Implementing IS Governance

1. Implementing IS Governance October 24, 2008

2. Introductions • Catherine Bruno, VP, CIO • Eastern Maine Healthcare Systems

3. Session Objectives • Weill/Ross IT Governance model: Participants will learn the key success factors and how to apply them to develop or evaluate their organization’s IS Strategic Plan and Governance Model. • Participants will have access to the EMHS IS Governance model and process flows to use as a starting point at their organization. • Participants will have a sample Balanced Scorecard Strategy Map and metrics to use as a starting point at their organization.

4. Agenda EMHS-Who we are CIO Challenge 2005 CIO Challenge 2006 EMHS IS Governance Process EMHS IS Governance Approach 2008: EMHS IS Governance Results EMHS IS Scorecard Metrics EMHS IS Governance Lessons Learned

5. Organization Profile • 7 hospitals • 729 licensed beds • 454 long term care beds • 110 residential “beds” • 574 active medical staff • 272 employed physicians • 2 strategic affiliates • AHS • Reference lab, retail pharmacy, • Transcription, materials • 1892 Bangor General Hospital (now Eastern Maine Medical Center) • 1980’s formed Eastern Maine Healthcare • 2004 formed Eastern Maine Healthcare Systems; Governance modernization • 2005 added 7th hospital $ 816 million net revenue 2.3% margin 7,600 employees

6. l l l l l l EMHS – 7 Affiliated Hospitals 89 Acute Beds 72 LTC Beds 14 Acute Beds 36 LTC Beds 9 Swing Beds Critical Access Hospital 411 Acute Beds 48 Acute Beds 76 LTC Beds 28 Acute Beds Critical Access Hospital 100 Acute Psychiatric & Substance Abuse Beds 25 Acute Beds 10 Swing Beds Critical Access Hospital

7. EMHS Mission The mission of Eastern Maine Healthcare Systems is to maintain and improve the health and well-being of the people of Maine through a well-organized network of local health care providers who together offer high quality, cost-effective services to their communities. May 1999 / Reviewed February 2004

8. EMHS Vision We will be the best rural healthcare system in America by 2012.

9. EMHS Pillar Goals – by 2012, EMHS will: • People – Become the employer of choice through significant employee engagement in the EMHS Mission, Vision and Values. • Service – Create a culture that demonstrates best of class consumer satisfaction and assures appropriate access to care throughout our continuum of clinical offerings. • Quality – Become recognized for achieving outstanding patient safety and exceptional patient care. • Finance – Achieve outstanding financial performance. • Growth – Achieve growth greater than any other New England healthcare system. • Community– Improve integration of EMHS in the community through transparency, community service, improved community trust and collaboration.

10. Awards • Most Wired Award 2008 • Avatar “Overall Best Performer” award for Patient Satisfactions – 5 years in a row! • NCQA certification for primary care practices. One practice is a Patient Centered Medical Home. • Best Places to Work – two years in a row • Welcoa Well Workplace Gold Award • ACS: Community Hospital Comprehensive Cancer Program

11. Together Project Vision Statement “All EMHS providers will be able to treat a patient using one shared electronic record system, no matter where in EMHS the patient seeks care. Information will be instantly available; improving patient safety, enhancing outcomes, and saving money.” CEO Cabinet approved 01-20-2004

12. Together Project: 5 Core Vendors

13. Agenda EMHS-Who we are CIO Challenge 2005 CIO Challenge 2006 EMHS IS Governance Process EMHS IS Governance Approach 2008: EMHS IS Governance Results EMHS IS Scorecard Metrics EMHS IS Governance Lessons Learned

14. CIO Challenge 2005 - State of EMHS and EMHS IS • EMHS “young” as a system (formed in 2004) • New CEO Search (hired in 2006) • Outdated EMHS IS Strategic Plan • IS Governance Process ad hoc • System-wide common systems project underway – but • Centralized EMHS IS started – but • Mix of in-source and out-source • Lack of system-wide priority process • Lack of IS funding model • Lack of centralized EMHS decision process

15. CIO Challenge 2005: Solidified the Base Restructured the common systems project “Together” Stabilized the IS organizational and technology base Established CIO as member of EMHS Leadership Council Developed relationships with all Affiliate CEOs Developed and implemented Cerner Remote Hosting plan Developed an IS Governance & IS Strategic Plan RFP

16. Agenda EMHS-Who we are CIO Challenge 2005 CIO Challenge 2006 EMHS IS Governance Development Process EMHS IS Governance Approach 2008: EMHS IS Governance Results EMHS IS Scorecard Metrics EMHS IS Governance Lessons Learned

17. CIO Challenge 2006 CIO Challenge 2006: Lack of an IS Governance Structure and IS Strategic Plan IS Governance Definition: Specifying the • decision rights, • accountabilities, and • processes required to encourage desirable stakeholder behaviors in the use of information technology to achieve desired medical and business outcomes.

18. IS Governance Design Outcomes • Ensure that EMHS IS resources are effectively and efficiently deployed in support of the strategic and clinical needs • Ensure EMHS senior management set the priorities • Organize and align action across EMHS IS • Provide a means for monitoring performance and tracking progress of both implementation of the plan and long-term IS performance

19. Designing IS Governance CIO Challenge 2006 – March through September – Developed the model • Committee structure • Representatives from each EMHS organization • IS Strategic Plan Task Force (ISSPTF) • IS Strategic Plan Working Group (ISSPWG) • Comprehensive System-wide Interview List • CEOs, COOs, CFOs • CMOs, CMIO, CNOs Key consideration – Ensure organization wide buy-in

20. EMHS IS Strategic Planning & Governance Design Approach

21. Implementing IS Governance EMHS-Who we are CIO Challenge 2005 CIO Challenge 2006 EMHS IS Governance Process EMHS IS Governance Approach 2008: EMHS IS Governance Results EMHS IS Scorecard Metrics EMHS IS Governance Lessons Learned Agenda

22. Network/Telecom Strategy IS Strategy IS Statements of Direction IS Scorecard IS Governance Design IS Business Principles IS Metrics EMHS IS Strategic Plan and Governance Design Model

23. EMHS IS Strategic Planning and Governance Design Approach Purpose • Strategic support organization • Enables all of EMHS to improve efficiencies and quality of decisions Vision – Information Systems • Collaborates throughout EMHS to support integrated IS and processes that advance • The quality of patient care • Growth • The strength of EMHS • Will be the steward of technology and process design, ensuring timely and easy access to affordable solutions for clinical and business needs.

24. Six EMHS IS Principles • The Principle of Active Business Partnership • The Principle of Total Organization Optimization • The Principle of Governance • The Principle of Self Service Systems and Processes • The Principle of Talent Stewardship • The Principle of Customer Service

25. EMHS IS Governance Approach IS Governance Design Assumptions • The Governance Process is robust and repeatable • The Governance Process has accountability informed by measurement and feedback. • The governance matrix is fixed for 2 to 3 years. • EMHS IS is a system-wide functional capability with distributed resources.

26. EMHS IS Governance Approach The Principle of Governance – Information Systems is a system-wide functional capability, driven by user needs including patient safety, patient outcomes, and economies of scale. Information Systems is a strategic business asset and will be governed as such. The Leadership Council will appoint a committee to govern Information Systems’ limited resources to ensure they are applied to meet strategic business objectives throughout EMHS. EMHS Information Systems shall be funded based on the value it provides throughout EMHS.

27. EMHS IS Governance Approach Weill and Ross IT GovernanceMatrix Model* Best Practices Governance Patterns * Anarchy archetype was removed and not considered

28. EMHS IS Governance Approach

29. EMHS IS Governance Approach Decision Clinical, Business, IS IS IS IS Domains Web Principles Architecture Infrastructure Investment Applications Decision Makers Input Decision Input Decision Input Decision Input Decision Input Decision EMHS Business Monarchy CFO IS Directors IS Directors IS Monarchy Group Group CIO, CIO, CIO, CIO, CIO, Federal Affiliate Affiliate Affiliate Affiliate Affiliate CEOs CEOs CEOs CEOs CEOs CIO, IS CIO IS Duopoly Governance Leadership Council Committee

30. IS Governance Committee Structure Existing Committees New Committees

31. EMHS IS Governance Approach EMHS IS Governance Committee Accountabilities • The IS Value Equation: the overall value EMHS receives for its investment in information technology. • The quality of IS Governance: • responsiveness, definitiveness, and transparency of decision-making • keeps IS aligned strategically with the needs of EMHS and its Members

32. EMHS IS Governance Committee Decision Making Responsibilities • IS Principles • How IS fits into the EMHS business model and contributes to EMHS success • IS Applications • The selection and prioritization of applications, running on the IS infrastructure, that address specific EMHS and Member clinical and business needs. • IS Investment • Priorities, resource limits, resource allocations, and projects required to fulfill the expectations derived from the IS Value Equation. • IS Performance Against Plan • Changes in IS strategic and business plans to better achieve IS strategic goals and annual business plan targets.

33. EMHS IS Governance Approach IS Governance Committee • Chaired by EMHS CEO • 4 Affiliate CEO’s • 2 physicians, a nurse, VP Continuum of Care, CFO, CIO • Project prioritization • IS Resource allocation • New framework for project approval • Major projects (>400 hrs) to IS Governance Committee • 20% of project hours reserved for minor projects • Business Plans with Net Project Value (including 5 year Total Cost of Ownership), tie to pillars, and risk

34. EMHS IS Governance Approach EMHS IS Governance Committee Minimum Time Commitment • 1 annual full-day meeting to plan for the next fiscal year (including directional and funding issues). • 3 quarterly half-day meetings to address issues emerging from execution of the annual IS business plan and the IS Strategic Plan. • Additional meetings as deemed necessary by the Chair to address unexpected issues and priorities.

35. EMHS IS Governance Approach Established the Role of Affiliate Account Manager Accountability • Spans the boundary between a specific Member and corporate IS • Represents the concerns and interests of each to the other • Works with IS leadership to orchestrate IS resources across EMHS to address Member needs Capabilities • Student of the Affiliate’s business • Effective member of the Affiliate leadership team • Advocate to the Affiliate for treating IS as an EMHS strategic resource • Building consensus, managing conflict productively • Balancing multiple and potentially conflicting priorities

36. IS Directors Group • Charter: Operationally implement the governance decisions and direct the IS architecture and Infrastructure • Membership • CIO Chair • Account Manager (IS Director) from each Affiliate Organization • Corporate Directors of IS • PMO Representatives • Director of Clinical Engineering • Director of PACS

37. EMHS IS Governance Approach EMHS IS Directors Group Decision Making Responsibilities • IS Architecture • the organizing logic for data, applications, and infrastructure • captured in a set of policies, relationships, and technical choices to achieve desired business and technical standardization and integration • IS Infrastructure • technical foundation • available throughout the business as a shared and reliable service

38. EMHS IS Governance Approach EMHS IS Governance Responsibility/Process Maps

39. EMHS IS Governance Approach Nine EMHS Recommended EMHS IS Governance Process Maps Implemented • IS Principles • IS Architecture • IS Infrastructure • Clinical, Business & Web Applications • IS Funding • Update IS Strategic Plan • IS Performance Against Strategic Plan • IS Performance Against Annual Business Plan • IS Operational Performance

40. EMHS IS Governance Approach IS Strategy Areas of Focus • Project Governance • Electronic Medical Record • IS Infrastructure • Network Strategy • Strategic Governance • Organization

41. EMHS IS Transformation Map and Timeline Status October 1, 2007 Green (bold) is completed. Red (italics) is moved to FY 08 Purple other major accomplishments. FY 2007 FY 2008 FY 2009 Establish and implement common PMO and portfolio management methodology Consolidate across EMHS Project Governance • Desired State • Improved patient care and operational efficiencies • Affordable costs • Timely, easy, confidential, system-wide access to patient information • EMHS-wide alignment, trusting relationships, professionalism, accountability Establish system-level IS PMO Appoint IS PMO Director Implement surgery physiological monitoring integration Implement biomedical integration at EMMC Implement physician documentation at other Affiliates Implement inpatient CPOE at other Affiliates Implement nursing documentation at other Affiliates Implement cardiology, oncology, and anesthesia at EMMC Implement inpatient CPOE at EMMC Implement biomedical integration at all Affiliates Implement ambulatory EMR Finalize EMR Roadmap with governance, scope, budget, risks & timeline Start Positive Patient ID at EMMC Implement physician documentation at EMMC Implement Together EMR Blue Hill and CA Dean Implement service cluster II Implement ICU documentation at EMMC Electronic Medical Record Consolidate user access across EMHS Test Business Continuity Plan Implement Together EMR at TAMC and SVH Behavior Health Nursing Documentation at Acadia Improve patient discharge at EMMC Initiate system-wide capacity budgeting Implement service clusters Perform a Fit and Fitness Survey Evaluate and redesign (as necessary) the entire governance design Evaluate and redesign (as necessary) the EMHS IS organization design Surginet Case Tracking/Big Board at EMMC Implement consolidated user access at EMMC (Single Signon) Initiate system-wide capacity planning Establish user access mgt Service Level Agreements Implement HR/Payroll/Time and Attendance – Blue Hill, TAMC, SVH Test system-wide redundancy BHMH live with PACS Conduct Info Technology Service Management (ITSM) audit Perform a Fit and Fitness Survey Implement continuous improvement for all process maps Implement Voice Over Internet Protocol Complete Business Continuity Plan Create ITSM charter and vision Establish Business Continuity Plan team Implement continuous improvement for the EMHS IS organization design Implement HR/Payroll/Time and Attendance at EMMC, Inland Acadia Implement the IS strategy update process map Webmail rollout Implement system-wide redundancy Integrate voice and data management Establish Security & User Access Mgt team (VPN) Centralized Storage Project IS Infrastructure Initiate system-wide obsolescence plan Implement the three IS performance process maps Initiate system-wide capacity measurement Perform a Fit and Fitness Survey Define changes necessary to EMHS management systems to to support fully EMHS IS • Current State • Non-systematic approach to improving patient care and operational efficiencies • Unknown IS value equation • Disjointed access to patient information • Affiliate alignment, low trust, inefficiencies, problematic accountability Develop Voice Over Internet Protocol project charter Implement the five IS governance process maps Initiate system-wide availability measurement Initiate staff development for project management,accountability, andempowerment Complete redundancy evaluation Initiate voice and data consolidation plan Implement the IS scorecard Implement the new IS reporting structure Centralize telecommunications Form, charter the IS Directors Group Sell the new IS structure to EMHS and Affiliates Form, charter the IS Architecture & Infrastructure Committees Implement communication plan Complete Single Point Of Failure elimination plan Develop staffing profile for the new IS structure Form, charter the IS Governance Committee Implement training for the Account Managers Strategic Governance Organization Network Strategy

42. EMHS IS Organization • Over 200 IS staff spread across several different organizations • Increase integration of the IS functions throughout EMHS under the leadership of the EMHS CIO • Account Manager role • Coordination meetings with Lab & PACS

43. Agenda EMHS-Who we are CIO Challenge 2005 CIO Challenge 2006 EMHS IS Governance Process EMHS IS Governance Implementation 2008: EMHS IS Governance Results EMHS IS Scorecard Metrics EMHS IS Governance Lessons Learned

44. EMHS IS Governance Results IS Governance Committee • Project prioritization for major IS projects • Require business plans with clear value measures • FY 2007 – Grandfathered projects that were already in progress. Prioritized 29 of 32 proposed projects • FY 2008 – Prioritized 13 of 29 proposed projects

45. EMHS IS Governance Approach Progress • Current State - 2006 • Non-systematic approach to improving patient care and operational efficiencies • Unknown IS value equation • Disjointed access to patient information • Low affiliate alignment, low trust, inefficiencies, problematic accountability • Current State - 2008 • Improved patient care and operational efficiencies: e.g., Dose range checking; CPOE live at EMMC • Value equation defined for major IS projects; not yet measured • Timely, easy, confidential system-wide access to patient information • EMHS-wide alignment through formal IS Governance process and Account Manager role

46. EMHS IS Transformation Map and Timeline Status October 2008 Green Bold is completed Red Italics moved to FY 2010 Purple other major accomplishments FY 2008 Proposed FY 2009 FY 2010 • Desired State • Improved patient care and operational efficiencies • Affordable costs • Timely, easy, confidential, system-wide access to patient information • EMHS-wide alignment, trusting relationships, professionalism, accountability Project Governance Consolidate across EMHS Implement EMHS Project Portfolio Management Tool Establish and implement common PMO and portfolio management methodology Med. Reconciliation To remaining affiliates Implement biomedical integration at all Affiliates Implement physician documentation at EMMC PowerChart Office Specialties Continued Implement inpatient CPOE at EMMC Implement Bar coding POC at EMMC EMMC PowerInsight EDW Quantify Benefits of Clinical IT Standard Formulary EMMC ED EMAR and Nurse Doc Initiate EMMC Med. Reconciliation Cross-Functionality Access Control Transfusion Med DB Implement physician documentation at other Affiliates Implement INet and Virtual INet at TAMC Implement cardiology, oncology, and anesthesia at EMMC TAMC Document Imaging Cerner 2007 Upgrade Remote ICU at non-affiliates Implement ambulatory EMR at Inland Implement Together EMR CADean Implement surgery physiological monitoring integration Electronic Medical Record Implement Together EMR Blue Hill Meridios Initiate EMMC CPOE Phase 2 Implement Hospira Implement Fusion Transcription AGFA PACS Upgrade Implement INet and Virtual INet at SVH INet phase 2 Consolidate User Access across EMHS Implement INet and Virtual INet at Inland ImplementAuto Tester Initiate inpatient CPOE at Acadia Implement Lighthouse EMMC Orthopedics Implement ambulatory EMR at CA Dean Implement Voice Over Internet Protocol Implement HR/Payroll/Time and Attendance – Blue Hill Implement consolidated user access at EMMC (Single Signon) Evaluate and redesign (as necessary) the entire governance design ALI Chemistry Analyzers Perform a Fit and Fitness Survey Initiate system-wide capacity budgeting New Brewer Professional Building PCO Power Notes EMHS Teleconferencing Solution Set Direction For Single Sign On ALI Care Evolve Evaluate and redesign (as necessary) the EMHS IS organization design Implement Problem Management Implement continuous improvement for all process maps Implement 3 Service Level Agreements Test Disaster Recovery Plan Health InfoNet Pilot Lawson Upgrade Implement Service Level Management Test system-wide redundancy Create an IS Business Plan Implement continuous improvement for the EMHS IS organization design Establish user access mgt Service Level Agreements (VPN) Complete Disaster Recovery Plan EMMC Financial Decision Support (ePSi) Implement Change Management IS Infrastructure Initiate system-wide capacity planning Implement communication plan Define changes necessary to EMHS management systems to support fully EMHS IS SupportMIHGH Initiate UnifiedCommunications Inland Financial Support Implement the IS strategy update process map • Current State • Non-systematic approach to improving patient care and operational efficiencies • Unknown IS value equation • Disjointed access to patient information • Affiliate alignment, low trust, inefficiencies, problematic accountability Implement HR/Payroll/Time and Attendance –TAMC, SVH IS Focus Group Action Items Develop Roadmap for Voice Over Internet Protocol OneMaine Health Initiatives Physician Surveys at EMMC and Acadia Fully implement the IS Account Manager role Implement Lawson GL/Materials, AP at Blue Hill Update Agency Access Agreement to allow Non-Affiliate Access Optimize the EMHS IS Management Structure Implement System-wide availability measurement Develop a network/telecommunications Strategy Implement the three IS performance process maps Optimize the effectiveness of the EMHS IS Management Team Initiate staff development for accountability & empowerment Initiate System-wide capacity measurement Implement the IS Balanced Scorecard Strategic Governance Organization Financial/HR Systems Network Strategy 09/02/2008

47. Agenda EMHS-Who we are CIO Challenge 2005 CIO Challenge 2006 EMHS IS Governance Process EMHS IS Governance Implementation 2008: EMHS IS Governance Results EMHS IS Scorecard Metrics EMHS IS Governance Lessons Learned

48. EMHS IS Balanced Scorecard Strategy Map EMHS is the best rural healthcare system in America by 2012 EMHS Efficiency Due to IS EMHS Effectiveness Due to IS EMHS Reduced EMHS operating unit costs Lower unit costs of IS services Increased EMHS net revenues Impact on EMHS becoming the best rural healthcare system Improve EMHS business performance Improve Affiliate business performance Improve patient safety, outcomes, and satisfaction Customers Manage the IS Project Portfolio Nurture Affiliate Partnerships Manage IS Services Support EMHS in Becoming the Best Rural Healthcare System Choose the right projects Manage to agreed service levels Understand the Affiliate’s Business Understand EHMS’ Business Provide the right resources Provide architecture management Improve Affiliate effectiveness and efficiency IS Processes Provide information services to share knowledge, support standardized evidence-based care, and facilitate patient safety and interdependencies among Affiliates and patients Oversee project performance against plan Provide infrastructure services Mediate Affiliate and IS Priorities Realize project benefits Provide service management (ITIL) Provide IS staff competencies and organizational capabilities Learning and Growth Maintain the IS technology base Lead and manage IS

49. IS Metrics EMHS IS is establishing an IS Scorecard with specific metrics will report to the IS Governance Committee

50. Project Performance Against Plan: Discuss and Approve the Measures