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Health Care Information Technology 2010
David S. MuntzAugust 25, 2010
©
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© 2010 Baylor Health Care System2
Agenda: Let’s talk about
• Us – Baylor Health Care System
• US healthcare system• Current state• Future state
• Me
• Advice for those of us seeking opportunities within healthcare IT• You• You and Us
08/25/20102
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© 2010 Baylor Health Care System3
08/25/2010
Trick Question:
Is this half-full or half-empty?
Healthcare CIO Personality Test
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Us – Baylor Health Care System
4
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© 2010 Baylor Health Care System5
Baylor Health Care SystemFounding Statement
George W. Truet t(In His World War I Uniform)
“Is it not now time to build a great humanitarian hospital, one to which men of all creeds and those of none may come with equal confidence?”
Dr. George W. Truett, 1903 Co-founder of Texas Baptist
Memorial Sanitarium, predecessor of Baylor Health Care System
08/25/2010
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© 2010 Baylor Health Care System6
Guided by
Baylor Values IntegrityServanthoodQuality InnovationStewardship
Baylor Health Care System Circle of Care
08/25/2010
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© 2010 Baylor Health Care System7
Baylor Health Care System – By The Numbers
• Faith-based, not-for-profit health care provider based in North Texas
• 26 owned, leased or affiliated hospitals • 120,700+ admissions • 20,000+ babies born • 340,000+ emergency department visits • 550,000+ outpatient registrations
(excluding ED and home care)• 3,423 licensed beds • 20,000+ employees • 3,000+ physicians on active staff• Largest hospital has 1025 beds;
smallest community hospital has 69 beds
08/25/2010
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© 2010 Baylor Health Care System8
Baylor Information Services (BIS)
Innovation*
Information
08/25/2010
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© 2010 Baylor Health Care System9
Top 20 Great Ideas - 2009
08/25/2010
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© 2010 Baylor Health Care System10
Health Care Innovator Finalist 2009
08/25/2010
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US Healthcare System
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© 2010 Baylor Health Care System
Information Technology is Changing Rapidly
• Virtualization of servers, storage, and workstations• Remote hosted versus in-house• Zero tolerance for downtime• Data network bandwidth needs• Wireless and mobile data and voice• Explosive demands for medical image storage• Data security threats and prevention requirements
08/25/201012
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© 2010 Baylor Health Care System
The Healthcare Industry is Changing Rapidly
• ARRA Stimulus/HITECH Act• Meaningful use• Quality reporting• Obtaining certified products
• HITECH Act HIPAA rule changes• Health Care Reform
• Data needs for new payment models (i.e. ACOs, Medical Home)• Ubiquitous access to records and quality data across the continuum
08/25/201013
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© 2010 Baylor Health Care System
Test: How does this relate to a healthcare CIO?
08/25/201014
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© 2010 Baylor Health Care System
Transformation Must Happen
08/25/201015
EHR
AncillaryServices
Eclipsys& GE Suites
FinancialSystems
AdministrativeSystems
...more than 400 applications...
Relationship between clinical transformation, electronic health record (EHR), and information systems
August 1, 2008
Enterprise Project Management, Application Portfolio Management, Security, Customer Support (Help Desk, Super User, System Administrator Recruitment, Post-implementation Support Model development), Operations, IT Infrastructure, Unified Data Strategy
Evidence, Clinical Decision Support, Process Redesign, Change Management, Governance, Customer Involvement, Training and EducationCommunication, Coordination, Collaboration
· The goal of all activities is to improve adherence to STEEEP (safe, timely, effective, efficient, equitable, patient centered care) which can be summarized as “hardwiring STEEEP.”
· The number of applications will be reduced through a concerted effort to achieve Systemness with broad stakeholder involvement.
Clinical and Other Systems
Baylor Health Care System Mission, Vision, Values, Strategy, and The Care Model
clinical transformation
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© 2010 Baylor Health Care System16
Clinical Transformation:A Simple Definition
• People
• Processes
• Technology
• People
• Processes
• Technology
Integrating clinical and non-clinical process improvements with enabling technologies
Hardwiring STEEEP*
*IOM Model: Safe, Timely, Effective, Efficient, Equitable, Patient-centered care.
08/25/2010
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© 2010 Baylor Health Care System17
Transforming Healthcare Delivery
• Installation is hard, and mainly technical
• Implementation is really hard, and mainly organizational
• Transition (lasting change) is incredibly hard, and purely human
• Transformation is a state of profound new personal and enterprise behavior
Marc Overage, MD, Regenstrief Institute, Inc: A Healthcare Laboratory and a Community of Scholars
08/25/2010
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© 2010 Baylor Health Care System18
Patient View of Hospital Workflow
08/25/2010
Patient Identification and Registration
Patient Medical Services and Procedures Provided
Patient Billing and Account Reconciliation
Understanding Integration
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© 2010 Baylor Health Care System19
08/25/2010
Finance and Resource Planning
Patient Records and Patient Accounting
Patient Access
SCHEDULING
ADT / REG
MEDICAL RECORDS
ORDERS / RESULTS
Rules & Alerts
ELIG / VERIF
PATIENTACCOUNTING
EDICLAIMS
SCRUBBER
MEDICALNEC
CHECKING
CONTRACTMGMT
DECISIONSUPPORT
LAB
PHARMACY
ClinicalDocumentation
RADIOLOGY(& PACS)
ENCODING
CARDIOLOGY
NUTRITIONSERVICES
GENERALLEDGER
MATERIELSMGMT
ACCOUNTSPAYABLE
PAYROLLHR
TIME /ATTENDANCE
ePROCURE
RESOURCESCHEDULING
Payor
TRANSCRIPTION
ABSTRACTINGData
Warehouse
Document ScanFORMS MGMT
Infection Control
Safe Choice(Employee
Injuries)
Emergency Dept (ED)
OB/GYN
Neurology
PT / OT
GI (Gastrointestinal)
Epidemiology
Bone Marrow Transplant
Metabolic Disease
Oncology
Anesthesiology
Orthopedics
Transplant
Pharmacy Dispense
RESPIRATORYTHERAPY
Physician Performance Management
Hospital Case MgmtSocial Work, Care
Coordination (Case Mgmt), Patient Relations
Healthcare Improvement
Risk, Clinical Studies, Infection Control
(Epidemiology), Safe Choice (Employee
Safety)
STATE REPORTING
Patient Survey
O.R. SCHEDULING
Perioperative Services
CPM / iPath (GE)
Clinical Care
Very Simplified Data Flow Map
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© 2010 Baylor Health Care System20
08/25/2010
Communications between programs is our biggest challenge.
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© 2010 Baylor Health Care System21
08/25/2010
Communications between programs is our biggest challenge.
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© 2010 Baylor Health Care System22
Let’s talk about the future.
08/25/2010
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© 2010 Baylor Health Care System23
Predictions are dangerous, especially when you are talking about the future.
- Yogi Berra
08/25/2010
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© 2010 Baylor Health Care System24
“That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations.”
from The London Times in 1834
Commenting on ... the “stethoscope”
A computer for patient care?
08/25/2010
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© 2010 Baylor Health Care System25
Other Prognosticators
• “Everything that can be invented has been invented.”
• “I think there is a world market for maybe 5 computers.”
• “Who the hell wants to hear actors talk?”
• Charles Duell, Director of the Patent Office, 1899
• Thomas Watson, IBM, 1942
• H. M. Warner, Warner Bros., 1927
08/25/2010
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© 2010 Baylor Health Care System26
Healthcare Today: There are so many participants.
08/25/2010
DeliverySystems
Physicians
Payers/CMS
Patients (Well & Ill)& Families
BHCSBoard
Vendors & Suppliers
Community
Employees
CDC, DeptsHealth
EmployersPharmacies
& PBMs
ReferenceInformationProducers
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© 2010 Baylor Health Care System27
We must have electronic health records.
08/25/2010
Yesterday & Today
Today & Tomorrow
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© 2010 Baylor Health Care System28
Why can’t you do what my bank does?
08/25/2010
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© 2010 Baylor Health Care System29
08/25/2010
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© 2010 Baylor Health Care System30
We’re building a Health Information Exchange (HIE)
08/25/2010
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© 2010 Baylor Health Care System31
Will my health information be safe at Baylor?
08/25/2010
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© 2010 Baylor Health Care System32
How do you balance security and access?
Security Access
Moredata
…others
08/25/2010
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© 2010 Baylor Health Care System33
HITRUST announced today, March 17,2009, that it has recognized five organizations with the HITRUST Leadership Award. These organizations are honored for their exceptional dedication and contribution in the creation of the HITRUST Common Security Framework (CSF), and their exemplary leadership for the entire healthcare industry. The HITRUST Leadership Awards are presented to:
• Baylor Health Care System • Express Scripts Inc. • Humana • Highmark • Kaiser Permanente
Is there a benchmark which measures the security of my
information?
March 2009
08/25/2010
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Underway in FY 2010 FY 2011 and beyondE
nte
rpris
e D
ata
M
an
ag
em
en
tIn
fra
stru
ctu
re
Patient Provider Integration & Portals
New Areas, Research, Education, & Business
Continuity Planning
BCHS Information Services Timeline – Start Dates
Enabling Technologies
Ele
ctro
nic
He
alth
Re
cord
, C
linic
al S
erv
ice
s, &
Glo
ba
l E
lem
en
ts
Administrative Systems
Future StateHardwiring STEEEP
Eclipsys, LIS, RIS
Ambulatory EHR
Patient Acuity & Staff
Scheduling
EHR for non-HTPN Physicians
CLMM – BUMC, Plano
CLMM – All Others
BCP - All
Scheduling
Secure Messaging/Reminders
e-Visits
e-Prescribing
Clinical Decision Support
Disease Management
Medical Home
Bariatrics
Diabetes
Women’s Services
Neuroscience
Oncology
Cardiovascular
Population Management
Medical Informatics
- Local- Regional- National
Health Information Exchange
Knowledge Bases
Personalized Patient
Schedule
Personal Health Records
Telemedicine
Home Monitoring
AP & GL
Portals Enhancement
Security Management Program
EDM Governance
Integration of USPI
Integration of Eclipsys and GE
Med Staff
AR
HR
SCM
CDM
Biometrics
SSO
Identity Management
Audit Framework
OfficeAutomation
Videoconferencing
Robotics
Remote Access
Encryption
InterpreterServices
Smart Cards
Podcasts
Device Management
RFID
Platform management & capacity planning
Common Desktop
Image Management
Unified Messaging
Switch Upgrades
VOIP
Uniform Dialing Plan
Consolidation of 500+ Applications
Physician EngagementChange Management
CPM/Zynx
Systemness
Redefinition of Legal Medical Record
Governance
LEAN
VMR
Pain Management Centers
ArlingtonOrthopedic
Hepatology Clinic
Cancer Center
McKinney
Business Continuity – AR/HR
Simulation
Education
Research
08/25/201034
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© 2010 Baylor Health Care System35
The FUTURE: HIT is at the foundation.
http://www.healthpolicyaudioconferences.com/hpaudio20090521/index.html
08/25/2010
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Me
08/25/201036
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© 2010 Baylor Health Care System
Most frequently asked question
08/25/201037
• Q: What path did I take to reach my position today?
• A: I followed my passion.
• Serendipity, mercy, and compassion.
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You
08/25/201038
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© 2010 Baylor Health Care System39
Now Let’s Talk About You
Q: What suggestions do you have for those of us seeking opportunities within healthcare IT?
08/25/2010
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© 2010 Baylor Health Care System40
08/25/201040
Critical Success Factors?Degrees and Certifications
•AART•AB•BA•BS•CAN•CCA•CCNA•CCNP•CDP•CIA•CISSP•CNE•CPA•CPHIMSS•FACHE
•FCHIME•MBA•MCP•MCSE•MD•MHA•MHSA•MSE•MSE•MT(ASCP)•PMP•RHIA•RN•RT•Equivalent experience
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© 2010 Baylor Health Care System41
08/25/201041
The Real Critical Success Factors
• Ability to communicate• Orally• In writing
• Deep understanding of business• Customer empathy• Collegiality / collaborative posture• Humor• Optimism• Patience• Technical skills
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You and Us: How to create an
employee/employer relationship.
Disclaimer: Beware of subliminal messages!
08/25/201042
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© 2010 Baylor Health Care System43
08/25/201043
You and us: How can I apply for a job?
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© 2010 Baylor Health Care System44
08/25/201044
You and us: How can I apply for a job?
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© 2010 Baylor Health Care System45
08/25/201045
Advice Before You Get the Job
• Create a great resume• Accurate• Customized to the recipient• Interesting
• For the interview• Listen• Be sincere• Ask questions• TAKE NOTES• Ask for other leads• Ask more questions• TAKE NOTES
• After the interview• Send a thank you• Be persistent, patient, realistic
• Don’t accept the first offer• Make sure you want the job• Pursue your passion
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© 2010 Baylor Health Care System46
08/25/201046
Advice After You Get The Job
• Listen• Seek advice and counsel from coworkers at all levels• Honor diversity • Don’t assume that if you deserve something, you will get it• Persistence is more important than intelligence• Don’t let great get in the way of good• Most important motivator is recognition• Money is the least important motivator• Be grateful• Be respectful• Be honest• Acknowledge the contribution of others• Greatest compliment you can give is “Can I get your advice?”
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© 2010 Baylor Health Care System47
"Computers are incredibly fast, accurate, and stupid; humans are incredibly slow, inaccurate and brilliant; together they are powerful beyond imagination."
- attributed to Albert Einstein -
08/25/2010