Managing the Tidal Wave of Demand for IT: The Keys to Successful IT Governance

1. Managing the Tidal Wave of Demand for IT: The Keys to Successful IT Governance Susan Heichert, Joanne Sunquist, Guy Scalzi May 31, 2012

2. REMINDER: Please silence electronic devices Conflict of Interest Disclosure • Susan Heichert and Joanne Sunquist have no real or apparent conflicts of interest to report. • Guy Scalzi is employed by Aspen Advisors that provides services that are discussed as a part of this educational presentation. He has also authored a book on the topic which is available for sale viawww.himss.org.

3. Background • Hospital administrator in NYC • Co-founded software development firm • CIO at New York Presbyterian, The New York/Cornell Medical Center and the Hospital for Joint Diseases • Managed FCG’s Outsourcing Services division • Co-authored recent book released at HIMSS

4. Objectives • Describe why IT governance in hospitals and health systems is important. • Outline processes and workflows that lead to successful governance. • Share lessons learned and critical success factors.

5. Putting structure around how organizations align IT strategy with business strategy, ensuring they stay on track to achieve their strategies and goals, and implementing good ways to measure IT’s performance. - K. D. Schwartz, CIO.com, 5/22/07 Definition

6. Why It’s Important • Confers legitimacy on decisions • Standardizes processes • Shapes expectations • Ensures benefits are achieved • Aligns strategy • Provides input to capital budget process • IT demand management

7. Quick Start Guide • Create a governance or steering committee • Define a governance process • Create advisory committees • Define the role of the CEO • Require project sponsors who are accountable • Create a PMO or hire project managers

8. Keys to Success • CEO should communicate process, prepare and disseminate charter and clarify that projects cannot be submitted to the CEO or the board directly. • Deadlines for submission to the advisory committees and the Steering Committee are predefined. Communication

9. Keys to Success • Meet regularly and follow the Finance Committee calendar for submission of proposals. • Don’t be afraid to cancel meetings when no decisions need to be made. • Meetings are for new project review, prioritization and review of existing and completed projects. Meet Regularly

10. CEO needs to communicate that there will be no “end runs”. Set the threshold for review at a very low level to avoid attempts to break projects into pieces below the submission threshold. Budgets for the project may also be underestimated. Project managers in IT should do a careful review of proposals to identify necessary components and a realistic budget. Keys to Success Don’t Allow Gaming

11. Keys to Success • Effective governance is simple and transparent. • The governance process unambiguously defines the responsibility or objective for a specific person or group. • How the process works is clear to those who are affected by or want to challenge governance decisions. Keep It Simple & Transparent

12. Keys to Success • Important for holding clinical and business sponsors, as well as IT leaders, accountable for project success. • Vital for assuring that resources are actually available until projects are completed. • Assure adherence to the governance process so that the benefits of governance are received. Executive Involvement

13. Susan HeichertSVP, CIOAllina Health

14. Quick Facts Allina Health Core Initiatives • Clinical Portfolio – Epic Beaker Lab Implementation, Affiliate Implementations, Meaningful Use • Business Portfolio – Peoplesoft 9.1 Upgrade, Patient Placement • Information Privacy and Security Portfolio – Soft Token Implementation • Infrastructure Portfolio – Desktop Videoconferencing, New Data Center build (Anoka) About Allina Health • ~22,800 employees, 1,200+ employed physicians • 109,000+ inpatient admissions • 1.0 million+ outpatient admissions • Specialty Operations: Transportation, Pharmacy, Lab, Homecare/Hospice About Information Services • 493 IS employees; 296 HIM employees • Major systems vendors • Epic – Hospital and Clinic EHR and Revenue Cycle applications • GE Ultra Lab – switching to Epic Beaker • Lawson – Finance, Supply Chain • Peoplesoft - HR • 32% inpatient market share - Twin Cities • 11 hospitals – MN and Western WI • 1,706 staffed beds • 82+ clinics • 20 hospital based clinics • Received the 2007 HIMSS Davies Award for EHR implementation • Received Stage 6 Hospital Award on the EMR Assessment Model

15. Prioritizing Initiatives The Prioritization Grid is key in determining the value of the request to the organization. The request must have data to support the score. A TRF Prioritization Grid Total: 22

16. Doing The Right Work Requests, Alignment Group Review Quick Win/Just Do IT! IS Governance Cmte. Benefit Scores/Approval Mondays IS Council Resource & Impact Scores Wednesdays Non-Discretionary/ Above the Line CLT, BLT, ILT, or HIPS Prioritization Quarterly Resource Allocation IS PMO Review Benefit/Impact Grid; Project Reviews/Oversight Twice a Month Project Implemented

17. Doing The Right Work Decision Tools: Benefit/Impact Grid Benefit Impact

18. Lessons Learned • Provide education regarding the benefits of IT Governance with ongoing communication plan. • Seek sponsorship for the design and implementation of enterprise IT governance for efficient and effective decision making. • Define clear IT governance scope and responsibilities. • Decision rights and escalation process. • Define how controversial decisions will be mediated and final decisions made. • After initial implementation, address work intake process refinement with governance structure.

19. Lessons Learned • Support IT governance with engaged and supportive leaders: • Define roles/responsibilities of operational leaders to support change. • Engage leadership at the highest levels, visibly and frequently. • Implement team-building strategies. • Set up communication checkpoints for customers. • Realize governance is the foundation for IT strategy, work prioritization, resource management, and ITIL best practices. • Test, modify and evolve governance structure and process to ensure effectiveness. • Four Ps: perseverance, patience, passion, process.

20. Joanne SunquistVP, CIOHennepin County Medical Center

21. Quick Facts Hennepin CountyMedical Center About HCMC • 462 Operating Beds • 21,315 Discharges • 353,872 Clinic Visits • 97,540 Emergency Visits About Information Services • Major Systems Vendors • Epic • PeopleSoft HR & Finance • Cerner Lab • McKesson CV • Phillips PACS • Service Areas – 248 Staff • Bioelectronics • EHR • ERP • HIM • IT Applications • IT Infrastructure • Knowledge Management • Telecom Core Initiatives • Attain HIMSS Stage 7 • EHR Clinical & Revenue Cycle Optimization • Advanced Analytics • ERP Upgrade • ACO/Hennepin Health • ICD10 • Minnesota’s premier Level 1 Adult and Pediatric Trauma Centers • An essential teaching hospital for doctors who go on to practice throughout the state • A safety net hospital providing care for low-income, the uninsured and vulnerable populations • A major employer and economic engine in Hennepin County • Named one of America’s Best Hospitals by U.S. News & World Report for the 15th consecutive year.

22. IS Governance Overview • IS 3 year strategy and annual plan are driven by HCMC’s focus areas: • Patient Experience, Quality and Safety, Physician Satisfaction and Engagement, Workforce Engagement, Growth, Financial Vitality, Community • Multidisciplinary IS Steering Committee provides oversight: • Reports to highest level operations committee (Clinical Practice Committee) • Chaired by rotating medical staff member, IS members are non-voting • Responsible for recommending IS strategy and prioritizing both capital and operational spending • Final OK for all IS projects >$50,000 • Projects brought forth for approval by business owner • Policy and process in place for assessment and approval of all new technology, including medical equipment • ERP and EHR Steering Committees provide focused oversight. All IS-related committees have charters defining responsibilities, membership and authority levels.

23. EHR Governance Clinical Practice Committee EHR Steering Committee reviews decisions made by program management, user groups, clinical and revenue committees. EHR SteeringCommittee EHR Leadership Recommendations are aligned with Program Guiding Principles and input from user groups, clinical and revenue committees. Clinical Revenue Decisions are reviewed with clinical leadership and the user community to ensure they support regulatory standards and models of practice. User Groups and Champions

24. EHR User Groups & Champions • Clinical User Groups • Cancer Center • Inpatient • Ambulatory • Physicians • OR and Anesthesia • Radiology • Emergency Department • Hospital Service Departments • Revenue User Groups • Registration/Scheduling • Payor and Plan • Revenue Integrity • HIM / Document Imaging • Physician Champions • Psychiatry • Emergency Department • Obstetrics • Family Medicine • Internal Medicine • Surgery • Pediatrics • Ambulatory • Procedural Areas • Affiliates • Champions are dedicated four hours/week and are each assigned an EHR analyst partner

25. EHR Request Process (ITSM)

26. Lessons Learned • Communication and education on governance model is ongoing. • Decision making structure must be supported “at the top” to prevent workarounds. • The Purchasing Department has to be your ally. • Customers need to be constantly reminded of the bigger vision which the governance model supports (integrated vendor strategy vs. “bolt on” products). • Organization change (HFA integration) requires re-visiting roles and re-aligning model. • Challenging to work with customers who want to prioritize the work but not help do the work. Need clarity on responsibilities and time built into functional roles. • IS needs to understand customers’ business needs and provide leadership in the new technology process vs. finding out “after the fact.” We put in place a new customer service liaison model. • Built in workflow and project management are extremely important.

27. Final Word • Clarifies priority of projects, the resources available, and who is accountable for project implementation • Results in a portfolio of projects that move the organization towards the achievement of a single, unified vision • Increases key stakeholder support • Increases the # of IT projects that support the strategy and are on-time and on-budget

28. Questions? www.HIMSS-MN.org Susan Heichert Allina Health Susan.Heichert@allina.com Joanne Sunquist Hennepin County Medical Center • Joanne.Sunquist@hcmed.org Guy Scalzi Aspen Advisors gscalzi@aspenadvisors.net