Yesterday s Vision Tomorrow s Destiny

Transcription

1 1

2 Yesterday s Vision Tomorrow s Destiny MultiCare s Journey to Implementing an EHR Florence S. Chang Senior Vice President and CIO MultiCare Health System

3 Agenda MultiCare Overview Our Journey Creating the Vision Shaping the Vision Projecting the Vision Looking Ahead our Future Vision 3

4 Tacoma, Washington 4

5 Statistical Overview 93 Sites of Care 3 Adult and 1 Pediatric Hospitals in Pierce County Only Pediatric Hospital in Southwest Washington Level II Pediatric & Adult Trauma Centers 6 Ambulatory Surgery Centers 818 Licensed Beds 8,300 Employees 1,301 Physicians on the Medical Staff Annual Net Revenues of over $2 billion Multi-Specialty Clinics Rehabilitation Services Mental Health Services Physicians specialties including: Pediatric & Adult Medicine Fellows/Residents Pediatric ER Physicians Pediatric Neurologists Surgeons General Orthopedic Neurosurgery Plastic Surgery Oncologists Hospitalists OB/GYNs 5

6 2008 Patient Care Statistics Inpatient Admissions: Tacoma General / Allenmore (Adult) Tacoma General Neonatal Intensive Care Unit (Infants) Mary Bridge (Children) Good Samaritan TOTAL INPATIENT ADMISSIONS Outpatient Visits Surgical Procedures Emergency Department Visits Allenmore Tacoma General & Mary Bridge Good Samaritan TOTAL EMERGENCY DEPARTMENT VISITS Radiology Procedures Lab Tests 17, ,165 14,938 37, ,556 28,579 21,857 71,057 61, , million 3.5 million 6

7 Serving South Puget Sound Area Since 1882 Tacoma General & Mary Bridge Children s Hospital Gig Harbor Multi-Specialty Medical Center Allenmore Hospital Gig Harbor Tacoma Covington Multi- Specialty Medical Center Good Samaritan Hospital Legend Hospitals MultiCare Multi-Specialty Medical Centers MultiCare Primary Care Clinics Good Samaritan Clinics 7

8 MultiCare Integrated Care Delivery Model 8

9 MultiCare s Position as a Pierce County Employer Top 10 Pierce County Private Sector Employers # of Employees MultiCare Health System 5,567* Franciscan Health System 4,059 Chambers Bay Golf Course Opened: US Open: 2015 Safeway Stores, Inc. Fred Meyer Stores, Inc. 2,650 2,360 Convention Center Wal-Mart Stores 1,850 Emerald Queen Casino 1,688 The Boeing Company 1,450 Art Museum Museum of Glass McDonald s Restaurants 1,290 Milgard Manufacturing 1,115 Intel Corp 1,110 Tacoma Narrow Bridge 1 Source: The News Tribune, April 15, 2007 * Currently at 8,300 employees Fort Lewis 9

10 2008 National CEO IT Achievement Awards Diane Cecchettini, RN President & CEO MultiCare Health System Tacoma, WA Douglas D Hawthorne Chief Executive Officer Texas Health Resources Arlington, TX James Mongan, MD President & CEO Partners HealthCare System Boston, MA 10

11 Creating the Vision The history of the ideal patient experience Using technology to achieve the vision

12 Background The idea of the Ideal Patient Experience was originated as part of the MultiVision Conference in The MultiVision Conference involved hundreds of MultiCare employees, providers and patients and was designed to identify what would be characteristics of an ideal patient experience. From this conference, a number of foundational initiatives were identified and have been pursued by MHS management since this time. 12

13 MultiVision System --Change System-wide, long-term change process that will focus on on MHS culture, clinical, service and financial performance in in order to to achieve a higher level of of sustainable healthcare. Transformation Patient and and customercentered Passionate about quality Financially sustainable Communityconnected 13

14 MultiCare s Mission & Vision Quality Patient Care To create a seamless, easy, valued, and sustainable continuum of health care that enhances the experience of our patients, providers, caregivers, and employees. 14

15 Our Journey to the Ideal Patient Experiences Center of Emphasis Careline Strategy One One Patient. One One Record. Core Strategies & Infrastructure Organic Growth Execution & Growth Excellence In Quality Integration 15

16 Key Milestones Core Strategies & Infrastructure Organic Growth Execution & Growth Excellence In Quality Integration Vision Culture Change Learning Organization Center for Human Potential Institute of Learning Revenue Cycle Optimal Use of Technology Financial Performance Carelines (Center of emphasis) Imaging Cardiovascular Neuroscience Peds Central Data Repository Enterprise Master Patient Index MMA Ortho Urology Good Sam Affiliation Capital Plan Reduce Mortality Reduce Med Errors CMS Guideline Gig Harbor Medical Park Allenmore C MultiCare Connect PACS Powerscribes (Voice Recognition) Customer Services Branding Awareness Wayfinding Computerize Physician Order Entry Advanced Clinical Documentation Strategic Quality Initiative 16

17 Strategic IT Capital Investment Phase Phase Phase Phase $30M $20M $62M $30M Care in Ambulatory Clinics Data Year 2000 Administrative System Replacement Standard Desktop Software Pharmacy System Enterprise Master Patient Index Clinical Data Repository HIPAA Telecom/Data Integration Data Quality Enterprise System Administrative System Upgrade Network Infrastructure Upgrade Disaster Recovery & Business Continuity Common Business / Administrative Information System Common Revenue Cycle & Clinical Information System Good Sam Physician Network Integration Picture Archiving & Communication System 17

18 Our EPIC Journey South Sound Health Information Exchange Inpatient, CPOE, Advanced ClinDoc, Revenue Cycle and OpTime at Good Samaritan Home Health & Hospice at Good Samaritan and Hospice at MultiCare Pre 2008 Care at Good Samaritan s clinics 2008 MultiCare Connect Advanced ClinDoc & CPOE 2008 OpTime at MultiCare Pre 2007 MultiCare Connect Inpatient EHR 2007 Beacon Oncology at MultiCare Pre 2005 ASP available to any community provider 2004 Remote read-only access for community providers 2004 Home Health & My MultiCare 2004 Clinical Data Repository links inpatient and clinic information 2004 Board Approval Enterprise Contract Signed 2002 Enterprise Master Patient Index 2001 First ASP clients pediatric sites 1998 ambulatory implementation 18

19 Shaping the Vision Creating the ideal patient experience Using technology to achieve the vision

20 One Patient One Record Quality Patient Care Right Way Right Now the connection between patients and providers. utilizing the best technology and processes to connect providers to information. connecting information and people to transform the way we deliver care. 20

21 Goals of MultiCare Connect Patient Safety Do no harm Access Know the patient s story Accuracy Efficiency Effective communication among caregivers Eliminate steps that do not add value Financial Performance Reduce length of stay 100% Adoption Innovate to deliver the Ideal Patient Experience Delivering the ideal patient experience by focusing on patient safety, clinical outcomes, service and value 21

22 Key Milestones Accomplishment June 1, 2007 Dec. 3, 2007 Aug. 19, 2008 Oct. 14, 2008 Oct. 30, 2008 MultiCare Connect Part 1 Replaced LastWord at Tacoma General, Allenmore and Mary Bridge Implemented electronic Medication Administration Record Implemented Voice Recognition Power scribe for radiologists Beacon Implemented Beacon (Oncology) Module MultiCare Connect Part 2 PICU Pilot with Computerized Physician Order Entry and Clinical Documentation MultiCare Connect Part 2 Computerized Physician Order Entry and Clinical Documentation at Tacoma General, Mary Bridge and Allenmore Physician Network Integration MultiCare Connect at all ten clinics at Good Sam OpTime (Operating Room System) January 27,

23 Key Benefits At-a-Glance June 1, 2007 Dec. 3, 2007 Aug. 19, 2008 Oct. 14, 2008 Oct. 30, 2008 MultiCare Connect Part 1 Improved AR days from 52 days to 46 days (Best in all Customers) Improved Imaging turnaround time by 50% Over 85% of our radiologists using self editing mode for dictation Improved Lab turnaround time by 30% Beacon Achieved zero chemotherapy medication errors! MultiCare Connect Part 2 89% of all orders are entered directly by physicians in PICU MultiCare Connect Part 2 75% of all orders are entered directly by physicians as of December % reduction in medical record transcription Physician Network Integration One clinic per month Patient case load back to normal schedule within 2 weeks after Go-Live 23

24 Current System Usages 10,156 Active Users 322 Employed Physicians 48 Clinics 4 Hospitals 249 Hospital Services Departments 15,704 MyChart Active Users 284 Application Service Providers Active Users 1,490 Community Providers 1,637,384 Patients In the Database 24

25 We aligned our entire organization to focus on the realization of our dream. Diane Cecchettini, RN President and CEO MultiCare Health System 25

26 Good Samaritan Affiliation Phase 4 Strategic Plan Objectives Design, develop, and implement a strategic integration plan to bring MultiCare and Good Samaritan Hospital onto a common business and clinical information systems platform 26

27 Original MHS System Portfolio Orders/ Results MedQuist Transcription- CMT Nuance Radiology Dictation/ Transcription QuadraMed- WinPFS Nurse Scheduling Clinical Systems Business Systems MultiCare Pre Good Sam MultiCare Pre Good Sam CORE CLINICAL SYSTEMS Clinical Data Repository Midas Care Manager/ UR Nightingale Consulting Nurse Scheduling MedQuist Dictation Phillips Critical Care- Clinical Documentation emar QuadraMed- WinPFS Patient Acuity Meditech Orders/ Results Crescendo Transcription- CMT CORE CLINICAL SYSTEMS Meditech Clinical Data Repository Meditech Care Manager/ UR Meditech E-Signature Crescendo Dictation Enterprise Patient Scheduling Clinic Practice ncoder Coding Patient Billing REVENUE CYCLE SYSTEMS Patient Access/ Registration HDX Insurance Eligibility epremis Claims Processing Patient Tracking Bed HIM Third Millenium Claims Digital Archive Meditech Enterprise Patient Scheduling Misys Clinical Practice 3M Coding Meditech Patient Billing REVENUE CYCLE SYSTEMS Meditech Patient Access/ Registration Provider Advantage Insurance Eligibility epremis Claims Processing Meditech Bed Meditech HIM E-Cabinet Claims Digital Archive Misys Lab ANCILLARY SYSTEMS Rx HBS Outpatient Rx- Retail POS Meditech Lab ANCILLARY SYSTEMS Meditech Rx NDC Outpatient Rx- Retail POS Accounts Payable FINANCIAL SYSTEMS General Ledger McKesson Budgeting/ Financial Planning Meditech Accounts Payable FINANCIAL SYSTEMS Meditech General Ledger Budget Advisor/ Financial Budgeting/ Financial Planning Pyxis Medication Distribution Siemens Cardiology ImageCast Radiology MedSelect Medication Distribution GE Cardiology Payroll Human Resources Workbrain Time & Attendance Infinium Payroll Infinium HR Kronos Time & Attendance Computrition Nutrition Services Stryker Surgery Center Systems Home Health/ Hospice VST Nutrition Services SurgiServ Surgery Center Systems PTcT Home Health/ Hospice Recruitment TractManager Contracts Ascent Contract E-Labor Recruitment TractManager Contracts Ascent Contract CoPath Pathology ORSOS Surgery Scheduling GE NICU Fetal Monitoring CoPath Pathology Meditech OR GE Labor & Delivery McKesson Decision Support Materials HBI/HPM Reporting Power Manager Decision Support Meditech Materials Meditech Reporting Provation GI Lab Documentation System Hospira Smart Pumps / Varian Oncology Hospira Smart Pumps MISCELLANEOUS SYSTEMS MISCELLANEOUS SYSTEMS Hologic Digital Mammography Pyxis OR Surgical Supply Station Ansos Scheduling- Clinical Various Scheduling- Non-Clinical Ansos Scheduling- Clinical Kronos Scheduling- Non-Clinical 27

28 Portfolio After Phase 4 ( ) Clinical Systems MultiCare Pre Good Sam MultiCare Pre Business Systems Good Sam CORE CLINICAL SYSTEMS CORE CLINICAL SYSTEMS REVENUE CYCLE SYSTEMS REVENUE CYCLE SYSTEMS Orders/ Results Clinical Data Repository escription Dictation Orders/ Results Clinical Data Repository escription Dictation Enterprise Patient Scheduling Patient Access/ Registration Bed Enterprise Patient Scheduling Patient Access/ Registration Bed escription Transcription Midas Care Manager/ UR Clinical Documentation escription Transcription Midas Care Manager/ UR Clinical Documentation Clinic Practice HDX Insurance Eligibility HIM Clinical Practice HDX Insurance Eligibility HIM emar E-Signature Powerscribe emar E-Signature Powerscribe ncoder Coding epremis Claims Processing Third Millenium Claims Digital Archive 3M Coding epremis Claims Processing Third Millenium Claims Digital Archive QuadraMed- WinPFS Nurse Scheduling Nightingale Consulting Nurse Scheduling QuadraMed- WinPFS Patient Acuity Patient Billing Patient Tracking Patient Billing ANCILLARY SYSTEMS ANCILLARY SYSTEMS FINANCIAL SYSTEMS FINANCIAL SYSTEMS Sunquest Lab Rx HBS Outpatient Rx- Retail POS Sunquest Lab Rx NDC Outpatient Rx- Retail POS Accounts Payable General Ledger Kaufman Hall Budgeting/ Financial Planning Accounts Payable General Ledger Kaufman Hall Budgeting/ Financial Planning Pyxis Medication Distribution Siemens Cardiology ImageCast Radiology MedSelect Medication Distribution GE Cardiology Meditech Radiology Payroll Payroll Human Resources Workbrain Time & Attendance Payroll Human Resources Kronos Time & Attendance Computrition Nutrition Services Stryker Surgery Center Systems Home Health/ Hospice VST Nutrition Services SurgiServ Surgery Center Systems Home Health/ Hospice Peopleclick (Recruitment) TractManager Contracts Ascent Contract Peopleclick (Recruitment) TractManager Contracts Ascent Contract CoPath Pathology OR GE NICU Fetal Monitoring CoPath Pathology OR GE Labor & Delivery Decision Support Materials Reporting Decision Support Materials Reporting Provation GI Lab Documentation System Hospira Smart Pumps / Varian Oncology Hospira Smart Pumps MISCELLANEOUS SYSTEMS MISCELLANEOUS SYSTEMS Hologic Digital Mammography Pyxis OR Surgical Supply Station Ansos Scheduling- Clinical Various Scheduling- Non-Clinical Ansos Scheduling- Clinical Kronos Scheduling- Non-Clinical 28

29 Portfolio After 2010 Clinical Systems Business Systems MultiCare Pre Good Sam MultiCare Pre Good Sam CORE CLINICAL SYSTEMS CORE CLINICAL SYSTEMS REVENUE CYCLE SYSTEMS REVENUE CYCLE SYSTEMS Orders/ Results Clinical Data Repository escription Dictation Orders/ Results Clinical Data Repository escription Dictation Enterprise Patient Scheduling Patient Access/ Registration Bed Enterprise Patient Scheduling Patient Access/ Registration Bed escription Midas Care Manager/ UR Clinical Documentation escription Midas Care Manager/ UR Clinical Documentation Clinic Practice HDX Insurance Eligibility HIM Clinical Practice HDX Insurance Eligibility HIM emar E-Signature Nuance Radiology Dictation/ Transcription emar E-Signature Nuance Radiology Dictation/ Transcription ncoder Coding epremis Claims Processing Third Millenium Claims Digital Archive 3M Coding epremis Claims Processing Third Millenium Claims Digital Archive QuadraMed- WinPFS Nurse Scheduling Nightingale Consulting Nurse Scheduling QuadraMed- WinPFS Patient Acuity Patient Billing Patient Tracking Patient Billing Misys Lab ANCILLARY SYSTEMS Rx HBS Outpatient Rx- Retail POS Meditech Lab ANCILLARY SYSTEMS Rx NDC Outpatient Rx- Retail POS Accounts Payable FINANCIAL SYSTEMS General Ledger Kaufman Hall Budgeting/ Financial Planning Accounts Payable FINANCIAL SYSTEMS General Ledger Kaufman Hall/ Budgeting/ Financial Planning Pyxis Medication Distribution Siemens Cardiology ImageCast Radiology MedSelect Medication Distribution GE Cardiology Meditech Radiology Payroll Human Resources Time & Attendance Payroll Human Resources Time & Attendance Computrition Nutrition Services Stryker Surgery Center Systems Home Health/ Hospice VST Nutrition Services SurgiServ Surgery Center Systems Home Health/ Hospice Peopleclick (Recruitment) TractManager Contracts Ascent Contract Peopleclick (Recruitment) TractManager Contracts Ascent Contract CoPath Pathology Operating Room System GE NICU Fetal Monitoring CoPath Pathology Operating Room System GE Labor & Delivery McKesson Decision Support Materials HBI/HPM Reporting McKesson Decision Support Materials HBI/HPM Reporting Provation GI Lab Documentation System Hospira Smart Pumps / Varian Oncology Hospira Smart Pumps MISCELLANEOUS SYSTEMS MISCELLANEOUS SYSTEMS Hologic Digital Mammography Pyxis OR Surgical Supply Station Ansos Scheduling- Clinical Various Scheduling- Non-Clinical Ansos Scheduling- Clinical Kronos Scheduling- Non-Clinical 29

30 Journey to a Common Information Systems Platform Hospital Hospital Information Information System System Integration Integration () () ADT, ADT, HIM, HIM, Hospital Hospital Billing, Billing, Claims, Claims, ED, ED, Physician Physician Oder Oder Entry, Entry, Physician Physician and and Nursing Nursing Clinical Clinical Documentation Documentation Home Home Health Health / / Hospice Hospice Information Information System System Integration Integration () () Operation Operation Room Room Information Information System System Integration Integration ( ( OpTime) OpTime) Inpatient Inpatient Pharmacy Pharmacy Information Information System System Integration Integration ( ( Rx) Rx) Business Business / / Administrative Administrative Information Information Systems Systems Integration Integration () () AP, AP, GL, GL, HR, HR, Payroll, Payroll, Material Material GSH GSH Physicians Physicians Network Network Integration Integration Scheduling, Scheduling, Professional Professional Billing Billing and and EMR EMR () ()

31 Projecting the Vision Creating the ideal patient experience Using technology to achieve the vision

32 Community Physicians CareConnect provides MultiCare s application under an Application Services Provider (ASP) model to community physicians MultiCare owns, operates, and maintains the central data system and owns the licensing and support relationship with System Corporation MultiCare recognizes CareConnect as a service and benefit to the community operated at an initial financial loss 32

33 CareConnect Customer Base Our 47 CareConnect clients are located in the primary service area and beyond Approximately 1,400 independent community physicians practice in MultiCare s primary service area of Pierce County, south King County, and southwest Washington 33

34 CareConnect Services Offered Read-only remote access with In-Basket messaging is offered, and encouraged, at no charge to MHS privileged providers Full use of Clinical and Practice applications is offered at a per provider per month fee of $309 Applications include: Clinical Care (EMR) Front Office patient registration and scheduling Business Office patient billing, claims processing, A/R management and Clinical Reporting 34

35 Regional Health Information Exchange South Sound Health Information Exchange A collaborative effort in the South Puget Sound region between MultiCare Health System, Franciscan Health System, and Madigan Army Medical Center to exchange health information for patients in the community. 35

36 Goals of South Sound Health Information Exchange Improve Quality of Care Improve the quality of care by bringing information to health care professionals at their decision making moment. Increasing access to information translates into better decisions that ultimately result in higher quality care and outcomes for the community. Improve Continuity of Care Enhance care so that continuity is improved as patients pass from the care of one group or provider to another. Better continuity of health care information results in greater patient safety. 36

37 Goals of South Sound Health Information Exchange Increase Affordability of Health Care Improve the efficiency of health care delivery by automating administrative practices that are currently performed manually, reducing redundant costs, and unnecessary tests. Foster Community Partnerships Enable collaborative partnerships in the community among both public and private organizations that will serve as a basis for future regional health care innovations and patient care improvements. 37

38 Carol Milgard Breast Center A collaborative effort between MultiCare Health System, Franciscan Health System, and Tacoma Radiology Group to provide screening & diagnostic mammography services. Build, establish and operate a jointly owned, centrally located, not-for-profit, comprehensive breast health center. Centralize and consolidate key breast health services to best leverage resources, such as radiologists, technology, equipment, labor, and access. Carol Milgard Breast Center 38

39 Future Vision Creating the ideal patient experience Using technology to achieve the vision

40 Going Forward Achieving the Benefits Focus on the Return of Investment Optimization Goals Reduce variation (Rework, redundancy, work-around) Increase standardization Optimization Opportunity Physician Optimization Operational Process Optimization Integrated System Optimization Turn data into Information Business Intelligence and Decision Support Drive performance based on Key Performance Indicators Proactive and smart alerts Focus on Patient Information following patient Care Everywhere: Information exchange between System Customers 2009 Connecting MHS with Swedish and The Everett Clinic as the pilot for the region Care Elsewhere: Information exchange between & non- System customers Date and pilot health system to be determined Personal Health Record and My MultiCare 40

41 RFID Home Monitoring y ac m e ar sid ing Ph d d Be r c o Ba eicu econsult Su D e pp cis B In us ort ion te in a llig es nd en s ce O Clin u C tc o i c a u Se sto me l rv m s ic er e t y os c C ien fic Ef Smart Care Room Device Integration Continue the Ideal Patient Experience Journey Patient Safety 41

42 Where is MHS in comparison to the rest of the country? Stage Stage 7 Stage 6 EHR Adoption Model SM Cumulative Capabilities Medical record fully electronic; HCO able to contribute CCD as byproduct of EHR; Data warehousing in use Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 2007 Final Q % 0.0% 0.8% 0.9% Stage 5 Closed loop medication administration 1.4% 1.0% Stage 4 CPOE, CDSS (clinical protocols) 2.2% 1.8% Stage 3 Stage 2 Clinical documentation (flow sheets), CDSS, (error checking), PACS available outside Radiology Clinical Date Repository, Controlled Medical Vocabulary, Clinical Decision Support, may have Document Imaging 25.1% 32.0% 37.2% 33.9% Stage 1 Ancillaries Lab, Rad, Pharmacy All Installed 14.0% 12.6% Stage 0 Al Three Ancillaries Not Installed 19.3% 17.7% Data from HIMSS Analytics Database (derived from the Dorenfest IHDS+Database ) 4242

43 MultiCare Health System will be one of the top 20 Stage 6 hospitals by

44 Value of Information Services Paradigm Shifting Evidence of High Performance Competitive Differentiation Innovative IT Conditions for a High Performance Organization Integrated Information Stability & Security Commodity IT Infrastructure & Connectivity 44

45 Yesterday s Vision - Tomorrow s Destiny 45

46 Thank you Florence Chang Chief Information Officer (253) Matt Eisenberg, MD, FAAP Medical Director, Information Services (253)