New Hanover Regional Medical Center

2007

IS Business Plan ReviewOctober 2006 – September 2007

Governance

Information Systems Steering Committee

Avery Cloud Ed OllieMary Ellen BonczekDonna BostSam SpicerJohn GizdicKeith Strawn

Technology Requests

NHHN Dollars

NHHN Resources

NHHN Strategy

Information ServicesManagement Team

CIODirectorsManagers

Physician IS Committee

HIPAA Core Team

Clinical Informatics Committee

Medical Records Committee

Sets Priorities, Selects Projects,Allocates Resources

Assesses Needs, Manages Project Portfolio,Promotes Learning

Financial Planning Committee

CEO

Business Goals

• Highest quality & safest medical practice• Supplement limitations of human brain• Most satisfying patient & family experience possible• Efficient effective environment for physicians & Nurses• Maximize physician and hospital earnings• Maintain and grow market share and reach

Method For Achieving Goals• Promote Service Excellence through the

implementation and skillful use of paperless clinical & financial information systems by 2010*. – Clinical Initiatives (MEDNET)– Financial Initiatives (LAWSON)

• Education and training to produce high level of skill using automated systems.

• Metrics to measure impact of changes.

Clinical Lane

Financial Lane

Business & Administrative Lane

Infrastructure Lane

Construction Lane

Organizational Initiatives Lane

50 Projects

Six categories of IT projects are being pursued simultaneously as represented by the six swim lanes. Coordination must be achieved across all swim lanes and resources balanced. NEEDS TO BE RATIONALIZED AGAINST ALL NHRMC INITIATIVES.

Project Portfolio Mix

4 Projects

17 Projects

19 Projects

12 Projects

6 Projects

Clinical Lane

Financial Lane

Business & Administrative Lane

Infrastructure Lane

Construction Lane

Organizational Initiatives Lane

ProgressThe position of the swimmers indicates the approximate level of completion implementing necessary systems to achieve automation goals. However, this does not necessarily indicate how effective the enabling technologies are being used. Skillful use goals can only be achieved by on-going education and training.

Physician Related Initiatives• Heartlab• Powerscribe• Other Voice Recognition Products• Alerts, Warnings, Reminders (Knowledge Mgmt)• Protocols, Order Sets (Knowledge Mgmt)• Interactive Realtime Reference (Knowledge Mgmt)• Anesthesia Documentation• Remote Access• Admin Rx• PACS Expansion• Patient & Equipment Tracking• Centralized Scheduling• ASP Ambulatory Care• ED system• Going filmless• RHIO• Perinatal Care System• OB images integration• Physician Computer Areas

Portal Downtime ReductionAug 2004 thru Sept 2006

0

2

4

6

8

10

12

Aug

'04

Sep

t

Oct

Nov

Dec

Jan'

05

Feb

Mar

Apr

May Ju

n

Jul

Aug

Sep

t

Oct

Nov

Dec

Jan'

06

Feb

Mar

Apr

May Ju

n

Jul

Aug

Sep

t

Great success achieved fixing physician primary complaint of Portal downtime.

Divided By Swim Lanes Follows.

Acronym Index• HED

• HPF

• HSM

• HAD

• HEO

• HAC

• HPP

• HEC

• HPC

• HBF

• HBI

• PCA

• PCON

• PHS

• Care Alerts

• Admin RX

• Series

• Horizon Expert Documentation (Nursing documentation)

• Horizon Patient Folder (Electronic Patient Records)

• Horizon Surgical Manager (Surgery Documentation)

• Horizon Anesthesia Documentation

• Horizon Expert Orders (CPOE (Computerized Provider Order Entry))

• Horizon Ambulatory Care (Clinic Electronic Patient Record)

• Horizon Practice Plus (Clinic Scheduling and Registration)

• Horizon Emergency Care (ED patient documentation)

• Horizon Perinatal Care

• Horizon Business Folder (Business Office Scanning)

• Horizon Business Insights (Clinical Reporting and Measures)

• Pathways Compliance Advisor

• Pathways Contract Management

• Pathways Hospital Scheduling

• Clinical Alerts, Reminders, Protocols

• Barcoded Medication Administration

• Hospital Patient Registration and Billing

Admin RXAdmin RX

• Timeline for implementation to be decided by Admin RX steering committee

Surgical Services InitiativesSurgical Services Initiatives

• Horizon Surgical Manager roll-out at New Hanover campus

• Horizon Surgical Manager v 11.1 upgrade– Provides Clinical Integration with HED– Provides Allergy Integration with HED

• Horizon Business Insight Upgrade

Horizon Ambulatory CareHorizon Ambulatory CarePlanned kick-off 6/2007, Go-live November 2007

• Implementation timeline dependent on Integration with Horizon Patient Folder scheduled for v9.5.0 release in 3rd quarter 2007

• Problems, Allergies, Medications planned for ER 10.1 release

Horizon Enterprise Release 7.8Horizon Enterprise Release 7.8Planned Date for release Spring 2007

• This release is a pre-requisite to Horizon Perinatal Care

• Provides the ability to print the Medication Reconciliation report from Physician Portal v12.1(to be implemented in the future)

• Will provide fixed column and row headers in the Physician Portal v 12.1 flowsheet view

Physician Portal Build 58Physician Portal Build 58

• Provides the following features:– Mom/Baby Link – Hide patients from your census (goes to

inactive status)– Station census will have unit plus description– Visual indicator available in Data Monitor view

on census page for critical/high/low/new LAB and RAD values

– Pull up Physician by Specialty on Locator tab

Horizon Expert DocumentationHorizon Expert Documentation

• Will continue to update system with quarterly patches

• ER 7.8 release will provide a charting link with Alerts so documentation will remove the alert

• Migration to new Hardware and Database structure

Horizon Clinical AlertsHorizon Clinical Alerts

• Delayed until May 2007

• Software fix planned for March 2007 to address the issue with Alerts removal after viewed by user. Alerts currently remain for all clinicians to address at every shift.

Horizon Anesthesia DocumentationHorizon Anesthesia Documentation

• No integration with Physician Portal – access the anesthesia documentation by all providers will not be possible unless viewed through HAD

• Requires Horizon Surgical Manager v11.1 for Pre-admission testing data to pass to HED for Medication Reconciliation across all 3 products: HSM, HAD, HED.

• Prioritization Needed

Horizon Perinatal Care Horizon Perinatal Care

• The first release of this product will be with the Enterprise Release level ER7.8

• Generally Available to all customers Spring 2007

• Dependency for this implementation is the successful completion of the ER 7.8 upgrade

• Prioritization Needed

Horizon Emergency CareHorizon Emergency Care

• Triage Documentation

• Nursing Documentation

• Discharge Documentation

• Integrated with Horizon Clinicals

• Integrated with Horizon Orders Management – McKesson provided a retro fit to our current ER7.6 sp2 version

• Prioritization Needed

PACSPACS• 3.1.1 Upgrade – Workflow and image processing

enhancements • Content Switch – Load Balancing of Image Storage• Common View – Database share with Delaney• Ortho View – Ortho templating – will reduce film printing

for Ortho• Power Scribe Upgrade – Workflow enhancements• PACS Expansion – Complete OR Rollout• Remote Access

CardiologyCardiology• Heartlab Remote Access – Web-based

product more like native client

• Heartlab -Easy access to Report on Portal

• Witt Replacement Evaluation

• Heartlab Replacement???

LABLAB• Instrument Manager – Updates code for

instrument interfaces• Co-Path Upgrade – Support expires Dec 2006

for current version• Co-Path Visual Writer to Microsoft Word

Conversion – lays the groundwork for VR• Lab 6.2 Upgrade - Support expires Dec 2006 for

current version• Core Lab Automation - Integration of analyzers

with LIs through middleware automation and tracking application

Environment

• 70 IT employees– 80% dedicated to daily maintenance– 20% to new projects

• 86 Medical Records employees

• IT Budget - $16 million– $7 million in annual recurring maintenance

• 300+ software/hardware maintenance contracts

• Medical Records Budget $4 million

Environment

• 3,400 desktop & laptop PC’s• 650 printers• 300+ servers• Gigabit ethernet (sufficient)

– 13,530 typewritten pages per second

• Clinical areas wireless (11 megabits)• Nortel phone network (5 PBX’s)

Data CenterData Center• Current Location Redesign – Position

current data center for future through 2010 or beyond

• PPD Location – Create future disaster recovery center and Test Center

SecuritySecurity

• Enterprise Password Mgt Strategy – Standardize user login format

• Identity Manager – Centralized Login and Password Mgt

• User Assignments to Internet – Ability to trace Internet activity by user – Will require all users to enter login / password to access Internet sites

Misc. InfrastructureMisc. Infrastructure•Remote Access – CITRIX

•VMWare – Server Virtualization / Consolidation – Increase capacity / decrease footprint

•System Monitoring – Vantage – Realtime monitoring of servers and infrastructure equipment

•Software Distribution Windows Server

•Wireless Upgrade – Required for Admin Rx

•Blade PC Conversion

Disaster RecoveryDisaster Recovery

• Business Impact Analysis Refresh

• Disaster Recovery Planning

• Enterprise Storage Replication

• Enterprise Storage Upgrade

• TSM Tape Storage Upgrade

CommunicationsCommunications

• SwitchBoard Automation

• VideoConferencing to Cape Fear

• Vocera – OR, ASU, PACU

Performance Stats

• 67 projects completed

• 68 projects carried over

• 40,353 help desk tickets closed. – 155 per business day

• 36,741 tickets opened– 141 per business day– 35 per person per day

New AgeNew AgeAlerts, Core Measures

• Alerts– Phase I (No dependencies – work with New Age to abstract

Care Manager data – planned for late Feb ’07 go-live)

– Phase II (Dependent on the Care Manager Alerts availability from McKesson – tentative kickoff in May ’07)

• Core Measures– Planning stages (Need to look into Midas CPMS functionality

and align requirements/goals)

New AgeNew AgeBed Control Phase II

• Are in planning stages currently (Working with David Long to determine project team)

• ED/PACU waiting Q, Pending transfer, Rapid Admit: Discovery for ADT & people process

• Transport module in early discussions • Go-live planned for June ‘07

Lawson EnvironmentLawson EnvironmentLBI 9.0, LSF 9.0

• LBI 9.0– Lawson Business Intelligence (Upgrade to eBroadcast,

SmartNotes, and Lawson reporting services)– Kickoff in Feb ’07 with completion late May ’07– Need funding (approx $120K)

• LSF 9.0 Lawson Environment– Dependent on LBI 9.0– Tentative dates are Jan ’08 – May ’08– Lawson to decommission 8.0.3 environment in July ’08 (support

will no longer be available)– Will require new hardware and web services– Will allow security restructuring (reduction of logins per user)

Lawson ApplicationsLawson ApplicationsMSS, Absence Mgmt, 9.0 Upgrade

• MSS: Manager Self Service– Training in December with go-live Jan. 8, 2007– Automation of Personnel actions and Labor reqs– To include remote access for managers, directors, VPs

• Position Manager Integration – Jan – Mar ’07 (once funding source is determined)

• Absence Mgmt– Kickoff in March ’07 with go-live late June ’07 pending

agreement with HR and Payroll

• Lawson 9.0 Apps Upgrade– Dependent on LBI 9.0 & LSF 9.0 completion– Kickoff planned for Dec ’08 with completion in Apr ‘09

AvegaAvegaADS, AFM, DecisionPoint, KPI

• Major upgrade to Avega system combining ADS & AFM databases

• Migration to Linux available• Planned kickoff in Nov ’07 with go-live in late

March ’08 (coordinate with Business Analysis & Planning and Fiscal Services)

• Key Performance Indicators: Need to develop strategy for dashboards (HBI, Lawson, DecisionPoint)

Patient Financial ServicesPatient Financial Services• Imaging Link Engine

– Patient documents can be captured at registration and automatically indexed to the patients record, eliminating the risk of being misplaced and ensuring they are available when needed

– Integration with your HIS ensures the security of protected health information

– Billing and collections personnel can view source documents and financial information online

– Allows for electronic capture of patient signature at time of registration

– Roll out to begin Dec 5 2006 – Jan 2007

Patient Financial ServicesPatient Financial Services

• PCON Upgrade – Jun – Aug ’07– Need to upgrade from V10.0 to V12.0 prior to Denials & Appeals

• PCON Denials & Appeals – Sept – Dec ’07– Boost revenue recovery by efficiently identifying, tracking and

managing denied claims – Improve processes and monitor payors based on executive

reports – Provide a centralized repository of denial information, making

the necessary claim detail readily available to support communication with payors during the recovery process

– Reduce collection timeframes by working within your receivables management system to prioritize recovery efforts and track appeal status

Patient Financial ServicesPatient Financial Services

• Series 12.0 Upgrade – Jul – Nov ’07

• Horizon Business Folder – Dec – Mar ’08– Minimizes self-pay bad debt write-offs and improves patient

satisfaction by enabling an accurate review of financial responsibility before service is delivered

– Improves business office productivity by reducing the labor expense needed to support a paper-based claim system

– Reduces the document materials and storage expenses generated from a manual, paper-based claim system  

NursingNursingAnsos, Optio, Discharge Call Manager

• Ansos Upgrade – to include Bid-a-Shift functionality. Also referred to as eShift.

• Ansos/Payroll Integration – Prior to nursing using the shift bidding features, IS will need to work with Payroll to define and develop this interface

• Optio Housewise rollout – FY07 capital to replace all PT650 label printers with Optio printers. Nursing will have the capability to reprint labels through Series/IBAX and have them print on a Laser printer.

• Discharge Call Manager – Inpatient satisfaction team driving continuing rollout of this Studer product. IS working in a technical support and security role only.

Food & Nutrition - CBORDFood & Nutrition - CBORD

• Credit card module – Allows patients and families to use credit cards in Kona and cafeteria (March – April ’07)

• CBORD Upgrade – May – August ‘07

• Room Service – Cape Fear – Roll-out to coincide with reconstruction of Cape Fear cafeteria

(July – Oct ’07)

• Room Service – New Hanover– Roll-out to coincide with tower reconstruction

Food & Nutrition - CBORDFood & Nutrition - CBORD

• Other Projects (FY07 – FY08)– TempTrak monitoring system– NetNutrition module– Tube Feeding module– Dates to be determined

FinancialFinancial

• Documentation Integrity Process Improvement – Navigant engagement

• PCA(Claims Admin)/EC2000 V12.0 Upgrade – Jan – Mar ’07– UB-04 bill form effective Apr ’07 (will replace UB-92)– Regulatory updates will be required in Series for UB-04

Organizational Organizational

• Equipment Construction on Hwy 17

• Equipment WOG Building

• Pender IS Support

• Transcription Joint Venture – NH & Pitt Memorial

• PACS Partner Integration (Dosher, Pender, Physician practices, Clinics, etc.)

Construction Construction

• PPD Move

• Cape Fear

ENDEND