Sameer Badlani, MD, FACP Chief Medical Information Officer Assistant Professor, Section of Hospital Medicine The University of Chicago Medicine and Biological Sciences iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.

1. Case Study: Building an
Effective Governance Model
Sameer Badlani, MD, FACP
Chief Medical Information Officer
June 11th , 2014

2. About the University of Chicago Medicine
Established in 1927
Located on the Southside of Chicago in Hyde park
Approximately 600 beds
9500 employees
700 + physicians
900 + residents and fellows
1500 + nurses
Epic Implementation
2009 - CPOE - 2009
2011 - Inpatient, Stork, Transplant, Beacon, OpTime - 2011
2012 - Ambulatory, AIMS - 2012
2014 – MyChart, CareLink, CareEverywhere, Bar Coding &
Epic 2014 Upgrade
2

3. Objectives
• Define Governance
• Why do we need it
• Creating and Implementing
• Assessing effectiveness
• Iterative improvement
• Future work
3

4. Define Governance
IT governance (ITG) is defined as the processes that
ensure the effective and efficient use of IT in enabling
an organization to achieve its goals. (Source: Gartner)
4

5. Define Governance
IT governance (ITG) is defined as the processes that
ensure the effective and efficient use of IT in enabling
an organization to achieve its goals. (Source: Gartner)
5

6. Define Governance
IT governance (ITG) is defined as the processes that
ensure the effective and efficient use of IT in enabling
an organization to achieve its goals. (Source: Gartner)
More:-
- Transparent
- Timely
- Seamless
- Equitable
- Measurable
- Iterative
6

7. Why do we need it
• Health IT Spending to Top $34 Billion in 2014
(Healthcare Informatics Aug 2013)
• % of total IT Budget/ Total Hospital Expense Overall in 2011
was 4.87% up from 2.77 % in 2010
( HIMSS 2012 Annual Report)
• Organizations' IT spending expected to keep growing
( Modern Healthcare Feb 2014)
7

8. Why do we need it
• Volume to Value Based Contracts
• ACA/ ACO
• PQRS
• MU Stage 2
• Managed Medicaid
8

9. Why do we need it
• ROI
• Clinical Efficiency
• Analytics
• Big Data
• Are you using what you have already?
• Survival
9

10. Creating and Implementing
• Iterative model refined every year for the last four years
• Broken into 40 hour plus and below 40 hour projects
• Approved by the IS steering, Clinical Chairs Committee,
Practice Plan Board
• Socialized extensively and exhaustively before final
implementation
10

11. UCM IS Governance: Portfolio Committees
11
COLT
(Epic Program )
Portfolio
Hospital
Operations
Portfolio
Administrative
Operations
Portfolio
Enterprise
Informatics
and Analytics
Portfolio
Infrastructure
Portfolio
Information
Exchange
Portfolio
UCM IS Governance |
Executive IS
Steering Committee
Ambulatory
Portfolio
Group
Inpatient
Portfolio
Group
Practice
Management
EHR/EpicCare
Ambulatory
OB/GYN
(Stork)
Oncology
(Beacon)
Transplant
(Phoenix)
Perioperative
Tools
Medication
Tools
EHR/EpicCare
Inpatient
HIM
Tools
EHR Advisory
Group

12. • Co-Chairs – VP, Amb Care Serv, CMIO
• Members:
• Executive VP, Practice & Bus Dev
• 2 MD Practice Directors TBD
• Director, Ambulatory Access
• Director, Ambulatory Operations
• CMIO
• ACMO, Quality
• ACMO, Clinical Effectiveness
• VP – Pt Safety/Risk/Compliance
• Ambulatory Practice Administrators
• Director, IS Epic Program
• Asst Director, IS Epic Ambulatory
12Clinical & Operational Leadership Team
Ambulatory Portfolio Membership 1/17/2012

13. • Co-Chairs – CMIO, CNO
• Members:
• ACMO, Quality
• ACMO, Clinical Effectiveness
• VP, Pt Safety/Risk/Compliance
• 2 Medical Practice Directors
• VP, Pharmacy
• VP, Procedural Services
• Anesthesia Physician Sponsor
13Clinical & Operational Leadership Team
Inpatient Portfolio Membership 1/17/2012

14. UCM IS Portfolio Management: High Level Process for 40 hour plus requests
14UCM IS Governance |
Project
Request
submitted to
VP or above
for
authorization
to progress to
Portfolio
Comm
Portfolio
Comm
reviews
and
prioritizes
or denies
request
Portfolio
Comm
representati
ves
communicat
e outcome
to requestor
IS reviews
prioritized
projects for
resourcing
and proj
execution
timeline
Prioritized
projects
executed
Portfolio
Comm
monitors
realization
of business
value

15. 15UCM IS Governance |
Scoring Model for Prioritization
Category Impact Score Description Weight
Patient Safety
4 - Severe Impact Immediate high risk patient safety issue with no workflow fix and/or Critical event - liability claim
8
3 - High Impact Immediate high risk patient safety issue with available workflow fix and/or Documented near miss
2 - Medium Impact Risk/Suspected safety issue
1 - Low Impact Potential low risk patient safety issue with available workaround
0 - No Impact No Impact
Compliance
4 - Severe Impact Clear CMS or Joint Commission mandate with no exceptions (within 30 days impact)
6
3 - High Impact UCMC Policy Standard or CMS/JC mandate with 60 day plus date of impact
2 - Medium Impact UCMC Standard of Care
1 - Low Impact UCMC "nice to have"
0 - No Impact No Impact
Strategic Goal
4 - Severe Impact Organizational AOP goal or CEO Inititiave
5
3 - High Impact VPs, CNO, CMO, CMIO, aCMO, CIO, CCO initiative
2 - Medium Impact Director/Department Quality Chief level initiative
1 - Low Impact Single department goal and/or less than 25 users
0 - No Impact No Impact
Efficiency/Productivity
4 - Severe Impact >250 users and/or daily issue
4
3 - High Impact >100 users and/or weekly issue
2 - Medium Impact >10 users and/or monthly issue
0 - No Impact No Impact
Revenue Impact
4 - Severe Impact More than $1M
4
3 - High Impact Between $500k and $1M
2 - Medium Impact Between $100k and $500k
1 - Low Impact Less than $100k
0 - No Impact No Impact
Scholarly Impact
3 - High Impact Enterprise wide research/education project or initiative
4
2 - Medium Impact Research/Education project for multiple departments, facilities and/or areas of care
1 - Low Impact Single department Research/Education project
0 - No Impact No Impact

16. • Review projects before meeting with stakeholder for clarity and operational readiness
• Validate score and remind committee it is to lend some objectivity to a subjective process
• Focus on not only approval and prioritization but resolution of issues for ongoing work
• Communicate bandwidth issues well in advance
• Create top ten list not in an order of importance
• High-threshold to stop a project inflight
• Communicate, communicate and hold accountable
Best Practices
16

17. Under 40 Hours
• Requests collected through various intake mechanisms
including but not limited to
• Help desk complaints
• Sub portfolio groups
• Emails to CMIO
• Offshoots from unrelated discussions
• Every clinical section has designated SMEs
• Refreshed every year
• Monitored for response time and collaborative spirit
• Counted towards service to institution in the promotion criteria
• Can delegate but have to be final sign off
• Operational units have designated director level point of contacts
17

18. Under 40 Hours
• Racked and stacked per Director of Epic applications
• Resource allocation closely monitored and balanced with demands for
over 40 hour bucket
• CMIO and medical directors for informatics act as liaisons to mitigate
escalation and resolution
• Criteria
• Do you still need it?
• How are you functioning now?
• How will this impact your process
• How will you measure roi?
18

19. Assessing effectiveness
• Monitor turn around time
• Check in with institutional leaders, influencers ( including constipators)
• End user feedback around transparency, turnaround time
• Gut sense
• Close the loop on operational readiness and ROI
19

20. • 316 Clarity Report Requests & Updates
• 1,812 Scheduled Classroom Hours
• Application Changes, Updates and Support:
• 3,797 Service Desk Tickets Resolved
• 2,098 Application Change Controls
• More than 150 projects delivered (> 40 hours)
Epic Application Support FY13 Summary
20Epic Optimization Status Summary |
33%
55%
12%
Ambulatory
Inpatient
Other
2%
21%
76%
1% 0%
MEANINGFUL USE
NHP
OPERATIONAL
PHOENIX
RESEARCH
0 200 400 600 800
Other
Nurses
Providers

21. Assessing effectiveness
• Be able to tie in every project to annual operating and strategic goals
• Do we have a line of sight for projects requested by me and my direct
reports
• Assess resource utilization between
• RUN
• GROW
• TRANSFORM
21

22. Iterative improvement
22

23. Future work
• Online dashboard
• Outreach and communication
• Translate paradigm to Clinical and Business Intelligence Initiatives
• Involve more front line users in process and decision making
• Share and Learn
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