of-breed Ability to aggregate data difficult Clinicians were faced with multiple

accounts and feeder systems Unable to provide standard training


External Assessment

The interfaced “best-of-breed” IT environment at the former CMH sites is extremely complex, difficult to interface, lacks a common database and can no longer be adequately supported by staff and/or vendors;

Causes include extensive in-house modifications, not keeping current with released versions of software, etc.


External Review Result

“Given the financial and clinical situation that the corporation finds itself in, it is important for HHS to move to a common clinical information system in the shortest possible timeframe, to alleviate some of the constraints and bottlenecks it faces in providing solid patient care.”


Conclusion

Mandate the expansion of the MEDITECH (General site) clinical system to the remainder of the hospital within a 12-18 month time period.


Scope

Integration of clinical applications to MEDITECH– Admissions/registration– Medical records (MPI)– Scheduling– Order entry/result reporting– Pharmacy– Laboratory (regional)– Diagnostic imaging

Previously we had moved Human Resources, Payroll and G/L to PeopleSoft


Goals

Implement Enterprise–wide common core clinical systems

Reduce in-house developed or maintained applications and related support costs

Minimize interfaces Implement in a window of opportunity that does not

adversely impact on clinical program moves, capital construction projects or other initiatives

Implement the MEDITECH system as generically as possible

No extensive “re-engineering” of processes


Critical Success Factors

Endorsement and ongoing support from VP’s and all management levels

Availability and commitment of staff time by directors and managers

Significant time commitment and involvement by all those involved in the project

Ability of staff to change and adopt new methods of information retrieval and/or procedures

Timely decisions by Sponsor and Senior Management


Benefits

A single source core system for the clinicians Training streamlined in the organization Improved and consistent clinician data access Common consistent Order Entry and Result

Reporting Common dictionaries for user consistency and

maintenance Better intermodule communication Community wide appointment scheduling Fewer interfaces to be designed and maintained Fewer downtimes for the organization


Infrastructure Budget

MEDITECH Licenses - $4.5M PC’s/Printers – $1.0M Servers - $1.2M Misc. Equipment and Services (Lab, Rad, Rx) -

$0.3M No Back fill budget


Approach

Server Acquisition and Installation Merge General and Henderson MEDITECH

Databases Specific Terminal to PC replacements including

printers Upgrade to latest version of MEDITECH Extend existing MEDITECH to McMaster & Chedoke Implement MEDITECH’s Radiology Imaging &

Therapeutic Services system MEDITECH training Integration / Interface Services Legacy data conversion to follow


Timelines

Feb 2001 - Servers Installed April 2001 - Merge of General & Henderson June 2001 - Sep 2001 - Installation of PC’s/Printers Sep 2001 - Version 4.8 at General / Henderson Nov 2001 - Build of 4.8 for MUMC /Chedoke Jan 2002 - Apr 2002 - User Training at MUMC Apr 2002 - Live with MEDITECH across HHS Apr 2002 - Radiology / ITS


Major System Changes

Allegra (Inpatient System) and ER replaced MT Medical Records replaces CPI (Central Patient

Index) MT MIS (Medical Information System) will replace

CDI (Central Doctor Index) MT Billing/Accounts Receivable (B/AR) replaces

MUMC and Chedoke Billing and Accounts Receivable Systems

MT Community Wide Scheduling replaces Clinic Scheduling System


Major System Changes

MT Pharmacy replaces Cerner Pharmacy MT ITS Radiology (ITS – Imaging Therapeutic Services

System) replaces Cerner Radiology and transcription and MT $T Radiology at General and Henderson

MT Laboratory including Hematology/Chemistry, Microbiology, Transfusion Medicine & Pathology replaces Sunquest Lab

Additional devices (PC’s/Printers/Label printers) to be deployed – eg: OR, ICU, ADP, Home Transcription, Health Records, DI, MDU

Transition and decommissioning planning


Conversions / Data Access

Sunquest Transfusion Medicine / Anatomical Pathology

Cerner Radiology Reports Cerner Master Film Bag locators Future Appointments MPI (Master Patient Number) and patient

demographics Link from MEDITECH to EMR


Results

One copy of Admissions, Medical Records, Laboratory, Radiology, Pharmacy, Billing, Order Entry, Patient Care Inquiry, Reporting

All visits to all sites maintained on a shared Master Patient Index (over 2 million patients)

Demographic Updates are shared among admitting facilities


Legacy Shutdown Project…Purpose & Goals

Purpose Streamline IT

environment Save $ on support and

maintenance

Goals Archive required data Move historical data off of

legacy systems Decommission legacy

apps and hardware Completion

– Apps, Dec. 2002– Hardware, Apr. 2003


Legacy Shutdown Project…Business Case

System Cost– $87,000

Savings…This Year– $59,000

Savings…Future– ~$40,000/yr licensing

for Sunquest and Cerner


Legacy Shutdown Project…Strategy

Work with clients to identify required data

Select reports with data, convert to text files

Move text files to archiving application

Provide ongoing view-only access


Legacy Data Outcome

In shutting down the "Legacy" systems our clients still wanted/expected/demanded "Online Access" to the information in these systems to deliver patient care, meet legal requirements, and support for research with data search/extract ability

The support costs for the aging hardware, vendor maintenance costs, and the ICT operational staff to maintain these older technologies....were significant issues

Implemented an Online Web-based solution which enable the organization to shutdown the legacy hardware, operating systems, and applications


The Good, The Bad and the …

Pro’s of moving to single HIS – simplified support environment– cost savings re: staffing, contracts, etc. – data availability

Con’s re: – overcoming the political barriers - "why did they

pick MEDITECH?" when we had a perfectly good system(s)

– Former Civic Hospital already running MEDITECH - is that favoritism?

– stress need for ‘buy in’ – how to get it?


Successful outcome

Received strong sponsorship Able to implement consistent technology

(printers, application, standard desktop) across 4 sites – therefore, more efficient to purchase and support

Totally integrated clinical system – less overhead (staff to maintain) - interfaces etc.– less administration for staff (passwords)


Successful outcome

Used MEDITECH the way it should be and NOT tweaking it to work the same way the legacy application worked (system and processes)

Kept learning curve down as half of the hospital was already using MEDITECH – rather than an entirely new system

Benefit for staff who floated between sites - common platform


Issues

Enforcing merger of processes and entities and then systemize the results

What we are still struggling with is the fact that departments at each facility continued to do their own thing rather than be expected to work together to establish common shared processes

Need support for the process changes not just the system changes


New Technology Add-ons

FileNexxus– Archiving former legacy best-of-breed

data– Ability to search/report on data

Sovera for HIM– Document Imaging System for

completed charts– Document completion

Interbit Fax Services– Report distribution system

AccessPT Web View– New user interface to integrate clinical

data


Clinical Web View

AccessPt Inc. has been selected to help integrate multiple data sources and in real-time, consolidate and present the information via web based portal technologies.


A few features . . .

Single Sign On Single Patient Search Intuitive Web Browser navigation Consolidated information in real-time Supports data and images Multi-vendor integration

– allows consolidation of MEDITECH data sources but also other vendors sources such as GE PACS, HBOC Lab, AMS Sovera, OPIS, cardiology, fetal monitors and others

Expandable, customizable Simplified remote access Support for various types of computers

– PC’s, PDA’s, tablets, Apple MacIntosh, Wireless Secure / Audit trails


Overview

http://www.accessptinc.com/web/accesspt2/images.nsf/Attachments/ScreenShotBarium/$file/ScreenShotBarium.pdf


Conclusion

Integrated ‘legacy’ systems can provide a foundation to build your organization

Using new technologies strategically can advance your investment and acceptance

A focus on the processes with the systems will create a winning combination

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