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Health Care IT Suite
Learn to Speak “IT” in 30
Minutes Making IT a Team Sport
©2014 The Advisory Board Company • advisory.com
LEGAL CAVEAT
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to verify the accuracy of the information it
provides to members. This report relies on data
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©2014 The Advisory Board Company • advisory.com
9
Critical Area About Which CxOs May Know the Least
Changing Question Marks to Checkmarks for IT
Finance HR IT
Why is it
important?
What should it
do?
What do I need to
know and do?
How does it work?
Satisfactory Levels of Knowledge to Derive Value?
Example of Functional Areas Supporting 3 Critical Resources
It’s hard to be a team player if
you don’t understand the game.
! Translate strategic goals into
specific CxO competencies. !
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
10
CxO Education: “What Do I NEED to Know?”
IT Must Be a “Team Sport” at All Levels
Possible Domains and Sample Topics for Basic Education
• IT capacity
• IT cost management
• Sourcing strategies
• Prioritization processes and criteria
• Funding mechanisms and levels
• Roles and responsibilities
• Principles
Future Advisory Board Research
The Advisory Board plans to continue developing research, presentations, and other resources to help facilitate mutual
understanding on IT-related topics between CIOs and non-IT leaders.
Please let us know what topics would be the most beneficial for you and your leadership team.
• IT for accountable care
• IT-enabled PHM
• Meaningful Use
• ICD-10
• EMR optimization
• Business Intelligence
• Mobility strategies
• Interoperability strategies
• Cloud computing strategies
• Privacy and security issues
Enabling Capabilities
Enabling Technologies
IT Operations Governance
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
11
Learning the Terms of Health IT
New terms supporting healthcare transformation
Electronic Health Record
Personal Health
Record PHR
Patient Centered
Medical Home
Primary Care
Accountable
Care
Population Health
Management
Clinical Quality Measures CQM
Patient
Old term “electronic medical record” (EMR) for use in a single location now replaced with the newer term for an
interoperable record that has capability to share information across organizations “electronic health records” (EHR)
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
12
United States EMR Adoption Model SM
Source - HIMSS Electronic Medical Record Adoption Model
(EMRAM)SM http://www.himssanalytics.org/emram/emram.aspx
1) Electronic Medical Record
2) Continuity of Care Document
3) Clinical Decision Support System
4) Radiology Picture Archiving and Communication System
5) Computerized Provider Order Entry
6) Picture Archiving and Communication System
7) Clinical Data Repository
8) Clinical Decision Support
9) Health Information Exchange
Stage Cumulative Capabilities 2013 Q3 2013 Q4
Stage 7
Complete EMR1; CCD2 transactions to share data;
Data warehousing; Data continuity with emergency
room, ambulatory, inpatient
2.2% 2.9%
Stage 6 Physician documentation (structured templates), full
CDSS3 (variance & compliance), full R-PACS4 11.1% 12.5%
Stage 5 Closed loop medication administration 20.9% 22.0%
Stage 4 CPOE5, Clinical Decision Support (clinical protocols) 15.1% 15.5%
Stage 3 Nursing/clinical documentation (flow sheets), CDSS
(error checking), PACS6 available outside Radiology 31.9% 30.3%
Stage 2 CDR7, Controlled Medical Vocabulary, CDS8, may
have Document Imaging; HIE9 capable 8.4% 7.6%
Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 3.5% 3.3%
Stage 0 All Three Ancillaries Not Installed
Data from HIMSS Analytics® Database ©2013 N = 5437 N = 5458
©2014 The Advisory Board Company • advisory.com
13
Annual Benefits of a Successful EMR Implementation Add Up
Source 1: Thompson DI, Classen DC, Haug PJ, EMRs in the Fourth
Stage: The Future of Electronic Medical Records Based on the
Experience at Intermountain Health Care, JHIM, 2007.
Save 28-36 minutes of
time per nurse, per shift
Reduce average lengths
of stay by 5% to 10%
Reduce lab test use
& drug costs by 15%
Prevent 344 to 481
ADEs annually Reduce order turnaround
time by at least one hour
Ensure 99% compliance
with vaccinations
Potential to Save $4M - $10M Annually Based on 300-Bed US Hospital
Reduction in paper forms
costs (67% reporting) Improvement in charge
capture (64% reporting)
Reduction in the costs of
transcription (61% reporting)
Source 2: HIMSS Analytics and Advisory Board Company survey of
EMRAM Stage 6 and 7 hospitals, 2011.
Lite
ratu
re-B
ased
S
tag
e 6
-7 S
urv
ey
Potential HIT Benefits Are Real
©2014 The Advisory Board Company • advisory.com
14
“Federal Speak” in Health IT
Code of Federal Regulations (CFR) in Health IT
Content exchange
standards and
implementation
specifications for
exchanging
electronic health
information
• CCDA1
• HL72
• NCPDP3
§ 170.210
Standards for health
information technology to
protect electronic health
information created,
maintained, and exchanged
• NIST10
• FIPS11
• ASTM12
§ 170.205 § 170.207
Vocabulary standards
for representing
electronic health
information
• SNOMED – CT4
• LOINC5
• CPT6
• CVX7
• OMB8
• RxNorm9
So what do all the acronyms mean?
Source: Health Care IT Suite research and analysis.
1. Consolidated Clinical Document Architecture
2. Health Level 7
3. National Council for Prescription Drug Programs
4. Systematized Nomenclature of Medicine-Clinical Terms
5. Logical Observation Identifiers Names and Codes
6. Current Procedural Terminology
7. Codes for Vaccine Administered
8. Office of Management and Budget
9. National Library of Medicine US-specific terminology in medicine
that contains all medications available on US market
10. National Institute of Standards and Technology
11. Federal Information Processing Standards
12. American Society for Testing and Materials
All components have individual unique CFR assigned numbers
©2014 The Advisory Board Company • advisory.com
15
Capitalizing on Care Transformation
Adding Value as Care Managers in Emerging Affordability Economy
Source: Health Care Advisory Board interviews and analysis.
Inputs Products
Acute Care Episodes
• High-quality, low-cost
treatment of acute illness
• Includes pre-acute, post-
acute services, readmission
Specialist Office Visits
Care Management
Imaging & Lab
Emergency Care
Inpatient Procedures
Outpatient Procedures
Rehabilitation
Long-Term Care
Pharmacy
PCP Office Visits
Health
System
Ongoing Care Management
• Longitudinal, comprehensive
health management
• Includes chronic disease
care, wellness, prevention
©2014 The Advisory Board Company • advisory.com
16
Meaningful Use
• “Voluntary mandate” involving
both incentives and penalties
• Helps offset costs of EMR
acquisition, implementation,
and optimization
• Requires considerable
resources / opportunity costs
Key questions to ask (examples)
• How will we leverage and
integrate our MU efforts with
other organizational priorities?
• What should we be doing to
exceed MU performance
thresholds?
Why is this important? CxO’s roles / responsibilities
• Help align MU efforts with
organizational direction and
strategy
• Help prioritize and govern the
efforts
• Assign responsibilities and hold
people accountable
ABC Resources (examples)
• MU—The Whiteboard Story
• MU web conferences—Is Your
MU Game Plan Solid?
• MU Audit Checklist
• MU Incentive and Penalty
Calculator
• MU Navigator membership/
Scorecard Services
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
17
EMR Implementation and Optimization
• Large, complex, costly, risky
undertaking
• System backbone that supports
improved clinical and financial
performance
• Robust EMRs are essential to
improving the science of health
promotion and care delivery
Key questions to ask (examples)
• How can we best utilize our
EMR to help implement
organizational strategy?
• Which EMR capabilities
provide the biggest “bang for
the buck”?
• How do we get the most
return and manage risk?
Why is this important? CxO’s roles / responsibilities
• Define organizational strategy
• Clarify links between EMR
capabilities and strategic goals
• Quantify and track realization of
EMR benefits
• Assign accountability for benefit
realization (“benefit owners”)
ABC Resources (examples)
• Best Practices for Realizing EMR
Business Value
• Remediating and Optimizing Your
EMR for Usability and Long-Term
Value
• Implementing an EMR for the
Money
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
18
ICD-10
• Mandate
• Potentially “bet your business”
impacts on cash flow if not
done right
• Will impact many areas of the
organization
Key questions to ask (examples)
• What is our overall strategy
and plan for ICD-10?
• How will we manage coder
productivity reduction under
ICD-10?
• How will we combine ICD-9
and ICD-10 data for
BI/reporting?
Why is this important? CxO’s roles / responsibilities
• Take ownership—It’s not an “IT
project”
• Help leverage the efforts
• Balance competing priorities
ABC Resources (examples)
• ICD-10 Readiness Progress
Report
• Computer-Assisted Coding: A
Primer
• Preparing for ICD-10
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
19
IT for Accountable Care
• Can’t be both paper-based
and risk-based
• Requires new transaction
systems and BI capabilities
Key questions to ask (examples)
• What are our current
capabilities / gaps for quality,
performance, and utilization
risk contract?
• What should we be doing
regardless (i.e., the new
performance standard)?
Why is this important? CxO’s roles / responsibilities
• Involve CIO early in risk-based
contract negotiations
• Understand basic IT
requirements for different types
and levels of risk
ABC Resources (examples)
• The New IT Strategy Map
• IT for Accountable Care PPT
• New Performance Standard—IT
Implications
• ACO IT Maturity Model
Assessment Tool
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
20
IT for Population Health Management
• Can’t be both paper-based
and risk-based
• Requires new transaction
systems and BI capabilities
Key questions to ask (examples)
• What are our current
capabilities / gaps for PHM?
• How do we integrate with our
partners?
• What IT-related evaluation
criteria should we include for
partner selection?
Why is this important? CxO’s roles / responsibilities
• Define the organization’s role in
and strategy for PHM
• Understand basic IT
requirements for the 6
categories of IT-enabled PHM
ABC Resources (examples)
• A Framework for PHM
• Predictive Business Intelligence,
Proactive Medicine, and IT for
Population Health Management:
Building the Time Machine
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
21
Business Intelligence
• Improve decision making and
performance by providing a view
into current operations and future
risks and opportunities
• Critical to at-risk and value-based
contracts
• Key to maximizing value from IT-
related investments
Key questions to ask (examples)
• What capabilities and limitations do
we have today?
• What capabilities do we need
based on our current strategy and
direction?
• What are the pros and cons for our
options for core BI strategies?
• What are the biggest obstacles to
improving our capabilities and how
can I help?
Why is this important? CxO’s roles / responsibilities
• Help establish culture of data-informed
decisions—analytic and fact-based
• Exhibit the desired behavior by using
standard KPIs and dashboards
• Ensure that different, formerly “siloed”
business areas collaborate
• Collaboratively develop a BI roadmap
• Align BI initiatives with strategic and
operational needs
ABC Resources (examples)
• BI primer
• BI reports on generating value,
data governance, etc.
• BI presentations such as BI
maturity model, BI for PHM
• BI survey results
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
22
Mobility
• Key to physician and patient
engagement
• Potential to extend access and
provide unified communications
with RTLS1
• Significant advances in mobile
devices, networks, and application
deployment
• Must be managed and secured
Key questions to ask (examples)
• How can we leverage mobility to
improve transitions of care?
• How can mobility enable
telehealth and support PHM?
• How are we addressing security
and manageability for corporate
and “Bring Your Own Device”?
Why is this important?
CxO’s roles / responsibilities
• Develop guiding principles and
mobile policies jointly with IT
experts
• View mobility as a key element
to strategy
• Revisit as technology and
manageability improves
ABC Resources (examples)
• Mobile Health Care 2.Oh!
presentation
• Mobility in Action presentation
• Reports on Mobile Device
Management
• Note on Medical Device
Connectivity
Source: Health Care IT Suite research and analysis.
1) Real-Time Locationing Systems
©2014 The Advisory Board Company • advisory.com
23
IT Governance
• Effective IT governance is the
single most important predictor
of the value an organization
generates from IT
• Key to optimal use of scarce
resources
Key questions to ask (examples)
• What responsibilities should the
non-IT leaders have for
governance and IT selections,
implementations, and
optimizations?
• How is our IT governance
process synchronized with our
business planning process?
Why is this important?
CxO’s roles / responsibilities
• Help develop business and IT
principles (e.g., risk levels)
• Determine funding approaches for
different types of assets
• Establish clear prioritization process
and criteria
• Communicate
• Establish and monitor business
success metrics for major initiatives
• Define and enforce roles,
responsibilities, and accountabilities
ABC Resources (examples)
• IT governance presentations such
as “Stopping the Yes Machine”
and “IT Governance: Building a
Strong IT Governing Structure”
• IT governance compendium and
tools (coming soon)
• Instilling Disciplined IT
Governance book
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
24
IT Operations
• Understand how costs behave
• Get more for your investments
• Help manage and match supply
and demand
• Have transparency into costs and
performance
Key questions to ask (examples)
• How do we reduce our percent of
resources spent “keeping the lights
on”?
• What are the impacts of budget cuts?
• What are good / better / best
alternatives (e.g., for SLAs1)?
• Sourcing strategies benefits and risks
(and how addressed)?
• What metrics do we use to manage
the business of IT?
Why is this important? CxO’s roles / responsibilities
• Understand IT operational and
capital / operating budget impacts of
major initiatives
• Insist on measuring and monitoring
key metrics that make sense to you
ABC Resources (examples)
• IT Performance Management:
Upping the Bar During Cost
Containment
• Staffing survey results and report
• Boosting IT Capacity without
Adding Costs
Source: Health Care IT Suite research and analysis.
1) Service level agreements
©2014 The Advisory Board Company • advisory.com
25
Stage 1 Stage 2 Certification Standards
More IT Terms Meaningful Use Whiteboard Story
www.advisory.com/MUwhiteboard and zoom in to see all the details
Data
Elements
and
Certification
terms Legend
Stage 1
changes
starting
in 2014
in blue
font
Health IT
terms on
entire right
side of the
poster
Print size is 4 feet by 6 feet
©2014 The Advisory Board Company • advisory.com
26
Meaningful Use Whiteboard Story – Zooming In
26
Zoom in to 75% to see the details
Source: Health Care IT Suite research and analysis.
©2014 The Advisory Board Company • advisory.com
27
Source: Health Care IT Suite research and analysis.
Download Useful Tools and Educate Yourself
Publicly Available Tools
Meaningful Use—The Whiteboard Story
www.advisory.com/MUwhiteboard
Quick Guide Comparison―Stage 1
to Stage 2 Objectives and Measures
www.advisory.com/MUpocketguide
Bookmark Versions of the Final Rules
www.advisory.com/MUbookmarkCMS
www.advisory.com/MUbookmarkONC
Additional Resources
o 2014 Eligible Hospitals Clinical Quality Measures Grouped by National Quality Domain
o 2014 Eligible Professionals Clinical Quality Measures1 Grouped by National Quality Domain and Disease Type
2445 M Street NW I Washington DC 20037
P 202.266.5600 I F 202.266.5700 advisory.com
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