What IT Takes for Success

Transcription

1 What IT Takes for Success March 2 nd, 2016 Marc Probst, Chief Information Officer Intermountain Healthcare Jeff Townsend, Executive Vice President and Chief of Staff Cerner Corporation

2 Conflict of Interest Marc Probst, Chief Information Officer Intermountain Healthcare Has no real or apparent conflicts of interest to report. Jeff Townsend, Executive Vice President and Chief of Staff Cerner Corporation Is a Cerner Corporation employee and is a stock shareholder

3 Today s Outline The Learning Health System IT becomes IT Systematizing the Innovation Cycle Making the Turn Starting your Journey

4 Learning Objectives Recognize what an agile development system is Define the benefits of an agile approach to patients and stakeholders Identify the challenges of agile development and how to overcome those challenges Identify the tools needed to implement data-driven, agile cultures within other organizations

5 HIMSS Value Suite Satisfaction Patient Satisfaction Staff Satisfaction Provider Satisfaction The Intermountain and Cerner collaboration provides values to patients and those who care for patients by developing learning tools that satisfactorily learn the role of clinicians and what is needed from technology to provide better care. It assists with the treatment of clinical and financial needs by using electronic information data. That data is the primary source for continuing to learn and improve the system. As the system learns and those who use the system find more value in using the tools to treat patients and provide care, we begin to make better decisions in support of managing population health for those we treat and our communities. With smarter healthcare decisions, we are reducing unnecessary costs to the patient and the healthcare organization Treatment/Clinical Quality of Care Efficiencies Safety Electronic Secure Data Data Reporting Enhanced Communication Evidence Based Medicine Data Sharing Patient Engagement and Population Management Prevention Patient Education/Engagement Savings Efficiency Savings Financial/Business Operational Savings

6 Implementing the big 4 Hospital EHR, Clinic EHR, Hospital Revenue Cycle, and Clinic Billing and Scheduling Contract signed 12 months 24 months The agile methodology differentiates icentra from other implementation by creating an environment and operational structure for continuous improvement beyond the first go live so that once the implementation is complete across all hospitals and systems, icentra will be a fully extendable, true learning environment. 17% 33% Data provided by 50%

7 The Learning Health System

8 The imperative for accelerated change Evidence demonstrates significant room for improvement Our economy depends on bending the cost curve People trust and depend on us We count our successes in lives Dr. Brent James

9 The Learning Health System Series (IOM ) To facilitate progress toward the development of a learning health system - in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral byproduct of the delivery experience

10 Learning Health System There is no control over the demands on an informaticist When demand is high, the rate of change needs to be high Collaboration and speed are best tools to combat Roadmaps need to be agile

11 Information Technology becomes Improvement Technology

12 Concepts that Shaped Improvement Technology The Fifth Discipline The Art & Practice of The Learning Organization Peter M. Senge (1990) Manifesto for Agile Software Development Feb 2001 Snowbird, Utah Begin with the End in mind - 7 Habits of Highly Effective People Stephen R. Covey (1989) Utah The Innovator s Prescription Clayton M. Christensen (2009) Intermountain Healthcare Board of Trustees

13 Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations (1990) 1. Personal Mastery is a discipline of continually clarifying and deepening our personal vision, of focusing our energies, of developing patience, and of seeing reality objectively. Design teams participation to cross skill sets and experiences 2. Mental combine Models their are accountability deeply ingrained assumptions, generalizations, or even pictures of images that influence how we understand the world and how we take action. Real world modeling as a discipline to validate assumptions and 3. Building shared vision - a practice of unearthing shared pictures of the future create that common foster genuine work experiences commitment and team enrollment navigates rather together than compliance Integration requires systems thinking create events to cross boundaries 4. Team learning starts with dialogue, the capacity of members of a team to suspend assumptions and enter into genuine thinking together. 5. Systems thinking - The Fifth Discipline that integrates the other four.

14 The Agile Manifesto Feb 2001 Snowbird Lodge - Utah while there is value in the items on the right, we value the items on the left more. Individuals and interactions Apply the concepts Processes beyond and Tools software development Live Enhancements Co-locate teams Comprehensive for increased Documentation interaction More Less Stakeholder Collaboration Iterative demos Contract/Scope & prototyping Negotiation (design/build) Responding to Change Extend teams to Following include Preset advisory/sponsor Tasks roles Shorter cycle times increase team building

15 12 Principles of Agile Software Adapt these to Organizational & Change Management Principles Our highest priority is to satisfy the customer through early and continuous delivery of valuable software. Welcome changing requirements, even late in development. Agile processes harness change for the customer's competitive advantage. Deliver working software frequently, from a couple of weeks to a couple of months, with a preference to the shorter timescale. Business people and developers must work together daily throughout the project. Build projects around motivated individuals. Give them the environment and support they need, and trust them to get the job done. Agile processes promote sustainable development. The sponsors, developers, and users should be able to maintain a constant pace indefinitely. Working software is the primary measure of progress. The most efficient and effective method of conveying information to and within a development team is face-to-face conversation. Continuous attention to technical excellence and good design enhances agility. Simplicity--the art of maximizing the amount of work not done--is essential. The best architectures, requirements, and designs emerge from self-organizing teams. At regular intervals, the team reflects on how to become more effective, then tunes and adjusts its behavior accordingly.

16 Continuous Improvement Change becomes routine Capability Agile Ecosystem Staged Change Waterfall Time

17 Model Experience Base set of content from industry learnings and best practice Model Practice Application of Model Experience from insight gained from evidencebased practice, outcomes and usage EMR Intermountain s interpretation of their learnings and how to package it within the practice of care Continuous improvement to achieve a model system Model System

18 Start with the end in mind (End = Running ) Start with a live system and improve Model Design Model roles & process workflows 1st 320+ roles, 750+ process workflows Model Adoption Scope the software/technology 2nd Implement technical change management Model Improvement

19 Iterative Releases a new narrative Discover Continuous release cycle Release is more than software Process Workflow Policy & Procedures Configuration Clinical Content Decision Support Training Experiences Medical Device Integration End User Device Kit Train Validate Each release is demonstrated, validated, and adjusted Learning team actively involved in the release process Tailored learning delivered with the release Release #1 Demo Train Validate Release #2 Discover Demo Train Validate Release #3 Discover Demo

20 Systematizing the Innovation Cycle

21 Agile strategy is like patient care With an EHR we: Have multiple teams working in parallel Put plans together every 6 weeks Assess work completed, work remaining, velocity and time to completion Adjust, recalibrate, update plan When we treat patients, we: Have multiple teams working in parallel Put together treatment plan every 6-12 hours Assess clinical goals, patient goals, rate of improvement and time to discharge Adjust, recalibrate, update discharge plan

22 Governance Designed for agility and improvement Empower work streams to make 90% of decisions Include necessary operational and clinical sponsorship Match frequency of leadership meetings to iterations (~10%) Executives Sponsor & Present (Know the Topic) Adapt participation with evolving needs / review periodically Include regional (impacted) organizations to create ownership Constantly improving dashboards & analytics to match needs Expectation that blocks and repeated delays are automatically reviewed

23 Model Design Team Leadership: Clinical/Business Leader & Solution Architects & Alignment with Existing Committee Structures Process Workflows (flowcharts) Roles Bill of Materials In/Out of Scope Boundaries Technology Kit Scripted Scenarios (Demos/Training) Validation & Certification Scripts Training Materials Key Performance Indicators / Expected Impacts

24 Modeling Real World Automated Experience Process Workflow Designer Application Experience Clinical Content =

25 Stories - Build Progression within Iterations

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27 Model Adoption (Deployment) Technical Readiness Standardized Kit Reviewed for each Venue, Department, Location Staging of Procurement & Installation (Includes Computing Devices and Medical Devices) Field Teams are Responsible for Pre-Activation Testing & Cutover of all equipment First Adoption HR Job Codes mapped to icentra Roles Process Workflow Reviews Selection of Workforce for Knowledge Network Training Portfolio - Touches & Early Adoption Continuous Adoption Knowledge Network Active Match the Change with the Method Reactive & Proactive Engagement

28 Training Beyond the Classroom (Touches vs Time) Classroom Training 4-Hour Foundation Class CPOE Validation Sessions Curriculum Review Hands-On Training Independent Practice Parallel Workflow Events Physician Coaching Mock Go-Live Flexible to accommodate change Lessons Learned Adaptable to operations Closer to the point of care

29 Learning Strategies for Iterative Releases November 6 Release 1 Updates to Referral Orders

30 Learning Strategies for Iterative Releases November 13 Release 2 Alternative Medication Therapy for Pneumonia Care Process Models November 6 Release 1 Update to Referral Orders

31 Learning Strategies for Iterative Releases November 6 Release 1 Update to Referral Orders November 20 Release 3 November 13 Release 2 Alternative Medication Therapy for Pneumonia Care Process Models Cross Encounter Reconciliation Be sure to schedule your 1-on-1 session

32 Model Improvement Customer Centric Experience Analytics as a Part of a Continuous Advancement Plan End Users System Changes Prioritize which opportunities to pursue Do deeper analysis and create plan Analytics, Rounding, Smart Auditor Coordinate implementation Measure the impact of actions

33 Orders Activity Analysis One Click Orderable Intermountain Quick Orders Coverage % 81% 95% 80% 90% 100% 90% 80% Order Count % 52% 37% 42% 32% 60% 60% 43% 72% 60% 70% 60% 50% 40% 30% Order Coverage % % Old Design: New Design: Old Design: New Design: Current Design: Potential in new Design: Current Design: Potential in new Design: Current Design: Potential in new Design: Current Design: Potential Inpatient: Potential Clinic: Current Design: Potential Inpatient: Potential Clinic: 20% 10% 0% Dermatology OB/GYN (Clinic) OB/GYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic, Inpatient, ED) # Orders in New QOC Design Coverage Family Medicine (Clinic, Inpatient, ED)

34 Dermatology (Ambulatory) QOC Redesign Old design: 500+ orders covering 67% of ad hoc orders entered New design: 45 orders covering 89% of ad hoc orders entered OLD NEW

35 Day in the Life Clinic Activity Emerging Analytics How Care Teams Collaborate Revenue Cycle Flows & Workqueues

36 Making the Turn Starting Your Journey

37 It s a Change Management Journey, not a Project This is an attitude, not a formula recruit your change agents, advance a Vision & Narrative Start Small Create the First Work Stream Take Advantage of Millennium Role based configuration Be disciplined to Model First Experience over Feature/Function Use Analytics (data) as much as possible, it is part of the cultural shift Software, Configuration and Clinical Content will Blur design your teams for that reality Don t Get Paralyzed by Tools, they will come with Scale The Strategy will change your Structure continue to reflect and adjust the right answer may be the next question

38 HIMSS Value Suite Satisfaction Patient Satisfaction Staff Satisfaction Provider Satisfaction The Intermountain and Cerner collaboration provides values to patients and those who care for patients by developing learning tools that satisfactorily learn the role of clinicians and what is needed from technology to provide better care. It assists with the treatment of clinical and financial needs by using electronic information data. That data is the primary source for continuing to learn and improve the system. As the system learns and those who use the system find more value in using the tools to treat patients and provide care, we begin to make better decisions in support of managing population health for those we treat and our communities. With smarter healthcare decisions, we are reducing unnecessary costs to the patient and the healthcare organization Treatment/Clinical Quality of Care Efficiencies Safety Electronic Secure Data Data Reporting Enhanced Communication Evidence Based Medicine Data Sharing Patient Engagement and Population Management Prevention Patient Education/Engagement Savings Efficiency Savings Financial/Business Operational Savings

39 Questions Contact Information: Marc Probst, Chief Information Officer Intermountain Jeff Townsend, Executive Vice President and Chief of Staff Cerner Corporation