Clinical Integration: Driving Value Through Health Informatics & Analytics

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1 Clinical Integration: Driving Value Through Health Informatics & Analytics CCHC Clinical Quality & Leadership Forum February 27, 2015

2 Discussion Topics Share the CHRISTUS Informatics & Analytics journey Discuss CHRISTUS Informatics & Analytics strategies to drive Clinical Integration Provide a framework for building Informatics & Analytics capabilities Rethink the role of IT and Quality

3 Luke Webster, MD Vice President & CMIO 3 Over 20 years of clinical and health informatics experience specializing in health informatics and physician leadership, clinician adoption and change leadership, clinical transformation, evidencebased medicine, clinical analytics and process improvement. As the first system CMIO for CHRISTUS Health in Dallas, led the creation and staffing of a Health Informatics department for a complex Integrated Delivery Network consisting of 22 US based hospitals and multiple LTACHs, physician practices and long term care facilities, 9 hospitals in Mexico and 2 hospitals in Santiago, Chile including a large prestigious academic medical center. Under his leadership, CHRISTUS Health has rapidly progressed to a fully implemented Electronic Health Record with high physician adoption and successful Meaningful Use attestation. Brought evidence-based medicine programs, tele-medicine and remote patient monitoring capacity to CHRISTUS as well as the foundation of what will become an advanced clinical intelligence/health analytics platform. For over 11 years was a senior physician with The Southeast Permanente Medical Group in Atlanta serving as the Physician Lead for Epic MyChart implementation and an integral leader for the EpicCare Ambulatory EMR implementation for a 250 physician multispecialty group

4 Pam Arlotto President & CEO 35 year track record as a healthcare industry consultant, thought leader and entrepreneur Fellow and Past National President of HIMSS, recognized in HIMSS 50- in-50 top HIT thought leaders Consulting clients include: regional clinical integration networks, leading healthcare providers, software and services providers, health information exchanges, certification agencies and associations Frequent speaker and author, HIMSS all time best selling series on HIT Return on Investment and winner Book of the Year, Center for Healthcare Governance Monograph: Journey to High Value Healthcare: The Board s Role in Clinical Transformation and winner Health Care Financial Management Article of the Year Recent service as Board Member: The Georgia Tech Foundation and Alumni Association The Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology & Emory University School of Medicine The Scheller College of Business at Georgia Tech MedShare International Advisory Boards of several privately held healthcare companies Faculty of UAB Health Informatics Masters program, member ACHE, HFMA and AMDIS Foundation 4

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8 THE CHALLENGE. Starting Point c No implementation plan in place No content developed No standard Informatics structure Docs completely on paper processes No System CMO. Regional CMOs variable Medical staff culture variable across multiple geographies and generally highly resistant to change 8

9 THE CHALLENGE. Desired Future State Implement CPOE 24 hospitals Within 18 months: In time for earliest MU attestation Full EBM program Standardized order sets (What do you mean give up MY order sets?) 9

10 10 Health Informatics is as much about computers as cardiology is about the stethoscope (Coiera, 1995)

11 Where are we now? CPOM live in all hospitals. 72% adoption Successful MU attestation first 3 years. MU2 ready Physician documentation coming soon Health Informatics Department created, centralized Connected Care Division Clinical Intelligence Division 11

12 12

13 Health Informatics at CHRISTUS Health 13

14 What s Next? Making the pivot Developing an intentional strategy, operating model and value methodology Transforming from the MU mandate to becoming an Informatics & Analytics Center of Excellence Aligning with enterprise strategy Offering demonstrable value to the organization beyond MU Supporting and enabling Clinical Integration 14

15 Maestro Research: IT, Informatics, Analytics, Quality Operating Models Over 40 health system CMOs, CIOs and CMIOs 12 CEOs from quality award winning health systems interviewed regarding leadership and operating model emerging trends for IT, Informatics, Analytics and Quality Results presented January 2015 at Annual UHC CEO Board Meeting 15

16 Key Questions What are the enterprise strategic priorities given the transformation from volume to value? How are the information and technology leadership roles changing? Describe the responsibilities of: Information Technology Informatics Analytics Quality 16

17 17 The Challenge of Organization Design Traditional leadership, organization structures and operating models are challenged to support: Increasingly complex healthcare enterprises that have grown through merger, acquisition and partnerships Understanding the needs of new customers: physicians, patients, consumers and payors Creating new business models and addressing value based payment Leveraging investments in health information technology Building competencies in population health management, risk management, cost reduction, transformation and innovation

18 Landmark HBR Article The Work of Leadership Adaptive Change People and organizations are forced to adapt to radically altered environments Strong leaders have the capacity to move from the field of play to the press box By understanding the game from a broader perspective, they see how offense and defense are working together, who is missing the block, who is open for a pass they are able to execute strategy by considering a larger field of play Source: Heifetz and Laurie, The Work of Leadership, Harvard Business Review, Dec 2001 Many CMIOs fall prey to the fix it now problem solving approaches that served them so well in clinical practice 18

19 Transformation Framework Enterprise Strategy Fee for service reimbursement Hospital Consolidation Practice Aquisition Clinical Integration Patient Engagement Cross Venue Process Redesign Performance Measurement Early Stage Population Stratification Risk Management Population Health Management Retail Care Virtual Care Consumer Behavior Management 19 Some say its too fast, others too slow, all agree the stages are additive Copyright Maestro Strategies, LLC 2015

20 Transformation Framework Health Informatics & Analytics Implement EHR systems and align lean with traditional quality functions Build new informatics, analytics, transformation and innovation capabilities Rethink IT and Quality operating models Weave digital capabilties into the fabric of new business, care delivery & reimbursement models 20 The future will be about getting the right information to the right person at the right time to make the right decision to create value Copyright Maestro Strategies, LLC 2015

21 Information & Technology Enables Transformation Strategies 21 As we move from a holding company to an operating company, the information technology platform will drive standardization and localization Copyright Maestro Strategies, LLC 2015

22 Recognize Market Progress Drives Transformation Strategy Ongoing horizontal & vertical consolidation Extreme focus on the Triple Aim: 1. Improved access 2. Improved quality 3. Reduced cost Development of networks of care Creation of new business & care delivery models: PCMH, ACOs, PHM, etc. Partnerships with nonhealthcare providers "Our vision is to use our collective resources wisely by being good stewards of the clinical, administrative, IT, research, patient experience, care management and other shared expertise within our systems. We want to provide better value in healthcare." Greg Devine, President and CEO of the partnership 22

23 Recognize Market Progress Drives Transformation Strategy We are in 18 states, and readiness is different in each market. We must consider where they are competitively, do they have ACOs and PCMHs, state laws, technology maturity, clinician mindset, etc. when we deploy any new technology. We must balance corporate standardization and the need to localize specifics Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC, Vice President of Applied Clinical Informatics for Tenet Healthcare, Chair - HIT Standards Committee Implementation Workgroup, Office of the National Coordinator 23

24 Understand the Virtuous Cycle INFORMATICS QUALITY IT ANALYTICS There is a virtuous cycle created by having the foundational IT systems in place, applying health informatics skills to help make the systems smart, building analytics capabilities to inform decision making and partnering with quality to drive performance improvement and transformed care processes. 24 Copyright Maestro Strategies, LLC 2015

25 Understand the Virtuous Cycle While no perfect leadership structure or operating model is in place, a number of patterns emerged from the research. There is a need to: Formalize the strategy and role of Health Informatics and Analytics Rethink the traditional scope of IT and Quality Design organizations and methodologies to: Leverage clinical leadership of the information and performance improvement functions Ensure accountability for value creation and realization Chief Health Information Officers (or teams who fit that role) are needed to ensure we harvest information to improve performance, support population health, and drive the transformation of the healthcare business model 25 Copyright Maestro Strategies, LLC 2015

26 Build Capabilities in Informatics and Analytics The Pivot Micro: Medical and clinical informatics focused on the adoption of EHRs Department or functional analysts and tools Macro: Health Informatics focused on strategic transformation Health Analytics driving real time insights, embedded in operations to predict and prescribe accountability and transparency 26

27 Typical 1.0 Informatics Attributes CMIO is often known as the doctor in IT and reports to CIO Focuses on adoption of acute care EHR and meaningful use Assumes role of cheerleader or doctor police Tactical Informatics resources are: Distributed across the health system Not trained in leadership or business Reactive, focused on responding to requests CMIO has limited budgetary authority C-Suite often is unclear of role Key Take- Away The CMIO is focused the tactics of MU and EHR adoption at the entity level 27

28 Emerging 2.0 Informatics & Analytics Attributes CMIO is aligned with Clinical leadership CMIO must pivot focus from EHR adoption to people, process, information and change value realization Expands responsibility beyond acute care to the system of care or enterprise, analytics and innovation Dyads, triads, matrix and dotted line leadership Creates governance, demand management and value management processes Aggregates fragmented resources and defines standard practices Key Take- Away The CMIO needs a game plan to formalize Health Informatics 28

29 From 1.0 to 2.0: Game Plan for Formalizing Health Informatics & Analytics Clear Vision for Health Informatics & Analytics Defined Strategy for Health Informatics & Analytics Defined Organization Structure and Operating Model Specific Roles & Responsibilities for core activities such as data definition and analysis, workflow design, content development, education, value management, etc. Metrics or KPIs defined based on financial, quality or process metrics 29

30 Build Capabilities in Informatics & Analytics Decentralized Operating Model No alignment or standardization of people, process, data integrity and use, technology, information policies, etc Hub and Spoke Operating Models Hub - Corporate Standards, Centers of Excellence and Governance Spoke Localization v Customization Daisy Multi-Entity and Complex Organizations 30 I am currently recruiting a strategic CMIO to help leverage our investment in our electronic health record and analytic tools

31 31 Rethink IT and Quality Operating Models Information Technology Centralized to build economies of scale, reducing complexity and rapidly integrating system of care Transitions operations from hospital IT department to multi-entity shared services provider Expands focus on security Consulting with operational and clinical leaders to integrate targeted SaaS & Cloud based technology, mhealth, social media and other digital innovations Quality and Performance Improvement Applies decision support and analytics tools to stratify problems to solve, design improved processes and improve performance Plans for and deploy performance improvement skills, data, knowledge and capabilities to the frontline Engages consumers and patients to improve processes Shifts from retrospective analysis to real time, point of care decision making enablement Adopts agile, experimentation and business model redesign techniques Copyright Maestro Strategies, LLC 2015

32 Emerging 3.0 Informatics & Analytics Attributes CHIO has responsibility for information strategy and leadership of Health Informatics & Analytics Collaborative leadership across the C-Suite, less focus on dotted lines and who reports to who Digital capabilties are woven into the fabric of new business, care delivery & reimbursement models Focus on getting the right information to the right person at the right time to make the right decision to care to create value New capabilities in predictive and prescriptive management of populations, personalized medicine, virtual care, retail care and consumer behavior management Key Take- Away CHIO partners to achieve convergence of quality, informatics & analytics Local MIOs support service lines, entities, regions, etc. 32

33 The Focus of the Pivot Value 33 Source: Rethinking ROI: The Challenge of Accountable Meaningful Use, Arlotto et al, 2012

34 Shift to Strategic View of Value Strategic Transformation $$$ Business Model Redesign/Innovation (e.g., PCMH) Systemic, Holistic, Breakthrough Change New Care Delivery Models New Reimbursement Methods Cross Venue Process Redesign $$ Continuum Based Lean Value Mapping (e.g., Service Lines, Orders Management) Standardization Analytics Data Exchange Traditional View Tactical $ Benefits through Automation Optimization of the EHR Silo based Quality Initiatives Incremental Performance Improvement (e.g. EHR optimization) 34

35 HI s Role in Redesigning the Care Delivery Model Home Monitoring Pressure on CGCAHPS penalties (2-4%), is driving larger group practices to go out of network if in network providers can not see patients in a timely manner. Orders/ Referral Management Patient Identity Information & Workflow Business Intelligence Data Exchange Increases provider interactions to alter care plans, improve patient compliance, and avoid readmissions penalties. Access Management Electronic Health Record Integration prevents rework & billing errors Mobile Health Practice Management Reducing no-shows and improving access by creating multi-channel contact centers that aggregate disparate hot-lines (i.e., find a doc, Ask a nurse, scheduling, etc.) and moves a portion of call volume to online tools. Stratified routine visits become e- visits which enables PCPs to meet same day appointment regulations for PCMH Telehealth Patient Portal/PHR Reducing treatments and improving recoveries by monitoring data collected via wearable devices. 35

36 CHRISTUS Health Informatics Strategy Highly Effective Clinically Integrated Risk Management Clinical Operations Care Delivery & Accountable Care Value Connected Care Meaningful Use Clinical Intelligence Clinical Decision Support Population Health Management Clinical Documentation Strategic Imperatives Micro Clinical/Medical Informatics Health Informatics Macro 36

37 Clinical Intelligence Strategic Imperative Defined by enterprise strategy and direction Access Ambulatory Growth Integrated Network Patient Engagement Operational Efficiency Shifting from historic, to real time to predictive and prescriptive analytics 37

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40 40 Discussion

41 About Maestro Orchestrating Change Maestro Strategies combines strategic and operational insight with deep understanding of advanced information technologies, analytic tools and performance improvement techniques to help our healthcare clients execute strategic priorities and accelerate value creation 41 Contact: x101

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