1. Effective IT Implementation in Health Care Patient Safety and National Resource Center Annual Conference June 2005 Donald Crandall, MD, FACS

2. 2 Trinity Health – Our Communities Sixth largest tax-exempt health system in the United States Operating revenues of $5.3 billion 44,000 FTEs 7,582 physicians – 95% private practice community hospital based 45 hospitals (29 owned and 16 managed)

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4. 4 Project Genesis Is... Trinity Health’s leading-edge initiative to transform the way we deliver care and improve patient safety Our vision to unite state-of-the-art computer information systems with best-practice business processes across Trinity in three areas: Clinical Revenue Cycle Supply Chain

5. 5 Project Genesis Will Transform the Delivery of Health Care... Improve Quality of Care and Safety Improve Clinical and Operational Processes -Redesign more than 300 clinical and business processes Touch Almost Every Employee and Physician in Trinity Health

6. 6 Primary Clinical and Business Applications (as of 2001) Tool Diversity  Process Diversity  Variable Performance

7. 7 Primary Clinical and Business Applications (2008) Best Practices + Consistent Tools = Operational Excellence Eastern DivisionWestern Division Operating Units Silver Spring, MD Columbus, OH Port Huron, MI Mt. Clemens, MIPontiac, MILivonia, MI Ann Arbor, MI Battle Creek, MI Grand Rapids, MI Muskgeon, MI South Bend, INClinton, IA Dubuque, IA Mason City, IA Sioux City, IABoise, ID Fresno, CA Revenue Management Registration Patient Accounting HealthQuest Medical Records Cerner Profile ERP General Ledger Payroll/Human Resources A/P Materials Management PeopleSoft and Lawson Clinical Systems Clinician Order Management Results Reporting ADEs Clinical Documentation Cerner Laboratory Pharmacy Surgery Management Radiology Integration Tools DSS EMPI xCare.net (E-merge) / TIBCO / Internal Development Web Foundation TIBCO Shaded =denotes core systems STAR                           = Completed  = To be Completed within 6 months  = Active Implementations  McKesson                     

8. 8 Scope: Computer Systems CLINICAL ( Cerner/Millenium ) Power Chart - Orders and results Clin Doc - Clinical documentation PharmNet - Pharmacy FirstNet: Emergency Dept. RadNet: Radiology Dept. SurgiNet: Operating Room Inet: ICU Profile - HIM application EMPI CPOE Electronic Record - Clinical functions by pt. type - Current clinical documentation forms

9. 9 Investment Capital $180 million capital investment in clinical and revenue cycle systems $30 million capital investment in supply chain systems Operations Process redesign Training Go-live and post-go-live support Increased depreciation

10. 10 Transformation: 1 Part Technology + 2 Parts Culture & Work Process Transformation:

11. 11 Getting there: Implementation Readiness Implementation Readiness Process Requires 20-24 Months People –Culture and implementation strategy –Manage organizational change and resistance to change –Training & competency testing –Communication Process –More than 300 discrete processes affected by implementation –Process maps (current – future = gap) Technology –Infrastructure –Wireless network and device deployment –Redundancy –Response time

12. 12 Example: Readiness Process Timeline (Months prior to Go-Live) Preliminary Design (-20) Detailed Design (-15) Core Build (-10) Core System Test (-7) Integration Test (-3)) Activation (-0-) Project Definition (-22 months prior to G0- Live) Systems Readiness [one iteration per system] Hospital System Readiness (one iteration per site) QA Design Confirmation (-13) Operational Testing & Training (OTT) Operational Impact Analysis (OIA) Operational Build (OB) Current State Analysis (CSA) QA Baseline Materials Development Building / Sustaining Alignment Operational Testing and Training Site Specific System Build

13. 13 Readiness Structure Office of Project Management Project Genesis Steering Team Clinical Executive Oversight Group Revenue Enhancement Oversight Group Supply Chain Oversight Group Clinical Rules Oversight Group Benefits Management Office Knowledge Management Steering Committee Clinical Information Oversight Group Physician Advisory Group Facilitated Decision Making Process

14. 14 Trinity Health Major IS Projects as of May 2005 FY05 FY06FY07 South Bend J/A/S 2007 Fresno O/N/D 2007 Columbus J/F/M 2008 FY08 Oakland J/A/S 2006 Ann Arbor O/N/D 2006 Clinton J/F/M 2007 Silver Spring A/M/J 2007 Completed In Process Not Started Port Huron May 2003 Muskegon July 2004 Grand Rapids October 2004 Battle Creek February 2005 Macomb April 2005 Mason City July 2005 Dubuque J/F/M 2006 Livonia J/F/M 2006 Boise A/M/J 2006 Sioux City September 2005

15. 15 Project Genesis – Planned Metrics Metrics (measured before go-live and then after go-live) Implementations beginning in July 2004 will be tracked these categories: Clinical Safety Financial Patient and Employee Satisfaction Operational/Productivity

16. 16 Clinical CPOE % orders placed online CPOE % of physicians using system Improvements in clinical indicators e.g.: Beta Blockers; ACE inhibitors; Aspirin for AMI, LVF assessment, pneumococcal vaccination, misidentification rate Medication time to first dose for STAT orders Procedure/order turn-around time (pharmacy, lab, radiology orders) Duplicate orders Incomplete charts Examples of Actual and Planned Metrics

17. 17 Safety Medication errors and ADEs resulting in intervention Rate of identification of errors Finance Reduction in bad debt Reduction in operational write-offs Percentage of clean claims Satisfaction Nursing satisfaction and retention Patient satisfaction Operations Staffing and productivity levels Physician and nursing time studies Additional Planned Metrics

18. 18 ADE Benefits Statistically Significant Reductions in… Severity adjusted mortality (7.4 percent) Severity adjusted length of stay (2.4 percent) Pharmacy department and variable drug cost reductions ($18 million) 25,000 physician drug orders changed

19. 19 Physician COPE Results

20. 20 Project Genesis: Clinical Results Major Learning: Realizing clinical benefits of transformational change is a function of time –Stage 0: Mobilize or prepare for implementation –Stage 1: Digitize or install the enabling information technology –Stage 2: Stabilize not only the technology but also the myriad clinical processes that have been redesigned –Stage 3: Analyze the impact of the transformational change on organizational metrics –Stage 4: Realize clinical benefits (quality, safety, satisfaction, productivity, financial) at MO level –Stage 5: Optimize clinical benefits by leveraging MO learnings across the system

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