1. Institute for Healthcare Technology Transformation
UMass Memorial Health Care:
CIO and CMIO Partnerships
Michael Bakerman, MD, FACC, FACPE, MMM
Chief Medical Informatics Officer
Richard Mohnk, MSA, MT(ASCP)
Associate Chief Information Officer
iHT2
January 2012

2. Disclosures
We have no disclosures
We have no conflicts of interest
Describe the UMass Memorial System
Define our Cornerstone Strategy
Illustrate CIO and CMIO differences and opportunities for
collaboration
Case Presentations and discussion
2
iHT2 January 2012

3. UMass Memorial Health Care
7 Hospital System
Clinical Partner to
UMass Medical School
13,500 employees
3,000 registered nurses
Approximately 1,600
physicians
1,111 beds
$1.4b in Annual Revenue
~60,000 inpatient visits
~1,000,000 outpatient visits
3
iHT2 January 2012

4. UMass Memorial Healthcare Information Technology
Cornerstone Initiatives
Fundamental Goal: Move from a
predominantly paper environment
to one that is predominantly
electronic
– Core Ambulatory EMR
– Inpatient EMR/CPOE
– Inter & Intra Enterprise Identification
– Inter & Intra Enterprise ‘Interoperability’
– Connected Healthcare Community
Improve Availability and Flow of
Information
Improve Quality and Safety
Increase Efficiency and
Effectiveness
4
iHT2 January 2012

5. The Future State
Private Medical HealthAlliance
Practice Hospital Clinton
Hospital
Wing Memorial
Hospital
Hahnemann
Memorial Marlborough
Hospital
University
Community
Medical Group
Medical Group
Inpatient EMR Private Medical
Practice
Outpatient Enterprise EHR Private Medical
Practice / Affiliate
Ambulatory EHRs Hospitals
Data Integration Application
5
iHT2 January 2012 5

6. CORNERSTONE TIMELINE (rev 12/2011)
Jan/Feb/Mar Apr/May/Jun Jul/Aug/Sept Oct/Nov/Dec Jan/Feb/Mar Apr/May/Jun Jul/Aug/Sep Oct/Nov/Dec Jan/Feb/Mar Apr/May/Jun
2011 2011 2011 2011 2012 2012 2012 2012 2013 2013
Soarian Financials scheduled Live 1/15/12 MAK Roll Out scheduled Live 3/12
Soarian Upgrade
Soarian Clinicals scheduled Live 1/15/12 CPOE Roll Out scheduled Live 5/12 HealthAlliance
Soarian WING scheduled Live Summer/Fall
2012
Hyland OnBase LIVE at the Med Ctr, Picis (ORIS) scheduled Live post Soarian
Marlboro, Clinton and Wing
Enterprise MPI LIVE with IDX Enterprise MPI scheduled Live with
Registration and Scheduling 8/11 Med Ctr Soarian Reg 3//12
dbMotion (Phase 1) LIVE 5/11 HealthAlliance dbMotion/Soarian
Smart Button Live
Salar LIVE Hospitalist Programs at Med Center / Clinton / /Marlboro - continued roll-out to additional hospital departments
Allscripts Enterprise LIVE - continued roll-out of new CMG practices, additional functionality (Orders, Tasking, Dictation) to the hospital clinics and physician offices
Allscripts 11.2 Upgrade 90 day
reporting
COMPLETED period to meet
2011 Stage 1
Meaningful Use
Picis PulseCheck – ED
6
iHT2 January 2012 TBD

7. Prior Philosophy of Physician Behavior
Is this the best way to motivate highly skilled and
intelligent people?
7
iHT2 January 2012 7

8. But Why Would You Want To?
8
iHT2 January 2012 8

9. Hierarchical Management and Influence
Medical
Staff CIOs and CMIOs share
accountability for IS
projects
Their direct and indirect
CMIO spheres of influence
requires a delicate
CIO
balance between
voluntary participation
and direct managerial
supervision
IT Staff
Used with permission Jack Shlegel Consulting
9
iHT2 January 2012

10. CIO and CMIO Interactions
CMIO role is evolving
– Developed from traditional medical staff roles (CMO)
– Initially part time, but now fulltime
AMDIS 2011 Survey
– 64% are currently in first CMIO role, down from 81% in 2010
– 71% want to stay in CMIO role, 7% want to become CIO, 7% would
like to be CEO or COO and 4% would like to become CMO
– Wide range in compensation
• Largest areas range from $250,000 to $300,000 and $345,000 to $375,000
– 81% work at Integrated Health Systems, 9% work in stand alone
hospitals. Most have enterprise wide responsibilities
– Reporting structure
• 47% report to CIO
• 29% report to CMO
• 5% dually to CIO and CMO
• 19% report to CEO or COO
10
iHT2 January 2012

11. CMIO and CIO Can be True Partners
Extend each others influence
– Cover each others blind spots
– Let’s each do what they do best
– Teach each other
Understand the different perspectives
– Budget
– Personnel
– Project management versus clinical decisions
• Scope, resources and schedule
• Need for advocacy and accountability
Drive adoption of technology
– The journey is about adoption of technology and not simply implementation
– Understand the clinical workflow
– Know the strengths and weakness of the applications
– Work together to satisfy the end user (clinician, nurse, registration, etc)
11
iHT2 January 2012

12. Stylistic Differences Between CIO and CMIO
Physician I.S.
Time to process issues Rapid Requirement gathering
Authority Captain of the ship Diffuse
Need for closure Immediate Longer term
(gratification)
Ability to deal with ambiguity Low Medium to high
Precision of data Intermediate (learned to High
live with incomplete
data)
Clinical thinking skills High Low
Project management skills Low High
Primary To Patient To Organization
commitment/responsibility
12
iHT2 January 2012

13. Life is what happens between the time you plan
and execute your plan
• The roadmap is about adoption of new technology, not
implementation
• What we are discussing are clinical applications and not
IT projects
• Process change without personal growth and education is
not sustainable
• Physicians must be leaders, but must accept responsibility
and accountability
13
iHT2 January 2012

14. IS Can Also Drive the Management and Analysis of
Data
Planning: Opportunity assessment and metric definition
Establish Metrics Set future-state goals
and Value Goals
Model economic impact
Implementation: Incorporate Benefits Realization into committee
Strategy,
Resources &
structure
Implementation Develop implementation plans
Focus resources on improvement goals
Measurement:
Baseline and Post- Establish baseline measures pre-live
live Measures Conduct post-live measurement at specified intervals
Interpret results and continuously improve
performance
14
iHT2 January 2012

15. Case Discussion
Roll out of Follow Me Desk Top
Device Deployment Selection and plan
Development of Sign out process
Web launch point
15
iHT2 January 2012

16. Roll out of Follow Me Desk Top (FMD) and Single Sign On
(SSO)
Together, the CMIO and CIO develop the project principles
– Build the case and vision
• Speed, efficiency, less clicks
• Stable environment
CIO is key to listening first and then building
– Build a proof of concept to garner feedback
– Don’t just ask what is desired
– Listen to the need
– Partner and participate with the CMIO in physician meetings
CMIO is key to articulate the value to clinicians
– Ease of access
– Clinical use cases
– Test and provide constructive feedback
– Listen and brain storm approach with CIO
16
iHT2 January 2012

17. Web launch point for Single Sign On (SSO)
It was apparent to CIO that we could develop a communication
device as well:
– Create method to communicate
– Build ease of access
– Enhance redundancy and system reliability
17
iHT2 January 2012

18. Demonstrate
Follow Me Desktop
18
iHT2 January 2012

19. Device Deployment Considerations
Perfect storm
– overlapping technology devices that can be useful,
– Variety of operational, clinical, nursing and engineering teams
involved
– Capital Planning, regulatory and environmental concerns needed to
be considered
Required to support clinical process,
– However, regulations and permit requests could be a roadblock
Each group, in isolation, had their primary concerns and needs
Required teams to live in current workflow, but think in a future
state
No matter what we choose, the technology and equipment will
continue to change
19
iHT2 January 2012

20. Device Deployment Guiding Principles:
Place a device in a patient room or exam room
– Required to support the clinical and administrative process of
patient intake and assessment
– Should provide FTF opportunity for nursing to interview and talk
with patient
Workstations on wheels (WOW) and/or fixed devices
– Recommendations made by each clinical area during walkthrough
– Reviewed by IS and Capital Planning
– Approved by CMIO
– Signed off by Capital Planning
– Approved by ACNOs and IS.
Caveats
– Phase 1 focused on nursing and back office
– Favor mobile workstations over fixed
– Storage and hallway traffic are important system constraints
– Built into assumption was no new construction
20
iHT2 January 2012 20

21. Device Deployment Guiding Principles
Devices cannot be deployed (stored) in hallways except
when installed in Wall-a-roos..
– Added to hallway congestion
– Safety and regulatory issue
Power will be addressed on a case by case basis
– Need to access room when patients are not there
– Optimize install process
– Certain facilities need to be prioritized for Capital Planning
Included assessment and implementation of any peripheral
devices to support EMR
– Printers, embossers, etc.
21
iHT2 January 2012 21

22. No WOWs initially
recommended. Added 6
after review. Will need to
determine storage policy
22
iHT2 January 2012 22

23. Recommendation Based on Nursing Device
Fairs and Analysis
Work Station on Wheels (WOW)
– Clear consensus choice
– Assist with emerging and yet-unknown needs
– Alternative non-powered or laptop configurations
– Supply line economies of scale
– Local vendor support
23
iHT2 January 2012 23

24. Development of Sign Out process
The new EMR application did not support current workflow
– A round peg in a square hole, just will not work!
– Residents and Attending were frustrated and resisting
CMIO
– Agreed with physicians with the need to develop something different
and develop guiding principles
– Used a separate, but integrated application to satisfy the clinicians
needs
– Created the environment were IS team could work with clinicians
CIO
– Supported with resources, technology and experience
– Overcame internal resistance to change project plan
– Participated in development of solution and provided feedback
Win Win for all
24
iHT2 January 2012

25. Creating Sign Out (Work) Lists
The process:
Log in
Search for patient
Add the patient to a team
Click on the Sign out button
Edit the sign out fields for each individual
patient on the team
25
iHT2 January 2012

26. Sign Out (Work) List
Area for
Text
26
iHT2 January 2012

27. We Can Speak a Common Language
Underlying consistency in our relationship
We will focus on the adoption of technology to provide
information to providers
We will collaborate with providers in developing workflow
automation and improvement, based on evidence based
medical information
We will assist in providing performance measurements to
improve care, improve efficiency and reduce harm
Our goal is to provide seamless applications that improve
efficiency and provider satisfaction
27
27
iHT2 January 2012

28. Overcoming Challenges
Pulling together
– Allow the system to act as a system
Physician leadership and engagement
– Senior leadership fully engaged
– Super users identified and supported
Work in today’s world, but think in the future world
– Communicate the vision of the ideal future state and work
towards that goal
– Avoid recreating broken and fragmented solution
Existing processes and procedures will need to be
revisited and adjusted
– Be flexible, open-minded and creative
You will be connecting parts of your system that have
never before been connected – ‘connected healthcare’
is just that – all inclusive for technology and people
– Communication, communication, communication
– Understanding of different environments of care
– One size does not fit all
28
iHT2 January 2012

29. Q & A / Thank You