INFORMATION TECHNOLOGY: NEXT GENERATION
Rose Ann Laureto
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Background McKesson announced in November 2011 that they are transitioning from
Horizon clinical applications to Paragon (another McKesson product line) over time
At a national level, 50+ % of the McKesson healthcare clients had decided to transition to an integrated platform, leaving McKesson, after MU Stage 1 – this combined with the uncertain future of Allscripts –cast doubt on ProMedica’s long term core vendor strategy
A level of dissatisfaction with the McKesson and Allscripts clinical applications reached an all time high
In addition we were starting an optimization program with both Acute Care / McKesson and PPG / Allscripts
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Background We lack basic integration .. We have several EHRs across the
system .. McKesson and Allscripts Integration is the foundational component for IT enabling
healthcare systems for health care reform, advanced stages of Meaningful Use, population health and cost efficiencies
ProMedica currently has a best of breed IT Strategy Movement to an integrated IT strategy is a major shift … so
we enabled a new governance structure
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Expanded EHR Membership
• Dee Bialecki-Haase, MD• Daniel Cassavar, MD• Todd Cooperider, MD• Jamie Dargart, MD• John Evanoff, MD• Eric Ferguson, MD• Lee Hammerling, MD• Khurram Kamran, MD• Neeraj Kanwal, MD• David Mierzwiak, MD• Brian Miller, MD• Julie Yaroch, MD
• Gary Akenberger• Holly Bristoll• Tari Cecil• Morgan Ethington• Terry Jacobs• Tim Jakacki• Jo Hines• Lori Johnston• Kathleen Krueger• Rose Ann Laureto• Alan Sattler• Hayley Studer• Maurine Weis
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All aspects of Health System represented, 12 Physicians, 1 Mid Level, 3 Presidents, 1 CNO, 2 Ancillary, 3 Operations, 2 Finance and 1 IT
Best-of-Breed Integration: Costly and Complex
Source: Impact Advisors5
ProMedica - 750 Applications -1000 Interfaces
Best of Breed Application Portfolio: Current Landscape
6 Source: Impact Advisors
Best-of-Breed Concerns
• Creates fragmented clinical information which leads to creating multiple failure points
• Usability is usually not good-Users straddle multiple systems; multiple looks and feels
• Vendor accountability and management becomes complex• Technical environment and maintenance efforts are more
complex• Requires many different IT skill sets and resources• Highest cost, longest path to benefits
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The Alternative – an integrated suite of applications
• Stream line our process providing greater efficiency across the organization Automation of key processes affecting daily operations Utilizing staff for high value activities
• Improves the visibility through real time information accessibility Reduced downtime caused by multiple data sources Employees are better informed causing accurate, faster decisions
• Aides in Customer Retention Provide exceptional customer experience through timely
information Reduction in redundant tests and information requests
• Scaling what we have to others locations - ease of additional locations/channels-growth Access information from multiple locations Sharing of information across offices and across specialties
Why an Integrated Platform?
It’s about enabling TRANSFORMATION
An integrated software platform is required to support population health and meaningful use 3, ACO and Medical home
An integrated, community-wide network with seamless patient data exchange
Evidence-based medicine, decision support, cost and quality analytics
Engaging patients in their own care to improve outcomes and health (e.g. patient portal, telemedicine)
Leverage analytics to assess and manage population health risk and total cost of care (e.g. data mining, business intelligence)
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State of Industry Vendors
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Numbers within the arrow – Net Hospitals Gained/Lost, 2006–2012 Numbers outside the arrow – Net Hospitals Gained/Lost, 2012 Source: HIMSS Analytics Database
66 79
–22–10
+170 –2–19–11+22
628226
1491322
Vendor 2006-2012
2012
Epic 628 170
Cerner 226 22
Meditech 149 -11
McKesson 22 -19
Allscripts 13 -2
Ohio’s Vendor Landscape > 400 Beds
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Michigan’s Local Vendor Landscape > 400 Beds
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51% of the U.S. population will be cared for
by EpicCare
50 states
153-187M people46% to 56%
273,000 EHR physicians
In Ohio and MichiganMcKesson 6 ProvidersCerner 10 ProvidersEpic 24 Providers
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1st Motion: The IT strategy for ProMedica, should over time, move from a
best of breed to an integrated platform. Approved: Unanimously
EHR Meeting of August 22, 2013
2nd Motion: As we proceed towards an integrated platform, given the market position of the products, our aligned and proposed business partners, we will implement an inclusive program over the next 120 days to affirm Epic as our preferred platform.
Approved: Unanimously
ProMedica’s Guiding Principles
Guiding Principles serve as a framework for making strategic EHR related decisions
• ProMedica will adopt a core vendor strategy, favoring information integration over departmental functionality
ProMedica will seek a proven, viable vendor with a track record of implementation success and customer satisfaction
There will be a single, standard system design and build across the enterprise
Core vendor applications are preferred over third party solutions
ProMedica’s Guiding Principle
• Assuming the decision to proceed with Epic is made, all ProMedica facilities would migrate to Epic along with a standardized set of third party applications
• Workflows would be standardized and streamlined with as much integration as possible to maximize the efficiency and effectiveness of patient care delivery
• ProMedica would limit its investment in legacy systems to only what’s necessary to meet legal and/or regulatory compliance
• We will implement a system that will provide interoperability functionality in order to share clinical information with other Health Care Organizations
Current and Future State 3-5 year journey
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Current State
Future State
Integrated/Primary Vendor
Engaged a consulting firm with a proven methodology to assist ProMedica over the next 120 days with due diligence i.e. application scope, implementation timelines, transformation opportunities, resources requirements, 3-5 year cost profile…
Draft Project Governance Hierarchy
Integrated Systems Team
ProMedica SystemBoard of Directors
Operational & Clinical Leadership Evaluation Workgroups
Executive System Team
EHR Steering Committee
Physician Leadership Group
Finance Leadership Group
CardiologyPhysician I/P Clinicals
Labor & DeliveryEmergency/Urgent Care
Intensive Care UnitHealth Information Mgt.Technology & Support
LaboratoryNursing I/P Clinicals
RadiologyMedical OncologyADT & Scheduling
Paramount Health Care
PharmacyPost-Acute
OR & AnesthesiaAmbulatory Clinicals
PediatricsEnterprise Billing
Innovation
Phase 1: Epic Planning & Analysis
- Initiate Project- Develop Guiding principles- Develop Approach & Assumptions- Validate and Document Scope- Determine Project Timing- Define Project Organization- Determine Project Resourcing- Determine Project Governance- Evaluate Outsourcing Opportunities- Develop 5 Year Cost Model- Develop IS Budget Analysis- Prepare Committee & Board Materials
Phase 2: Communication & Validation
- Conduct Project Kickoff- Conduct Organizational Education- Prepare & Facilitate Retreat- Develop Communications Plan- Facilitate Epic Validation * Demonstrations * Reference Calls * Site Visits
Phase 3: Contract Negotiations
- Develop Contract Position Paper- Facilitate Negotiations- Document Issues & Resolutions
August September October DecemberNovember
Project Activities & Timing
A Successful Milestone
• EPIC Software demonstrations Preparation:
20 operational leaders acting as work chairs,
60 hours of preparation,
25 active physicians,
30+ presentations to various management groups, IST, Physician Leadership, MECs and several major communication cycles
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Workgroup Chairs# Workgroup Chair
1 Pharmacy Tari Cecil2 Cardiology Clark Corey3 Laboratory Mark Sattler4 Ambulatory Clinicals Jo Hines5 Post Acute Randy Schimmoeller6 Physician Inpatient Clinicals Dr. Cassavar7 ADT & Scheduling Ann Savage8 Enterprise Billing Paul Ferrell9 Emergency Paula Grieb10 OR & Anesthesia Maurine Weis11 Technology and Support Anshul Pande12 Nursing Inpatient Clinicals Theresa Konwinski13 Labor and Delivery Jan Schwarzkopf14 Radiology Terry Jacobs15 Medical Oncology Ann Kujawa16 Pediatrics Lori Ferguson17 Paramount Health Plan Jack Randolph
18 Health Info/UR/CodingSandy Lewallen/Dr. Maria Johar
19 Intenstive Care Unit Dr. Wainz20 Innovation Karen Strauss
Results Conducted 40 demonstration sessions for 28 workgroups over 5 days with 1,400
participants AVERAGE SCORE WAS 2.4
Analytics, Population Health, Inpatient Nursing, Surgery highest @ 2.6
Home Health, Retail Pharmacy, Long Term Care the lowest 1.9 – 1.2
The majority of participant feedback was positive and focused on how Epic can better support their current and future needs Integration of all applications on a single, consolidated platform will be a major
improvement and further enhance patient safety, efficiency and user satisfaction.
While participants generally thought Epic would work well for them, many indicated that significant training and education will be needed to make an Epic implementation a success.
“Same as any EMR - slow, cumbersome “
Epic Application Scope Phase 1
Ambulatory EMR Ophthalmology MyChart/ Patient Portal Emergency Department Inpatient Clinical
Documentation Labor & Delivery Intensive Care Unit Inpatient Physician Order
Entry HIM Release of Info. &
Deficiency*Subject to further consideration
Operating Room Anesthesia Radiology Medical Oncology Home Health & Hospice Cupid Cardiology Data Warehouse/ Analytics Enterprise Registration Enterprise Scheduling Enterprise Billing & Collections
Epic Application Scope Phase 2
Laboratory (Clinical Pathology, Micro, Anatomic Pathology)*
Wisdom General Dentistry Ambulatory Pharmacy (Retail) HIM Chart Tracking Call Management Nurse Triage Managed Care (Paramount) Transplant
*Subject to further consideration
Preliminary (best case) Milestone Dates
• November 19th 2013 Finance Committee • December 10th 2013 PHS System Board• January 2, 2014 Project preparation • March 2014 ProMedica Core Team at Madison for Epic Training• July 2014 ProMedica Enterprise Design begins• 2014 Enterprise Testing • 2014 Training • July 2015 1st group of the Ambulatory Practices go Live • September 2015 2nd group of Ambulatory Practices go live• January 2016 1st group of hospitals – St Luke's, Bay Park• July 2016 2nd group of hospitals-Toledo• September 2016 3rd Group - Flower and Freemont• January 2017 4th group – Bixby, Herrick, Defiance, Fostoria• April 2017 Phase 1 Optimization and Evaluation of Phase 2
Estimated ProMedica Implementation Resource Requirements
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Subject Matter Experts TBD
Super Users TBD
Resource Type ProMedicaImplementation
Team FTE Equivalents
Management/ Leadership 23
Clinical 97
Revenue Cycle 38
Technical 20
Total Dedicated FTEs 178
The Total Cost of Ownership Model
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Capital10-Year Total
Annual Operating10-Year Total
System Software Costs (Cache, Microsoft SQL, etc.) 7,019,510$ 14,620,714$
Epic Software Application Costs 23,115,600$ 54,782,819$
System Hardware Costs 22,200,000$ 27,841,095$
Vendor Implementation Costs (Epic) 19,458,000$ 2,400,000$
Interfaces and Data Conversion 9,574,808$ 3,979,552$
Network and Infrastructure Costs 2,000,000$ $ 3,876,552
Legacy AR & Legacy Systems Decommissioning $ 630,000 $ 31,687,561
Third Party Vendors (Applications) 4,006,000$ $ 14,406,601
Third Party Implementation (Consulting) 20,308,630$ $ -
Implementation and Support Team Costs 45,678,073$ $ 159,422,772
End-User Training Costs $ 2,000,000 $ 21,290,887
Oth er Contingency (10% Capital, 10% Operating) $ 15,599,062 $ 33,430,855
Totals - All Costs $ 171,589,683 $ 367,739,409
Red
uct
io
ns Minimum Reductions (retired legacy apps, redeployed staff,
reallocated infrastructure costs, etc.) (4,000,000) (244,773,550)
Net 10 Year Total Cost of Ownership $ 167,589,683 $ 122,965,860
Epic Cost Model Summary - "All-In" Implementation
Epic Enterprise Implementation
Clie
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Epic Cost Summary (CY 14 - 23)
Ep
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Cleveland Clinic Activities
• Purchasing Opportunities More exploration is needed; an estimate is not apparent yet but there should be an
opportunity. More than Epic software; IT needs including network, hardware, cache, 3rd Party Software
• Shared Knowledge and it’s transfer Quality and Predictability Potential speed to value improvement in certain project phases
Integration Starting with what we have – exchanging laboratory and radiology Driving increased integration as we converge on similar software platforms
Strategic Alignment Use of common tools for care coordination – use of shared clinical content and workflow-
potential collaboration at all clinical and operational levels
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The Epic Impact
When Epic is introduced to a hospital, it is a transformational moment in that organization’s IT history as an integrated, enterprise-wide system
is put in place. This is a generational-level opportunity that occurs once every few decades and should not be taken lightly. Approaches to
IT need to be thought through differently and traditional team and technology barriers must be disassembled and then reassembled to create
the new IT architecture for the future. We are not implementing an infrastructure, we are architecting the clinical application delivery
platform
Vision
One Patient.
One Record.
One Bill.
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