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CHRISTUS Health, Biosense and NEDSS : An Administrator’s Perspective Hank Fanberg

CHRISTUS Health, Biosense and NEDSS : An Administrator’s Perspective Hank Fanberg CHRISTUS Health May 28, 2008. AGENDA. CHRISTUS Health background CHRISTUS IT Infrastructure The Experience. I wonder what they meant by that?.

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CHRISTUS Health, Biosense and NEDSS : An Administrator’s Perspective Hank Fanberg

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  1. CHRISTUS Health, Biosense and NEDSS : • An Administrator’s Perspective • Hank Fanberg • CHRISTUS Health • May 28, 2008

  2. AGENDA • CHRISTUS Health background • CHRISTUS IT Infrastructure • The Experience

  3. I wonder what they meant by that? • We just got word this morning that Downstream is having a problem with the format of one of our fields in the OBX4 segment of the Lab Results. We believe that what we are sending is correct (it is what CHRISTUS is sending us), but somebody is going to have to make a change in order for all Lab data to be stored and displayed correctly in the BioSense application.  

  4. Our Healing Ministry

  5. Our VisionWhat We Are Striving To do. • Strengthen current ministries and expand into new locations and services • Implement innovative approaches to caring for the whole person • Increase access to health care for the poor and underserved through advocacy and other initiatives • Make significant contributions to creating healthy communities • Create a work environment filled with hope, dignity and mutual respect

  6. Our Legacy • In 1866, Texas was faced with illness, disease and poverty of staggering proportions. • Galveston Bishop Claude M. Dubuis turned to his native France and issued a plea to Religious Sisters for assistance • Three Sisters answered the Bishop’s call, Mother Blandine, Sister Ange, and Sister Joseph

  7. On the Way to San Antonio 1869 • The Sisters arrived in Galveston in October 1866 and founded the Congregation of the Sisters of Charity of the Incarnate Word. • In 1887 the Sisters opened the state’s first Catholic hospital in Galveston, Charity Hospital. • Mother Madeline, Sister Agnes and Sister Pierre traveled from Galveston to San Antonio in 1869 • Within months, the Sisters established Santa Rosa Infirmary in San Antonio.

  8. Facts and Figures - Today • 40 hospitals and other health care ministries in more than 70 communities • Dozens of other health services in Texas, Louisiana, Arkansas, Utah, Oklahoma and Mexico • Approximately 27,000 employees • More than 8,000 staffed beds Cont’d

  9. A Snapshot of our Demographics • Texas leads nation in uninsured; Louisiana is third (2005) • Majority are: - Working families with low and moderate incomes - Young adults age 19-34 - Disproportionately Hispanic and African-American - Legal, US residents • Health care coverage is not available from employer or is unaffordable Sources: Health Policy Institute; The Access Project

  10. CHRISTUS Direction From To Focus on high cost, ER-based charity care to treat illnesses that Could have been prevented. Comprehensive strategies to address the symptoms and underlying causes of health problems. Proprietary approaches to planning and implementation. Community collaboratives that mobilize and build upon existing community assets.

  11. Comprehensive Integrated Care Enrollment Medical Home Admission Wellness & Prevention Disease Management Prepare for treatment & discharge Mental Health Dental Health Community Collaboration Care Management Diagnostic Service Medical or surgical treatment Expanded Insurance Coverage Pharmaceuticals Access Project & Information Management Discharge to home and/or aftercare Referrals System Durable Medical Goods

  12. Biosense: Two years in the Making • Major upgrade of core clinical information system • Convert all facilities to MEDITECH • Three year project • Had to wait for CHRISTUS human resources availability (team of about 12 people with a changing cast of characters) • Project Manager • Security SME • Architects • Interface engineer • Data manager • Network architect

  13. BioSense: Using Health Data for Early Event Detection and Situational Awareness Wayne Myers, Project Director Constella Group, LLC - Contractor to CDC Emilie Kralicek Clinical Specialist June 15, 2006

  14. Why Participate? • Two reasons: • Texas and Louisiana • Situational Awareness is a good thing • We participated in a situational awareness project with the city of Houston following 9/11 • But it’s a lot of work • Requires a lot of resources • Concerns about privacy and confidentiality

  15. Health Care Landscape • The Healthcare Continuum or Landscape is comprised of various patient demographics, located in multiple settings and includes a population with different economic realties. Across this continuum, we have multiple care channels that provide a comprehensive and robust inventory of services. Patients Care Channels Focus Age Group Settings Socio-economicStatus Access Location Provider/ Payer Service Geographical Area Infants Rural High In Person Home Traditional Providers Alliances Local Adolescent Suburban Medium Telephonic Rehabilitative Public/Private Insurers Partnerships Regional Adult Men Urban Low Electronic Hospital Acute National Alternate Providers Adult Women Proxy Emergency Department Retail Midlevel Provider Regional Poverty Municipal Senior Men Long Term Care Non-Acute Health Infomediary Federal Senior Women Clinical Home Health International Laboratory State Community Wellness

  16. Some Key Technologies Needed by Health Systems in General (which we don’t have) • Enterprise Master Person Index (EMPI) • Accurately identify the patient • Deliver comprehensive view of patient • Streamline patient registration across facilities • Enterprise Interface Engine • Exchanges data via • HL7 messaging • Standardized communications • Lower long term costs • Enables cross coordination and interoperability • Clinical Data Repository • Consolidates data from a variety of clinical sources to present a unified view of a single patient • Improve the quality of patient care • Reduces the cost of health care • Service Oriented Architecture (SOA) • Allows for effective and affordable business-level interoperability • No application rip and Replace requirements • Enabler of business change (Plug and Play) • Leverage the Web

  17. HIE Infrastructure

  18. The CHRISTUS Health Enterprise Goal Standardization Integration Integration Standardization Acceptable Satisfactory Excellence Customer-centric innovative and integrated approaches to care delivery Alignment IT Governance Strategic Goals Optimization Governance Business Alignment End State Goal: A complete picture of the patient across time and services

  19. Governance Model • Differing IT Systems & Applications • Multiple views of the same patient • Fragmented Data • Higher IT Costs • Higher Acute care costs • Strained and reduced resources • Geographical disparity of care • Disparate, uncoordinated enterprise systems • Functional silos • Cross functional inefficiencies • Disconnected business decisions • Central Leadership • SLT • IMOC • Regional Oversight • Regional CEO • Regional IM Executive • Trans Regional Requirements Planning • Long Term Care • Home Health • Community Health • Local Execution • Acute facility • Long Term Care • Home Health • Community Health • Retail • Non-CHRISTUS local entities Implications

  20. Customers and Consumers Patients Providers Insurers Alliances Partnerships CHRISTUS Health Model (Today) Regional Execution Santa Rosa Health Care Spohn Health System Ark-La-Tex Central Louisiana Northern Louisiana Southwestern Louisiana Southeast Texas Gulf Coast Acute Care Non-Acute Care Environments Long Term Care International USFHP Clinical Services Home Care Physicians GL General Ledger PP Payroll and Personnel QM / RM Quality / Risk Management BAR Billing / Accounts Receivable AP Accounts Payable Business Functions MM Materials Mgmt GL|AP|AR|PP|MM|BAR|MM|QM GL|AP|AR|PP|MM|BAR|MM|QM Standards /Interfaces HL7 ASTM DRG ITS TCP/IP HTML DSM X12 XML EDI Common IT Governance ITIL Processes Problem Management Release Management Incident Management Change Management Configuration Management Capacity Management Availability Management Service Continuity Service Desk Service Level HDW & SFTW Shared IT Infrastructure

  21. Existing New BioSense Technical Approach Data Source Systems CDC BioSense Applications Vocab PHINMS Mapping Receiver BioSense Data Warehouse Interface Engine BioSense PHINMS Or Tools Integrator Sender Internet (SSL) Transport Queue Other BioSense BioSense Web Applications Local Public Health Data Feeds Viewer Linker Database

  22. Difference • CHRISTUS needs a unified view of the patient (a lot of information about one person) • Biosense and NEDSS need a little bit of information about everyone

  23. Patient Portal Referral Kiosk Ambulatory CHRISTUS Health Enterprise View – TomorrowIt’s not about me, It’s about us Customer Channels Acute Care Standardized Products across Services and Regions • Uniform face to the customer • Standardized language • Tools point of need, when, where • needed Integrated Products and Services Services CHRISTUS Digital Nervous System Clinical Data Repository Personal Health Record Retail International Services Value Added Services Value Added Services Services • Analytics • Clinical • Business • Patient • Single View • Quality Care Enterprise Master Person Index SOA Architecture Optimized Products, Services and Processes Aligned Strategic Goals, Strategies and IT Services Services Non-Acute Care Customer Channels Medical Travel Referral Kiosk Ambulatory Retail Patient Portal

  24. Good document is critical • BioSense Team meeting: Progress since our last meeting. • Closed Items: • MOU sent to CHRISTUS Health • Hardware configuration approved by CHRISTUS Health Solution Architects • SNOMED Codes received. • Requirements further refined. • Met with Peter V to confirm a number of key technical assumptions • Technical design featured by CDC in presentation at AMIA • Approval given by CHRISTUS Health to collapse NEDSS-ELR project into the overall CHRISTUS Health BioSense project. • Key outstanding items on for the CHRISTUS Health • Hardware installation • Validating test scripts and working with CHRISTUS Health to verify that they are part of integration testing • Coding in the BioSense Integrator • Confirmation of SNOMED codes required by the state • Delivery and confirmation of business requirements to TDSHS • SOW in final stages of development/review/approval process • Risk: Upgrade activation date set for CHRISTUS Health MediTech upgrade (BioSense dependency on this date) The upgrade is date driven, and is set for 2/14/08. 11/16: CHRISTUS Health project members confirm that the project is on schedule.

  25. We had challenges • A lot had to do with our MEDITECH conversion • But we persevered • And just became certified

  26. QUESTIONS QUESTIONS

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