Healthcare Leaders Embrace Reform

1. Healthcare Leaders Embrace Reform Beyond the EMR, CPOE, eMAR, SCM, HIT and HIEs: Alphabet Soup for the Next Ten Years Paul Browne, MPH/MHA, SVP & CIO, Trinity Health

2. Alphabet Soup / Acronyms • A word formed from the initial letter or letters of each of the successive parts or major parts of a compound term; or • An abbreviation formed from initial letters • Radar – Radio Detection and Ranging • CIO – Chief Information Officer • FAQ – Frequently Asked Questions • SNAFU – Situation Normal All Fouled Up • Information Superhighway - “Interactive Network For Organizing, Retrieving, Manipulating, Accessing And Transferring Information On National Systems, Unleashing Practically Every Rebellious Human Intelligence, Gratifying Hackers, Wiseacres and Yahoos”

3. Discussion Outline • Background • Trinity Health Overview • Trinity Information Services (TIS) Overview • Planning Model • Retrospective: 1999 – 2009 • Key Focus Areas • Outcomes • 2010 – 2020: Looking Forward • Environmental Overview • Trinity Health Strategic Imperatives • IS Key Focus Areas • Summary Thoughts • Q & A

4. Trinity Health…Who We Are • Fourth-largest Catholic health system in the United States (based on Operating Revenue) • 47,000 full-time equivalent employees • More than 8,000 active staff physicians • 19 Ministry Organizations, encompassing 47 hospitals 35 owned, 12 managed • Revenues of $7 billion • Nearly $400 million in community benefit ministry

5. Trinity Information Services Profile TIS is a business within a business … a wholly owned, $300m / year subsidiary of Trinity Health • Operational Structure • Single IS Organization - Consolidated Application Management, Infrastructure Management, Financial Management, Planning • Workforce - Approximately 1,400 associates • Applications • Clinical – Cerner • Patient Administration / Revenue Mgmt – McKesson • HR / Payroll / GL / FA – PeopleSoft • Supply Chain / AP - Lawson • Infrastructure • Enterprise Data Centers – Novi MI / South Bend IN • Approximately 100,000 Networked Devices • Services & Other • Portfolio of Routine IS Services • 7*24*365 Help Desk Fielding 720,000 / Year – Specialized Cerner knowledge • Strong Program Management, Change Management Services, and Benefits Management • Nationally recognized leader in deployment and usage of electronic health records • Provider of outsourcing services to external organizations

6. Planning Approach Retrospective Analysis Prospective Analysis Where do we go from here? Can we generate an even better return on investment within TH (quantity / quality / distribution of data)? What will it take? Why did we do this? Comparative Effectiveness Analysis Inpatient Ambulatory Care Continuum Other What did we complete relative to what we originally envisioned? Can we turn what we’ve done into new revenue streams? Business Model Asset / Capability Inventory Potential Customers Potential Competitors What outcomes were achieved? What are the organizational requirements to execute? What did we spend? Personnel Resources Financial Resources Other Resources What will truly differentiate Trinity Health? What were key decision points? What decisions did we make? Learnings? Innovation Key Processes Partnerships Business Model Economics What are the Trinity Health, industry, and policy implications?

7. Organizational Consolidation Infrastructure Standardization Application Rationalization Process Redefinition Y2K .com XP EMR/EHR ADE CPOE SEM URO CDM Retrospective: 1999 – 2009 IS Focus Areas Major Themes The Soup • HIPAA • HIT • HIE • RAC • BMDI • POC • IPOC • EWS • ARRA

8. Genesis – Trinity Health: Circa 1999 . . . Tool Diversity  Process Diversity  Variable Performance

9. Trinity Health: circa 2009 Common Tools + Best Practice Processes = Performance Excellence

10. 1999 – 2009 Outcomes

11. 1999 – 2009 Outcomes (cont.) Reduced Severity Adjusted Mortality from 107% of expected to 60%

12. April 2010: HIT, Uncertainty Remains

13. 2010+ - Where do we go from here? • Healthcare Environmental Challenges • Trinity Health Strategic Imperatives • Key IS Focus Areas for the Next Decade Strategic Scrabble!

14. Healthcare Environment / Trinity Strategic Imperatives

15. 2010+ IS Focus Areas Major Themes The Soup • Solidifying the Gains • Embracing Reform • Extending the Core • Redefining our Ministry • Evolving our Intelligence • MDA • AHN • ACO • AEHR • BD • INNV • BI • CI • ILM • CC • OMG • HCRA • MU • CE • GSSP • VIT • RTE • POC • IPOC • BMDI • eICU • I____

16. Solidifying Gains:GSSP – Genesis Safety and Simplification Program Simpler is Safer

17. Solidifying Gains:VIT – IS Value Improvement Teams

18. Embracing Reform:HCRA – Health Care Reform Act BTW – HCRA is aka PPACA + HCEARA • Comparative • Effectiveness Research • Finding what works • Elimination of unnecessary variation • Appropriate standardization of care • Foundation for value-based • payment • Payment Alignment • Bundled payments • Value-based payment • Readmission penalties • Primary care/medical home • Chronic care coordination • Health IT • Funding in stimulus bill • Bonuses starting 2011 for “meaningful use” • Penalties start 2015 for noncompliance

19. Embracing Reform:MU – Meaningful Use • The spirit of “really meaningful use”: • Implement technologies and processes that improve care • Ensure they are used • Measure outcomes and keep going

20. Extending the Core:MDA – Mergers, Divestitures & Acquisitions MDA produces value when it results in clinical integration that improves care. Increasingly, clinical integration is dependent on technology integration. Significant MDA’s last 36 months

21. Instrumentation Intelligence Interoperability POC IPOC BMDI eICU Private HIE Public HIE Portals EWS Etc. Extending the Core:RTE – Real Time Enterprise Significant technology innovations and cost reductions in the ability to capture, move, and use data will increase information velocity allowing for real-time or near real-time decision-making in many aspects of healthcare.

22. Redefining our Ministry:AHN – Accountable Health Networks Health reform and market forces are driving more integrated models of care – it is expected that each Trinity Health market will evolve to some form of an ACO While the ultimate design is uncertain … it is certain to be complex and to vary by market … therefore, Trinity’s technical design must be robust and adaptable

23. Redefining our Ministry:Accountable Health Networks Technologies • Physician Practices • Enterprise Practice Management • Electronic Medical Record • ePrescribing • EMPI Integration • Interoperability • Patient Portal • Consumer Portal • Long-term Care • Electronic Medical Record • EMPI Integration • Interoperability • Home Health Care • Care Management • EMPI Integration

24. Redefining Our Ministry:BD – IS Business Development

25. Evolving Our Intelligence:BI / CI – Business & Clinical Intelligence Business Intelligence systems allow leaders to manage the enterprise by looking out the windshield rather than the rear view mirror ~ Unknown Stages of BI Maturity Leading Trinity Health’s Current Position Advanced • Personalized dashboards and alerts • Near real-time performance monitoring • Forward looking analytics, forecasting and predictive models • BI competency center to maintain strong governance • Information integration across organization • Enterprise data warehouse, including robust metadata repository • Processes exist to integrate additional data sources and domains • Single version of truth • Formal data governance requirements and policies Defined • Organization has a formal BI strategy • Data is gathered from disparate systems • Some integration across business units • Improved information access and delivery • Subject area data warehouses • Developing data governance processes Developing Beginning • Ad hoc models / spreadsheets • Automated reporting limited to transactional systems • Many operational performance measures have definitions, but different values are reported • Spreadsheet driven • Significant manual effort to collect data • Limited to operations and regulatory reporting • Limited knowledge of data sources

26. Evolving Our Intelligence:CE – Comparative Effectiveness Trinity Health  Accelerating the Cycle! CE Within Trinity • Pain Management • Pressure Ulcers • Fall Prevention • Enterprise Formulary • ICU Utilization • Order Set Standards • Implant Management • CAUTI Reduction Capture Data Financial Incentives Improve Quality & Efficiency Comparative Effectiveness Research Change Operations Bundled Payment Methods  Aligned Incentives Technology Infrastructure (HIT)

27. Summary – The Journey Continues Transactional Era Era of Intelligence 2020 1999 2009 VI. Commercializing From 1999 to 2009, the primary focus of Trinity Health was levels I, II, and III of the IS Maturity & Value Model. From 2010 to 2020, the primary focus will be increasing value in levels IV, V, and VI. V. BI / CI IV. Extending Core • Standard • Data Capture / • Transaction Systems IT-Enabled Value • Standard • Infrastructure • Organization • Consolidation

28. Conclusion IT Can Be Free And IT’s as Easy as ABC!! • MDA • AHN • ACO • AEHR • BD • INNV • BI • CI • ILM • CC • OMG • HRA • MU • CE • GSSP • VIT • RTE • POC • IPOC • BMDI • eICU • I____ • HIPAA • HIT • HIE • RAC • BMDI • POC • IPOC • EWS • ARRA • Y2K • .com • XP • EMR/EHR • ADE • CPOE • SEM • URO • CDM

29. Q & A