* Yeah, It kinda feels like this….

* Healthcare Reform – Meaningful Use

* Decreasing Volumes

* Increasing Financial Pressures

* Increasing Reporting Needs

* Replacing the Core Information System * Used for 25 Years

Soarian Conversion

January 14, 2012

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*  7 Hospital System (5 campuses) *  Clinical Partner to UMass

Medical School *  13,500 employees *  3,000 registered nurses *  Approximately 1,700

physicians *  1,111 beds *  $2.2b in Annual Revenue *  ~70,000 inpatient visits *  ~1,600,000 outpatient visits

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* Only Academic Medical Center (AMC) in Massachusetts without a clinical Electronic Medical Record (EMR) and Computerized Provider Order Entry (CPOE) * Only AMC in the country running Meditech as its core

information system * Clinical and Financial limitations of the system * Focused on back-end remediation vs. front-end data

capture * We knew we had to upgrade/replace our core system

* Under pressure to move quickly – short time to implement change

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* Initiate Enterprise Master Patient Index

* GE Centricity (IDX) *  Ambulatory Scheduling and Physician Billing

* Allscripts * Ambulatory EHR

* Siemens Soarian * Hospital/Acute Care EHR and Hospital Billing

*  Pharmacy

* GE Imagecast (RIS) Philips PACS

* Meditech Laboratory

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PCHIS

PowerScribe

ForwardAdvantage

     Metrico

   

IDX

Cardiology

R4Ob  US IBEX

ED

PACS

TSI

PCI

Laboratory

Cycle

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R4

Ob  US

IBEX

ED

PACS

IDX

TSI

EMPI

                                                       G

 M  B

             

BizcomdbMotion

MeditechLab

   M

o

PCI

Meditech

Siemens Soarian

Allscripts / IDX

University

Memorial Hahnemann

Clinton Hospital

HealthAlliance Hospital

Wing Memorial Hospital

Medical Group

Marlborough Hospital

Private Medical Practice

Private Medical Practice

Private Medical Practice / Affiliate

Hospitals

Current Information Systems as of January 2012

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Health Alliance has been running a separate instance of Soarian since 2005

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* HIM Repository and Remote Coding/Abstracting * Transition of Care Automation * Ambulatory Meaningful Use ($10M) * Combining E-Mail Systems * Wireless Device Expansion * Virtual Desktop/Device Independence *  Single Sign-On * Application Linking/Switching *  Single Patient ID/IDX Active Registration *  Soarian/IDX 2-Way Interface *  ePSI Financial Planning System * Ambulatory Dashboard *  eICU Expansion *  Salar Inpatient Physician Documantation * MedCPU/ NLP

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* The Conversion * Replacement of the core system used for 25 years * Largest Soarian implementation to date * Multi-entity implementation * Financials AND Clinicals – touched EVERY process at once * Significant changes in practice/workflow * “Big Bang” conversion of 5 campuses * Over 20,000 users converted * 3.9 million patient records converted * 300,000 scheduled future appointments moved * 284 new interfaces built and implemented * Introduced Virtual Desktop Technology, Wallaroos,

Workstations on Wheels

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* Conversion Week * 4 Hospital Operation Command Centers * 7 Soarian Support Centers * Open 3-4 weeks 24/7

* The First Three Weeks * 300,000 results into Soarian * 250,000 non-med orders * 17,000 hours working on Soarian within IT

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1/14/12 12:00 am Conversions begin Hospitals on Downtime Procedures

1/14/12 11:00 am Meditech Conversion Complete

1/14/12 4:00 pm Interface Conversions Complete

1/15/12 6:00 am Interface Backloads Complete

1/15/12 6:00 am Soarian Financials Live Patient Access

1/17/12 8:00 am Business Offices Live Revenue Management

1/18/12 7:00 am Clinton and Marlborough Hospitals Live Soarian Clinicals

1/19/12 7:00 am Memorial Campus Live Orders

1/20/12 7:00 am University Campus Live Orders

1/23/12 7:00 am Memorial and University Campuses Live Nursing Documentation

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* Unforeseen * 4 Power Failures in our Soarian Support Center

* Network Switch Failure on Lakeside A

* Lower Census did not materialize

* We should have foreseen…… * Security Issues * Effect of SSO (Single Sign-On) introduction with Soarian

* Problems with Role-Based Access

* Limitations of Siemens Security Tool

* Downtime backlog * Design of downtime forms based on issues with backload

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* Spread support resources throughout hospital

* Eliminated Single Sign On with Soarian

* Established a Security “swat” team

* Relaxed Role-based access requirements

* Staged phased introduction to orders and documentation

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* Training * Planning and executing initial training program * Flashes during transition * Downtime Planning * Dedicated Activation Project Manager * Engaged Emergency Preparedness Coordinator * Support Centers * Definition, logistics, scheduling, metrics/dashboard tools * Communications with Operational Command Centers * Flexible and scalable during the transition * MPI Conversion * Integration cutover * Meditech conversion * Room Renumbering deployment

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* Operational and clinical buy-in * Created Applications for Operations Committee (SKTT)

* Communications: * More vehicles, more frequently

* Transparency

* Using the experience gained by HealthAlliance

* Timeline * Engage activation manager and operations sooner

* Live date changes (10/1/11, 12/1/11, 1/14/12) constrained transition planning

* Testing: more workflow and reports

* Incorporate QA and reports development team in future design

* Technology * Mock cutover

* Simulation testing

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* Consider pilot go-live then big bang * Staging a rapid roll-out * Assign a dedicated communications manager * Link support center network

* Provide ability to leverage more tools (blogs, Twitter, Facebook, etc.)

* SWEEPS work; will keep for subsequent activations * Do not underestimate the space and other accommodations needed for

you support staff * Can not overemphasize training and training * Establish a formal coaching program * Formal commitment; long term

* Invest in temporary support staff * Internal and external

* More training sooner * Plan to include internal staff in testing efforts as an education opportunity

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Organizational Culture and Governance

Clinical Adoption

Technical Build

•  Discuss Lessons Learned •  Share the discussion between technical

and clinical •  Provide successes and challenges

•  There is no magic here •  The key tenets of successful

implementations remain •  Planning •  Communication •  Detailed Workflow •  Testing •  Training •  Support

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* Replacing Meditech rather then implementing a “new” approach * Long term Meditech client

* Customized the application significantly * PDI

* Provider Dictionary

* Patient instructions

* Bulletin Board

* Reports

* Workflow was primarily paper * Little standardized work

* Complicated areas * Dialysis

*  ED

* Outpatient

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*  "Thank you, thank you. I will get you a huge bag of chocolate! I am so happy now I have access to the forms and reports I need and they work since the folks in the support center spent time with me…”

*  "I can't believe how much easier Soarian has made my job…”

*  “This system is much more user friendly than Meditech”

*  “Slowly learning and I will be an expert soon”

*  "Don't quote me but this is kind of fun"

*  “…We love this! We get credit for what we do!"

*  “I never thought I'd say this but this is easier.”

*  "You know what I like about Soarian? The target behaviors page. Boom.- there it is!"

*  “…love it love it love it took 4 hour class, left crying but it turns out Soarian is really easy to use and intuitive”

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* Stabilization and Enhancement * Allscripts Expansion * Order Entry/Results Verification * Population Health Management * Patient Portal

* Wing Memorial * Soarian & Allscripts

* Electronic (Bar Coded) Med Administration * Computerized Provider Order Entry

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* No definitive formulation – each attempt at creating a solution changes understanding of the problem * No stopping rule – since you cant define, you can’t tell when it is resolved.

Problem solving ends when resources are depleted. * Solutions are not true/false but good/bad – no unambiguous set of criteria for

solution – what is “good enough” * No immediate or ultimate test of a solution – impossible to know how all

consequences will play out * Every implemented solution has consequences – you can’t reverse, it’s one way…. * No well described set of potential solutions – all stakeholders have differing views

of acceptable solutions * Every problem is essentially unique – no “classes” of solutions * Every problem can be considered a symptom of another problem – interlocking

issues and constraints that change over time * Causes can be explained in numerous ways – many stakeholders with varying and

changing ideas about the problem, its cause and potential solutions * Planner/designer has no right to be wrong – scientific method does not apply

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