UMass Memorial Health Care: CIO and CMIO Partnerships

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1 Institute for Healthcare Technology Transformation UMass Memorial Health Care: CIO and CMIO Partnerships Michael Bakerman, MD, FACC, FACPE, MMM Chief Medical Informatics Officer Richard Mohnk, MSA, MT(ASCP) Associate Chief Information Officer iht 2 January 2012

2 Disclosures We have no disclosures We have no conflicts of interest Describe the UMass Memorial System Define our Cornerstone Strategy Illustrate CIO and CMIO differences and opportunities for collaboration Case Presentations and discussion 2

3 UMass Memorial Health Care 7 Hospital System Clinical Partner to UMass Medical School 13,500 employees 3,000 registered nurses Approximately 1,600 physicians 1,111 beds $1.4b in Annual Revenue ~60,000 inpatient visits ~1,000,000 outpatient visits 3

4 UMass Memorial Healthcare Information Technology Cornerstone Initiatives Fundamental Goal: Move from a predominantly paper environment to one that is predominantly electronic Core Ambulatory EMR Inpatient EMR/CPOE Inter & Intra Enterprise Identification Inter & Intra Enterprise Interoperability Connected Healthcare Community Improve Availability and Flow of Information Improve Quality and Safety Increase Efficiency and Effectiveness 4

5 The Future State Wing Memorial Hospital Private Medical Practice University Memorial Hahnemann HealthAlliance Hospital Clinton Hospital Marlborough Hospital Medical Group Community Medical Group Inpatient EMR Outpatient Enterprise EHR Ambulatory EHRs Data Integration Application Private Medical Practice / Affiliate Hospitals Private Medical Practice 5 5

6 CORNERSTONE TIMELINE (rev 12/2011) Jan/Feb/Mar 2011 Apr/May/Jun 2011 Jul/Aug/Sept 2011 Oct/Nov/Dec 2011 Jan/Feb/Mar 2012 Apr/May/Jun 2012 Jul/Aug/Sep 2012 Oct/Nov/Dec 2012 Jan/Feb/Mar 2013 Apr/May/Jun 2013 Soarian Financials scheduled Live 1/15/12 Soarian Clinicals scheduled Live 1/15/12 MAK Roll Out scheduled Live 3/12 CPOE Roll Out scheduled Live 5/12 Soarian Upgrade HealthAlliance Soarian WING scheduled Live Summer/Fall 2012 Hyland OnBase LIVE at the Med Ctr, Marlboro, Clinton and Wing Picis (ORIS) scheduled Live post Soarian Enterprise MPI LIVE with IDX Registration and Scheduling 8/11 Enterprise MPI scheduled Live with Med Ctr Soarian Reg 3//12 dbmotion (Phase 1) LIVE 5/11 HealthAlliance dbmotion/soarian Smart Button Live Salar LIVE Hospitalist Programs at Med Center / Clinton / /Marlboro - continued roll-out to additional hospital departments Allscripts Enterprise LIVE - continued roll-out of new CMG practices, additional functionality (Orders, Tasking, Dictation) to the hospital clinics and physician offices Allscripts 11.2 Upgrade COMPLETED 90 day reporting period to meet 2011 Stage 1 Meaningful Use 6 Picis PulseCheck ED TBD

7 Prior Philosophy of Physician Behavior Is this the best way to motivate highly skilled and intelligent people? 7 7

8 But Why Would You Want To? 8 8

9 Hierarchical Management and Influence Medical Staff CIOs and CMIOs share accountability for IS projects CIO IT Staff CMIO Their direct and indirect spheres of influence requires a delicate balance between voluntary participation and direct managerial supervision Used with permission Jack Shlegel Consulting 9

10 CIO and CMIO Interactions CMIO role is evolving Developed from traditional medical staff roles (CMO) Initially part time, but now fulltime AMDIS 2011 Survey 64% are currently in first CMIO role, down from 81% in % want to stay in CMIO role, 7% want to become CIO, 7% would like to be CEO or COO and 4% would like to become CMO Wide range in compensation Largest areas range from $250,000 to $300,000 and $345,000 to $375,000 81% work at Integrated Health Systems, 9% work in stand alone hospitals. Most have enterprise wide responsibilities Reporting structure 47% report to CIO 29% report to CMO 5% dually to CIO and CMO 19% report to CEO or COO 10

11 CMIO and CIO Can be True Partners Extend each others influence Cover each others blind spots Let s each do what they do best Teach each other Understand the different perspectives Budget Personnel Project management versus clinical decisions Scope, resources and schedule Need for advocacy and accountability Drive adoption of technology The journey is about adoption of technology and not simply implementation Understand the clinical workflow Know the strengths and weakness of the applications Work together to satisfy the end user (clinician, nurse, registration, etc) 11

12 Stylistic Differences Between CIO and CMIO Physician Time to process issues Rapid Requirement gathering I.S. Authority Captain of the ship Diffuse Need for closure (gratification) Immediate Longer term Ability to deal with ambiguity Low Medium to high Precision of data Intermediate (learned to live with incomplete data) High Clinical thinking skills High Low Project management skills Low High Primary commitment/responsibility To Patient To Organization 12

13 Life is what happens between the time you plan and execute your plan The roadmap is about adoption of new technology, not implementation What we are discussing are clinical applications and not IT projects Process change without personal growth and education is not sustainable Physicians must be leaders, but must accept responsibility and accountability 13

14 IS Can Also Drive the Management and Analysis of Data Planning: Establish Metrics and Value Goals Opportunity assessment and metric definition Set future-state goals Model economic impact Implementation: Strategy, Resources & Implementation Incorporate Benefits Realization into committee structure Develop implementation plans Focus resources on improvement goals Measurement: Baseline and Postlive Measures Establish baseline measures pre-live Conduct post-live measurement at specified intervals Interpret results and continuously improve performance 14

15 Case Discussion Roll out of Follow Me Desk Top Device Deployment Selection and plan Development of Sign out process Web launch point 15

16 Roll out of Follow Me Desk Top (FMD) and Single Sign On (SSO) Together, the CMIO and CIO develop the project principles Build the case and vision Speed, efficiency, less clicks Stable environment CIO is key to listening first and then building Build a proof of concept to garner feedback Don t just ask what is desired Listen to the need Partner and participate with the CMIO in physician meetings CMIO is key to articulate the value to clinicians Ease of access Clinical use cases Test and provide constructive feedback Listen and brain storm approach with CIO 16

17 Web launch point for Single Sign On (SSO) It was apparent to CIO that we could develop a communication device as well: Create method to communicate Build ease of access Enhance redundancy and system reliability 17

18 Demonstrate Follow Me Desktop 18

19 Device Deployment Considerations Perfect storm overlapping technology devices that can be useful, Variety of operational, clinical, nursing and engineering teams involved Capital Planning, regulatory and environmental concerns needed to be considered Required to support clinical process, However, regulations and permit requests could be a roadblock Each group, in isolation, had their primary concerns and needs Required teams to live in current workflow, but think in a future state No matter what we choose, the technology and equipment will continue to change 19

20 Device Deployment Guiding Principles: Place a device in a patient room or exam room Required to support the clinical and administrative process of patient intake and assessment Should provide FTF opportunity for nursing to interview and talk with patient Workstations on wheels (WOW) and/or fixed devices Recommendations made by each clinical area during walkthrough Reviewed by IS and Capital Planning Approved by CMIO Signed off by Capital Planning Approved by ACNOs and IS. Caveats Phase 1 focused on nursing and back office Favor mobile workstations over fixed Storage and hallway traffic are important system constraints Built into assumption was no new construction 20 20

21 Device Deployment Guiding Principles Devices cannot be deployed (stored) in hallways except when installed in Wall-a-roos.. Added to hallway congestion Safety and regulatory issue Power will be addressed on a case by case basis Need to access room when patients are not there Optimize install process Certain facilities need to be prioritized for Capital Planning Included assessment and implementation of any peripheral devices to support EMR Printers, embossers, etc

22 No WOWs initially recommended. Added 6 after review. Will need to determine storage policy 22 22

23 Recommendation Based on Nursing Device Fairs and Analysis Work Station on Wheels (WOW) Clear consensus choice Assist with emerging and yet-unknown needs Alternative non-powered or laptop configurations Supply line economies of scale Local vendor support 23 23

24 Development of Sign Out process The new EMR application did not support current workflow A round peg in a square hole, just will not work! Residents and Attending were frustrated and resisting CMIO Agreed with physicians with the need to develop something different and develop guiding principles Used a separate, but integrated application to satisfy the clinicians needs Created the environment were IS team could work with clinicians CIO Supported with resources, technology and experience Overcame internal resistance to change project plan Participated in development of solution and provided feedback Win Win for all 24

25 Creating Sign Out (Work) Lists The process: Log in Search for patient Add the patient to a team Click on the Sign out button Edit the sign out fields for each individual patient on the team 25

26 Sign Out (Work) List Area for Text 26

27 We Can Speak a Common Language Underlying consistency in our relationship We will focus on the adoption of technology to provide information to providers We will collaborate with providers in developing workflow automation and improvement, based on evidence based medical information We will assist in providing performance measurements to improve care, improve efficiency and reduce harm Our goal is to provide seamless applications that improve efficiency and provider satisfaction 27 27

28 Overcoming Challenges Pulling together Allow the system to act as a system Physician leadership and engagement Senior leadership fully engaged Super users identified and supported Work in today s world, but think in the future world Communicate the vision of the ideal future state and work towards that goal Avoid recreating broken and fragmented solution Existing processes and procedures will need to be revisited and adjusted Be flexible, open-minded and creative You will be connecting parts of your system that have never before been connected connected healthcare is just that all inclusive for technology and people Communication, communication, communication Understanding of different environments of care One size does not fit all 28

29 Q & A / Thank You