More than medicine.

Making Sense of

Implementation Madness

through Technical Innovation

Jim Feen

Executive Director/Associate CIO

Southcoast Health, Massachusetts

CIO Summit - March 8th, 2016

Joan McFaul

SVP/CIO

2 More than medicine.

Working though the chaos of an enterprise-wide EHR

implementation presents hundreds of challenges. A key part of

solving some of the seemingly intractable problems is having a

group of creative developers that can apply current technology

in order to provide solutions. This group became especially

important to South coast in the face of an accelerated

Enterprise EMR install that was recently completed within 21

months, start to finish.

Even though modern EHR’s are extremely sophisticated and

robust, they can miss the mark when it comes to addressing

unique issues that arise in organizations as they seek to adapt

to complex workflows.

We will cover:

• What an “innovation” team looks like

• What tools are necessary

• Several case studies on successful applications of innovative

ideas

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• According to Miriam Webster

– Innovation is:

• A new idea, device or method

• According to Miriam Webster

– Creativity is:

• The ability to make new things or think

of new ideas

Innovation and Creativity - Defined

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• Why is an innovation team important?

– Communication and ease of information

flow

– Aggregating disparate information around

your EMR implementation

– Ease complexity for both operations and

IT

– This team can span experience gaps that

typically occur between core technology

teams, the user community, and the rest

of the IT service teams.

Innovation Team – Why?

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Why?

– Introduce tools that facilitate and advance

cultural and technical transformation

– Remember ‘Buy Versus Build’? Because

of the unique nature of each organization,

using an innovative approach to leverage

technology development to solve niche

business, clinical workflow, or data needs

that cannot otherwise be easily solved

from the open market.

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What?

• Team Size

– Will vary

– Can be very effective with a small team

– Requires appropriate governance

– Need to be nimble in the face of

changing demands

– Must be connected to both IT Security

and IT Engineering for Software

Development Life Cycle Planning

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What Skills?

• Soft Skills:

1 Listening!

2 Listen some more!

3 Creative Thinker

4 Problem Solver

5 Establish your Development platform

strategy – must be in tune with industry

standards.

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What Technical Skills?

• Web Services

– Ability to develop and consume RESTful

and SOAP web services

– JSON and XML data structures

– Ability to implement and consume token

based security like Auth 2.0 and SAML

• Networking and Systems Skills

– Web Servers and their configurations,

specifically Microsoft IIS

– Must understand the various moving

parts in a potential HTTP request

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Other Technical Skills

• Examples of moving parts Firewalls, Load

Balancers, Proxy Servers, Web Servers and

Database Servers

– Ability to read and fully understand HTTP

status codes for troubleshooting

purposes

– Deep understanding in Web Security

• These are the same skill-sets that will be needed to

implement stage 3 objectives that intend to allow

patients to View/Download/Transmit data that was

attained via an API.

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A Sampling of Southcoast Case Studies

I. Provider Data Management

I. South coast Messenger & FindADoc Platform

II. Patient Movement Matrix

III. Position Control Verification

IV. Ambulance Rotation

V. IT Governance - System Optimization and Project

Request Submissions

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Provider Data Management

The Problem: Within the span of 3 years, a rapidly growing

primary and specialty group practice. A need existed to

connect Providers both socially and functionally. On the

technical side, there was an immediate need to establish

Provider Master Data for our growing organization.

The Solution: Establish the South coast Provider Management

system (web app) that allows marketing and our medical staff

office to manage all physician credentialing, practice

locations, and Provider biography information. Establish the

source of truth for our master Provider data.

The Functional Benefit: The FindADoc & South coast

Messenger platforms, as well as EMR Provider Integration.

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The Patient Movement Matrix

The Problem: Transferring Patients between hospital units in our

new EMR was going to require more education and steps

compared to our legacy process.

The Solution: Break down the very detailed new process into

basic steps for the entire organization.

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Position Control Verification

The Problem: Supporting a “No Pass No Access”

universal training policy for our new EMR required

tight management controls around End User

training compliance. This problem was

compounded by the fact our EMR implementation

was bringing together 3 functionally separate

corporate entities on a common platform, with no

single position control tool.

The Solution: Aggregate all existing position control

data, and engage management to validate/update

reporting hierarchy using a simple web tool.

Validated data would then be migrated to our LMS

system for training enrollment and management

reporting.

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Position Control Verification

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Ambulance Rotation Requests

The Problem: Our legacy EMR supported an

ambulance rotation program to ensure ambulance

requests were evenly distributed across ambulance

companies; a contractual obligation. Our new EMR

did not have a solution for this need.

The Solution: Utilize APIs to integrate custom

Ambulance Rotation feature into the new EMR to

support this business requirement.

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Integrated Web Tools Within the EMR

• Keeping staff within their EMR workflow, they are

able to seamlessly utilize the custom web

application.

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OneApp System - Driving the PMO and

Post Go Live IT Governance Process

• The Problem: Our IT Services organization

needed a process to manage IT project and system

optimization requests, while offering transparency

around Health System priorities for all IT staff,

along with basic tools to assist IT management.

• The Solution: The OneApp system for

organization-wide IT Project Requests. Physicians

can submit optimization ideas directly from the

EMR. Leadership can submit project/optimization

ideas over the Southcoast Intranet. This tool drives

a significant po

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OneApp System - The Benefit

• Allows for full project tracking and prioritization of projects,

feeding the IT governance process.

• IT Time Tracking for both Payroll and Staff Hours –

management reporting.

• Change Control Workflow Tools, integrated with Projects to

show end-to-end process of project submission through to go-

live.

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OneApp System – The Benefit

• Management 101 – knowing where your IT

resources are allocated in real time.

• Capacity planning – within the broader IT

governance process, empower middle

management to schedule project work, not just

react to the ever increasing demand!

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Wrap-Up

• Development projects require basic ROI studies

and a business plan from operations.

• Over the last 5 years, aggregate ROI on custom

application development exceeds $12m (total

investment cost `$1.5m).

– This program has earned Senior Executive

endorsement for annual funding that is split

between the IT capital and operating budgets.

• Program has remained lean on hardware/space

requirements, while continuously providing value to

meet niche business and clinical workflow and data

needs.

• Thank you! Questions?