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Health Care IT Suite

Learn to Speak “IT” in 30

Minutes Making IT a Team Sport

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9

Critical Area About Which CxOs May Know the Least

Changing Question Marks to Checkmarks for IT

Finance HR IT

Why is it

important?

What should it

do?

What do I need to

know and do?

How does it work?

Satisfactory Levels of Knowledge to Derive Value?

Example of Functional Areas Supporting 3 Critical Resources

It’s hard to be a team player if

you don’t understand the game.

! Translate strategic goals into

specific CxO competencies. !

Source: Health Care IT Suite research and analysis.


10

CxO Education: “What Do I NEED to Know?”

IT Must Be a “Team Sport” at All Levels

Possible Domains and Sample Topics for Basic Education

• IT capacity

• IT cost management

• Sourcing strategies

• Prioritization processes and criteria

• Funding mechanisms and levels

• Roles and responsibilities

• Principles

Future Advisory Board Research

The Advisory Board plans to continue developing research, presentations, and other resources to help facilitate mutual

understanding on IT-related topics between CIOs and non-IT leaders.

Please let us know what topics would be the most beneficial for you and your leadership team.

• IT for accountable care

• IT-enabled PHM

• Meaningful Use

• ICD-10

• EMR optimization

• Business Intelligence

• Mobility strategies

• Interoperability strategies

• Cloud computing strategies

• Privacy and security issues

Enabling Capabilities

Enabling Technologies

IT Operations Governance



11

Learning the Terms of Health IT

New terms supporting healthcare transformation

Electronic Health Record

Personal Health

Record PHR

Patient Centered

Medical Home

Primary Care

Accountable

Care

Population Health

Management

Clinical Quality Measures CQM

Patient

Old term “electronic medical record” (EMR) for use in a single location now replaced with the newer term for an

interoperable record that has capability to share information across organizations “electronic health records” (EHR)



12

United States EMR Adoption Model SM

Source - HIMSS Electronic Medical Record Adoption Model

(EMRAM)SM http://www.himssanalytics.org/emram/emram.aspx

1) Electronic Medical Record

2) Continuity of Care Document

3) Clinical Decision Support System

4) Radiology Picture Archiving and Communication System

5) Computerized Provider Order Entry

6) Picture Archiving and Communication System

7) Clinical Data Repository

8) Clinical Decision Support

9) Health Information Exchange

Stage Cumulative Capabilities 2013 Q3 2013 Q4

Stage 7

Complete EMR1; CCD2 transactions to share data;

Data warehousing; Data continuity with emergency

room, ambulatory, inpatient

2.2% 2.9%

Stage 6 Physician documentation (structured templates), full

CDSS3 (variance & compliance), full R-PACS4 11.1% 12.5%

Stage 5 Closed loop medication administration 20.9% 22.0%

Stage 4 CPOE5, Clinical Decision Support (clinical protocols) 15.1% 15.5%

Stage 3 Nursing/clinical documentation (flow sheets), CDSS

(error checking), PACS6 available outside Radiology 31.9% 30.3%

Stage 2 CDR7, Controlled Medical Vocabulary, CDS8, may

have Document Imaging; HIE9 capable 8.4% 7.6%

Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 3.5% 3.3%

Stage 0 All Three Ancillaries Not Installed

Data from HIMSS Analytics® Database ©2013 N = 5437 N = 5458

http://www.himssanalytics.org/emram/emram.aspx




13

Annual Benefits of a Successful EMR Implementation Add Up

Source 1: Thompson DI, Classen DC, Haug PJ, EMRs in the Fourth

Stage: The Future of Electronic Medical Records Based on the

Experience at Intermountain Health Care, JHIM, 2007.

Save 28-36 minutes of

time per nurse, per shift

Reduce average lengths

of stay by 5% to 10%

Reduce lab test use

& drug costs by 15%

Prevent 344 to 481

ADEs annually Reduce order turnaround

time by at least one hour

Ensure 99% compliance

with vaccinations

Potential to Save $4M - $10M Annually Based on 300-Bed US Hospital

Reduction in paper forms

costs (67% reporting) Improvement in charge

capture (64% reporting)

Reduction in the costs of

transcription (61% reporting)

Source 2: HIMSS Analytics and Advisory Board Company survey of

EMRAM Stage 6 and 7 hospitals, 2011.

Lite

ratu

re-B

ased

S

tag

e 6

-7 S

urv

ey

Potential HIT Benefits Are Real


14

“Federal Speak” in Health IT

Code of Federal Regulations (CFR) in Health IT

Content exchange

standards and

implementation

specifications for

exchanging

electronic health

information

• CCDA1

• HL72

• NCPDP3

§ 170.210

Standards for health

information technology to

protect electronic health

information created,

maintained, and exchanged

• NIST10

• FIPS11

• ASTM12

§ 170.205 § 170.207

Vocabulary standards

for representing

electronic health

information

• SNOMED – CT4

• LOINC5

• CPT6

• CVX7

• OMB8

• RxNorm9

So what do all the acronyms mean?


1. Consolidated Clinical Document Architecture

2. Health Level 7

3. National Council for Prescription Drug Programs

4. Systematized Nomenclature of Medicine-Clinical Terms

5. Logical Observation Identifiers Names and Codes

6. Current Procedural Terminology

7. Codes for Vaccine Administered

8. Office of Management and Budget

9. National Library of Medicine US-specific terminology in medicine

that contains all medications available on US market

10. National Institute of Standards and Technology

11. Federal Information Processing Standards

12. American Society for Testing and Materials

All components have individual unique CFR assigned numbers


15

Capitalizing on Care Transformation

Adding Value as Care Managers in Emerging Affordability Economy

Source: Health Care Advisory Board interviews and analysis.

Inputs Products

Acute Care Episodes

• High-quality, low-cost

treatment of acute illness

• Includes pre-acute, post-

acute services, readmission

Specialist Office Visits

Care Management

Imaging & Lab

Emergency Care

Inpatient Procedures

Outpatient Procedures

Rehabilitation

Long-Term Care

Pharmacy

PCP Office Visits

Health

System

Ongoing Care Management

• Longitudinal, comprehensive

health management

• Includes chronic disease

care, wellness, prevention


16

Meaningful Use

• “Voluntary mandate” involving

both incentives and penalties

• Helps offset costs of EMR

acquisition, implementation,

and optimization

• Requires considerable

resources / opportunity costs

Key questions to ask (examples)

• How will we leverage and

integrate our MU efforts with

other organizational priorities?

• What should we be doing to

exceed MU performance

thresholds?

Why is this important? CxO’s roles / responsibilities

• Help align MU efforts with

organizational direction and

strategy

• Help prioritize and govern the

efforts

• Assign responsibilities and hold

people accountable

ABC Resources (examples)

• MU—The Whiteboard Story

• MU web conferences—Is Your

MU Game Plan Solid?

• MU Audit Checklist

• MU Incentive and Penalty

Calculator

• MU Navigator membership/

Scorecard Services



17

EMR Implementation and Optimization

• Large, complex, costly, risky

undertaking

• System backbone that supports

improved clinical and financial

performance

• Robust EMRs are essential to

improving the science of health

promotion and care delivery


• How can we best utilize our

EMR to help implement

organizational strategy?

• Which EMR capabilities

provide the biggest “bang for

the buck”?

• How do we get the most

return and manage risk?


• Define organizational strategy

• Clarify links between EMR

capabilities and strategic goals

• Quantify and track realization of

EMR benefits

• Assign accountability for benefit

realization (“benefit owners”)


• Best Practices for Realizing EMR

Business Value

• Remediating and Optimizing Your

EMR for Usability and Long-Term

Value

• Implementing an EMR for the

Money



18

ICD-10

• Mandate

• Potentially “bet your business”

impacts on cash flow if not

done right

• Will impact many areas of the

organization


• What is our overall strategy

and plan for ICD-10?

• How will we manage coder

productivity reduction under

ICD-10?

• How will we combine ICD-9

and ICD-10 data for

BI/reporting?


• Take ownership—It’s not an “IT

project”

• Help leverage the efforts

• Balance competing priorities


• ICD-10 Readiness Progress

Report

• Computer-Assisted Coding: A

Primer

• Preparing for ICD-10



19

IT for Accountable Care

• Can’t be both paper-based

and risk-based

• Requires new transaction

systems and BI capabilities


• What are our current

capabilities / gaps for quality,

performance, and utilization

risk contract?

• What should we be doing

regardless (i.e., the new

performance standard)?


• Involve CIO early in risk-based

contract negotiations

• Understand basic IT

requirements for different types

and levels of risk


• The New IT Strategy Map

• IT for Accountable Care PPT

• New Performance Standard—IT

Implications

• ACO IT Maturity Model

Assessment Tool



20

IT for Population Health Management

• Can’t be both paper-based

and risk-based

• Requires new transaction

systems and BI capabilities


• What are our current

capabilities / gaps for PHM?

• How do we integrate with our

partners?

• What IT-related evaluation

criteria should we include for

partner selection?


• Define the organization’s role in

and strategy for PHM

• Understand basic IT

requirements for the 6

categories of IT-enabled PHM


• A Framework for PHM

• Predictive Business Intelligence,

Proactive Medicine, and IT for

Population Health Management:

Building the Time Machine



21

Business Intelligence

• Improve decision making and

performance by providing a view

into current operations and future

risks and opportunities

• Critical to at-risk and value-based

contracts

• Key to maximizing value from IT-

related investments


• What capabilities and limitations do

we have today?

• What capabilities do we need

based on our current strategy and

direction?

• What are the pros and cons for our

options for core BI strategies?

• What are the biggest obstacles to

improving our capabilities and how

can I help?


• Help establish culture of data-informed

decisions—analytic and fact-based

• Exhibit the desired behavior by using

standard KPIs and dashboards

• Ensure that different, formerly “siloed”

business areas collaborate

• Collaboratively develop a BI roadmap

• Align BI initiatives with strategic and

operational needs


• BI primer

• BI reports on generating value,

data governance, etc.

• BI presentations such as BI

maturity model, BI for PHM

• BI survey results



22

Mobility

• Key to physician and patient

engagement

• Potential to extend access and

provide unified communications

with RTLS1

• Significant advances in mobile

devices, networks, and application

deployment

• Must be managed and secured


• How can we leverage mobility to

improve transitions of care?

• How can mobility enable

telehealth and support PHM?

• How are we addressing security

and manageability for corporate

and “Bring Your Own Device”?

Why is this important?

CxO’s roles / responsibilities

• Develop guiding principles and

mobile policies jointly with IT

experts

• View mobility as a key element

to strategy

• Revisit as technology and

manageability improves


• Mobile Health Care 2.Oh!

presentation

• Mobility in Action presentation

• Reports on Mobile Device

Management

• Note on Medical Device

Connectivity


1) Real-Time Locationing Systems


23

IT Governance

• Effective IT governance is the

single most important predictor

of the value an organization

generates from IT

• Key to optimal use of scarce

resources


• What responsibilities should the

non-IT leaders have for

governance and IT selections,

implementations, and

optimizations?

• How is our IT governance

process synchronized with our

business planning process?

Why is this important?

CxO’s roles / responsibilities

• Help develop business and IT

principles (e.g., risk levels)

• Determine funding approaches for

different types of assets

• Establish clear prioritization process

and criteria

• Communicate

• Establish and monitor business

success metrics for major initiatives

• Define and enforce roles,

responsibilities, and accountabilities


• IT governance presentations such

as “Stopping the Yes Machine”

and “IT Governance: Building a

Strong IT Governing Structure”

• IT governance compendium and

tools (coming soon)

• Instilling Disciplined IT

Governance book



24

IT Operations

• Understand how costs behave

• Get more for your investments

• Help manage and match supply

and demand

• Have transparency into costs and

performance


• How do we reduce our percent of

resources spent “keeping the lights

on”?

• What are the impacts of budget cuts?

• What are good / better / best

alternatives (e.g., for SLAs1)?

• Sourcing strategies benefits and risks

(and how addressed)?

• What metrics do we use to manage

the business of IT?


• Understand IT operational and

capital / operating budget impacts of

major initiatives

• Insist on measuring and monitoring

key metrics that make sense to you


• IT Performance Management:

Upping the Bar During Cost

Containment

• Staffing survey results and report

• Boosting IT Capacity without

Adding Costs


1) Service level agreements


25

Stage 1 Stage 2 Certification Standards

More IT Terms Meaningful Use Whiteboard Story

www.advisory.com/MUwhiteboard and zoom in to see all the details

Data

Elements

and

Certification

terms Legend

Stage 1

changes

starting

in 2014

in blue

font

Health IT

terms on

entire right

side of the

poster

Print size is 4 feet by 6 feet

http://www.advisory.com/MUwhiteboard


26

Meaningful Use Whiteboard Story – Zooming In

26

Zoom in to 75% to see the details



27


Download Useful Tools and Educate Yourself

Publicly Available Tools

Meaningful Use—The Whiteboard Story

www.advisory.com/MUwhiteboard

Quick Guide Comparison―Stage 1

to Stage 2 Objectives and Measures

www.advisory.com/MUpocketguide

Bookmark Versions of the Final Rules

www.advisory.com/MUbookmarkCMS

www.advisory.com/MUbookmarkONC

Additional Resources

o 2014 Eligible Hospitals Clinical Quality Measures Grouped by National Quality Domain

o 2014 Eligible Professionals Clinical Quality Measures1 Grouped by National Quality Domain and Disease Type

http://www.advisory.com/MUwhiteboard

http://www.advisory.com/MUpocketguide

http://www.advisory.com/MUbookmarkCMS

http://www.advisory.com/MUbookmarkONC

http://www.advisory.com/~/media/Advisory-com/Research/ITSC/Resources/2013/ITSC-29-EH-CQMs-Group-Domain.pdf



http://www.advisory.com/~/media/Advisory-com/Research/ITSC/Resources/2013/ITSC-64-EP-CQMs-Disease-and-Domain.pdf



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learn to speak “it” in 30 minutes - advisory · learn to speak “it” in 30 minutes making it...

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