Healthcare Leaders Embrace Reform
Beyond the EMR, CPOE, eMAR, SCM, HIT and HIEs:
Alphabet Soup for the Next Ten Years
Paul Browne, MPH/MHA, SVP & CIO, Trinity Health
Alphabet Soup / Acronyms
 A word formed from the initial letter or letters of each of the
successive parts or major parts of a compound term; or
 An abbreviation formed from initial letters
 Radar – Radio Detection and Ranging
 CIO – Chief Information Officer
 FAQ – Frequently Asked Questions
 SNAFU – Situation Normal All Fouled Up
 Information Superhighway - “Interactive Network For Organizing, Retrieving,
Manipulating, Accessing And Transferring Information On National Systems, Unleashing
Practically Every Rebellious Human Intelligence, Gratifying Hackers, Wiseacres and
Yahoos”
Page 2
Discussion Outline
 Background
 Trinity Health Overview
 Trinity Information Services (TIS) Overview
 Planning Model
 Retrospective: 1999 – 2009
 Key Focus Areas
 Outcomes
 2010 – 2020: Looking Forward
 Environmental Overview
 Trinity Health Strategic Imperatives
 IS Key Focus Areas
 Summary Thoughts
 Q&A
Page 3
Trinity Health…Who We Are
• Fourth-largest Catholic
health system in the
United States (based
on Operating Revenue)
• 47,000 full-time equivalent
employees
• More than 8,000 active
staff physicians
• 19 Ministry Organizations,
encompassing 47 hospitals
35 owned, 12 managed
• Revenues of $7 billion
• Nearly $400 million in
community benefit ministry
Page 4
Trinity Information Services Profile
TIS is a business within a business … a wholly owned, $300m / year
subsidiary of Trinity Health

Operational Structure



Applications





Clinical – Cerner
Patient Administration / Revenue Mgmt – McKesson
HR / Payroll / GL / FA – PeopleSoft
Supply Chain / AP - Lawson
Infrastructure



Single IS Organization - Consolidated Application Management,
Infrastructure Management, Financial Management, Planning
Workforce - Approximately 1,400 associates
Enterprise Data Centers – Novi MI / South Bend IN
Approximately 100,000 Networked Devices
Services & Other





Portfolio of Routine IS Services
7*24*365 Help Desk Fielding 720,000 / Year – Specialized Cerner
knowledge
Strong Program Management, Change Management Services, and
Benefits Management
Nationally recognized leader in deployment and usage of electronic health
records
Provider of outsourcing services to external organizations
Page 5
Planning Approach
Retrospective Analysis
Why did we do this?
Prospective Analysis
Where do we go from here? Can we generate an even better return on
investment within TH (quantity / quality / distribution of data)? What will it
take?
Inpatient
What did
we complete relative
to what we originally
envisioned?
What outcomes
were achieved?
Ambulatory
Care
Continuum
Comparative
Effectiveness
Analysis
Other
Can we turn what we’ve done into new revenue streams?
Asset
/ Capability
Inventory
Potential
Customers
Potential
Competitors
Business
Model
What are the organizational requirements to execute?
What did
we spend?
Personnel
Resources
Financial
Resources
Other
Resources
What will truly differentiate Trinity Health?
What were key
decision points? What
decisions did we
make? Learnings?
Innovation
Key
Processes
Partnerships
Business
Model
Economics
What are the Trinity Health, industry, and policy implications?
Page 6
Retrospective: 1999 – 2009 IS Focus Areas
Major Themes
Organizational Consolidation
Infrastructure Standardization
Application Rationalization
Process Redefinition
The Soup









Y2K
.com
XP
EMR/EHR
ADE
CPOE
SEM
URO
CDM









HIPAA
HIT
HIE
RAC
BMDI
POC
IPOC
EWS
ARRA
Page 7
Genesis – Trinity Health: Circa 1999 . . .
Tool Diversity  Process Diversity  Variable Performance
Operating Units
Silver Spring, Columbus,
MD
OH
Port Huron,
MI
Eastern Division
Mt. Clemens,
MI
Pontiac, MI
Livonia, MI
Ann Arbor,
MI
Battle Creek, Grand
MI
Rapids, MI
Muskegon,
MI
Western Division
South Bend,
Dubuque,
IN
Clinton, IA IA
Mason City, Sioux City,
IA
IA
Boise, ID
Fresno, CA
Patient Administration
Registration
Patient Accounting
SMS Med
Series4
HBOC STAR
HBOC Plus
2000
Medical Records
3M
DRG Grouper
3M
HBOC
Series
HBOC
Health-Quest
HBOC
Health-Quest
SMS Med
Series4
SMS Med
Series4
HBOC STAR
HBOC
STAR
QuadraMed
3M
Quadramed
APC/APG Grouper
HSS
3M
HSS
Enterprise Resource Planning (ERP)
General Ledger
Payroll/Human
Resources
A/P
Materials
Management
People Soft
Global
SMS Med
Series4
GEAC
Ceridian
HBOC
People Soft
SMS Med
Series4
Global
Self Developed
(Analysis &
DSS)
TSI Mainframe
People Soft
GEAC
Self
Developed
(Analysis &
DSS)
TSI AS400
TSI Mainframe
SMS Med
Series4
HBOC
Cost Accounting
Contract
Management
HBOC
Self
Developed
(Analysis &
DSS)
TSI AS400
SARMC
Clinical Systems
Physician Order
Management
Eclipsys
SMS
HBOC Plus
MedSeries 4 2000
HBOC STAR
Order Entry
In-house/3M
Results Reporting
ADEs
Clinical
Documentation
Eclipsys
HBOC Care
Manager
HBOC STAR
Cerner
Pathnet
Laboratory
Pharmacy Hospital
Surgery
Management
RES-Q
Healthcare
Patient Scheduling
Radiology
Transcription
McKesson
HBOC
Softmed
SMS MedSeries4
Cerner
Pathnet
Cerner
MsMeds
Sunquest
Cerner
MsMeds
HBOC STAR
CWS
TDS
HBOC Care
Manager
Classic
Cerner
MsMeds
HBOC ALG
HBOC
Series
Cerner
Cerner
MsMeds
Eclipsys
Cerner
Millenium
Cerner
MsMeds
Classic
Cerner
MsMeds
Classic
Cerner
MsMeds
Omni-server
Softmed
HBOC Pathways
HBOC
Series
Dolbey
In-House
TDS
Classic
HBOC Pathways
ADAC MARS
II
IDX
Dolbey
TDS
CWS
Per-Se'
ORSOS
HBOC STAR
HBOC
Series
TDS
SMS
MedSeries HBOC STAR
4
ADAC MARS
II
Softmed
Cerner
Pathnet
Cerner
Millenium
Cerner
HBOC STAR
MsMeds
Softmed
Sunquest
Cerner
MsMeds
Cerner
Millenium Sunquest
Cerner Mediware
MsMeds WORX
HBOC
STAR
Omni-server
Medline
Systems
HBOC STAR
Medrite
United
Clinical
Labs
Cerner
MsMeds
LifeServ
Petronics
Dictaphone
ADAC MARS II
Softmed
HBOC Pathways
Per-Se'
HBOC
Consort
STAR
SARMC
Softmed
Page 8
Trinity Health: circa 2009
Common Tools + Best Practice Processes = Performance Excellence

            
Page 9
1999 – 2009 Outcomes
IT can be FREE!
Joseph Swedish
President and CEO, Trinity Health
April 30, 2009
Like Quality, IT Can Be Free
Quality Is Free
• 1980 best seller by Philip Crosby
• “How to manage quality so that it becomes a
source of business profits”
At Trinity Health, IT is free
• Internal studies identify specific, technology-enabled benefits
• Many external studies support the findings within Trinity
• Year-over-year increased demand for IT solutions
• People, process and culture evolve along with technology
Copyright 2008 Trinity Health – Novi, Michigan INTERNAL
2
Page 10
1999 – 2009 Outcomes (cont.)
Genesis Outcomes: Quantified Benefits
Dozens of Genesis-related benefits studies have been completed and there
are many areas of likely benefits still to be studied and quantified.
Clinical Benefit Areas
• ADE avoidance
• Order management
efficiencies
• Liability expense
avoidance
• Reduction in Clinical
Documentation time
• Reduced pharmaceutical
expense
Revenue Mgmt Benefit Areas
• Reduction in bad debt and
operational write-offs
• Increased interest income
through AR reductions
• Reduction in claims
production error rates
• Improved charge capture
Supply Chain Benefit Areas
• Supply cost savings
• Increased penetration of
GPO contracts
• Improved inventory
management
• Increased rebates and
discounts from vendors
• Reduced forms, paper,
printing and postage costs
Over the expected 15 year life of Genesis,
Trinity Health expects $1.5b - $3.0b in benefits
Copyright 2008 Trinity Health – Novi, Michigan INTERNAL
13
Reduced Severity Adjusted Mortality from
107% of expected to 60%
Page 11
April 2010: HIT, Uncertainty Remains
Page 12
2010+ - Where do we go from here?
Healthcare
Environmental
Challenges
Trinity Health
Strategic Imperatives
Key IS Focus Areas
for the Next Decade
Strategic Scrabble!
Page 13
Healthcare Environment / Trinity Strategic Imperatives
2010+ Environmental Challenges
 Rising costs and reduced funding
 Increased utilization of high cost technology and medical supplies
 Reduced access to capital due to market volatility
 Concerns over healthcare reform and coverage for the uninsured
 Increasingly competitive market




Evolving business models
Rapid change and fluid transformation
Increase in transparency
Shifts in demand
 Workforce challenges
 Growing need for high quality, efficient healthcare
 Diminishing pool of experienced talent
 Difficulty retooling workforce to a more customer-focused mindset
Trinity Health Strategic Imperatives
Strategic Imperative
Page 16
IT
Dependency
Community Benefit Ministry

Excellence in Care Experience

Best People

Spiritual Workplace
Physician Alignment

Financial Stewardship

Growth

Accelerated Integration

Accountable Health Networks

Page 17
Page 14
2010+ IS Focus Areas
Major Themes
Solidifying the Gains
Embracing Reform
Extending the Core
Redefining our Ministry
Evolving our Intelligence
The Soup











HCRA
MU
CE
GSSP
VIT
RTE
POC
IPOC
BMDI
eICU
I____











MDA
AHN
ACO
AEHR
BD
INNV
BI
CI
ILM
CC
OMG
Page 15
Solidifying Gains:
GSSP – Genesis Safety and Simplification Program
Simpler is Safer
Page 16
Solidifying Gains:
VIT – IS Value Improvement Teams
TIS Sustaining the Ministry Program Overview
TIS Sustaining the Ministry Team Organization Structure
Oversight
TIS/PMO EMG
IS Planning Team
Program
Management
Team
Team Lead(s)
Toni Pratt (Lead)
Labor Cost
Jim Elert
Area of Focus Labor Costs.
Approval of all
New and
replacement
FTEs and
Contract Labor
Labor
Productivity
Kyle Johnson
Carla Robelli
Eliminate
Automate
Educate
Mark Kueber (Support)
Vendor
Maintenance
Value
Talent
Management
Teri Hohentanner
Tom Centlivre
Deb Rockey
- TIS Tools
- Reduction in
Vendor
Maintenance
Costs
- Evaluate
SOWs for
Benefits
- Train Staff
and Business
Owners
- Track
- Define TIS
Leadership
Profile
- Ensure
consistency in
promotion
- Manage costs
TIS Metrics being monitored for Sustaining the Ministry Contingency Plan
•
•
•
Labor savings as of February 2010, $4.5 million, FTEs favorable by 15 as
of February 2010
Vendor reductions - achieved $5.5 million as of February, target is $8
million.
Labor productivity achieved of 3.5% YTD.
04/13/2010
3
Page 17
Embracing Reform:
HCRA – Health Care Reform Act BTW – HCRA is aka PPACA + HCEARA
Payment Alignment
• Bundled payments
• Value-based payment
• Readmission penalties
• Primary care/medical home
• Chronic care coordination
Comparative
Effectiveness Research
• Finding what works
• Elimination of unnecessary variation
• Appropriate standardization of care
• Foundation for value-based
payment
Health IT
• Funding in stimulus bill
• Bonuses starting 2011 for
“meaningful use”
• Penalties start 2015 for
noncompliance
Page 18
Embracing Reform:
MU – Meaningful Use
The spirit of “really meaningful use”:
1. Implement technologies and processes that improve care
2. Ensure they are used
3. Measure outcomes and keep going
Page 19
Extending the Core:
MDA – Mergers, Divestitures & Acquisitions
MDA produces value when it results in
clinical integration that improves
care. Increasingly, clinical
integration is dependent on
technology integration.
Significant MDA’s last 36 months
Page 20
Extending the Core:
RTE – Real Time Enterprise
Significant technology innovations and cost reductions in the
ability to capture, move, and use data will increase information
velocity allowing for real-time or near real-time decision-making
in many aspects of healthcare.
Instrumentation
Intelligence
Interoperability
POC
IPOC
BMDI
eICU
Private HIE
Public HIE
Portals
EWS
Etc.
Page 21
Redefining our Ministry:
AHN – Accountable Health Networks
Health reform and market forces are driving more integrated models of care – it
is expected that each Trinity Health market will evolve to some form of an ACO
Market-Based Accountable Care Organization
Market-Based
Accountable Care
Organization
(ACO)
Aligned
Physician
Organization
Aligned
Health System
Acute
Care
LT
Care
Home
Care
Fully integrated
(employed)
physicians
Contracted
(clinical comanagement)
physicians
Private
practice
aligned
physicians
Copyright 2009 Trinity Health – Novi, Michigan
While the ultimate design is uncertain … it is certain to be complex and to vary
by market … therefore, Trinity’s technical design must be robust and adaptable
Page 22
Redefining our Ministry:
Accountable Health Networks Technologies
Physician Practices
• Enterprise Practice
Management
• Electronic Medical Record
• ePrescribing
• EMPI Integration
• Interoperability
Patient Portal
Consumer Portal
Long-term Care
• Electronic Medical Record
• EMPI Integration
• Interoperability
Home Health Care
• Care Management
• EMPI Integration
Page 23
Redefining Our Ministry:
BD – IS Business Development
We evaluated 30 Genesis assets with value, offering 15 potential business
opportunities; we believe there are 6 promising businesses
Moderate
Core capability
Device
integration
pilots
Innovation
simulation lab
Readiness
in a box
Sale of
clinical
data set
Application
add-ons
Low ($0 – 500M)
Low priority
End-to-end solutions
to Health systems
ASP ClinRev for
physician offices
Real-time CDS
ASP ClinRev to
ASCs
Benchmarking
and consulting
for providers
USO
services to
providers
Data
analytics
Business
opportunities fall
into 3 categories
Outsourcing
ASP of
Genesis
services
Data
IP
Clinical
knowledge
bases
Medium ($500M – 1B)
Recommended
Printed 3/10/2009 4:07:19 PM
Feasibility
Health/wellness programs &
patient care communities
Working Draft - Last Modified 3/11/2009 1:44:52 AM
Difficult
PRELIMINARY
High ($1B+)
Total potential market
SOURCE: McKinsey client experience
McKinsey & Company | 5
Page 24
Evolving Our Intelligence:
BI / CI – Business & Clinical Intelligence
Business Intelligence systems allow leaders to manage the enterprise by
looking out the windshield rather than the rear view mirror ~ Unknown
Stages of BI Maturity
Leading
Trinity Health’s
Current Position
Advanced
Defined
Developing
Beginning
 Spreadsheet driven
 Significant manual
effort to collect data
 Limited to operations
and regulatory
reporting
 Limited knowledge of
data sources
 Ad hoc models /
spreadsheets
 Automated reporting
limited to transactional
systems
 Many operational
performance measures
have definitions, but
different values are
reported
 Organization has a
formal BI strategy
 Data is gathered from
disparate systems
 Some integration across
business units
 Improved information
access and delivery
 Subject area data
warehouses
 Developing data
governance processes
 Personalized
dashboards and
alerts
 Information integration  Near real-time
performance
across organization
monitoring
 Enterprise data
warehouse, including
 Forward
robust metadata
looking
repository
analytics,
 Processes exist to
forecasting and
integrate additional data
predictive
sources and domains
models
 Single version of truth
 BI competency
 Formal data
center to maintain
governance
strong governance
requirements and
policies
Page 25
Evolving Our Intelligence:
CE – Comparative Effectiveness
Trinity Health  Accelerating the Cycle!
Capture
Data
Improve
Quality
& Efficiency
Financial
Incentives
Comparative
Effectiveness
Research
CE Within Trinity








Pain Management
Pressure Ulcers
Fall Prevention
Enterprise Formulary
ICU Utilization
Order Set Standards
Implant Management
CAUTI Reduction
Change
Operations
Bundled Payment Methods  Aligned Incentives
Technology Infrastructure (HIT)
Page 26
Summary – The Journey Continues
Transactional Era
1999
Era of Intelligence
2020
2009
From 1999 to 2009, the primary focus
of Trinity Health was levels I, II, and III
of the IS Maturity & Value Model. From
2010 to 2020, the primary focus will be
increasing value in levels IV, V, and VI.
VI. Commercializing
V. BI / CI
IV. Extending Core
III. Standard
Data Capture /
Transaction Systems
II. Standard
Infrastructure
I. Organization
Consolidation
Page 27
Conclusion
IT Can Be Free And IT’s as Easy as ABC!!









Y2K
.com
XP
EMR/EHR
ADE
CPOE
SEM
URO
CDM









HIPAA
HIT
HIE
RAC
BMDI
POC
IPOC
EWS
ARRA











HRA
MU
CE
GSSP
VIT
RTE
POC
IPOC
BMDI
eICU
I____











MDA
AHN
ACO
AEHR
BD
INNV
BI
CI
ILM
CC
OMG
Page 28
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