City of Paterson &

OHITPresent:

Process over Product:

Implementing

Health Technology to Achieve

and Measure Success

September 3-4, 2009

St. Pete’s Beach, Florida

Why are we here?

Share

Learn

Make a Difference

Expectations

Forum of exchange – interactive, nonjudgmental, practical over academic, fun.

Learn from the challenges & success of solutions for care and care management.

Increased awareness of process for implementation and expansion of HIT.

What this workshop is not…

HIT Life Cycles

HRSA Resources

Reception – Meet with Speakers

Speakers Exchange

AgendaAgenda

Where Are We From?

Background

• Bergen-Passaic TGA

• Paterson – Grantee & Grants Administrator

• HIV Service Providers (PART A, MAI, HOPWA)

• Quality Management Team & SPNS Partners

• Systems Partner & Consultant

• Performance based (unit cost contracting)

• Paper to Electronics

• Use of Tech

Funding Sources

AdministrationPlanning Council

Clients

Quality Management

Program Monitoring Fiscal Monitoring

Providers

Bergen-Passaic Network of Care

"How Grantees Can Collect Client Level Data and Performance Indicators Securely using a Web-based Tool."

August 2008 HRSA All Grantees Meeting

"Electronic Health Information Exchange: A Process of improved operations and measurement of Client health outcomes with an

update on health information technology projects (SPNS)."

August 2008 HRSA All Grantees Meeting

"People Take Action Save Lives (P-TAS): An interdisciplinary Approach using science, social science and technology to get special populations tested and engaged into care."

August 2008 HRSA All Grantees Meeting

Who are You?Who are You?

Interactive Clicker Exchange

What role best describes your function: 

Adm

inis

trato

r/Contra

...

Med

ical

/Clin

ical

Sta

ff

Qual

ity M

anag

emen

t ...

IT S

taff

Oth

er

36%

16%12%

28%

8%

:10

1. Administrator/Contractor

2. Medical/Clinical Staff

3. Quality Management Staff

4. IT Staff

5. Other

Which of the four HIT Life Cycles have been the greatest challenge - for which you want to know more about:

Get

ting

Ready

for I

T (...

Lau

nchin

g IT (a

doption..

Usi

ng IT (a

pplicat

ion

...

Get

Bet

ter a

t IT (e

nha.

..

30%33%

17%20%

:10

1. Getting Ready for IT (planning)

2. Launching IT (adoption - implementation)

3. Using IT (application - use)

4. Get Better at IT (enhance usage)

How satisfied are you with your user buy-in?

Abso

lute

ly N

ot Sat

isfie

d

Not S

atis

fied

Neu

tral

Sat

isfie

d

Com

plete

ly S

atis

fied

8%

33%

8%

25%25%

1. Absolutely Not Satisfied

2. Not Satisfied

3. Neutral

4. Satisfied

5. Completely Satisfied

How satisfied are you system capabilities?

Abso

lute

ly N

ot Sat

isfie

d

Not S

atis

fied

Neu

tral

Sat

isfie

d

Com

plete

ly S

atis

fied

0%

33%

0%0%

67%1. Absolutely Not Satisfied

2. Not Satisfied

3. Neutral

4. Satisfied

5. Completely Satisfied

How satisfied are you with your users’ utilization of system capabilities ?

Abso

lute

ly N

ot Sat

isfie

d

Not S

atis

fied

Neu

tral

Sat

isfie

d

Com

plete

ly S

atis

fied

14%

54%

0%

18%14%

1. Absolutely Not Satisfied

2. Not Satisfied

3. Neutral

4. Satisfied

5. Completely Satisfied

How satisfied are you with your technology partner(s)?

Abso

lute

ly N

ot Sat

isfie

d

Not S

atis

fied

Neu

tral

Sat

isfie

d

Com

plete

ly S

atis

fied

21%

25%

4%

25%25%1. Absolutely Not Satisfied

2. Not Satisfied

3. Neutral

4. Satisfied

5. Completely Satisfied

How satisfied are you with your ability to quickly make sense of data you tracking?

Abso

lute

ly N

ot Sat

isfie

d

Not S

atis

fied

Neu

tral

Sat

isfie

d

Com

plete

ly S

atis

fied

16%

26%

10%

19%

29%1. Absolutely Not Satisfied

2. Not Satisfied

3. Neutral

4. Satisfied

5. Completely Satisfied

“Begin with the end in mind”-- Steven Covey

Some Vignettes of Successful HIT

Co-Host & Guest Facilitators

What We Were Doing Before

• Reimbursement contracting

• Paper Outcomes Surveys

• Paper Client Satisfaction

• Multiple Systems:

• Contract Management

• Medical

• Paper-Based Needs Assessment

• Paper-Based Quality Management Reporting

• Manual CADR Reporting

But had strong foundation in Process

Funding Sources

AdministrationPlanning Council

Clients

Quality Management

Program Monitoring Fiscal Monitoring

Providers

Bergen-Passaic Use of HIT Now

What We Are Doing Now

• Performance-based contracting

• Web-based outcomes tracking and reporting

• Web-based Client Satisfaction and reporting

• One integrated system:

• Contract Management

• Medical

• Web-based Needs Assessment

• Web-based Quality Management Reporting

• Automated and clickable RDR/RSR Reporting and electronic upload

• Automated and interactive project improvements

Movement of HIT in Bergen-Passaic

Revolutionized Client Input and its affect on Planning & Program

Transformed Data Collection, Exchange & Operations

Enhanced Accountability & Patient Tracking

Enabled New Levels of Quality Management

Vignette: Connecting Prevention to Care & Treatment

The Problem: Falling Through the CracksAlmost half of those who are living with HIV/AIDS are not in care.

Some don’t make the decision to be tested. Why Not.

P-TAS: Filling in the Cracks

Real-Time Tracking & Monitoring: Myths and Misconceptions for Targeted Outreach

Over 26% of people in our community believe AIDS is not treatable!

Why bother get tested if you believe that HIV/AIDS is not treatable?

Banners Displayed at Testing Sites / Streets

A public and private partnership venture

Businesses, Merchants, Organizations, City Agencies,

Offices of Elected Officials display posters for public to

access

Colorful Posters with tear-offs Reward Cards

Tracking Outcomes

25-1423-821Real-time tracking of outcomes throughout entire process, anonymously with pre-printed incentive code on reward cards

Real-Time Tracking & Monitoring: Outreach Worker Effectiveness & Sharing of Best Practices

The success of each outreach worker is tracked.

Highly successful outreach workers are asked to share their best practices and inspire others.

Success is tracked in different ways, for example: number of people outreached; percentage tested; and number and percentage of people enrolled in care.

Outcomes

20062007

6

6.5

7

7.5

8

8.5

Paterson: New Patients into Care (%)

26.1% Improvement

26.1% Improvement

Source: eCOMPAS 8/13/2008

20062007

1460

1480

1500

1520

1540

1560

1580

1600

1620

1640

1660

1680

Number of ARV Prescriptions for Paterson Area

Outcomes

8.7% Improvement

8.7% Improvement

Source: IMS 8/13/2008

The Bottom Line• Saves time

• Saves money

• Saves paper

• Improves productivity

• Improves ability to tell the story / strengthened funding applications

• Reduces errors in data quality

• Improves responsiveness to requests

• Engages our clients directly

• Improves accountability

• Helps us learn where we can do better (CQI)

HIT, done right, is worth it.

Expectations – Ideas – ConcernsExpectations – Ideas – Concerns

HEALTH INFORMATION TECHNOLOGY

ADOPTION FRAMEWORK

What Broad Components Should We Consider When Implementing

HIT?

Technology

Strategy

PeopleProcess

Technology

Strategy

People Process

What affects what?

Everything affects everything!

What Are the Main Stages of the HIT Lifecycle?

ProcessPeople

Technology

Strategy

A Simple, Integrated Framework for HIT Implementation

It can be mapped to the OHIT toolbox sections.

It is meant to be a simple reminder about main areas to cover at each step in the lifecycle.

Don’t get stuck on whether something is a “People item” versus a “Process item” – they are all interrelated.

If it helps you think of an idea for action, it has done its job.

Notes About the Framework

Another Way to Think About It

So each component will be connected to another.

TQM / CQI Systems Theory Change Management Organizational Behavior Software Development Enterprise Architecture and Engineering Information Systems Management Knowledge Management Chronic Disease Management Public Health Policy Project Management Behavioral Psychology Social Science

Inspirations to and Resources of the Framework and the Overall Approach

Getting Ready for IT

Key Aspects & Challenges

Interactive Clicker Exchange

Which of the following areas was most difficult in HIT readiness:

Lea

dersh

ip

Buy-

in

Tec

hnolo

gy (s

yste

ms.

..

Use

r Cap

abili

ties

22%

30%

17%

30%

:10

1. Leadership

2. Buy-in

3. Technology (systems capacities)

4. User Capabilities

Financial costs Over-utilization of services Under-utilization of services Sub-optimal health care Unnecessary stresses on staff Being focused on putting out fires and dealing with

emergencies Lower revenues Lost time Lost productivity Lost patients Higher mortality Lower quality of life …?

What are the costs of getting HIT wrong?

Therefore the investment in preparation to get it done right is worth it.

Strategy

ProcessPeople

Technology

Define Success Early

Clients served Provider front-line staff Provider supervisors and administrators Administrative Program Staff: Ryan White Administrative Program Staff: HOPWA Administrative Program Staff: Prevention Administrative Epidemiology Administrative Researchers and Evaluators Administrative Policy and Planning Senior Administration Federal Funding Sources (HRSA, HUD, CDC) Grants Managers Quality Managers Information Technology Department / City / County / State Leadership Health Planning Bodies (Planning Council, Advisory, etc) …?

Define Success for EACH Stakeholder

System has high usage Users have high satisfaction levels People engaged in giving their ideas System and Process evolves at the right pace based on ideas (not too

fast, and not too slow) Health Outcomes get better over time (can set targets as you

learn more) New capabilities emerge that allow us to do our jobs better The data and reports help us tell our story better Less under-utilization Less over-utilization Enables us to spend less time on paperwork, and more on

clients. Enables us to elicit needs and feedback directly from clients Improve our ability to monitor programs for accountability. Provides reporting that enables better policy, planning, and

programming.

Sample Definition of Success

Leadership is Key

Authoritarian versus Collaborative leadership?

Strong versus Weak leadership Ensuring logistics Navigation Conflict resolution Setting the tone and leading by

example

Leadership

Strategic Partnerships and the

Role of Third Parties

Strategy

ProcessPeople

Technology

How best can you prepare your people for a smooth launch and successful adoption?

Engage folks and agree on a Shared Vision. A compelling vision motivates and clarifies.

Build a Project Mission Statement. What is the essence of this project?

Identify Restraining Forces and Barriers ahead of time. It’s best to anticipate challenges so you can

prevent and mitigate them. Agree on Guiding Principles.

A perfect detailed plan is impossible. Principles are more robust and will come in handy during times that require tough decisions.

People

Top 10 Guiding Principles for e2 Bergen Passaic

1. People are the most important component in success!

2. Success should be defined holistically by each stakeholder.

3. Everyone should be more empowered with better information.

4. Better action requires better system intelligence.

5. Visual is better.

6.

7. Ease of use is critical for success.

8. Time is better spent with clients than on paperwork!

9. Simple and clean is more powerful than complex and messy.

10. No one has all of the answers. But a great process, open to everyone, produces great results.

Think outside the box!

Additional Principles from State of Hawaii

1. Keep the Provider staff in mind. They are the important interface between the system and the Client.

2. Embed thinking about security and confidentiality at all levels of design, protocols, development and management.

3. Never assume software works. Always try to break it. What survives will be stronger.

4. Adopt a “Whatever it takes” attitude. The use of the phrase “That’s not my job” should be eliminated or minimized.

5. Keep the Client in mind. This is ultimately to help people live healthier with higher quality of lives.

Strategy

ProcessPeople

Technology

Family of SystemsFamily of Systems

System Components in Bergen Passaic (eCOMPAS)?System Components in Bergen Passaic (eCOMPAS)?

The eCOMPAS PhilosophyThe eCOMPAS Philosophy

The eCOMPAS ProcessThe eCOMPAS Process

Care and Treatment HOPWA Prevention

The eCOMPAS ProcessThe eCOMPAS Process

eCOMPASeCOMPASSystem System

Interorganizational Interorganizational Improvement InitiativeImprovement Initiative

Shared Vision and Guiding PrinciplesShared Vision and Guiding Principles

Stakeholder Engagement ProcessStakeholder Engagement Process

The eCOMPAS ProcessThe eCOMPAS Process

eCOMPASeCOMPASSystem System

Interorganizational Interorganizational Improvement InitiativeImprovement Initiative

Shared Vision and Guiding PrinciplesShared Vision and Guiding Principles

Stakeholder Engagement ProcessStakeholder Engagement Process

The eCOMPAS ProcessThe eCOMPAS Process

eCOMPASeCOMPASSystem System

Interorganizational Interorganizational Improvement InitiativeImprovement Initiative

Shared Vision and Guiding PrinciplesShared Vision and Guiding Principles

Stakeholder Engagement ProcessStakeholder Engagement Process

The eCOMPAS ProcessThe eCOMPAS Process

eCOMPASeCOMPASSystem System

Interorganizational Interorganizational Improvement InitiativeImprovement Initiative

Shared Vision and Guiding PrinciplesShared Vision and Guiding Principles

Stakeholder Engagement ProcessStakeholder Engagement Process

Surveys to ALL potential users and stakeholders

Focus groups One-on-one semi-structured interviews Goals / Objectives / Deliverables mapping

and prioritization Sharing introductory reports with

stakeholders before adopting Clicker tools Rapid Prototyping Piloting Online polling once launched

Some Ideas to Engage Stakeholders

Promote ownership Energy and Fun Be interactive Stress management Have early success (pick low hanging fruit

first) Having others see the early success Manage all as volunteers Recognition and appreciation Share in the credit Build local champions

Process Tips for Buy-In

Link your goals and objectives to your deliverables

Phases and TasksTask Phase

Stakeholder engagement and needs assessment summary 1 - Specs

Evaluation plan (pre-test, post-test, base lines, indicators, etc) 1 - Specs

Challenges and challenge mitigation plan 1 - Specs

Project plan update 1 - Specs

HIPAA approval 1 - Specs

Definition of system enhancements 1 - Specs

System enhancement specifications 1 – Specs

SSystem Enhancement and process improvement feasibility 1 - Specs

Develop / prototype system enhancement 2 - Prototype

Protocol definition Roles and responsibilities definitions updates 3 - Deployment

Pilot system enhancements 3 - Deployment

System and Process Training 3 - Deployment

Fully deploy system enhancements 3 - Deployment

Operation and TA 3 - Deployment

Evaluation 4 - Evaluation

Review and Learn for next iteration 4 - Evaluation

Strategy

ProcessPeople

Technology

Focus on features that make a difference.

What’s wrong with this picture?

Sample Definition from Bergen-Passaic Web-Based No installation / IT maint Hosted No desire to manage & maintain User Friendly Low learning curve HIV/AIDS-specific focused, not general Strong QM Be a tool Visual Reduce time to interpret data Technical Secure, Stable, Fast Community/Client Capability Want to

engage clients directly Integrated Reduce multiple systems Customizable Ability to evolve over time

Define System Requirements and Understand Impact

Decide: Vendor or Strategic Partner

Sample Definition from Bergen-Passaic Human-Centered Approach Process-Oriented Implementers Flexible and Responsive Attentive and Listens Asks Good Questions Non-Sales Focused Liaison Track Record and Reputation Has Organizational Capacity Understands HIV/AIDS Excellent Customer Support a Must Long-Term-Oriented

Define Characteristics of your Vendor / Strategic Partner

St. Mary’s Hospital

Success Despite Increased Load

Percent of outpatient services handled by St. Mary's

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09