CONFIDENTIAL© 2007 This report contains information that is confidential and proprietary to Infosys Technologies Ltd. and is solely for the use of Infosys. No part of it may be circulated, quoted, or reproduced for distribution outside Infosys Technologies Ltd. If you are not the intended recipient of this report, you are hereby notified that the circulation, quoting, or reproducing of this report is strictly prohibited and may be unlawful.

Meaningful Use Master Plan: A comprehensive approach

Mark BrownleeInfosys Healthcare Sector HeadEmail : mark_brownlee@infosys.comPhone : (917) 721-4302

By Infosys Technologies Ltd.

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Meaningful Use (MU) has an expansive vision of improving quality of care and reducing healthcare costs

Meaningful Use Vision

There is a 3-stage approach to achieve objectives of Meaningful Use

Electronic Data Capture and EMR Use

Increased Decision Support

Improved Outcomes

Stage 1

Stage 2

Stage 3

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Infosys strongly believes that Meaningful Use can act as an catalyst towards promoting a high performance culture in provider organizations

Meaningful Use : Infosys PoV

• Focus should be on ‘improving’ performance not just ‘reporting’

• Meaningful Use measures will be increasingly outcomes oriented in stage 2 and stage 3

• For proactive management of MU compliance, metrics impacting MU measures also need to be monitored

• Meaningful Use initiative should be planned and designed as an integral part of evolving BI needs

• Synergies of Meaningful Use with other initiatives like true clinical accounting for emerging payment models, pay for performance etc. must be leveraged

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Healthcare Enterprise Performance Management (HEPM) approach is the holistic approach towards Meaningful Use that shifts the focus on performance

MU : Healthcare Enterprise Performance Management Approach

Following are the key ingredients of HEPM approach towards Meaningful Use:

Sustained End User Adoption and Learning

Business Process Changes and Optimization

Promoting Continuous High Performance

Culture

Metrics Governance Structure and Clear

Accountability

Regular Performance Audits

Monitor and Maximize benefits realization

from Meaningful Use

Integrated Clinical, Operational and

Financial Performance Management

Meaningful Use

1

2

3

45

6

7

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Infosys’ Meaningful Use Master Plan (High Level) follows the HEPM approach towards MU solution design and implementation

Meaningful Use Master Plan

Meaningful Use Program Management and Governance

Set Direction Design the Details Make it Happen

MU Readiness Assessment of executives & staff Communication Plan Awareness Campaigns

EMR training and adoption strategy

Training Plan & Training Content Design

Feedback loop on training effectiveness

Meaningful Use Compliance Strategy

Meaningful Use Roadmap Definition

Proactive Management of Meaningful Use Compliance

Assess Data requirements availability

Design data collection methodology Data quality audits

Business Process Assessment Business Process Redesign Business Process Optimization

MU Enterprise Performance Management Strategy

Identify Clinical, Operational & Financial KPIs

Promote Continuous High Performance Culture

Plan Interventions Design intervention details Track Realized Benefits

MU Technology Selection MU + HEPM solution design and build

Pilot roll-out followed by phased implementation

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To achieve MU objectives we need integrated clinical, operational and financial Performance Management metrics

Meaningful Use Master Plan

• Establish a Metrics Governance Structure and clear accountability for every metrics; make achieving MU a collective responsibility

• A unique and mandatory requirement of HEPM approach towards MU is measuring realized benefits in dollar terms

• Encourage continuous performance improvements in clinical, operational and financial metrics through benchmarking and target setting

• As we move towards Accountable Care Organizations, an integrated and aggressive approach towards provider performance management will be required that HEPM facilitates

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The toughest challenge that providers are likely to face in MU compliance is data collection for reporting on MU measures

Meaningful Use Master Plan

?• “Hidden” data requirements for Meaningful Use reporting – analyze and plan to grab them all

• Plan for data integration across various systems

• Design processes to synchronize manual and electronic data

• Understand additional data needs for clinical, operational and financial performance measures

• Garbage in, garbage out : plan for data quality audits

Inclusions

Exclusions

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The final rule for Meaningful Use allows flexibility and choices hence providers must be diligent in planning their MU compliance strategy

Meaningful Use Master Plan

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Illustrative examples of MU measures and associated clinical, operational and financial metrics that must be managed for Enterprise Performance Management

Meaningful Use Master Plan

MU Measure Clinical Metrics Operational Metrics Financial MetricsMore than 30% of unique patients with at least one medication order entered using CPOE

• # of Medication Errors• # of drug interactions

• TAT from medication order to delivery

• Monitor physician preferences

• % use of generic alternatives

• Benefits realized due to reduced medication errors/drug interactions

• Savings in pharmacy supply chain by reducing physician preferences

• Cost savings by increased use of generic alternatives

Incorporate clinical lab- test results into certified EHR technology as structured data

• Reduction in redundant lab tests

• # of drug interactions

• Order entry time saving by use of predefined order sets

• Benefits realized due to reduced redundant diagnostic orders

Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay

• Readmission rate• # of ER visits• Post discharge

medication compliance

• Physician’s/nurses’ time spent on patient education

• Cost savings due to reduced ER visits and readmission rate

• Per episode cost of care

ILLUSTRATIVE

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Additional performance metrics associated with MU measures are good indicators of when to intervene; use them to plan necessary actions

Meaningful Use Master Plan

• “Proactive” and “real-time” management of measures

• Plan for process driven and IT systems supported interventions

• Align interventions with clinical pathways

• Define threshold levels for interventions

• Design for flexibility in mode of intervention

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Meaningful Use Dashboard Design – key principles

Meaningful Use Master Plan

Categorize measures

Support stage criteria simulation

Support Payment Year-1 simulation

Identify good and bad

performers

Set organizational benchmarks

Real time alerts and

interventions

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Meaningful Use Dashboard Design – key principles

Meaningful Use Master Plan

Drill down by department

Drill down to individual

patient

Drill down by individual physician

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Meaningful Use Dashboard Design – key principles

Meaningful Use Master Plan

Support problem analysis

Support predictive modeling

Measure benefits

realization in dollars

Measures performance

metrics influencing Meaningful

Use

Support What- if analysis

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Infosys Meaningful Use Master Plan is a holistic approach towards Meaningful Use that aims for better performance and higher healthcare IT ROI

• Comprehensive approach towards Meaningful Use that encompasses people, process and technology aspects of MU

• HEPM shifts the focus from Meaningful Use measures reporting to performance management

• Provides an integrated view of clinical, operational and financial metrics as well as their inter- relationships which allows better control over performance

• Ensures end users are trained and enabled in Meaningful Use of certified EMR and also have clear idea of the metrics they are accountable for

• Tracking realized benefits in dollar terms helps provider executives in justifying further Healthcare IT and performance management investments

• HEPM approach leverages synergies across various healthcare IT initiatives like ICD 10 migration, Accountable Care Organization BI needs etc. to achieve maximum value from Meaningful Use

Meaningful Use Master Plan

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Sustained End User Adoption and Learning is key to the success of EMR implementation and achieving Meaningful Use

Meaningful Use Master Plan

• Meaningful Use compliance and more importantly MU vision can be achieved if and only if all physicians and nurses are trained and enabled in Meaningful Use

• HEPM approach advocates identify training and adoption gaps with continuous feedback loop to design personalized trainings for ensuring Meaningful Use

• Besides Meaningful Use measures, MU solution must also track performance measures that can help identify end user adoption issues

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Infosys’ Approach to Sustained End-user Adoption & Learning : Using commonsense principles and a fresh approach

Meaningful Use Master Plan

”“

Training spike not sustained past rollout stage (2 weeks Vs 7 years)

Train‐the‐trainerrarely percolates 

Win @ the ScreenJust in TimeJust EnoughJust for MeJust my Peers

Reach End‐usersSustainably through the process’ lifetime

Absence of personalized / role based training content

Process change investments are a Use it or Lose it proposition. Sustained End‐user learning is the only way to realize any business benefit from process change programs  and upgrades.

CONFIDENTIAL© 2007 This report contains information that is confidential and proprietary to Infosys Technologies Ltd. and is solely for the use of Infosys. No part of it may be circulated, quoted, or reproduced for distribution outside Infosys Technologies Ltd. If you are not the intended recipient of this report, you are hereby notified that the circulation, quoting, or reproducing of this report is strictly prohibited and may be unlawful.

Thank You

Mark BrownleeInfosys Healthcare Sector HeadEmail : mark_brownlee@infosys.comPhone : (917) 721-4302