1. Managing the Tidal Wave of Demand for IT: The Keys to Successful IT Governance Dr. John Lee, Jamie Nelson, Guy Scalzi 1 May 2014

2. Guy Scalzi Principal Aspen Advisors 2

3. Definition of Governance 3 Putting structure around how organizations align IT strategy with business strategy, ensuring they stay on track to achieve their strategies and goals, and implementing good ways to measure IT’s performance. ~ K. D. Schwartz, CIO.com 5/22/07

4. Why Governance is Important Confers legitimacy on decisions Standardizes processes Shapes expectations Ensures benefits are achieved Aligns strategy Provides input to capital budget process Streamlines IT demand management 4

5. Keys to Success Communicate Meet regularly Don’t allow gaming Keep it simple and transparent Ensure executive involvement 5

6. Jamie Nelson VP and CIO Hospital for Special Surgery 6

7. Quick Facts About ISCore Initiatives 30,000 orthopedic surgeries/year 35 OR’s; 11 MRI’s; 200 beds 100 orthopedic surgeons 3 time Magnet designation 22 consecutive quarters 99th percentile Press Ganey Likelihood to Recommend question US News & World Report 2012-2013 America’s Best Hospitals issue ranked HSS: – #1 in Orthopedics – #3 in Rheumatology 30,000 orthopedic surgeries/year 35 OR’s; 11 MRI’s; 200 beds 100 orthopedic surgeons 3 time Magnet designation 22 consecutive quarters 99th percentile Press Ganey Likelihood to Recommend question US News & World Report 2012-2013 America’s Best Hospitals issue ranked HSS: – #1 in Orthopedics – #3 in Rheumatology 18 month Epic EHR and Revenue Cycle implementation underway – Epic Led – Epic Remote Hosting Network core replacement 18 month Epic EHR and Revenue Cycle implementation underway – Epic Led – Epic Remote Hosting Network core replacement 150 staff, many with clinical or business backgrounds “Invest in IT as Enabler” part of strategic plan 150 staff, many with clinical or business backgrounds “Invest in IT as Enabler” part of strategic plan 7

8. Governance Structure Former State 8

9. Linking HSS Vision to IT Strategic Direction Culture + Values Patient 1 Support and align a world-class medical staff 3 Advance through research and innovation 4 Serve as the most trusted educator 5 Enable growth and extend the brand 2 Maximize quality and efficiency: Operational excellence 7 6 Elevate employee engagement Invest in information technology Vision Mission

10. Operationalizing the IT Strategy 10 IT Governance Group Members  Lisa Goldstein, Chair  Lou Shapiro, Stacey Malakoff, Catherine Krna, Stephanie Goldberg, Jamie Nelson, Steven Magid, MD, Laura Robbins, Vincent Grassia, Marc Gould, Robin Merle and Karen Cohen Goals  Align IT expenditure with HSS strategic goals  Increase organizational commitment to IT programs  Insure adequate resourcing for IT projects  Prioritize the demand for IT resources  Align expectations across the business and IT  Provide transparency on progress and outcomes  Increase benefits realized from IT programs Surgical Advisory Board Security/ Standards Innovation Supply Chain Periop Executive IT Governance Group Advisory Groups IT Dept/ PMs Finance Inpatient Ops, DR and DC AMB Rev Cycle External Facing Systems Steering Committee Corporate Systems Steering Committee Technology Steering Committee Clinical Systems Steering Committee Research Systems Steering Committee Education Systems Steering Committee Vincent Grassia Laura Robbins Marc Gould Jamie Nelson Stephen Magid, MD Stephanie Goldberg Opeartionalizing the IT strategy and tactical plan starts with effective IT governance.

11. IT Project Request Process Timeline 11 JanFebMarAprMayJuneJulyAugSeptOctNovDec IT Project Request Refinement Ends IT Portfolio Annual Rebalancing Begins Next Year IT Portfolio Approved Corporate Budgeting Process Begins Corporate & IT Strategy Refresh Starts IT Portfolio Annual Rebalancing Ends IT Project Request Refinement Begins Corporate & IT Strategy Refresh Ends Corporate Budgeting Process Ends IT Governance committee meets 6x a year. Also meets for two rebalancing efforts 1x in March and 1x in October. Steering Committees meet 6-12x a year. Also meet for two rebalancing efforts – 1x in March and 1x in October IT Project Request Intake for Refinement Process Ends for following year. Communication to Business that IT Project Requests need to be in by May for next year.

12. Use Case Scenario Annual capital budget process IT no longer in the business of prioritizing – accountability at the Steering Committee Level CIO goal (tied to incentive comp) – no project receives capital funding unless it has gone through Steering Committee Prioritization Process Steering Committees, staffed by business unit owners, negotiate priorities amongst themselves considering: – Strategic alignment – Employee and patient impact – Organizational impact – Financial impact – Risk factors – Alignment with single vendor strategy 12

13. Keys to Success Projects requiring only operational dollars still need to go through the IT governance process Transparency is important – end users are looking for process and communication Don’t let perfect get in the way of the good, (e.g., forget about weighting ) – we used: Broken or bleeding Strategic importance – can’t wait Strategic importance – can wait Can be deferred Figure out whether Executive IT Governance Group wants to be part of final decision-making process or just approver 13

14. John Lee, MD CMIO Edward Elmhurst Healthcare 14

15. Quick Facts About ISCore Initiatives Formed July 1, 2013 676 beds, 3 hospitals Edward, Elmhurst Memorial, Linden Oaks More than 50 locations Service area of 1.9 million residents in western suburbs of Chicago 7,600+ employees 1,680 medical staff 1,700 volunteers Formed July 1, 2013 676 beds, 3 hospitals Edward, Elmhurst Memorial, Linden Oaks More than 50 locations Service area of 1.9 million residents in western suburbs of Chicago 7,600+ employees 1,680 medical staff 1,700 volunteers Implementation of CPOE and improvement of patient safety. Edward Epic Ambulatory (~120 physicians) July 2012 Epic in Edward and Linden Oaks Hospitals April 2013 Share Epic with DuPage Medical Group, independent multi-specialty group of ~ 400 physicians Elmhurst Next Gen in physician practices (~100 physicians) >10 years Meditech in hospital >10 years Edward Epic Ambulatory (~120 physicians) July 2012 Epic in Edward and Linden Oaks Hospitals April 2013 Share Epic with DuPage Medical Group, independent multi-specialty group of ~ 400 physicians Elmhurst Next Gen in physician practices (~100 physicians) >10 years Meditech in hospital >10 years 15

16. Use Case Scenario Decision support Alert fatigue 16

17. Decision Support for a Driver

18. Use Case Scenario Clinical complexity Technical complexity Solution: break the blood (MD)-brain (IT) barrier Agility Governance challenges 18

19. Keys to Success Highly dependent on individual Don’t accept out-of-the-box Clinical focus with IT tools Plan to scale 19

20. Questions? 20 Jamie Nelson Jamie Nelson VP and CIO Hospital for Special Surgery nelsonj@hss.edu (212) 606-1654 John Lee, MD John Lee, MD CMIO Edward Elmhurst Healthcare jlee@edward.org (630) 527-5144 Guy Scalzi Guy Scalzi Principal Aspen Advisors gscalzi@aspenadvisors.net (646) 369-9310