Original Contributions Benefits Planning for Advanced...

Original Contributions

54 Journal of Healthcare Information Management — Vol. 19, No. 1

IntroductionAdvanced clinical information systems (ACIS), including

computerized provider order entry (CPOE), CPOE-drivendecision support, automated clinical documentation,electronic medical records, and clinical data repositories arebecoming increasingly popular. While only five percent ofAmerican hospitals have fully implemented these applica-tions to date,1 the latest HIMSS Leadership Survey shows

that ACIS components are ranked as four of the top five most important computer applications for the next two years.2

Providers purchase and implement ACIS for a variety ofreasons, including improving clinical quality and patientsafety, maintaining or improving competitive position,reducing waste by improving integration and communica-tion, improving efficiency and reducing operating costs, and

Benefits Planning for Advanced Clinical Information

Systems Implementation atAllina Hospitals and Clinics

Douglas Ivan Thompson, MBA, Sharon Henry, RN, Linda Lockwood, RN, MBA, Brian Anderson, MD, and Susan Atkinson, RN, MBA

K E Y W O R D S

■ Benefits planning ■ Computerized provider order entry (CPOE) ■ Clinical information systems■ Return on investment (ROI)

A B S T R A C T

Allina Hospitals and Clinics is implementing an enterprise-wide information system with inpatient

and ambulatory clinical documentation and orders, clinical decision support, and revenue cycle

applications.Allina has adopted a rigorous approach to planning for and realizing the expected

clinical and financial benefits from this investment.Allina’s strategies include:

• Forming a benefits realization team with formal responsibility for analysis, education, facilitation, and measurement.

• Studying system design to consider requirements for benefits realization.

• Integrating cultural, organizational and process change plans with system implementation plans.

• Measuring benefits using a measurement framework that matches organizational reporting, enables multi-level sequential analysis and adjusts for bias in quantifying benefits.

• Assigning accountability for achieving benefits by matching every benefit with an individual and an operational group; system executives, hospital executives, and department managers are held accountable for benefits within their scope of responsibility, and expected financial benefits are part of their yearly budgets.

This article describes Allina’s approach for benefits planning, contrasting it with the typical provider’s

approach to benefits realization. It argues that this approach may greatly increase the likelihood of

realizing the value of investments in integrated clinical and business IT.


Journal of Healthcare Information Management — Vol. 19, No. 1 55

preparing for future regulations requiring systems such asCPOE or electronic medical records.

However, the lack of verifiable evidence about theexpected benefits of these systems has made it difficult tojustify their purchase. For example, although improvingmedication safety is the most widely reported benefit ofCPOE, a recent literature review of 103 published papersdealing with CPOE found only three that quantified itsimpact on medication errors and adverse drug events.3

While provider executives and boards of directors expectto realize significant benefits to offset the cost and risks ofACIS implementation, most providers’ benefit realizationefforts are weak. First Consulting Group’s experience withdozens of ACIS implementations in recent years shows thathospitals’ IT benefit realization efforts typically have thefollowing characteristics:

• Weak justification: High-level, literature-based benefit estimates are used, often supported by soft, non-quantified benefits and platitudes, such as “It’s the right thing to do.”

• Delayed timing: Benefits realization efforts begin after implementation is complete.

• Lack of integration with implementation: Benefits are not explicitly considered in system design.

• Disorganization: Benefits realization efforts are ad hoc, with each function or department responsible for identifying and realizing their own benefits, without structure from a formal organization or structure.

• Limited or no measurement: Each function or department may measure their own benefits if they choose, without consistent, ongoing reporting.

Throughout the early stages of its ACIS implementationeffort, Allina Hospitals and Clinics has been highly focusedon achieving measurable benefits from advanced clinicalinformation systems. This focus has involved the use of fivekey strategies. While none of these strategies is unique, theuse of all five at once is unusual: a survey of 12 recentACIS implementations found no other healthcare providerorganization has used or is using all five strategies.

BackgroundAllina Hospitals and Clinics is an integrated delivery

system located in the metropolitan area of Minneapolis andSt. Paul, Minn. Allina has 22,583 employees and $1.8 billionin 2002 net operating revenues. Allina owns four largemetropolitan hospitals and seven small regional hospitals,and it manages one hospital, operating a total of 1,721staffed beds. Allina also owns and operates 76 single- andmulti-specialty clinics.

Allina took on three major systems implementations andprocess improvement efforts, beginning in the mid-1990s.One was the implementation of Eclipsys Corp. systems atAllina’s metropolitan hospitals, which began in 1995. By

2002, all of Allina’s metro hospitals were using Eclipsys insome acute-care units; one facility has functionality in allacute-care units.

Another initiative involved revenue redesign, with thegoals of removing waste, reducing cycle time, streamliningworkflow and reducing duplication. Overarching methodsincluded the introduction of technology and the reductionof process variation, and between 1997 and 2002, Allinameasured $20 million in increased contribution margin.

Finally, Allina’s clinics started implementing the Logicianmedical records system in April 1997. By 2002, reportedbenefits included annual savings of $640 per provider incharts forms and jackets, annual spending reductions of$3,000 per provider on transcription costs, and a 50 percentreduction in staff who previously handled paper charts.

In 2001 and 2002, Allina re-evaluated its IT strategy anddecided to select an enterprise-wide, integrated architecturefrom a single clinical and revenue-cycle vendor. In June2002, Allina completed a clinical IT strategic plan, and itsent seven vendors a scenario-based request for proposal in September. This vendor list was later reduced to two,and in January 2003, Epic Systems was selected over Cerner Corp.

In March 2003, implementation and benefits planningactivities began, and in May, the Allina Hospitals and ClinicsBoard of Directors gave overall final approval to theAutomated Medical Record and Revenue Cycle Services(AMR/RCS) project as one of the organization’s top priori-ties. Rapid design of Allina’s new information systemsbegan in July 2003, and by that October, an initial prototypesystem was successfully demonstrated.

In late 2003 and early 2004, Allina prepared for systemimplementation in a variety of ways. It conducted 250department walkthroughs at two hospitals scheduled forinitial implementation. It conducted 500 design, validate,and build sessions, as well as defined 500 workflows forapplications and integrated processes. The system alsoconducted an analysis of service denials through the consol-idated billing office, identifying potential cost savings of $60million through new workflow designs.

Allina also developed an open scheduling model andimplemented a patient access “accountability model” in all hospitals. It also developed ambulatory performancemetrics and reporting capabilities. IT staff converted 25million data items and brought 12 new interfaces live.

In preparing for the use of the new system, Allina developed 250 evidence- and consensus-based order sets with physician and clinical participants. It also developed accompanying pathways for order sets, and it formatted and distributed paper order sets for use before CPOE implementation and during system down time.

In September 2004, the replacement of Allina’s coresystems began at Buffalo Hospital.



Allina’s IT Strategy and VisionAllina set several guiding principles for the AMR/RCS

implementation.First, it seeks to make decisions that encourage integra-

tion of systems. For example, if a new or enhanced applica-tion is requested and its AMR/RCS vendor provides similarintegrated functionality, Allina will choose the AMR/RCSvendor’s product. Further, it decided to shift the focus ofinternal resources to designing and building the AMR/RCSsystem, away from supporting and enhancing legacysystems. To better manage software customization, theorganization prefers to install generally available software.

Similarly, in the area of core system design, Allinadecided to create a core system design that will be sharedby all business units.

Finally, in the area of project sponsorship, majortechnology change initiatives with significant operationalbenefit will be owned and driven by operational leadership.Allina also acknowledges the importance of changemanagement, committing to understand work process andchange management implications of technology improve-ments and provide the necessary support to effectivelymanage change.

Allina also set a clinical vision. As part of its vision, itexpects that patients, families, and caregivers have informa-tion about Allina hospitals and clinics that enables them tonavigate the system, and they receive timely and appro-priate information and services from Allina, (from the rightprovider, at the right place, at the right time). Also in thatvision, Allina caregivers can identify the appropriate careneeds of patients and families, and they are able to deliversafe, appropriate, efficient, and effective care. Finally, Allinaprovides ongoing care management to ensure maximumeffectiveness of and satisfaction with care.

Allina also established a revenue-cycle vision thatincludes offering one-stop scheduling and registration,collecting patient financial and clinical information at onetime, enabling front-end determination of a patient’s eligi-bility and financial obligation, collecting charges as anoffshoot of point-of-care documentation, creating under-standable and accurate bills, and providing immediateanswers to patients’ financial inquiries.

To achieve the greatest benefits from the concurrent

implementation of clinical and financial systems, Allina ispaying special attention to the linkages between revenue-cycle and clinical-care processes.

Benefits Planning ApproachAllina’s approach to realizing the benefits of its ACIS

implementation, called benefits planning, includes thefollowing five strategies:

Organizing for Benefits. Allina formed a benefitsrealization team that has formal responsibility for analy-sis, education, facilitation, and measurement.

Designing for Benefits. System design includesexplicit consideration of what requirements are necessary to realize benefits.

Planning for Benefits. Allina is integrating cultural,organizational, and process change plans with systemimplementation plans.

Measuring the Benefits. Implementation efforts arebiased toward quantification of benefits, with a measurement framework that matches organizationalreporting and a multi-level sequential analysis of benefit achievement.

Accountability for Benefits. Every anticipated benefitis assigned to an individual and an operating group,and system and hospital executives and departmentmanagers are held accountable for achieving benefitswithin their scope of responsibility—financial benefitsare factored into yearly budgets.

Organizing for BenefitsTypically, benefits realization efforts occur at the

department or operating-unit level; for example, the localpharmacy director is responsible for medication manage-ment benefits. Organizing for benefits involves creating aformal benefits realization function and team with definedroles and responsibilities, including a detailed work planand linkages to key groups of executives, operating staff,and technical experts. This type of organized function is nottypical for clinical systems implementations. Only four of 12provider organizations surveyed had a formal benefitsrealization team or function.

While department and operating unit accountability forbenefits is important, a formal benefits realization functionhas several advantages. It enables better coordination andoptimization of benefits for each function, department, orunit. There is better understanding, vision, and communica-tion about expected benefits. And finally, there is a morerigorous, focused approach to benefits realization than isachievable otherwise.

Allina’s AMR/RCS benefits team is charged with defining,designing, and facilitating the achievement of expectedbenefits. Team members are active advocates, drivers,measurers, facilitators, and educators. Team members areshown in the organization chart in Figure 1.

The team includes specialists in revenue cycle services

“While provider executives and boards of

directors expect to realize significant benefits to

offset the cost and risks of ACIS

implementation, most providers’ benefit

realization efforts are weak.”



and automated medical records. Revenue cycle specialistshave prior revenue cycle experience and are divided intohospital, clinic, and business office accountabilities. A nurseon the RCS team also has accountability for case manage-ment category denials. The medical records team membersprimarily are nurses who are assigned specific high-volumeDRGs. They research and summarize practice for each DRG,develop a crosswalk of all current Allina order sets anddevelop potential order set models for a team of physicians,pharmacists, and other clinicians to review and modify.Responsibility for other benefits is assigned to teams orindividuals outside the core benefits team, with analyticalsupport from benefits team members.

Analysis is an important responsibility for the benefitsteam. It maintains an updated and relevant catalogue ofanticipated benefits from implementing the new application.The catalogue includes a description of each majorexpected benefit, updated measurable estimates of eachbenefit, and descriptions of the system functionality andvarious changes that must occur to realize each benefit.

Toward this end, the team works with system designers andbuilders to ensure the Epic system incorporates all aspectsnecessary to achieve expected benefits.

The team also is responsible for organizing, facilitating,and tracking efforts that help realize benefit realization. Forexample, it maintains lists of the work steps needed toachieve benefits within specific timeframes, and it coordi-nates the implementation of these necessary changes. Itidentifies key organizational, cultural, and process issues,and it staffs key work efforts. It reports on benefit realiza-tion efforts to Allina project leadership, and it works withsteering committee or Allina leaders and stakeholders todefine accountability for benefits realization.

The team takes the lead role in measuring progresstoward achieving benefits and leads in developing quantita-tive metrics for doing so, creating an operational system forbenefits measurement and reporting. It also educates Allinaexecutives, clinicians, managers, and staff on benefit realiza-tion, with the aim of designing specific strategies to helpoperational units achieve benefits. Finally, the team

Figure 1. Organization Chart.



identifies and promotes opportunities to publicize andotherwise profit from Allina thought leadership to achievebenefits from the new system.

The benefits team interacts with five stakeholder groups.They include the project management office, which makesoperational decisions on benefit realization strategies andtactics; four advisory teams, which review and approvedecisions made by design teams and the benefit team;design teams, which make decisions about system designand build system functionality and content; local unit

leadership, which implement systems and make operationalchanges; and users, which take the new system and use it,along with new operating processes, to improve quality and performance.

The benefits team has been viewed positively by Allinaand project leaders, who value the focus they provide as akey to benefits realization. However, communicatingrequirements for benefits realization to the build teams has been difficult. Attempts were made as early as theimplementation planning phase to educate the builders andinclude them in meetings and conversations about benefits,but in retrospect, more could have been done to bring thebenefits and build teams together.

Communicating the vision from the benefits team toindividual hospitals is also a challenge. Because hospitalswere not formally involved in the creation of the initialbenefit estimates and may not have been given enougheducation about these estimates after they were completed,benefits data are questioned, and getting past the numbersis sometimes challenging. Although it is more time-consuming to seek upfront buy-in, this would have savedAllina a lot of time and effort.

Designing for BenefitsSystem benefits often are dependent on system design,

but many providers’ clinical system design efforts do notensure that the system capabilities required to supportexpected benefits are present before implementation.Designing for benefits means that the ability of the system to deliver expected benefits is a system design criterion. Only seven of 12 organizations in the survey used this strategy.

Allina’s planning and visioning sessions were structuredto support the idea of designing for benefits; however, therelative immaturity of the ACIS vendor’s inpatient product

made this a challenge. Allina often found it was “pushingthe envelope” of existing functionality.

For example, one potential gap was inadequate care planfunctionality, which is needed to improve clinical outcomesand reduce resource utilization and denials. Another short-coming was that order sets did not populate pathways,necessary for improvements in clinical outcomes and reductions in resource utilization. Also, the plan of care was difficult for nurses to use, impeding improvements inclinical outcomes and reductions in resource utilization.Uncertain capabilities for charge on documentation made itdifficult to achieve charge capture improvements in ED andsurgery. Finally, the loss of custom EMR reporting capabili-ties from the previous system made it hard to reducenursing and HIM workloads.

Many Allina hospitals currently use pathways to movepatients through the hospital and ensure that qualityoutcomes are met. When the design team began to translatethese pathways to the new system, they discovered that itscare plan functionality made it difficult to design and use adaily pathway format—the care plans and pathways couldnot be populated from physician’s orders. In addition, thelook of the care plans and pathways on the computerscreen made them look longer than they appeared in thepaper versions. To meet Allina’s requirements, the look andfeel of the vendor’s existing care plans had to be modified;however, missing functionality still required changes inclinical operations that must be communicated to the staff.

Designing for benefits requires all design team leads tobe closely aligned in their goals and communicatefrequently. As Allina work groups began to designprocesses, they realized that these design decisions woulddrastically affect benefits as well as system functionality. Forexample, design teams initially decided that all medicalrecords would be scanned before system implementation.Further analysis showed that this would greatly increasecost and workload, as well as slow down the system.Diligent communication and careful follow through arerequired to identify and resolve these types of issues.

Planning for BenefitsTypically, ACIS benefits realization efforts do not begin

until after system implementation. Planning for benefitsmeans identifying the process, cultural, and organizationalchanges required to realize the benefits; developing formalwork plans to ensure these changes are made; andintegrating these plans with the system design, build andimplementation plans. Only five of 12 provider organiza-tions in our survey used this strategy.

Planning for benefits is expected to both speed benefitsrealization and to increase the likelihood that expectedbenefits will be achieved by identifying barriers early in thedesign process so they can be resolved before the system is implemented.

“Organizing for benefits involves creating a

formal benefits realization function and team

with defined roles and responsibilities…”



At Allina, planning for benefits flows directly fromdesigning for benefits. The identification of functionaldeficiencies in the systems being implemented highlightedcultural, organizational, and process changes that also were required to realize benefits. After gaps in requiredsystem functionality were addressed, the remaining gapsoften required additional process changes or changes incultural norms.

Allina also found it necessary to create new organiza-tional structures to work with its physicians to drivedecisions about evidence-based care. Difficulties in reachingagreement on standardized nursing documentation toolsand procedures were a factor in the creation of a seniorAllina nursing executive role, which did not exist before theAMR/RCS implementation project.

Allina discovered that detailed plans must be developedto describe how these sometimes difficult changes will bemanaged. These plans must then be integrated with thetechnical implementation plans; when the system is implemented, the process, cultural changes, and organiza-tion structures needed to realize the benefits will already be in place.

Integrated benefit plans are being developed at Allina foreach major benefit area. These include detailed tasks,timeframes, responsible parties, approach to and organiza-tion of work, organizational structures, project charters,metrics, and calculation methods.

In planning for benefits, communication between teamsis critical. Allina achieved this communication byconducting numerous meetings throughout the differentphases of the project. The executive director for benefitsmet with team leads, key executives at each facility and ahost of other stakeholders to share the initial benefitmeasurements, reinforce the need to design and plan forbenefits, and answer questions about the process. However,more could have been done earlier in the process.

Building consensus order sets across the system waseasier than anticipated. Allina physicians are very collabora-tive and want to use “best practice” tools. Allina developedan elaborate input and feedback process to gain broadphysician exposure to all order sets before final approvalfrom the physician advisory team, and this has proven to bea successful approach.

Measuring the BenefitsFew hospitals carefully measure their ACIS benefits and

describe what they did to achieve them. Measuring thebenefits may involve one or two levels of benefit estimates,followed by operational baseline measurements just beforea system goes live, and the development and use of anongoing system to report against these metrics. Only four of 12 hospitals in our survey used this approach.

At Allina, Level One measurement was done as part ofthe clinical IT strategy completed in 2002. It involved

conservative and literature- and experience-based estimatesof potential benefits in many different categories. Thesenumbers were used as part of the business case that justified the investment in the new system. They also wereused in early planning activities, and to begin to educateand focus the organization on the types of benefits thatwere expected.

Level Two measurement was done in 2003 as part ofimplementation planning. This involved the measurement ofcurrent system and process capabilities, the identification of

benefit drivers, and gap analysis between current andexpected future system and process capabilities. This workwas used to validate and update expected benefit amounts,but more importantly, to inform the benefits planningefforts described earlier.

Level Three measurement is operational baselining, usingautomated measurements wherever possible. Some of thesebaseline measurements have been completed, others areunder way, and still others are not scheduled until laterphases of the implementation.

For example, in early 2002, literature-based estimates ofthe amount of duplicate tests that could be avoided atAbbott Hospital predicted it could save as much as $67,000.

At the second level, in mid-2003, a report of lab ordersrepeated less than four hours from the time of the originalorder, indicating duplication, was reviewed by laboratorydirectors, who determined whether duplicate orders werejustified or not. Redundant orders were analyzed to deter-mine rate and reasons for duplication by the hospital. Then,using Allina’s per-test cost accounting data, an estimate wasmade to project potential savings from preventing duplicatetests; savings at Abbott Hospital were estimated at $131,000with panel alerts and $70,000 if no alerts were used.

Third-level measurement will use system reports afterimplementation. Benefit realization metrics will count thenumber of alerts regarding duplicate tests during decisionsupport, analyzing the number provided and percentaccepted per 100 total orders. That figure will be used tocalculate the number of duplicate tests avoided through theuse of CPOE-driven alerts; cost accounting data will then beused to estimate total savings.

Table 1 shows Allina’s budgeted benefit targets by category.

“Planning for benefits is expected to both

speed benefits realization and to increase the

likelihood that expected benefits will be

achieved by identifying barriers early in the

design process…”



An AMR/RCS benefits dashboard has been developed forexecutive reporting, and data collection and reportingmechanisms have been defined and partially implemented.The dashboard shows quarterly values for the followingtypes of metrics and defines responsibility for data collec-tion and reporting:

Clinical outcomes of care: nine metrics for JCAHO coremeasures; two for ICU performance measures; two forchronic care, and one for medication safety.

• Financial outcomes: three metrics for revenue cycle performance measures, two metrics for resource use, and one for cost per case-by-case type.

• Satisfaction outcomes: four metrics for patient and family satisfaction, one for staff satisfaction.

• Process adoption: four metrics for CPOE/CDS adoption, two for functional resource utilization.

• Process reliability: two metrics for this category.

More detailed metrics have been developed for each ofthe major areas of potential benefit. Data collection for mostof these metrics can be automated. For example, detailedbenefit metrics for the emergency department includes:length of stay for emergency department admissions andoutpatient visits; the percentage of patients who left withoutbeing seen; per visit cost of MRI, CT head, and abdomenscans; gross and net revenues per visit; transcription linesand costs per visit; ADE types and location by facility; unitsecretary and billing specialist FTE; and time study ofemergency department activities.

Measuring system benefits, including clinical outcomes, istime-consuming and costly. Other organizations that Allinacontacted had little experience with IT benefits planningand measurement, which made benchmarking difficult.

Unless an information system has been designed forbenefits reporting, it is often difficult to obtain needed data.While every attempt was made to specify discrete data

elements that will enable automated benefitsreporting in the new system, it is unclear howsuccessful this initiative will be in the finalimplementation.

Allina has experienced difficulties whereclinical and financial data are measured andreported differently. For example, the initialbenefit targets for cost reductions related toelectronic order sets, guidelines, pathways,and alerts were developed using data fromthe cost accounting system. These early financial targets needed to be linked tospecific clinical process changes and expectedoutcome benefits for each of the targeted casetypes. However, existing clinical quality statistics did not always match the case definitions in the cost accounting system.

New organizational structures must be putin place to enable agreement on key metrics across thehospitals and clinics. The large number of hospitals andclinics at Allina makes it difficult to reach agreement. Theprocess for reporting and acting on reported benefits data isstill being defined.

Accountability for BenefitsTypically, individuals are not held fully accountable for

the quantitative benefits of ACIS implementation.Accountability for benefits means that the individuals withdirect responsibility for benefits are held accountable forachieving them. This accountability includes formal jobsuccess criteria and the inclusion of benefits realization indepartmental and organizational budgets. Only three of the12 provider organizations that were surveyed assignedaccountability for achieving clinical system benefits.

Expected system benefits are already loaded into Allina’sbudgets through 2008. The Allina benefits team beganmeeting with local hospital leaders before go-live to discussbenefit targets and the operational baseline metrics thatwould indicate success. These meetings included discus-sions with all department directors about the impact ontheir budgets. Each benefit line item, both AMR/Clinical andRCS, was discussed in detail for each hospital. In thesemeetings, the team proposed multiple strategies forobtaining benefits, especially around clinical resourceutilization. The team offered to help as needed andrequested by operational sites.

The benefits team is responsible for the developmentand timely reporting of implementation, process, andoutcome metrics for the department directors and otherlocal leaders to use to evaluate their performance inrealizing expected system benefits. However, the leadershipat the local hospitals and clinics are fully accountable forthe benefits expected from the system.

Maps of roles and responsibilities have been developed

Table 1. Budgeted benefit targets by category.



for major benefit areas to help each person on the broaderimplementation team and in the operating units understandtheir part in realizing expected system benefits. The samplein Table 2 is for several of the revenue cycle benefits.

The experience of meeting with local hospital and clinicleaders highlighted areas where potential benefits realiza-tion and measurement problems may occur. For example,potential problems described earlier with HIM operationsand document scanning emerged during one of thesediscussions. As stakeholders began to realize that they werebeing held accountable to achieve benefits, they beganlooking much more closely at systems and processes todetermine how they would achieve their targets. Thebenefits team learned that this must be a collaborativeprocess with give and take about methods, whilemaintaining a firm commitment to achieve benefits.

As each hospital nears go-live, their staffs have increas-ingly questioned the budgeted benefits they must achieve.Early agreements on benefit targets have sometimes beenforgotten, misunderstood or not clearly communicated.Earlier involvement of the individual hospitals and functionsin benefit discussions and calculations, as well as betterdocumentation of the process used to develop the benefittargets, would have helped to address these issues.However, Allina’s operating leadership clearly understandsthat they are accountable for benefits, and they havecommitted to realizing them.

ConclusionAllina’s past experience and the recent survey of ACIS

implementations show that its benefits planning strategiesare not typically used by other provider organizations. Thebarriers and challenges to using benefits planning aresubstantial. It takes time, effort, and money to put a processin place. It is not always possible to accurately estimate theamount of benefits that can be expected before systems

have been designed and implemented.Some disagreement over methods, results, and measure-

ment cannot be avoided. Overcoming the natural resistanceof a large organization to change, especially change thatwill be measured for accountability, has required and willcontinue to require a firm commitment from Allina’s leader-ship and staff.

While Allina understands that some of the expectedbenefits may not be realized, it is clear that other areas ofpotential benefit that were not part of the original estimateswill come to pass, and that the total impact, both clinicallyand financially, will be greater than was originally thought.Allina has chosen to hold itself accountable to the bestquantitative benefit estimates they could make, not lettingperfection get in the way of the good. The attention paid tobenefits realization in the form of organizational structuresand mechanisms, design, planning, measurement, andaccountability, is expected to pay off.

While there is natural tension over accountability forbenefits, these sometimes difficult conversations have raisedorganizational awareness of the possibility of, and need for,measurable system-driven benefits. This represents a realcultural change for Allina.

Allina expects that benefits planning will significantlyincrease the likelihood of realizing the benefits that Allina,along with its patients and staff, need.

About the AuthorsDouglas Ivan Thompson, MBA, is a leader in FCG’s value

measurement effort and has worked with more than 30provider organizations, including Allina, to help define andrealize CIS benefits. He is the Chair of HIMSS’ CIS DatabaseTask Force.

Sharon Henry, RN, leads Allina’s benefit realization effortfor the AMR/RCS implementation and is accountable for itssuccess. She has filled numerous clinical leadership roles at



Allina and is an expert in care process redesign.Linda Lockwood, RN, MBA, is a director in FCG’s clinical

transformation practice and a leader in performanceimprovement and benefits realization efforts at Allina.

Brian Anderson, MD, is Allina’s chief medical officer andthe liaison between the benefits planning effort and Allina’ssenior leadership team.

Susan Atkinson, RN, MBA, is a Manager in FCG’s clinicaltransformation practice and a key member of the clinicalconsulting team at Allina.

References 1. Computerized Physician Order Entry: Costs, Benefits and Challenges, AHA Study, 2003.

2. Fifteenth Annual HIMSS Leadership Survey, 2004.

3. Oren E, Shaffer ER, Guglielmo BJ, Impact of Emerging Technologies on Medication Errors and Adverse Drug Events, Am J Health Syst Pharm. 2003 Jul 15:60(14): 1447-58.

Congratulations CPHIMS Recipients!Congratulations to the followingindividuals who have achieved theCertified Professional in HealthcareInformation and Management Systems(CPHIMS) credential from August 16, 2004through October 22, 2004. The CPHIMScredential recognizes those individualswho have met the eligibility requirements

and passed the examination. CPHIMS encourages continued personal and professionalgrowth in the practice of healthcare information and management systems and providesa national standard of knowledge required for certification. In addition, the credentialassists employers, the public, and members of the healthcare profession in theassessment of healthcare information and management systems professionals.

Join this elite group. Go to www.himss.org to find out more about thecertification program. To see a full listing of certificants go tohttp://www.himss.org/asp/certification_cphims_certificants.asp.

Johnny E. Bates—Birmingham, AL

John Forrester—Dalton, GA

Ralph Fruchtman—Atlanta, GA

Paula J. Gibson—Maple Grove, MN

Joseph P. Knight-McKenna—East Freetown, MA

Robert E. Macauley—Wellesley, MA

John W. McLendon—Saint Petersburg, FL

Steven N. Menzies—Hampton, VA

Debra Miesle—Dayton, OH

John T. Sills—Columbus, OH

Mary Ellen Skeens—Duluth, GA

Tony Smith—Falls Church, VA

Fred H. Strobel—Springfield, VA

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