What IT Takes for Success March 2nd 2016

Marc Probst Chief Information Officer Intermountain Healthcare Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

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

Todayrsquos Outline

The Learning Health System

IT becomes IT

Systematizing the Innovation Cycle

Making the Turn ndash Starting your Journey

Learning Objectives bull Recognize what an agile development system is bull Define the benefits of an agile approach to patients and

stakeholders bull Identify the challenges of agile development and how to

overcome those challenges bull Identify the tools needed to implement data-driven agile

cultures within other organizations

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Implementing the big 4 Hospital EHR Clinic EHR Hospital Revenue Cycle and Clinic Billing and Scheduling

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

httpwwwhimssorgValueSuite

Contract signed

17

50

33

24 months 12 months

Data provided by

The Learning Health System

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

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

Todayrsquos Outline

The Learning Health System

IT becomes IT

Systematizing the Innovation Cycle

Making the Turn ndash Starting your Journey

Learning Objectives bull Recognize what an agile development system is bull Define the benefits of an agile approach to patients and

stakeholders bull Identify the challenges of agile development and how to

overcome those challenges bull Identify the tools needed to implement data-driven agile

cultures within other organizations

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Implementing the big 4 Hospital EHR Clinic EHR Hospital Revenue Cycle and Clinic Billing and Scheduling

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

httpwwwhimssorgValueSuite

Contract signed

17

50

33

24 months 12 months

Data provided by

The Learning Health System

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Todayrsquos Outline

The Learning Health System

IT becomes IT

Systematizing the Innovation Cycle

Making the Turn ndash Starting your Journey

Learning Objectives bull Recognize what an agile development system is bull Define the benefits of an agile approach to patients and

stakeholders bull Identify the challenges of agile development and how to

overcome those challenges bull Identify the tools needed to implement data-driven agile

cultures within other organizations

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Implementing the big 4 Hospital EHR Clinic EHR Hospital Revenue Cycle and Clinic Billing and Scheduling

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

httpwwwhimssorgValueSuite

Contract signed

17

50

33

24 months 12 months

Data provided by

The Learning Health System

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Learning Objectives bull Recognize what an agile development system is bull Define the benefits of an agile approach to patients and

stakeholders bull Identify the challenges of agile development and how to

overcome those challenges bull Identify the tools needed to implement data-driven agile

cultures within other organizations

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Implementing the big 4 Hospital EHR Clinic EHR Hospital Revenue Cycle and Clinic Billing and Scheduling

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

httpwwwhimssorgValueSuite

Contract signed

17

50

33

24 months 12 months

Data provided by

The Learning Health System

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Implementing the big 4 Hospital EHR Clinic EHR Hospital Revenue Cycle and Clinic Billing and Scheduling

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

httpwwwhimssorgValueSuite

Contract signed

17

50

33

24 months 12 months

Data provided by

The Learning Health System

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Implementing the big 4 Hospital EHR Clinic EHR Hospital Revenue Cycle and Clinic Billing and Scheduling

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

httpwwwhimssorgValueSuite

Contract signed

17

50

33

24 months 12 months

Data provided by

The Learning Health System

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

The Learning Health System

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

The imperative for accelerated change

People trust and depend on us

Our economy depends on bending the cost curve

Evidence demonstrates significant room for

improvement

ldquoWe count our successes in livesrdquo ndash Dr Brent James

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

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

The Learning Health System Series (IOM 2007-2011)

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Learning Health System

bull There is no control over the demands on an informaticist

bull When demand is high the rate of change needs to be high

bull Collaboration and speed are best tools to combat

bull Roadmaps need to be agile

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Information Technology

becomes

Improvement Technology

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Concepts that Shaped Improvement Technology

The Fifth Discipline ndash The Art amp Practice of The Learning Organization ndash Peter M Senge (1990)

Manifesto for Agile Software Development ndash Feb 2001 Snowbird Utah

ldquoBegin with the End in mindrdquo - 7 Habits of Highly Effective People ndash Stephen R Covey (1989) Utah

The Innovatorrsquos Prescription ndash Clayton M Christensen (2009)

Intermountain Healthcare Board of Trustees

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Focuses on group problem solving using the systems thinking method in order to convert companies into Learning Organizations ndash (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

2 Mental Models are deeply ingrained assumptions generalizations or even pictures of images that influence how we understand the world and how we take action

3 Building shared vision - a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance

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

Design teams participation to cross skill sets and experiences ndash combine their accountability

Real world modeling as a discipline to validate assumptions and create common work experiences ndash team navigates together

Integration requires systems thinking ndash create ldquoeventsrdquo to cross boundaries

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

The Agile Manifesto

while there is value in the items on the right we value the items on the left more

Feb 2001 Snowbird Lodge - Utah

Individuals and interactions

Live Enhancements

Stakeholder Collaboration

Responding to Change

Processes and Tools Comprehensive Documentation ContractScope Negotiation Following Preset Tasks

More Less

Apply the concepts beyond software development

Co-locate teams for increased interaction

Iterative demos amp prototyping (designbuild)

Extend teams to include advisorysponsor roles

Shorter cycle times increase team building

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

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 customers 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

12 Principles of Agile Software

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

Adapt these to Organizational amp Change Management Principles

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Capability

Time

Agile Ecosystem

Staged Change

ldquoWaterfallrdquo

Continuous Improvement ndash Change becomes routine

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Application of Model Experience from insight gained from evidence-based practice outcomes and usage

Model Practice

Intermountainrsquos interpretation of their learnings and how to package it within the practice of care

EMR Base set of content from industry learnings and best practice

Model Experience

Continuous improvement to achieve a model system

Model System

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Start with the end in mind (End = ldquoRunningrdquo)

Start with a ldquoliverdquo system and improve Model roles amp process workflows 1st 320+ roles 750+ process workflows Scope the softwaretechnology 2nd Implement technical change management

Model Improvement

Model Adoption

Model Design

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Iterative ldquoReleasesrdquo ndash a new narrative

bull Continuous release cycle bull Release is more than software

ndash Process Workflow ndash Policy amp Procedures ndash Configuration ndash Clinical Content ndash Decision Support ndash Training Experiences ndash Medical Device Integration ndash End User Device ldquoKitrdquo

bull Each release is demonstrated validated and adjusted bull Learning team actively involved in the release process bull Tailored learning delivered with the release

Release 1

Discover

Demo Validate

Train

Release 2

Discover

Demo Validate

Train

Release 3

Discover

Demo Validate

Train

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Systematizing the Innovation Cycle

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Agile strategy is like patient care

bull With an EHR we bull Have multiple teams

working in parallel bull Put plans together

every 6 weeks bull Assess work

completed work remaining velocity and time to completion

bull Adjust recalibrate update plan

When we treat patients we bull Have multiple teams

working in parallel bull Put together treatment

plan every 6-12 hours bull Assess clinical goals

patient goals rate of improvement and time to discharge

bull Adjust recalibrate update discharge plan

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Governance ndash Designed for agility and improvement

bull Empower work streams to make 90 of decisions Include necessary operational and clinical sponsorship

bull Match frequency of leadership meetings to iterations (~10) Executives Sponsor amp Present (Know the Topic)

bull Adapt participation with evolving needs review periodically Include regional (impacted) organizations to create ownership

bull Constantly improving dashboards amp analytics to match

needs Expectation that blocks and repeated delays are automatically reviewed

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Model Design

bull Team Leadership ClinicalBusiness Leader amp Solution Architects amp Alignment with Existing Committee Structures

bull Process Workflows (flowcharts) bull Roles bull ldquoBill of Materialsrdquo ndash InOut of Scope Boundaries bull Technology ldquoKitrdquo bull Scripted Scenarios (DemosTraining) bull Validation amp Certification Scripts bull Training Materials bull Key Performance Indicators Expected Impacts

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Modeling Real World Automated Experience

Process Workflow Designer

Application Experience

Clinical Content

=

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

ldquoStoriesrdquo - Build Progression within Iterations

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Model Adoption (Deployment)

bull Technical Readiness ndash Standardized ldquoKitrdquo Reviewed for each Venue Department Location ndash Staging of Procurement amp Installation (Includes Computing Devices and Medical Devices) ndash Field Teams are Responsible for Pre-Activation Testing amp Cutover of all equipment

bull First Adoption ndash HR Job Codes mapped to iCentra Roles ndash Process Workflow Reviews ndash Selection of Workforce for Knowledge Network ndash Training Portfolio - Touches amp Early Adoption

bull Continuous Adoption ndash Knowledge Network ldquoActiverdquo ndash Match the Change with the Method ndash Reactive amp Proactive Engagement

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Training Beyond the Classroom (Touches vs Time)

Classroom Training

bull 4-Hour Foundation Class bull CPOE Validation Sessions bull Curriculum Review

Hands-On Training

bull Independent Practice bull Parallel Workflow Events bull Physician Coaching bull Mock Go-Live

Lessons Learned Flexible to accommodate

change Adaptable to operations Closer to the point of care

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Learning Strategies for Iterative Releases

Release 1 Updates to Referral Orders

November 6

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Learning Strategies for Iterative Releases

Release 1 Update to Referral Orders

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 6

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Learning Strategies for Iterative Releases

Release 3

Cross Encounter Reconciliation

Be sure to schedule your 1-on-1 session

Release 1 Update to Referral

Orders

November 6

Release 2

Alternative Medication Therapy for Pneumonia Care Process Models

November 13

November 20

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Analytics as a Part of a Continuous Advancement Plan

Model Improvement ndash Customer Centric Experience

bull Prioritize which opportunities to pursue bull Do deeper analysis and create plan ndash Analytics Rounding Smart Auditor bull Coordinate implementation bull Measure the impact of actions

End Users

System Changes

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Orders Activity Analysis | One Click ldquoOrderablerdquo

500 45 650 55 650 50 240 70 240 63 0 106 97 1000 100 96

67

89

52

81

37

95

42

80

32

90

0

60 60

43

72

60

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

Old

Des

ign

New

Des

ign

Old

Des

ign

New

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l in

new

Des

ign

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Curr

ent D

esig

n

Pote

ntia

l Inp

atie

nt

Pote

ntia

l Clin

ic

Dermatology OBGYN (Clinic) OBGYN (Inpatient) Hospitalist Emergency Medicine Internal Medicine (Clinic InpatientED)

Family Medicine (Clinic Inpatient ED)

Ord

er C

over

age

Ord

er C

ount

Intermountain Quick Orders Coverage

Orders in New QOC Design Coverage

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Dermatology (Ambulatory) QOC Redesign bull Old design 500+ orders covering 67 of ad hoc orders entered bull New design 45 orders covering 89 of ad hoc orders entered

OLD

NEW

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Emerging Analytics How Care Teams

Collaborate Day in the Life Clinic Activity

Revenue Cycle Flows amp

Workqueues

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Making the Turn ndash Starting Your Journey

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Itrsquos a Change Management Journey not a Project

This is an attitude not a formula ndash recruit your change agents advance a Vision amp Narrative Start Small ndash Create the First Work Stream ndash Take Advantage of Millennium Role based configuration Be disciplined to ldquoModel Firstrdquo ndash Experience over FeatureFunction Use Analytics (data) as much as possible it is part of the cultural shift Software Configuration and Clinical Content will Blur ndash design your teams for that reality Donrsquot Get Paralyzed by Tools they will come with Scale The Strategy will change your Structure ndash continue to reflect and adjust ndash the right answer may be the next question

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

HIMSS Value Suite Satisfaction bullPatient Satisfaction bullStaff Satisfaction bullProvider Satisfaction

TreatmentClinical bullQuality of Care bullEfficiencies bullSafety

Electronic Secure Data bullData Reporting bullEnhanced Communication bullEvidence Based Medicine bullData Sharing

Patient Engagement and Population Management bullPrevention bullPatient EducationEngagement

Savings bull Efficiency Savings bull FinancialBusiness bullOperational Savings

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

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom

Questions

Contact Information Marc Probst Chief Information Officer Intermountain Healthcare

probst_marc Jeff Townsend Executive Vice President and Chief of Staff Cerner Corporation

jtownsendcernercom