When You Reach a Fork in the Road, Take It

1
When You Reach a Fork in the Road, Take It

• Annual HIMSS Conference Exhibition
• February 24, 2004
• Robert Pickton

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Five Year Journey
10
Responded to the strategies-3N
9

New Gap Greater than 1995
8
Web
7
Physician
6
User Expectation
Tough Stuff
5
Consolidation of all I/T costs to BIS
Investment Infrastructure BUMC
4

Original Gap
3
BBA Lack of Financial Stability
2
BIS Ability To deliver
1
95
96
97
98
99
00
01
02
03
3
BHCS Clinical Systems Current State
Portal Architecture
BHCS Clinical Transaction Processing Systems

35 vendors gt70 different applications Pharmacy
currently 4 vendors
Eclipsys E-7000 ADT, OE BUMC, BSH, OCH, BIR
HBOC Series 2000 ADT, OE, HIM BIR, Grapevine,
Garland, Ellis County Meditech ADT, OE,
Scheduling, Lab, Rad, ClinDoc, HIM BHVC
Siemens/SMS Unity ADT, OE Richardson OPry
Allegra ADT, OE Irving IHS/Dairyland ADT, HIM
Hopkins County Cerner Millennium OE Hopkins
County (implementation) Cerner Classic Lab,
Rad, Scheduling BUMC, BSH, OCH, BIR, Grapevine,
Garland, Ellis County, Richardson ATL LIM
Metabolic Disease Lab BUMC Cerner Millennium
Lab Hopkins County OPry Allegra Lab Irving
Cerner Millennium Rad, Scheduling Irving,
Hopkins County SkyRIS Rad Grapevine Cerner
Millennium Pharm BUMC, (in implementation) BSH,
OCH, Hopkins County Mediware Digimedics Pharm
Garland OPry Allegra Pharm - Irving PharmOne
Pharm Grapevine, Ellis County Cardinal Omega
Pharm Hopkins County Mediware WORx Pharm (in
implementation) Garland, Grapevine, Ellis
County GE/Marquette MUSE EKG BUMC, BSH, OCH,
BIR, Garland, Grapevine, Ellis County, Richardson
Mennen CV Digital Image Archive BUMC, Garland
Mennen CV Hemodynamic BUMC, Garland Lumedex
CV Perioperative Charting BUMC, Garland
Lumedex Diabetes Charting BUMC, Garland,
Grapevine, Irving, Ellis County, Hopkins County
Orthopedic Information System BUMC Transplant
Information System BUMC BMTServe Bone Marrow
Information System BUMC Liver Transplant
Research Database BUMC Oncolog Oncology
Information System BUMC Traumabase Trauma
Reporting System BUMC KOKO Pulmonary
Information System BUMC Spectrasoft
Scheduling Pulmonary BUMC AICE Epidemiology
BUMC BioTrack Pain Centers BUMC NeoData
Neonatology BUMC SoftMed HIM BUMC, BSH,
OCH, Grapevine (implementation) Quadramed HIM
Richardson Practice Partners Rehabilitation
Scheduling BUMC, Garland, Grapevine, Ellis
County, BIR, Irving-Rehab, Coppell iPath
Surgery Scheduling, Perioperative Charting, Case
Monitoring BUMC, Garland, Grapevine iPath
Scheduling Pain Centers, BIR Hill-Rom
WatchChild LD BUMC, Garland, Grapevine
Spacelabs Birthnet LD Hopkins County MedHost
Patient Tracking ED BUMC TeleTracking Bed
Tracking BUMC TeleTracking Patient Tracking
BUMC Kodak PACS BUMC Siemens PACS Irving
Remstar APRS Pharm BUMC Pyxis 2000 AMD
Pharm BIR, Garland, Grapevine, Ellis County
Pyxis 1000 AMD Pharm BUMC, BSH, OCH Net-IT
Central Bone Soft Tissue BUMC

• Cerner
• Meditech
• Mediware
• Allegra

Data Architecture
4
Background View of Our Industry- The Healthcare
Chasm

• FUTURE
• Profession of Medicine
• Systems of Care
• Team
• Electronic
• Reduced Variation
• Quality-driven
• MostTrusted

• CURRENT
• Craft of Medicine
• Autonomy
• Paper-based
• Variation
• Cost-driven

THE HEALTHCARE CHASM

• Aging population

• Patient safety standards

• Workforce shortage

• Rising healthcare costs

• Outcomes-based reimbursement

• Consumerism

• Regulatory complexity

5
BHCS Clinical Excellence Vision
Clinical Transformation is required for BHCS to
achieve its goals of providing Best Care and
becoming the Most Trusted source of healthcare
by 2010.

• Personalized, high-touch care that is patient-
  and family- centered across the continuum
• BHCS is delivering the safest care possible
• Best anywhere STEEEP measure performance99th
  percentile
• Automated clinical information available at the
  point of care
• Executable knowledge provided to physicians and
  care providers
• Real-time information sharing with BHCS
  stakeholders and partners

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Clinical Transformation

• If you dont know where you are going, You might
  not get there
• Yogi Berra

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What is Clinical Transformation?

• Ideal Patient Experience
• Redesign Care Processes Across All BHCS
  Facilities
• Inpatient and Outpatient Providers
• Focus on Patient Safety
• Adverse Drug Events (ADEs)
• Best Care Practices
• Implementation of Evidenced Based Medicine (EBM)
• Standardized Order Sets
• Clinical Decision Support

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What is Clinical Transformation?

• Standardize Portfolio of Clinical Software
  Products across BHCS
• Create a Strategic Alignment with a Technology
  Vendor
• Integration of Technology to Optimize Work Flow
  and Care Processes
• Minimize paper-based processes
• Improve Efficiency and Productivity
• Computerized Physician Order Entry (CPOE)
• Baylor Electronic Medical Record (BEMR)
• Single Electronic Patient Record
• Implications for Current and Future Business
  Partners
• Information Access and Sharing

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Components of Clinical Transformation

• Technology
• Recognition of strategic value of the investment
  and the commitment to standardization
• Infrastructure
• Architecture for access to applications, data
  sharing and integration
• Across the continuum of care
• Vendor Partnership-futures
• Eclipsys
• Replacement of existing systems
• Operations
• Enterprise design
• Workflow/Process re-design to integrate
  technology
• Paper
• Efficiency Productivity
• Best Practices
• Clinical Domain
• Culture and relationships
• Physician Adoption
• Best Practices

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Clinical Transformation- The Why Nots

• Why Not 2 Years Ago?
• Technology Solutions too Risky at Enterprise
  Level
• Purchasing/Business models
• Relative Market Immaturity
• Questionable ROI?
• Why Not 2 Years From Now?
• 3-5 year effort
• Plano Hospital Creates unique Opportunity
• Market Expectations-Playing Field is Changing
• Transparency-Outcomes, Reimbursement

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Clinical Transformation- The Whys

• So Why now?
• Cost Controls Alone Inadequate
• Patient Safety Issues
• Best Care/Quality improvement
• Paper Based Processes of Care Have Become a
  Barrier
• Enterprise Commercial Solutions Now Available
• Contracting Models Have Improved
• Compliance-HIPAA
• Demonstrated ROI
• Growing Complexity of Existing Clinical Systems

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Where are we? First steps.

• BHCS Board approval to begin the journey
• Reviewed TCO and budget for 7 year project
• Approved vendor selection
• Budget for year 1
• Implementation strategy
• Plano
• Challenged us to review and design model for
  success
• Signed contract with Eclipsys
• Development partnership in Ambulatory and
  Oncology
• RFP out for Intellectual capital-Best Practices
• Development of communications strategy
• Internal and external
• Begin Plano implementation

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What is Clinical Transformation?Fast Forward 5
yrs.

• Organizational Memory
• Registration
• Once-less than 10 minutes
• From home using a computer
• Physicians office
• Information is available at all BHCS facilities
• Best Care/Practices
• Safety
• Medications
• Clinical Experience
• The way care is actually delivered
• Outcomes
• Complete and up to date information
• Evidence based medicine- Best Practices
• Evidence based outcomes
• Patient Experience
• Strategic Journey
• Define what it is to be a system

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In Summary

• Continuation of the road we have been on
• Changes in the environment accelerating
• Clinical Transformation is not incremental
  business as usual, it is truly transformational
• Paper based processes minimized
• BHCS Clinicians expect us to head down this road
• Everyone is ready for the technology portion of
  the journey
• We have a critical mass of Physicians who are
  ready for the shift from craft based medicine to
  profession based medicine and systems of care
• The road to Clinical Transformation will define
  who Baylor is over the next 5-10 years if we can
  embrace it as our strategic focus
• Clinical Transformation is the key to achieving
  our vision of being the most trusted provider of
  health care services by 2010
• Partnership have been formed to help us achieve
  our vision

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Questions