OUR HEAD IS IN THE CLOUDS WHILE

OUR FEET ARE STUCK IN THE MUD: THE NEED FOR APPLICATION

CONSOLIDATIONJohn Kravitz, MHA, CHCIO, CIO, Geisinger Health System

Todd Hatton, MHSA, CHCIO, ACIO, Saint Luke’s Health System

William Reed, FCHIME, LFHIMSS, Huntzinger Management Group

Agenda

• Topic and Panelist Introductions

• Learning Objectives

• The Geisinger Perspective

• The Saint Luke’s Perspective

• Panel Q&A

Topic Introduction

• The ability to aggressively pursue cloud-based service is inhibited by the heterogeneity of most organizations’ application portfolios

• Question – How can rigorous application consolidation address this issue, enabling the exploitation of the benefits cloud-based services offer?

Learning Objectives

• Identify the extent application heterogeneity exists within organizations

• Identify the economic benefit of consolidating applications

• Explore the potential impact application consolidation can have on cloud-based services

• Discuss approaches for an application assessment with the intent to consolidate

Panelists Introduction

• John Kravitz, MHA, CHCIO, CIO, Geisinger Health System

• Todd Hatton, MHSA, CHCIO, ACIO, Saint Luke’s Health System

The Geisinger Perspective

• Established an IT Governance process which includes application rationalization.▪Governance process will provide a complete

review of new system requests.

▪Need to identify the problem to solve, not bring forward a solution.

▪Rationalization of IT Application Portfolio is a critical component of this process.

IT Strategy for Application Consolidation

• Geisinger IT supports nearly 1,700 software assets.

• Need to eliminate our Best of Breed environment, moving to an integrated environment▪ Reduces complexity of environment, reducing cost

to support

▪ Simplify the infrastructure – eliminate mainframes

▪ Simplifies the environment – less support cost

▪ Reduces cost of supporting multiple disparate computer platforms

IT Strategy for Application Consolidation – Example

Epic Module License Implementation Maintenance Personnel Cost

Removed

Billing $6,220,039 $10,879,552 $611,845 $1,680,000 $3,785,896

Radiology $ 860,000 $ 2,488,575 $107,796 Same $ 651,141

Laboratory $3,112,000 $ 4,500,000 $303,000 $500,000 $1,050,000

Cardiology $ 551,570 $ 3,500,000 $ 53,000 Same staff $ 243,075

Bed Mgmt. $ 250,000 $ 30,000 $ 35,000 Same staff $ 531,322

Outpatient Pharmacy $ 573,825 $ 2,435,300 $ 55,087 $160,000 $ 684,400

Utilization Mgmt $ 539,777 $ 705,840 $134,795 Same staff $1,884,000*

Summary $12,107,211 $24,439,267 $1,300,523 $2,340,000 $8,829,834

* 3.5 Year ROI

Application Rationalization Status Report - Example

Hosting in the Cloud

• Goal is to host 50% or more of our applications in the Cloud by 2020.

• Value of the Cloud:▪Cost transparency

➢Requesting party will have full visibility and accountability for cost of their application(s)

▪Security – Cloud providers providing the highest level of security protection

▪Opportunities: AWS, Google Cloud, Azure, etc.

SLHS Perspective

• Highlights from IT Guiding Principles:

• Pursue core vendors to support across enterprise

• Follow model build, avoiding customization

• Deploy generally available software

• IT Steering Committee to provide oversight / governance

• Execute on projects and IT Service Delivery

5-year plan to consolidate to a single EMR platform

1 EMR

12 Inpatient Clinical

13 Ambulatory Clinical

8 Critical Access Clinical

5 Ambulatory Rev Cycle

7 Inpatient Rev Cycle

3 Critical Access Rev Cycle

Inefficiencies in IT

Variation in servers, client software, support staff

Business continuity across all systems

Security hardening and auditing

Inefficiencies in Operations

Growth limited by over burdened IT

Patient safety due to variation of software in use

Lack of adoption / optimization

Analysis of patient populations increasingly complex

• Innovation vs. Scale

• Speed to market vs. Stability

SLHS Consolidation Plan

Move to the Cloud is Not a Guiding Principle

• Resilience against loss of service

• Ability to pass the appropriate security audit

• Supports larger strategic goal of IT Infrastructure

Panel Q&A

1. IT Governance and Project Sponsorship

Strong, unified governance process for making IT decisions requires discipline and a consistent and ongoing commitment by SLHS executives. Technology change initiatives will be owned and driven by operational/clinical leadership. Clear and consistent prioritization process in place.

2. Overall Vendor Strategy

Pursue integrated, core vendors (e.g., Epic, ERP solution) to support functions across the enterprise (vs. cluster of core vendors).

• Core vendor: integrated architecture and data base; cross continuum and all locations; includes physician, nursing and ancillary workflow.

• Consolidate systems where feasible.• Structures in place to say “no” to local desires at the expense of the greater good.• Assume the integrated vendor product will be the system of choice unless a business case demonstrates a clear and

compelling reason to consider an alternative solution.• Understand there will be requests to go outside core vendors’ product lines, including considerations for funding and

supporting interim solutions until a core vendor is able to support a specialized need. In these instances, SLHS will implement processes to ensure justification, accountability and adjudication.

3. System Ownership and Support

Subsequent to initial implementation, system support responsibilities will be shared by the Information Services and User Departments.

4. Core System Design

Focus on enterprise-wide process and system designs shared by all departmental/business/clinical units and service lines whenever possible. Leverage vendor-recommended model configurations and avoid customization wherever possible.

5. Resource Focus Shift the focus of our internal resources to designing and implementing new solutions from support and enhancement of applications that will be replaced. Explore discrete outsourcing opportunities to improve effectiveness, reduce cost sand/or enhance skills.

6. Risk Profile and Innovation

Deploy generally available software. SLHS will be a fast follower in most areas and an innovator in very high value areas (without putting organization at risk).

7. Reliability Standards

Appropriate financial investments will be made in reliable infrastructure and business recovery processes; these investments will be prioritized; (not all applications are equal).

IT Guiding Principles: Summary

Governance Committees

• Executive Sponsor meets monthly

• Steering Committee meet quarterly

• User Groups meet monthly or as needed