Using Process and Architecture Improvement to Achieve Health Transformation

1. Using Process and Architecture Improvement to Achieve Health Transformation Erik Pupo and Geeta Nayyar Vangent

2. Introduction to Webinar • What are we going to cover today? • What is an architecture? • How does an architecture tie in to process improvement? • What are the various levels of transformation required by healthcare in the next decade? • What is the role of architecture and process improvement in achieve healthcare transformation outcomes?

3. Webinar summary • This webinar will explore the use of business process improvement methods, including process modeling and analysis and enterprise architecture techniques, to improve healthcare. The use of health information technology promises to produce many positives, but the use of enterprise architecture will ensure that technology is used to improve healthcare outcomes and in a way that correlates to current healthcare processes.

4. What is architecture? • So what exactly is an architecture? • There are many different types of architecture to consider within an organization • Enterprise, systems, data, solution • So what is the right one? • The one that works for your organization’s strategy and requirements: • You must have an architecture to support process improvement • That view may include a lot of different architectures • This organizational view can take a wide variety of forms • Architecture is not just models! • Would you drive to a destination without a map? Is a map just a picture? • Architecture should include data that is useful to the user • In the end, an architecture exists to ANSWER QUESTIONS

5. What is Process Improvement? • And what exactly is process improvement? • Process improvement is a series of actions taken by a process owner to identify, analyze and improve existing processes within an organization to meet new goals and objectives. These actions often follow a specific methodology or strategy to create successful results • The only way to improve a process is to know the process

6. Why Architecture? • The primary driver of architecture is its your plan for transformation and change • That’s why there are many types of architecture – there are many different forms of change to plan for • Enterprise to system to data to privacy • The major struggle that many in healthcare have though is: • How do I construct that plan? • How do I build an architecture? • Is it worth the investment of time and money?

7. The importance of architecture and process improvement • Many areas of healthcare are in need of transformation • There are different types of transformation needed • Meaningful Use • Healthcare Reform regulations • Payment and Administrative • CPOE and e-Prescribing • There are significant concerns about how to achieve this transformation • Will implementing an EHR inhibit current processes? • Will new administrative transaction rules not work with existing data?

8. The role of architecture with health IT • The role of health IT has been mandated by HITECH and meaningful use • But how can IT be deployed into a diverse healthcare environment with many stakeholders without causing issues? • In order to drive change, you need to have a complete picture of what it is you are changing and what effect that change will have • You need an architecture, and it needs to evolve as your organization evolves • The architecture evolves as the organization evolves • It needs to change and evolve with the transformation, and you need to have a roadmap that supports this transformation

9. So what goes into your “architecture”? • Its not just a model • A common view of architecture is it’s a bunch of diagrams • Architecture is about information – the most valuable commodity to any organization • Gap Analysis – what issues do we currently have now and how do we plan to correct them? • Target Architecture – this is how we look now and this is how we want to look in the future • Data Architecture – what data sources do I have and how does someone access them? • Privacy Architecture – what systems presents privacy risks and how can I mitigate them? • What can you draw from to determine architecture requirements? • ISO 18308 EHR ArchitectureRequirements

10. Architecture – aligning process to technology • One of the major failings of many healthcare organizations is the inability to attach process improvement to technology • Lets buy an EHR system • Lets buy more storage capacity • Organizations can’t “solve the puzzle” • That’s one of the major benefits of any enterprise architecture • Tying your technology to your strategy and your processes • A line of sight from technology to strategy allows decisions to be made

11. Comparing architecture to shoes • What does a woman do when they buy shoes? • She asks questions! • What would I wear these shoes for? • How much do they cost? • Will these shoes work with my wardrobe? • Do I have room in my closet for these shoes? • That’s an enterprise architecture – the same kind of questions to consider • What is this new clinical system going to do? • What processes will this system support? • Is this system a privacy risk? • How much does this system cost compared to other systems?

12. Architecture isn’t everything • It has to be kept in alignment with the strategy of your healthcare organization • It has to be regularly updated • Bad data in, bad data out • It has to be presented in a way that makes sense to the average person • The modeling paradox - You cant just draw pictures, it has to connect with the user • It cant solve existing problems • It only presents a picture, it does not mandate what you do with that picture nor make the picture “prettier”.

13. Common enterprise architecture development problems • Not tying it to the organizational strategy or processes • Focusing on details in areas that are not important • Failing to represent it properly in a way people can understand • Keeping it up to date • Here is an example - Medicaid

14. What does an architecture “look like”? • Example – caBIG NCI Architecture and HITSP Conceptual Design Architecture • It can be complex like these types of architectures

15. Hopefully an architecture won’t look like this

16. Or it may be more simplified like this • Examples – HHS enterprise architecture and CMS CARE System Architecture

17. So is there a need for architecture in healthcare? • Virtually all healthcare organizations view IT as a key enabler for innovation, collaboration, and process improvement. Most healthcare providers also have a variety of incompatible, isolated systems in place. • Many of these applications do a good job of supporting dedicated processes like radiology, lab tests, and medication schedules, but it’s expensive and time-consuming to compose new applications that can support innovative processes – especially when they span system or organizational boundaries.

18. Common Healthcare Pain Points • Cumbersome interfaces • The links between clinical, patient management, and administrative systems are not well documented or known, and require constant maintenance • Redundant data • Medical and patient-related data may be stored in multiple places • Lack of visibility • Clinical staff may not have access to unified patient and treatment data, and IT staff may not know where that data is • Inflexible IT resources • Tightly coupled IT assets make it difficult and costly to respond to changes in the healthcare organization’s business climate

19. Common myths about EHRs • Broken HIM processes are resolved in an EHR automatically • Implementing an EHR will often shine a surprising spotlight on operational areas that need work. • A new EHR will fix everything • Technology works as an accelerator of momentum, not as a creator • A Plan will solve everything • It is often helpful to plan a basic “direction” and fill in the details later when you understand the product better. • You can buy one EHR in your lifetime • You should start planning for a replacement EHR system before you implement your first one

20. So how might architecture work in healthcare? • Lets use a typical inpatient scenario • The typical processes involved with an inpatient stay: • Admission • Diagnosis • Procedure Scheduling • Treatment • Medication • Discharge • Invoicing

21. How does the inpatient scenario linkage work? • Linkage may include phone, fax, computer systems, and handwritten notes • But who really has a handle on this scenario or its processes? • And what would happen if any of these current processes was changed? • Example – interfaces between processes may be “hard-coded” with dependencies, making changes to them problematic

22. Other examples where an enterprise architecture can help • A healthcare organization can develop a patient’s complete medical history by drilling down into several incompatible systems managed by diverse providers • Groups of hospitals, whether allied informally or as part of a network, can use strategic sourcing techniques to jointly manage demand planning and fulfillment for drugs, supplies, and equipment • Create a risk management framework to help determine whether a new system is needed and what the risks of that system are

23. Why architecture is so valuable in healthcare • Nearly 700 billion in waste annually in the healthcare system • Nearly 40% of that can be derived directly or indirectly from architectural issues • Administrative System Inefficiencies • Provider Inefficiency and Errors • Lack of Care Coordination • Unwarranted Use • Preventable Conditions and Avoidable Care • Fraud and Abuse

24. What are the primary benefits of an enterprise architecture in healthcare? • Leverage IT assets to achieve business goals • You can use the architecture to reengineer processes in support of strategic and tactical objectives – reuse versus buy • Create a more flexible healthcare enterprise • A more flexible IT environment can respond better to healthcare challenges • Improve privacy and security • Allows an organization to focus on privacy and security threats • Manage and minimize risk • Allows for the identification of business and technical risks • Leverage opportunities for collaboration • Allows for the connection of healthcare partners with visibility into you and your partner’s processes– the true goal of interoperability

25. Conclusions • Architecture is paramount to managing the changes that are forthcoming in healthcare • Most healthcare organizations are not prepared to manage this change and will invariably experience process or technology “trauma” • Just getting started in building an enterprise architecture is not enough – it has to be done right • Even a high-level enterprise architecture can help – detail is important but not critical in all cases