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

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Epic Cost Summary (CY 14 - 23)

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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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