Health Care Information Technology 2010

David S. MuntzAugust 25, 2010

©

© 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

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© 2010 Baylor Health Care System3

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Trick Question:

Is this half-full or half-empty?

Healthcare CIO Personality Test

Us – Baylor Health Care System

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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

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© 2010 Baylor Health Care System6

Guided by

Baylor Values IntegrityServanthoodQuality InnovationStewardship

Baylor Health Care System Circle of Care

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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

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© 2010 Baylor Health Care System8

Baylor Information Services (BIS)

Innovation*

Information

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Top 20 Great Ideas - 2009

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Health Care Innovator Finalist 2009

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US Healthcare System

© 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

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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

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© 2010 Baylor Health Care System

Test: How does this relate to a healthcare CIO?

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© 2010 Baylor Health Care System

Transformation Must Happen

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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

© 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.

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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

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© 2010 Baylor Health Care System18

Patient View of Hospital Workflow

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Patient Identification and Registration

Patient Medical Services and Procedures Provided

Patient Billing and Account Reconciliation

Understanding Integration

© 2010 Baylor Health Care System19

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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

© 2010 Baylor Health Care System20

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Communications between programs is our biggest challenge.

© 2010 Baylor Health Care System21

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Communications between programs is our biggest challenge.

© 2010 Baylor Health Care System22

Let’s talk about the future.

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© 2010 Baylor Health Care System23

Predictions are dangerous, especially when you are talking about the future.

- Yogi Berra

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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?

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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

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© 2010 Baylor Health Care System26

Healthcare Today: There are so many participants.

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DeliverySystems

Physicians

Payers/CMS

Patients (Well & Ill)& Families

BHCSBoard

Vendors & Suppliers

Community

Employees

CDC, DeptsHealth

EmployersPharmacies

& PBMs

ReferenceInformationProducers

© 2010 Baylor Health Care System27

We must have electronic health records.

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Yesterday & Today

Today & Tomorrow

© 2010 Baylor Health Care System28

Why can’t you do what my bank does?

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© 2010 Baylor Health Care System29

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© 2010 Baylor Health Care System30

We’re building a Health Information Exchange (HIE)

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© 2010 Baylor Health Care System31

Will my health information be safe at Baylor?

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© 2010 Baylor Health Care System32

How do you balance security and access?

Security Access

Moredata

…others

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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

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Underway in FY 2010 FY 2011 and beyondE

nte

rpris

e D

ata

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stru

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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

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© 2010 Baylor Health Care System35

The FUTURE: HIT is at the foundation.

http://www.healthpolicyaudioconferences.com/hpaudio20090521/index.html

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Me

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© 2010 Baylor Health Care System

Most frequently asked question

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• Q: What path did I take to reach my position today?

• A: I followed my passion.

• Serendipity, mercy, and compassion.

You

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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?

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© 2010 Baylor Health Care System40

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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

© 2010 Baylor Health Care System41

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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

You and Us: How to create an

employee/employer relationship.

Disclaimer: Beware of subliminal messages!

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You and us: How can I apply for a job?

© 2010 Baylor Health Care System44

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You and us: How can I apply for a job?

© 2010 Baylor Health Care System45

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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

© 2010 Baylor Health Care System46

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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?”

© 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 -

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