Trinity Health Advancing Clinical Quality and Patient Safety with Health IT Paul Conlon, PharmD, JD

Trinity Health Fourth Largest Catholic Health System in the U.S. 45 Hospitals (33 Owned and 12 Managed) Across the Nation 8,074 Active Staff Physicians 45,000 Full-Time Equivalent Employees Revenue of $7.0 Billion $400 Million in Community Benefit Ministry

Trinity Health Mission Core Values Vision Guiding Behaviors We serve together in Trinity Health in the spirit of the Gospel, to heal body, mind and spirit, to improve the health of our communities and to steward the resources entrusted to us. Respect Social Justice Compassion Care of the Poor and Underserved Excellence Inspired by our Catholic faith tradition, Trinity Health will be distinguished by an unrelenting focus on clinical and service outcomes as we seek to create excellence in the care experience. Trinity Health will become the most trusted health partner for life. We support each other in serving our patients and communities We communicate openly, honestly, respectfully and directly We are fully present We are all accountable We trust and assume goodness in intentions We are continuous learners Mission Core Values Vision Guiding Behaviors Copyright 2007 Trinity Health – Novi, Michigan

Trinity Health’s clinical and operations transformation initiative Best-in-class clinical and administrative processes that are enabled by information systems on a common platform Large-scale people, process, and technology advancement: Enhanced Care/Clinical Experience Implemented Electronic Medical Record (EMR) Computerized Physician Order Entry (CPOE) Unified Revenue management Clinically-driven Supply Chain management Improved productivity Copyright 2007 Trinity Health – Novi, Michigan

Decisive and Focused System-Wide IT Investment Trinity Health is using Genesis to standardize operational processes and information systems. The vision to unite state-of-the-art information management systems in three areas: clinical, revenue and supply chain, was launched in 2000 Goal is to transform care delivery, increase patient safety and improve financial performance Strategic investment in excess of $400 million capital over 10 years Unified people, process, culture, and technology Leveraged skill and scale to achieve efficiencies Standardized evidenced based processes to improve quality of care, patient safety and financial performance Provided critical transparency to data and processes Reduced variability in processes and costs Trinity Health’s bold vision and skillful execution of Genesis: Copyright 2007 Trinity Health – Novi, Michigan

Trinity Health: Circa 2001… Eastern Division Western Division Operating Units Silver Spring, MD Columbus, OH Port Huron, MI Mt. Clemens, Pontiac, MI Livonia, MI Ann Arbor, Battle Creek, Grand Rapids, MI Muskegon, South Bend, IN Clinton, IA Dubuque, IA Mason City, Sioux City, Boise, ID Fresno, CA Patient Administration Registration Patient Accounting Medical Records DRG Grouper 3M Quadramed QuadraMed APC/APG Grouper HSS Enterprise Resource Planning (ERP) General Ledger People Soft Global Payroll/Human Resources GEAC Ceridian A/P Materials Management Cost Accounting Self Developed (Analysis & DSS) TSI Mainframe TSI AS400 Self Developed Contract SARMC McKesson HBOC Clinical Systems Physician Order Eclipsys Order Entry HBOC STAR SMS MedSeries 4 HBOC Plus 2000 Series SMS MedSeries4 Results Reporting In-house/3M CWS Cerner In-House ADEs Clinical Documentation HBOC Care Manager TDS LifeServ Petronics Laboratory Pathnet Sunquest Classic HBOC ALG Millenium United Labs STAR Pharmacy Hospital MsMeds Mediware WORX Surgery RES-Q Healthcare Omni-server Patient Scheduling HBOC Pathways Radiology IDX ADAC MARS II ADAC MARS II Per-Se' Consort Transcription Softmed Dolbey Medrite Dictaphone SMS Med Series4 Medline Systems MedSeries 4 ORSOS Health-Quest This represents the wide variation in hardware and software our hospital systems had deployed nine years ago. We had an aging infrastructure, with diverse tools leading to wide diversity in processes, and therefore, wide variation in performance and clinical outcomes. Needed to address this variation – and address increasing external expectations (regulatory and otherwise) related to quality and financial performance. Copyright 2007 Trinity Health – Novi, Michigan

Trinity Health IT Unification 2012… Consistent Tools + Best Practice Processes = Operational Excellence Copyright 2007 Trinity Health – Novi, Michigan

Genesis Clinical Timeline 23 of 41 facilities are now live 3 ministries in readiness Ann Arbor Muskegon-Hackley Boise Genesis Standard Delivery Model (GSDM) in process Muskegon-Hackley will come live with current Muskegon footprint with additional functionality to facilitate barcode medication administration and PowerPlans. Chelsea will implement the Ann Arbor Genesis footprint Fresno & Columbus will implement GSDM Cadillac & Grayling TBD 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Clinton Go-Live Macomb Go-Live Chelsea Go-Live Dubuque Go-Live South Bend Mishawaka Plymouth Ann Arbor Go-Live Muskegon Go-Live Cadillac & Grayling Go-Live Columbus Go-Live Genesis Board Approval Battle Creek Go-Live Sioux City Go-Live Oakland Go-Live Port Huron Go-Live Mason City Networks Hackley Go-Live Grand Rapids Go-Live Mason City Go-Live Livonia Go-Live Silver Spring Go-Live Fresno Go-Live Boise Go-Live Copyright 2007 Trinity Health – Novi, Michigan

Project Genesis Single design deployed across 23 hospitals since May 2003. Identified deficiencies prioritized for correction and enhancements deployed across full system. 3 more hospitals in October 2009. Standardized readiness assessment Standardized deployment Standardization of care delivery Design heavily influenced by front-line care givers Constant enhancement/refinement Heavy focus on implementing evidenced based practices Full deployment of order entry, results reporting, rules, alerts and advisories. Over 75% CPOE rate Copyright 2007 Trinity Health – Novi, Michigan

Accomplishments to Date on the Clinical Platform Over 7 million patients within the EMR making it the 3rd largest repository in the nation. Data is contained in a single location including clinical, financial, and administrative information across all facilities. 2 facilities have clinics managing inpatient & outpatient care in the same system In 23 of the 41 hospitals scheduled for full implementation… They are live on Computerized Prescriber Order Entry (CPOE) with physician entry rates average 74% and as high as 84% of all orders 100%% of the previous paper medical record is now electronic More than 1,200 caregivers will use the system simultaneously during peak hours with over 300,000 chart openings per day. Inpatient nursing care, pharmacy, and medication administration is documented directly by providers in the same electronic system. Lab and Radiology data also feeds from regional and hospital based systems. Over 600,000 orders are placed, processed, and completed per day electronically from order to administration in the same system. Over 700 physicians place orders each day. Copyright 2007 Trinity Health – Novi, Michigan

Current Performance and Recognition Severity adjusted mortality rate at 71% of expected HCAHPS “Would Recommend” score at the 76th percentile 100% of core measure performance is greater than the national average 47% of hospital level core measures above the national top 10% Trinity Health is one of the Thomson Reuters 100 Top Hospitals®: Health System Quality/Efficiency Benchmarks award winners 5 of our hospitals are recognized as Thomson Reuters 100 Top Hospitals Trinity Health is the recipient of the 2004 National Health Care Quality Award Copyright 2007 Trinity Health – Novi, Michigan

Genesis: Process Impact Genesis has required fundamental changes to core patient care processes. Clinicians access records and place orders at any place and time Nurses spend 8% more time at bedside rather than with paper records Emergent medications administered 40% faster Comparative effectiveness eliminates clinical variation with 172 adopted standard order sets and over 2,500 standard drugs in our formulary Computer-generated alerts prompt physicians to change medication orders, avoiding approximately 14,000 potential Adverse Drug Events per year Automatic system alert on diabetes medication (Avandia) within 10 days of FDA warning Clinical Process Re-design has resulted in benefits in Pressure Ulcers (45% reduction) and Patient Falls (31% reduction) and improvements in DVT and Pain management. Copyright 2007 Trinity Health – Novi, Michigan

Key Implementations/Process Changes in FY09 Admit, transfer, and discharge Medication Reconciliation System-wide formulary Integrated electronic surgical record pilot Urinary catheter rules/alerts Universal protocol revision Change patient satisfaction vendor Phased in implementation of credentialing and privileging soft ware Standardized concentrations of key IV solutions Expansion of nurse witness functionality (double checks) Standardized heparin administration and availability OB program reviews Implementation of Genesis at large teaching hospital and 8 rural access hospitals. Surgical ‘tiger team’s’ Review of case management programs Copyright 2007 Trinity Health – Novi, Michigan

Patient Medication List from ED

Patient Medication List from ED New Rx’s Home Meds Copyright 2007 Trinity Health – Novi, Michigan

Patient Medication List from ED Meds received in ED Meds to hold Copyright 2007 Trinity Health – Novi, Michigan

Drivers A Unified Enterprise Ministry approach Relentless pursuit of improvement Extensive readiness preparation Frontline staff involvement Transparency Reliance on evidenced based care Collaboration across disciplines Strong technical and clinical expertise Many, many, many groups…. Copyright 2007 Trinity Health – Novi, Michigan