Implementing EHR in Health CareMay 30, 2012

Tim ThompsonSr. Vice President & CIO

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Title: Senior Vice President and CIO

Bio: Tim Thompson currently serves as Senior Vice President and Chief Information Officer for BayCare Health System (BayCare) in Clearwater, Florida. His responsibilities include leadership of the technology planning and operations for the system-wide Information Services operation.

Mr. Thompson has over 30 years of experience in health care administration and information technology. Prior to joining BayCare in 2010, he most recently served as Senior Vice President and Chief Information Officer for The Methodist Hospital System in Houston, Texas. Prior to working at Methodist, Tim was the CIO and Senior Vice President at both Adventist Health System in Orlando and Palmetto Health in Columbia, South Carolina. In addition he held senior management positions at The Cleveland Clinic, Dynamic Healthcare Technologies, Inc., and Proctor Healthcare Incorporated.

Tim earned a bachelor’s degree in management from the University of Illinois. He is a member of the College of Healthcare Management Executives (CHIME) and Healthcare Information and Management System Society (HIMSS).

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Why are Hospitals Implementing Electronic Health Record (EHR) Systems?

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Federal EHR Strategy•President Bush’s goal in 2004

– “… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”

State of the Union address, Jan. 20, 2004

•President Barack Obama announces an audacious plan– “Computerize all health records within five years.”

- during a speech atGeorge Mason University

on January 12, 2009

•February 17, 2009 – the American Reinvestment and Recovery Act (ARRA – Stimulus Bill) is signed into law

– HITECH component of ARRA provides a $19B incentive program to stimulate the adoption and use of HIT, especially EHR’s

– Dr. David Blumenthal appointed the new National Coordinator

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Meaningful Use Overview

• WHAT is Meaningful Use?– Meaningful Use (MU) means providers must

demonstrate they are using certified Electronic Health Record (EHR) technology in ways that can be measured significantly in quality and in quantity

– Achieving MU determines whether an organization will receive payments from the Federal government under the Medicare EHR Incentive Program, Medicaid EHR Incentive Program, or both

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Defining Meaningful Use (MU)• In a health information technology (HIT) context, there

are three main components of Meaningful Use:1. The use of a certified EHR in a meaningful manner, such as e-

Prescribing2. The use of certified EHR technology for electronic exchange of

health information to improve quality and coordination of health care

3. The use of certified EHR technology to submit Clinical Quality and other measures

• Achieving Meaningful Use determines whether an organization will receive payments from the federal government under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program or both.

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Meaningful Use Overview, continued

The REAL Bottom Line …• WHY is Meaningful Use (MU) so Important to Our

Patients?– Improves the quality, safety, efficiency, and coordination of

patient care– Provides patients and their families with timely access to

data, knowledge, and tools to make informed decisions and to manage their health across the care continuum

– Ensures privacy and security protections for confidential medical information

– Enables patients to promptly access their own Personal Health Information (PHI)

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BayCare EHR Implementation Strategy

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· 7-Year $236M Clinical Transformation Project

· The vehicle BayCare is using to drive toward practicing to a clinical standard

· It is not only driving clinical practice change enabled by technology, but also driving evidenced-based standardization

BayCare BEACON

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ClinicalScanning

ED TriageTracking

BayCare BEACON EMR Journey

Foundational Applications (Financial, Materials and Clinical)

Phase I

Pre-Phase I

Phase II

Phase III

“High-Availability” Infrastructure and Skills

Lab SchedulingPhysician

PortalRAD PACs Dictation

Demo-graphic

Future

PharmacyHIMSurgeryResultsViewing

eSigCritical

CareeMAR

Therapies(RT, PT, OT,

Speech, Rehab)

Hospital-based SNF

OrdersNursing

DocDevice

IntegrationClinical

Doc

ED CPOE &Phys Doc

SkilledNursing

BehavioralHealth

ASC

Cardiology Oncology

HomeHealth

Evidence-based Practice

Real-timeDecision Support

Closed-LoopMed Admin

Internal HIE

InpatientCPOE

E-PrescribingWomen’s

Health

CarePlansAnesthesia Physician Doc

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BEACON Timeline

Phase III Design/Build

20092008 20112010 2012 2013

Phase II Design/Build

Phase 1 - 19 Months Design and Build Phase 3 - 14 Months Design and Build Phase 2 - 24 Months Design and Build

Phase I Go-Live

Phase IIRollout

Phase IIIRollout

Oct SJ

SepSFB

AugMH

JulyMPH

JuneNBH

AprilSAH

Upgrade

CurrentState

Future State

Proof of Concept Build & Validation

Integration Testing

Build & Validate

Training

MP

NB

SJH

N

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Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1

MPNB

Phase III

SJHN

SFBH

MPNB Psych Facility

SJH,SJC,SJW

SAH

SJHN

MCH, MDH, BAH

MPH

2009 2010 2011

Clin. Doc. with ED CPOE, eMAR,Orders, Messaging Inbox to sign orders

ED Physician Documentation* FirstNet at SJH, SJC, SJW

Phase II Roll-Out Schedule

*

Oct

Feb

2012

BEACON InnovationPowerPlans & Problem Lists

May

Aug

Aug

Oct

Feb

April

June

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BEACON Phase III Activation Schedule

PowerChart Maternity (PCM) Go-Lives

Phase III includes: Inpatient Computerized Provider Order Entry (CPOE), PowerNote Documentation for Inpatient Physician’s with Dragon, Computerized Anesthesia Documentation, Interdisciplinary Plans of Care (IPOC), Quality Plans (Lighthouse), Stage I Meaningful Use Readiness, and PowerChart Maternity with

FetaLink (PCM)

2012 Q1 2012 Q2 Q3 Q4 Q1 2013 Q2 2013Today

SAHApr 2013

MPNBJan 2013

MPHOct 2012

MPH PCMSep 2012

MCH, MDHAug 2012

MCH PCMJul 2012

SJH, SJC,SJW

Jun 2012

SJW PCMMay 2012

SFBMar 2012

SFB PCMMar 2012

SJHNJan 2012

SJHN PCMJan 2012

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BEACON Implementation Methodology

• Clinical transformation is at the core of the entire project

• It’s all about adoption

• Early involvement by senior leadership in making key strategic design decisions is critical

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BEACON Methodology

Clinical Transformation

Executive / Clinical Leadership

Strategic and Change Management

Conduct Current StateAssessment

CSSCKickoff

BEACON Day One

BEACON Day Two

Identify Metrics

Facility Preparedness

BEACON Day Three Go / No Go

Define Standards

Validate Current and High Level

Future StateIdentify Gaps

CompleteDesign

DecisionMatrix (DDM)

FinalizeFuture State

FRAME THE FUTURE BUILD THE FUTURE REFINE AND ADOPT

Policies and Procedures

Capture Localized

Baseline Metrics

Roles andResponsibilities

BayCare BEACON Methodology

Complete Preliminary Workflow

Assessment (PWA) and Onsite WorkflowAssessment (OWA)

Analyze Options,

Scenarios, Key Decisions

System Build

ConductSystem and

Design Review

Complete Proof of Concept

Build

CompletePreliminary

DesignSession

ConductIntegration

Testing

Planning and

Preparation

ValidateProof of Concept

Build

Conversion

Complete Unit andSystemTesting

Complete Additional

Build

ConductConversion Readiness

Conduct Training

Develop Standard

Training and Testing Manuals

Optimization Assessment

Optimization Planning

Optimization Analysis

Implement and

Measure

OPTIMIZE

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The Importance Of Decision Making

MajorImpact

ModerateImpact

Less Impact

Mid Level DecisionsMid Level Decisions

HighLevelDecisions

HighLevelDecisions

Detailed Decisions Detailed Decisions

~ 25% of decisions

~ 10% of decisions

~ 65% of decisions

How will it be done?

Design the details

What will be done? Who will do it?

Clinical Systems Steering Committee (CSSC)

Clinical Standards Committee (CSC)Physician Advisory Council (PACo)

Subject Matter Experts (SME)

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Phase II BEACON Day 1 – Decisions Summary

Executives Voting on Key Decisions

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Phase I BEACON Day 1- Decisions Summary

Phase I

BD1 Decision Description

1 BayCare physicians will have remote access to Phase I functionality.

2 BayCare will practice to a standard for clinical documentation.

3 BayCare will practice to a standard for forms format.

4BayCare will practice to a standard for bar-coded patient identification across all facilities.

5Where results are available electronically, BayCare will discontinue placement of those results in the paper chart.

6BayCare will mandate electronic signature (signatures, completion, edits and corrections) by physicians for record completion via the Inbox.

7 BayCare will consider the electronic record the legal medical record.

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Phase II BEACON Day 1- Decisions Summary

Phase IIBD1

Decision Description

1 Computerized Physician Order Entry (CPOE) will be the standard across BayCare.

2 Order Sets will be standardized and required in all BayCare Emergency Departments.

3Physicians will use the BEACON Inbox (Message Center) to sign all verbal and telephone orders (Inbound Messaging).

4Physicians will have availability to (but not be required to use) BEACON Messaging / Inbox (Message Center) to communicate with each other (Outbound Messaging).

5 All orders will be placed in BEACON.

6 All medications will be documented in BEACON.

7All non-physician interdisciplinary clinical documentation will be captured in BEACON, with the exception of OB.

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Phase III

Decision Description

1Evidence based practice supported by standardized order sets will be implemented across all BayCare facilities.

2 A physician documented diagnosis and problem in BEACON will be the BayCare standard.

3Interdisciplinary plans of care (IPOC) will be the standard for BayCare and will be documented in BEACON.

4 All anesthesia documentation will be captured in BEACON.

5Physician documentation will be captured primarily using structured documentation tools in BEACON.

6 BEACON will be the source of truth for acute care clinical data.

7 Closed-loop bar-coded medication administration will be the standard for BayCare.

8 E-prescribing will be standardized and required in all BayCare facilities.

9 All medical device information will be captured in BEACON.

10 All OB documentation will be captured using structured documentation tools in BEACON.

Phase III BEACON Day 1- Decisions Summary

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· Communications– BEACON Communications will deliver simple specific targeted messages

early and often and through various mediums– Improve peer-to-peer communication using SuperUsers, SMEs and

Physician Informaticists to deliver messages · Change Management / Adoption

– Show organization that BEACON was designed, built, and validated by clinicians and physicians

– Conduct standardization assessments at local level and change readiness surveys

· Training– 75% of BEACON solution training will be web-based, available online or

facilitated in a classroom setting– 25% of BEACON solution training will be “Day in the Life” classroom

training, focusing on role based technology enabled process

Approach

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A disciplined and structured approach to standardizing the future state workflows and facilitating change management throughout the organization

– Workflow Localization assists each facility in creating a strategy for implementing critical clinical and operational workflows

– Workflow Localization assists in evaluating BEACON future state processes and driving necessary practice change to support BEACON best practices

Workflow Localization – What is it?

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One-on-one Training through FBEs, Trainers, Change Management, Readiness Rounds, etc

http://www.baycare.org/BEACON

E-Newsletters Web sites(intranet and internet)

Meetings

PowerPointpresentations

Hospital Signage

Bulletin boardflyers

Leadershipvoicemails

Ways We Communicate

Videos of team members

Leadershipe-mails

E-Newsletters Web sites(intranet and internet)

Meetings

PowerPointpresentations

Hospital Signage

Bulletin boardflyers

Leadershipvoicemails

Videos of team members

Leadershipe-mails

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Effective Process-Oriented Governance Structures

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Project Governance

Clinical Systems Steering Committee

(BEACON Executive Steering Team)

Office of the President

Board of Trustees

Medical Imaging

Sub-committee

BEACON Project Steering Team

(BEACON)

BayCare Clinical Standards

Committee

OB Collaborative Workgroup

BEACON PACo(Physician Advisory

Council)

Facility PACS

CIC(Clinical

Informatics Council)

= Information Services

= BEACON = Nursing

= Physician

Documentation Task Force

Medication Administration

Workgroup

Clinical Systems GovernanceBEACON Governance

Physician Advisory Governance

Pharmacy Informatics Workgroup

CardiologyWorkgroup

PedsWorkgroup

Adult MedWorkgroup

OncologyWorkgroup

OBWorkgroup

CDS Workgroup

NICU/PICUWorkgroup

EDWorkgroup

ICUWorkgroup

Clinical Practice Council

Peds Collaborative Workgroup

Surgery

Workgroup*Beh. Health

Workgroup*Neurology

Workgroup**

* = Workgroups Launching 9/09

** = Workgroup Launching 1/10

Legend

Critical Care

Workgroup

Executive Oversight Board

(BEACON)

CIO Council

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Questions and Discussion

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