Information Technology Service Process
Help Desk Institute Sacramento Regional Meeting
University
i
i off California
C lif
i Davis
i Health
l h System
S
April 18, 2012
Mike Minear, CHCIO, CPHIMS
Chief Information Officer
University of California Davis Health System
Speaker Disclosure
I have no personal financial relationships or interests in any entity producing,
marketing, re-selling, or distribution health care technology or goods and
services consumed by, for clinical care, or used on patients.
Michael N. Minear,
CHCIO, CPHIMS
Professional Affiliations
Chief Information Officer – University
y of California -Davis Health System
y
Associate Faculty - Johns Hopkins Bloomberg School of Public Health
Current
C
rrent Associations  Co-Chair of the Board – California Telehealth Network (CTN) (2012 – current)
 Member - Steering Committee - Group on Information Resources (GIR) of AAMC - (term 2012 to 2014)
 Co-Chair - California Hospital Association’s (CHA) Informatics and Technical Committee (2010 – current)
 Member - California Hospital
p
Association’s ((CHA)) Informatics and Technical Committee ((2008 – current))
 Member - Healthcare Information & Management Systems Society (HIMSS)
 Member - American College of Healthcare Information Administrators (CHIME)
 Member - American Medical Informatics Association (AMIA)
 Member of the American College of Clinical Engineering (ACCE)
•2
Mission
•3
•4
‘Improving lives and transforming health care’
 Clinical Care
 Among the top 50 hospitals in America
and also ranks as the top hospital in
Sacramento
 Research
 $200+ million in annual funding
 37th ranking NIH research funding
 Education
Ed
ti
 Ranked 35th among US Medical Schools

(ranked 62nd in 2001)
 Betty Irene Moore School of Nursing
5
UC Davis Health System
UC Davis Medical Center ranks among the top 50 hospitals in
America and also ranks as the top hospital in Sacramento with
nine high-performing medical specialties
UC Davis ranks among the nation's top medical schools for rural
medicine, primary care and research
National Cancer Institute ‘comprehensive’ designation cancer
center, one of only 41 in the country
one of just eight U.S. hospitals receive a Kidney Transplant
Excellence Award for 2012 from HealthGrades for superior
outcomes and survival rates for kidney transplants
UC Davis Health System: Key Statistics

Budget
•
•

People
p
•
•

$1.7 billion in revenue
$200 million in research funding
7,646 staff; 1,259 faculty and academic employees
871 residents, fellows and 816 students
Major economic engine for region
•
Economic impact
p
in Northern California of more than $3.4
$
billion*
* Source: Center for Strategic Economic Research
7
UC Davis Health System – Information Technology
Electronic Health Record
$160 million
Investment Over 11 years
2002 - 2013





Epic EHR
100% EHR use
ONC-ATCB Certified EHR Software
2.1
. million
ll o pat
patients
e ts in EHR
91% CPOE usage
195 Organizations
Epic is now used to
support 35% - 45% of all
American healthcare
encounters
 Stage 6-HIMSS Analytics EMR Adoption
 Most Wired award
 USN&WR Most Connected Hospital
EMR Adoption Model Stage 6
233 hospitals achieved Stage 6
58 hospitals achieved Stage 7
295 + 45 Physicians meeting
EHR meaningful use
requirements – 247 have
registered
eg ste ed and
a d attested
(January 2012)
118 hospitals
8
UC Davis Health System – Clinical Software Infrastructure
Specialty
p
y Clinical Software













Radiology information System
Transcription / Voice Recognition
Radiation Oncology
Pathology
Dietary
Pulmonary Function
Holter
Muse EKG
Echo
EMG – orders
Respiratory care – orders
Treadmill
CAPS TPN p
pharmacyy admixture
Health Information Exchange

Tethered PHR – over 57,000+ patients using
web portal or iPhone to access PHR

2,564+ community physicians have secured
remote access to UCDHS EHR,
EHR 27,858+
27 858+
patient records have been shared

6,600+ EHR records shared with other care
providers –connected to over 70 Epic
customers via Care Everywhere

All 5 federal mandated ePresccribing
interfaces in use – over 2 million
ePrescriptions shared

66,000+ outside clinical images loaded to
UCDHS PACS using PACSGear

TheraDoc reportable infections interface to
CDC

Interface to eHealth Global Technologies in
place to load outside scanned records and
DICOM images to EHR and PACS
Secondary Use EHR Content
Digital Clinical Images
NIH i2b2 Cohort Discovery
Many disease Registries:
 Cardiology
 Burn
 Trauma
 Cancer
 Many
y others…
 Tethered Meta Registry
 Radiology Dose Registry


Radiology – Philips PACS
Outside Clinical Images loaded to
Radiology PACS via PACSGear
 Ophthalmology PACS - Anka
 Non Radiology PACS images
 TeleHealth Store & Forward
 Digital Endoscope PACS - nStream
 Rad Oncology PACS - Teremedica
 Pathology PACS - Aperio


Clinical Equipment
Electronic Health Record












Pyxis Drug cabinets
Hemodynamic monitors
Telemetry
EKG
Fetal monitoring
Echo
Glucose Point of Care
Cardiac Cath Monitors
Bar code medication admin
Digital Infusion pumps
Bladder Scanner
Ventilators
Paper Medical Records Scanned
and Linked into EHR
 Consent forms
 Outside paper medical
Interfaced
With EHR:
records
Legend
In Production | In Process | Not yet started
9
UCDHS Information Technology Division

460 IT staff

$80 million operational budget
$15 - $40 million annual capital budget


IT staff manage a large and sophisticated technology infrastructure that
includes; 2 data centers, over 1,000 servers running a variety of operating
systems, 12,000+ client computers, 2,500+ network attached printers, over 125
interfaces, storage area networks, and a large IP network with integrated voice
and data transmissions

Supports over 410 major software applications in production use

HP OpenView system to manage IT assets,
assets the technology service process,
process
change management, and technology probes & monitors

Provides technology customer support to UCDHS via a 24 hour x 365 day modern
technology operations center that receives over 6,000
6 000 customer service
requests per month
10
Growth in Mobile Technologies
iPad Version of EHR for clinicians
Bar Code
M di ti Ad
Medication
Administration
i i t ti
Sigma infusion pumps
Smiths Medical
Syringe infusion pumps
iPhone Version of
EHR for clinicians
iPhone version of
PHR for patients
Accu Check
Wireless
Glucose Meter
iPhone support of email
‘Personal’ iPhones
11
Tethered Personal Health Record (PHR)
UC Davis Health System
MyChart Active Patients
February 2009 through March 2012
60000
50000
40000
30000
20000
10000
0
12
Health Information Exchange (HIE)
UC D i H l h S
UC Davis Health System
Patient Clinical Data Shared with other Care Providers
November 2008 through March 2012
70,000
60,000
50,000
40,000
30,000
20,000
10 000
10,000
CAIRS (CA Immunization
Registration System)
'Shots for Tots'
eHGT - Exchange EHR
Content
PACSGear -Load
Load clinical
images to PACS from other
providers
Epic Physican connect - EHR
Patient Records Remotely
Accessed
Allscripts - Share Clinical
Content - Support Discharge
& Transition of Care
Epic Care Everywhere Exchange EHR content
Epic and Surescripts ePrescription
P
i ti Records
R
d Shared
Sh d
0
13
Information Technology Service
14
IT Service Process in 2007

Current State







#
1
2
3
4
5
6
7
8
9
10
11
?
3 different IT divisions
Multiple Processes
Multiple technologies / databases used to support service
Few measures to assess and manage customer service
Many Silos
Few tools to manage
g technology
gy – p
poor use of existing
g tools
Not able to support ‘mission critical’ technology used by organization
System Name
Incident Management
ISMED
S
request system
EMR Defect tracking
EMR issue tracking
CIS report request tracking DB
Access request system
MAC database - service request
q
Teledat
Card key system
Vocera database
Kerberos access
Other security access systems
Primary Type
Problem
All
Problem
Problem
Req Service
Request Access
All
All
Request Access
All
Request Access
Request Access
Technology
Lotus Notes
C
Cold
Fusion ? MySQL
SQ
Old crappy DB
Mantis open source JAVA
MS Access DB
Lotus Notes
Lotus Notes
Informix
Johnson Controls Prop
MS Access DB
?
Various
Used By?
Replace
IS and CRS
Yes
SO & basic Sciences
SOM
S
CIS
CIS
CIS
IS, HIM, security officers
IS, HIM, CRS, CIS
Telecom
Telecom
Telecom
IET
?
15
Creation of New IT Service Process

Make customer service a priority

Take a holistic / total view

Focus on mission and process


Assess and document the IS process (current state)
Design the SHOULD process (optimal state)

Organization all resources and staff around the SHOULD process

Deploy and use tools

Create metrics and a culture of measurement

Strongly manage to mission and goals (use metrics)

Every IT manager
E
g has
h a ‘‘customer
t
service’
i ’ element
l
t tto th
their
i jjob
b
description
16
Tools

I
Invested
t d iin and
d deployed
d l
d the
th HP O
OpenView
Vi
product
d t suite
it






ITIL based
Service manager (with self service option)
Configuration Management database (CMDB)
Asset manager
Probes and monitors
Change management
17
HP Service Manager Interaction (IT staff)
18
HP Service Manager - Customer Self-Service Screen
19
IT Service Guidelines

P
Proactive
ti vs. R
Reactive
ti response

Created BEFORE the request or need occurs…

Define every reason a customer would need help from IT

Define the BEST and p
proven way
y to resolve the issue

Create the guideline - actual workflow / tasks to resolve the issue

Verify the guideline works and it is complete

Keep the guideline up to date
 New
N
versions
i
off software
ft
or h
hardware
d
 Current guideline needs updating, or a better way to resolve issue
found
 New technology deployed
20
How to Create Guidelines
1.
2.
3.
4.
Define the population of issues that requires a guideline
Prioritize the list
Start with the highest priority (most used)
Gather data
 data
d t ffrom pastt customer
t
needs
d
 Vendor documentation
 Inventory error messages
 Ask vendor for their service guidelines
 Ask staff, ask customers
5. Create initial version of guideline
6. Have others in team with expertise to review
7. Make changes and edit as needed
8. Put into ‘production’ use
9. Monitor Collect data from system – and feedback from customers
 Is it working?
 Is it being used?
 How can it be improved?
 Respond to new versions or changes in technology
 Support new technologies deployed
10. Edit/create new versions of the guideline as needed over time
IT Service Guideline Trend
UC Davis Health System IT Service Guidelines Jan 2012 started
w ith 4228
Guidelines
2009 ‐ 2012
April 2012
982 Guidelines
w ere retired
4500
4000
3500
3,246
3000
2500
2000
1500
Service Manager Go Live May 2009
1000
500
0
2009
2010
2011
2012
22
Technology Operations Center – Overall Design
23
Technology Operations Center – Showing Overhead Monitors
24
Technology Operations Center – During Construction
Technology Operations Center - As of January 15, 2009
25
Technical Operations Center – Current Day



New dedicated technology call center established in May 2008
 Open 24 x 7 x 365
Staffed all 3 shifts with additional staffing during Peak Periods
Uses Industry
dust y Standard
Sta da d approach
app oac to manage
a age technology
tec ology service
se v ce
26
IT Walk‐up Express
The Information Technology Walk‐up The
Information Technology Walk up
Express is easy to access touch point for customers
Open from 7:00 am to 4:00 pm Monday
Open
from 7:00 am to 4:00 pm Monday‐
Friday
Parking is available in a specially identified reserved space in front of the building
p
g
IT Walk‐up Express Services
 Pager drop‐off and pick‐up
g
p
p
p
 Pager exchanges
 Vocera device exchange
 Cell Phone drop‐off and pick‐up
 Laptop drop‐off and pick‐up (Loaners p p
p
p
p(
available)
 Vendor registration and badging
 Short‐term parking for quick service
 Walk‐up kiosk for campus visitors
p
p
27
Service Measures
28
Service Measurement

Can’t manage what you don’t measure

Make
Ma
e measurement
easu e e t a priority
p o ty

Service process and tools defines what is possible to measure

Morph measures over time



Learn how to measure better
Address new problems
p
Help absorb new challenges
29
IT Weekly Service Measures / Reports
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Technical Failure Log
Weekly Total Service Interactions and High Impact Incidents
Total Incoming Calls and Available Staff
Call Abandonment Activity
Total Incidents by Hour
Call Abandonment Rate by Hour
Average Time to Answer Call
Total Escalations by Team Name
Level 1 Warm Transfer
First Call Fix Percentage and Average Handle Time
First Call Fix Percentage ‐ Excluding Hardware Escalations
Total Successful and Unavailable Guidelines ‐ Team Name
Incident Aging and Backlog
Incidents Aged > 72 Hours By Team
Weekly MyChart Incidents
16
17
18
19
20
21
22
23
24
25
26
27
28
29
MyChart Incoming Calls by Hour (patient calls for support)
MyChart Requester Type (patient calls for support)
MyChart Guideline Usage (patient calls for support)
Desktop Support Daily Ticket Overview
Desktop Support Daily Ticket Overview (Education)
Desktop Services ‐ Status of Incidents
Educational Technology Desktop ‐ Status of Incidents
Desktop Services Siste Visit or Solved Remotely
Desktop Services Siste Visit or Solved Remotely (Educational Technology)
IT Walk Up Center ‐ Service Type
Weekly iPhone and iPad Requests
Customer Satisfaction Overall Weekly Score By Team
Customer Satisfaction Survey ‐ Average Score Per Question
Primary Functions of the IT Division
30
Cover / Summary of Weekly IT Service Measures
Reviewed by IT management team
Every Tuesday morning
Routinely shared and discussed in all
IT teams
Shared with customers and Health
System leadership
31
Average Time to Answer Call
Average Time to Answer Call
2012 ‐ 2008
5.00
Service
Process Go
Live 5/2009
Minutes.Seco
onds
4.00
3 00
3.00
Corrupted
Mail Server
05/2011
EMR
Upgrade
8/2010
Storage
issues
11/2010
2.00
1.00
0.00
32
Total Incoming Calls, Staffing, and Abandoned Calls
Total Incoming Customer Calls (Demand)
Available IT Staff (Supply) 2008‐2012
30
EMR
Upgrade
8/2010
Storage
issues
11/2010
10000
Totaal Incoming and Abaandoned Calls
Total Staff
25
Service
Process
Go Live
5/2009
12000
Corrupted
Mail Server
05/2011
20
8000
15
6000
10
4000
5
2000
0
0
Level One Staff
Additional Level One Staff
Total Incoming Calls
Abandoned Calls
33
Total Calls/Incidents by Hour of the Day
Total Incidents by Hour March 2011 ‐ March 2012
14000
12000
10000
8000
6000
4000
2000
0
00:00‐ 01:00‐ 02:00‐ 03:00‐ 04:00‐ 05:00‐ 06:00‐ 07:00‐ 08:00‐ 09:00‐ 10:00‐ 11:00‐ 12:00‐ 13:00‐ 14:00‐ 15:00‐ 16:00‐ 17:00‐ 18:00‐ 19:00‐ 20:00‐ 21:00‐ 22:00‐ 23:00‐
01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 24:00
Mar‐11
Apr‐11
May‐11
Jun‐11
Jul‐11
Aug‐11
Sep‐11
Oct‐11
Nov‐11
Dec‐11
Jan‐12
Feb‐12
Mar‐12
34
Customer Requests / Incident Backlog
35
Customer Satisfaction
36
MyChart PHR Calls / Incidents
(tracking patient calls)
37
Technology Failure Trend
UCDHS Information Technology Technical Failure Event 2008‐2012
40
10
Average
29
Maximum
1
Minimum
30
20
10
0
38
CDC Global Services Service Desk Assessment Model
Data for UC Davis Health System
Service Desk Assessment
Service Desk process and best practice implementation
Organization integration
Organization integration
Technology optimization
Staff development
Inforamtion management
Overall Service Desk Maturity Score
24
20
22
18
18
102
UCDHS
39
HDI Performance Metric Comparison
Service Metric
Average First‐
Call Resolution Target Average First‐Call Resolution Rate
All Industries*
Healthcare Industry*
UCDHS
68%
66%
61%
73%
75%
80%
Average Speed to Answer
to Answer
Customer Satisfaction
11‐20 seconds
170 seconds
120 seconds
51.30%
n/a
85%
* Source: 2011 HDI Practices & Salary Survey
40
Cliff Notes - UCDHS Information Technology Service Process







Leadership
p
 Key focus of the IT management team and CIO
 New customer service manager hired
Process
 Health System-wide - all Information Technology functions and teams
 Single process for all service support issues
 Process redesign for optimal efficiency and customer support
Service Response Guidelines
 Cross divisional teams formed to create & maintain ‘optimal problem resolution’
 Will start with hundreds and grow to thousands of guidelines
Tools
 HP OpenView
p
suite – fullyy integrated
g
functionalityy to manage
g IT technology
gy and
service, ITIL based
Facility
 New Operations Center and retail support area
 Call center function and key Level 11, 22, and 3 staffing
 24 x 7 x 365 - Integrate all technology teams and support functions
Measurement
 Create in-depth service measures and integrate into daily work
Communication
 Customer facing website, self service, customer messages, other
41
END
42