Mobile Application

Transformative Health System

(THS)

Case Study

2

Table of Contents

I. THS Background and Environment ………………………………………………….Pages 3-6

Environment and Drivers

Strategic Goals/Objectives

EHR & Seamless Customer Encounter Model (Figure 1.0)

Oversight and Management

Implementation Planning and Guidance

Strategic IT Methodology – Object Oriented

II. THS Current State (2016-2019) and FY 2020 Projection ……………………Pages 7-16

Summary of THS Electronic Health Record – Current Status

1. Connectivity

2. Applications

3. Integration

4. Information Management and EHR

5. Strategic Performance Index (SPI) Goals FY 2016

6. Resources and Structure to Support the EHR Deployment

7. Budget Status Summary

Current State Assessment and Summary

FY 2020 Projection Summary

III. THS 3-5 Year Strategic Projection …………………………………………………….Pages 17-20

IT Enables Technology

5 Year Budget Projection

3-5 Year Imperative Assessment

Summary of IT Strategic Imperative and Projections

IV. Reference Information: Historical (1997-2014) Background ………………Pages 21-28

Major Accomplishments – Deliverables 1997- June 2014

1. Connectivity

2. Applications

3. Integration

4. Information Management

3

I. THS Background and Environment

Transformative Health System (THS) is a community health system in the Midwest United

States. Through the merger of two additional community hospitals in 1999 the THS Hospital

Division consists of three hospital campuses (THS North, THS South and THS Specialty) that

cover a geographic service area of approximately 120 miles. THS also includes 100 employed

physicians, 12 medical mall ambulatory locations, 5 urgent care centers and a number of joint

venture partnerships involving post-acute care, senior residences outpatient pharmacy

management and population health organizations.

THS Environment:

The THS business environment is indicative of changes happening all over the U. S. Inpatient

volume projections beginning in fourth-quarter 2018 through second-quarter 2019 are between

3% to 5% below budget projections. This reflects a shift from patients being admitted through

the inpatient services to observation status. The shift toward utilizing observation beds which

results in lower levels of reimbursement is a national trend. Also, THS has seen a 7% above

budget increase in ambulatory volumes in their medical mall locations and urgent care centers in

the surrounding communities.

THS Strategic Goals:

The THS organizational Strategic Roadmap includes a five-year Plan for the Health System,

approved by the Board of Directors in 2016 which includes: maintaining current market share in

the 120-mile radius served by THS, exploring the strategic partnerships to expand sources of

revenue and reduce clinical and administrative expenses for the health system and continue to

support service lines and community initiatives that serve the community-based health mission

of the organization.

THS Consumer Strategy Focus:

Because of the change in business in the THS has decided to focus on leveraging the IT

investment in order to improve consumer access and promote consumer retention. The

organization is also shifting its focus to provide seamless IT solutions to both internal

stakeholders such as clinical and nonclinical staff as well as external stakeholders such as

consumers and the surrounding communities. The business strategy supporting this approach has

to do with the organizational value of both consumers and their provider teams being satisfied

with their respective experiences at THS. Focusing on the shift in delivering care solutions to

consumers in their home environment and other non-ambulatory environments such as medical

miles, office spaces etc.,

THS is launching a new consumer brand called THS Care2U. This is a comprehensive

consumer stakeholder strategy that focuses on individual consumers in the community,

employers, broad community constituents as well as the internal stakeholders such as providers

and administrative staff. The THS Care2U brand strategy is based in the concept of optimizing

relationships of all the stakeholders to support the most optimal delivery of care solutions at the

most reasonable cost. Information technology and evidence-based information management are

at the heart of this Strategy.

4

IT Environment and Drivers:

The formulation of the original IT Strategic Plan was accomplished in February of 2000 as part

of the newly founded organization’s efforts to address its immediate and future information

challenges with a structured and consistent approach to the complex and ever-changing IT

market. The environment at the onset of the Strategic Plan challenged us with highly disparate

information infrastructures; we were unable to communicate electronically, duplicate high cost

applications were being maintained, automated sharing of common data between systems was

non-existent, and the ability to perform basic information management as a total system was

impossible. With the continued changes in healthcare the demand for sharing and integrating

clinical and financial information to facilitate strategic partnerships, meet healthcare reform

requirements, and simply to manage our patients cost effectively continues to make our IT

Strategy a critical imperative to our success. Security of Protected Health Information (PHI),

consumer focused initiatives, and positioning for population health management are now key

drivers for IT.

IT Strategic Goal/Objective:

The initial goal set forth in 2000 was to “provide a Clinically Driven Information System that is

accessible across the Integrated Delivery System (IDS)”. Utilizing the integration infrastructure

and original Clinical Data Warehouse we have developed over the last 10 years we are now

implementing a Consumer Relations Management (CRM) strategy that ties our customer facing

kiosks, customer mobile apps, and e-marketing to support improved access to care and better

customer experiences. We have also focused on providing our clinicians integrated views within

our core EMRs (acute – Allscripts Sunrise Clinical Manager and Physician Office – Allscripts

Touchworks) of all clinical data from both acute and ambulatory environments. The

implementation of dbMotion in FY 2019 will provide a normalized continuum of care database

for clinically based population management during encounters and enhanced notification for

allergies and medications by allowing ingestion of appropriate ambulatory data into an acute

encounter. Clinicians also have access to the ClinicalConnect HIE within their EMR; we are a

leading member of ClinicalConnect and have contributed over 2 million records to the HIE.

In support of the THS Care2U organizational brand a new consumer “Boarding Pass” solution

will be implemented in FY 2019 that will enhance customer check-in through tablets and kiosks

and allow for real-time tracking of patient orders, monitoring for leakage, and predictive

modeling of patient utilization of our outpatient services. Utilizing the integration infrastructure

and original Clinical Data Warehouse we have developed over the last 10 years we are now

implementing a Consumer Relations Management (CRM) strategy that ties our customer facing

kiosks (Boarding Pass), customer mobile apps, and e-marketing to support improved access to

care and better customer experiences. Feasibility studies for the patient consumer mobile

platform and internal provider mobile platforms are being conducted.

5

Figure 1.0 demonstrates how current IT investments such as the EHR are incorporated into the

integrated customer model.

The Information Technology (IT) Strategic Plan Update has (4) objectives:

1. a historical view of our execution of the plan
2. a clear understanding of the current state of the plan
3. a twelve-month plan projection (FY 2020 Update)
4. a 3-5-year projection outlining the key initiatives expected to be accomplished

Figure 1.0

THS

THS THS

THS

THS

Transformative

Health System

THS

Transformative Health System

– 5 –

Oversight and Management:

The Original IT Strategic Plan was presented to the Board in February 2000 and received the

Board’s full approval. Annual reviews of the plan (specific updates on deliverables to date,

required adjustments, budget status, and next phases of the project) have been provided to the

Board every 12-18 months by the Chief Information Officer. In order to maintain business and

clinical alignment of the IT plan, adjustments have been made each year as the senior

management team balances the strategic vision with the operational and financial realities of the

organization. The development of Strategic Imperatives has provided points of focus which have

been utilized to guide and assess the annual IT goals and related plan adjustments. A continuous

process of evaluating and adjusting our IT objectives to meet the organization’s strategic and

tactical needs is in place. The IT Strategic Plan is revisited every 12-18 months and updated to

reflect historical progress as well as new goals and objectives as conditions change. Goals related

to the design implementation and adoption of the clinical record (HER) are outlined.

The Board is updated through the weekly CEO Blog of significant IT initiatives, CIO

presentations, and on-line access to the IT Strategic Plan. The oversight of system selection and

purchasing is provided through a structured process utilizing three areas of expertise or focus –

Functional, , and Technical. The Functional team and leaders (specific service line

directors and CMO or VP) guide the selection of applications and solutions to assure they meet

operational requirements. The team and leaders (CFO, Purchasing Leadership, and

Director of ) provide oversight of the request for proposal (RFP) process, assure that the

vendors have long term viability, and negotiate final contracts and pricing. The Technical team

and leaders (CIO, CTO, and CISO) ensure that the products purchased support the long-term

strategy and can be integrated into the existing infrastructure.

Implementation Planning and Guidance: Based on the specific implementation requirements

(scope of project, change management issues, entities impacted), the members and structure of

implementation teams have varied but the basic structure outlined below has been, and continues

to be utilized to guide in the creation of an appropriate committee structure for communications

and guidance during the design and implementation phases of the IT Strategic Plan:

– 6 –

Strategic IT Methodology – Object Oriented- Component Based Architecture:

In order to accomplish our goal, we utilized an object-oriented approach that has provided

consistent structure while allowing for significant changes in technology over time. For

example, “connectivity” – the ability to communicate and provide access to information has and

will always exist; however, the specific technology and approach will change. Although the

market environment and technology changes over time, the same objects are consistently

relevant for long term strategic planning. The diagram below provides a graphic overview of the

four core information technology objects that provide a consistent framework in the ever-

changing IT environment. With the increase of on-line information and connectivity, security

has become a major point of focus and is addressed under each object:

Connectivity – ability to communicate and access systems (network cabling and

hardware required to connect application servers to workstations and other

devices). Wireless is the prevalent connectivity to end user devices as mobility

becomes a standard requirement to support all our customers’ needs

Applications – front-end systems that provide data capture and viewing for

specific functions based on entity (physician office, hospital, clinic) and functional

requirements (Registration, Practice Management, Laboratory, and Radiology

Systems)

Integration – automated sharing of information between systems and feeding of a

common data repository (interface development and database aggregation)

Information management – the ability to integrate data from a variety of

disparate systems into common databases and formulate information that is

actionable, and value added to the organization (EPSi Decision Support, Nuance

Clinical Quality Reporting, Allscripts Quality Reporting Tools, and Clinical Data

Warehouse). Allscripts CPM Quality Tools for acute and CQS – Quality Tools for

Physician Offices. During the 1st quarter FY 2016 we went live with dbMotion as

the next evolution towards creating a normalized community data set to support

Population Health across the continuum

– 7 –

II. Current State (2016-2019) and FY 2020 Projection

Summary of THS Information Infrastructure – Current Status: THS’s Strategic Plan
methodology has been to systematically address the critical components required to deliver our vision for

the EHR, Pervasive Connectivity, Mobility, On-line Consumer solutions, and Population Health.

Through our budget commitments and object-oriented approach, we have delivered:

1. Connectivity

Connectivity – Current State:

THS has a high-speed enterprise Wide Area Network (WAN) composed of four distinct

components:

Corporate Network Infrastructure – provides the day to day connectivity between our

physicians, staff, management, Board and patients to the critical information and systems. THS

corporate network is composed of a structured cabling plant based on IEEE Ethernet Standards

with fiber cabling provided to our distribution closets and category 5 or 6 cabling to the

workstations. The Ethernet based infrastructure implemented in 2005 was built with Cisco Corp.

equipment and provides a scalable network that can be expanded to meet the growth of

bandwidth (network traffic) that will be required to support the evolving EHR. It is the backbone

to our other connection strategies. Replacement of the hospital facilities main data switches is

scheduled for 1st quarter FY2018. With the implementation of an upgrade to the Dragon voice

recognition system bandwidth to the physician offices will require all T1 lines to be upgraded to

10mb or higher connections. An improved fault tolerant redesign of the main circuit entrance

into the THS North Hospital facility will be complete by 2nd quarter FY2018. A new firewall

was implemented 4th quarter FY2017 to provide enhanced security solutions.

Internet Access infrastructure The Internet infrastructure is utilized to provide a Guest

wireless connection for customers, access for physicians for their iPads, and to provide access

for the Board, as well as all levels of leadership and staff to key data housed at Transformative.

Enhancement of our internet capacity (20mb) and redundancy were completed in 2007 and 2008

to support the growing bandwidth requirements generated by the use of remote PACS, E-

prescribing, and other critical applications. An upgrade is scheduled for 2nd quarter FY 2016 to

increase bandwidth to 100mb and to reduce cost.

In-house wireless infrastructure and cellular broadband connectivity – A secure in- house

wireless network provides wireless support at all points of care within hospital facilities, all THS

physician offices, and our clinics. Use of the wireless infrastructure includes bedside

registration, iPad iCAP access, CPOE carts, and laptops. Upgrades to both Hospital Emergency

Departments were completed to support a voice grade wireless network. An upgrade to the THS

North facility was completed in 2016 and Transformative South is being assessed based on

demand for in-house wireless VoIP needs.

– 8 –

Cloud Strategy – Transformative has two data centers (one at each hospital facility). A strategy

to move into hosting and public cloud computing was initiated when Allscripts Sunrise products

were purchased in 2012. The majority of the Sunrise solution is hosted by Allscripts. An RFI

was developed and initiated 4th quarter FY 2018 to seek a vendor to move the majority or all

server infrastructures to a cloud platform over the next 36 months. Our strategy has been to

systematically shift to Software as a Service (SaaS) models when purchasing new software or

upgrading existing software. We will combine a public cloud model with a SaaS model to

reduce our data center needs to one data center and then to a “lights out” data center for software

that is not cost effective in a cloud model or technically capable of running in a cloud model.

Connectivity – FY 2020 Projection: The next phase of the corporate network
development will be focused on several key initiatives. We will complete the implementation of

the two main Cisco switches at the hospital facilities. We will complete an enhancement to the

internet connectivity at the hospitals. We will upgrade all T1 office connections to 10+mb

connections by the 3rd quarter FY2020. The new firewall features will be implemented

systematically over the 1st and 2nd quarter FY2020. Most importantly we will initiate our Cloud

Strategy with the completion of an RFI and RFP process and transition of low risk applications

to the Cloud. We anticipate that our e-mail (Microsoft Exchange) solution will be moved to a

Public Cloud solution along with other targeted applications. Security will be enhanced through

both training and new tools to reduce the risk of a breach.

2. Applications

Applications – Current State:

Core Acute Care Clinical – The Allscripts Sunrise Clinical Manager solution is stable and is

effectively being utilized:

• documentation in place and being refined

• CPOE compliance is 90-93%

• Bar Code Medication Administration is 93%

• Physician on-line Documentation exists in the Emergency Departments and the OB units
at both hospitals

• Meaningful Use Stage 2 Measures were being met – Attestation in October 2015

• Upgraded RL Solutions event monitoring 4th quarter FY2015

• Upgraded Nuance Dragon Voice Recognition

• Implemented Anesthesia Full EMR iPad based solution 3rd quarter FY2015

– 9 –

Ambulatory EMR

• 95% of all Transformative Medical Group physicians are utilizing the full EMR
(Allscripts Touchworks) with documentation (combination of forms and Dragon), orders,

and tasking

• 95% of all Transformative Medical Group offices are supporting Health Link patient
portal with on-line scheduling, secure messaging, and prescription renewal. We now
have 32,000 enrolled Health Link users.

• Transformative Pediatrics went live on the full EMR (Allscripts Touchworks) in July
2015.

Applications – FY2019 Projection:

Core Acute Care Clinical –

• Upgrade SCM to version 15.1 and implement dbMotion Fusion integration solution to
provide Touchworks ambulatory data to SCM seamlessly 1st quarter

• Upgrade Dragon voice recognition 1st – 2nd quarter

• Full rollout of physician documentation across both hospital facilities with a goal to have
50%-75% of documentation being done on-line utilizing Dragon voice recognition by the
end of the fiscal year

• Continued enhancement to clinical workflows

• Complete refresh of clinical workstations to Windows 7 devices 2nd and 3rd quarter

• Implementation of ROTEM Blood Analyzer 1st quarter

• Upgrade Kronos Time & Attendance solution to include integrated nursing self-
scheduling and absence management

Ambulatory EMR

• Provide Improved EMR Solution to outlier offices 2nd quarter

o Pediatrics Kasi & Kasi
o FPA Hopewell
o THS Shetty

• Continue to enhance Touchworks build and workflow

• Expand Consumer Connectivity – eHealth Functionality

• Support Access Management – Health Link Patient Portal

– 10 –

3. Integration

Integration – Current State:

Integration focuses on four key areas of the Electronic Health Record:
• The ability to share information between disparate systems – Interface Engine

• Aggregation of data from all points of care into a single cross continuum
view – Clinical Data Repository

• Creation of a single point of reference and identification for our patients
(Master Patient Index and Care Card)

• Integration to other entities through health information exchanges (HIE)

Interface Engine – A new Interface Engine (Core Point) was implemented in 2012. The

integration infrastructure has grown to 224 interfaces. More than 57 disparate systems are

integrated with 18+ million messages a month being transmitted and shared between systems or

stored in our Clinical Data Repository.

The Clinical Data Repository – Provides a single point of storage and retrieval for all

transactional patient clinical and administrative information. The depth of content stored in our

Clinical Data Repository continues to grow as we implement the full ambulatory EMR solution

as well as expand other ancillary solutions to capture more electronic data. The Clinical Data

Repository is our strategic single point of capture and reference for all patient data regardless of

the originating clinical system. In order to support Population Health initiatives, the dbMotion

normalized data repository solution is being implemented. The solution is targeted for the 2nd

quarter of FY2016 and will provide tighter integration between SCM and Touchworks as well as

clinical alerts to assist in managing major disease groups such as diabetes, congestive heart

failure, and asthma.

Master Patient Index (MPI) – A required component when combining patient data from all

points of care is the ability to identify the patient accurately. Our MPI solution was developed

in-house and provides the ability to link the disparate data for our patients. It will also play a

critical role as we move into further development of the HIE, allowing us to link patient

information beyond THS’s points of care. A new tool for managing MPI issues such as

duplicates and merging of patient records was deployed.

Health Information Exchange (HIE) – THS is one of the 9 founding members of the

ClinicalConnect HIE. Provider members include Jefferson, St Clair, Butler, Altoona, Excela,

Washington, Armstrong, and THS. THS played a key role in the creation of the HIE and

currently our CEO is the board chair. THS was the lead organization piloting integration and

access to ClinicalConnect and continues to lead both in governance leadership and execution of

sharing of clinical data with over 2 million records sent since June 2012.

– 11 –

Integration FY 2019 Projection:

Interface Engine/Tools– Data sharing:

Support for the implementation of the dbMotion normalized data repository, expansion of

ClinicalConnect HIE data feeds 4th quarter FY2016.

Clinical Data Repository – EHR Content: Integration of dbMotion and the Clinical Data

Repository will continue through FY2019. The Clinical Repository will be utilized to develop a

cloud-based Customer Relations Management solution (Boarding Pass) to support improved

patient access and communication, targeted marketing, improved check-in and registration

processes, integrated medical necessity and order authorization, and predictive modeling of

outpatient activity.

Master Patient Index (MPI) and Care Cards – Patient Identification: A new Boarding Pass

solution will be introduced in FY2019-20 which provides a QR code printed on every outpatient

order produced by THS physicians, allowing customers to scan the QR code at any outpatient

location providing automated registration. The QR code will connect the patient to the most

recent and accurate patient identification data and all details of their orders. It is expected that

the new solution will eventually replace much of the Care Card activity as an enhanced patient

experience at check-in.

Health Information Exchange (HIE) Expansion of document feeds into ClinicalConnect is

being reviewed and targeted for 3rd or 4th quarter FY2016. Focus is now on expanding the use of

ClinicalConnect by all clinicians.

4. Information Management and EHR

Information Management and EHR – Current State:

Today THS possesses the following portals or Dashboards to facilitate Information Management
at all levels of the organization:

Board and Foundation Dashboards – All Board members have been provided iPads and the

Board and Foundation Dashboards have been ported to the iPad. Distribution of the Board paper

packet has been discontinued.

Management Dashboard – The Management Dashboard has been modified to run on both an

iPad and a traditional web environment. Senior management has been provided iPads and a roll

out plan for middle management is in development. Allscripts Epsi provides comprehensive

service line analysis and budgeting tools.

Employee Connection Portal – The Employee Portal provides employees the ability to access

all critical information on-line. Feedback opportunities and other tools are provided to

employees through the portal.

– 12 –

Clinical Access Portal (CAP) The iPad based iCAP solution is now the primary tool used by

physicians to access the complete patient record. The Continuum of Care Tab in both SCM and

Touchworks provides the same content view integrated directly into these Allscripts EMR

products. Over 600 iPads have been distributed to date. Clinicians currently do not have access

to smart phone solutions.

Patient Portal (Allscripts PHR- FollowMyHealth) – The Allscripts FollowMyHealth patient

portal branded as Health Link is now our Customer Portal solution

• Added 18,000+ New Customers FY2018

• Total Customer 32,000+

• Averaging 6000+ logins month

• Now able to provide:
– Results/Documents/Meds/Allergies
– Prescription Renewal
– Secure Messaging
– On-line Scheduling

• Requested functionality from Patient Portal Focus Groups
– Online bill pay
– Care online for routine illness
– Monitoring online like blood pressures and glucose for diabetics

Clinical Quality Dashboards – Allscripts CPM acute setting and Team Practice CQS for

physician offices provide individual provider, group, and enterprise views of our compliance to

quality measures.

Information Management and EHR – FY2020 Projection:

Execution of the next phase of Information Management will focus on several enhancements to

key infrastructure components of our Strategic IT Vision for developing a seamless service

experience for our patients/customers and physicians:

• Continued growth of Health Link enrollment and use

• Improved On-line Lab Results viewing

• Feasibility, Design and Deployment of Mobile Solutions for External and Internal

Stakeholders

o Align with THS Care2U organizational brand

o Mobile access for external and internal stakeholders (patients, families, providers)
o Customer Feedback – “5 Star Rating” tool that allows customer to provide real time

feedback regarding any of our service areas.

o Trending and Average Scores by Service Area in real time

– 13 –

• Implementation of “Boarding Pass”
o QR Code Printed on all (Allscripts Touchworks) Orders with associated back-end

database table(s) storing all the latest order, demographic, insurance information
o Ambulatory site check-in/out Kiosks and Waiting Room Tablets

o Medical Necessity Checking and Authorization automated – prior to visit
o QR Code scanned at every outpatient encounter will streamline registration –

enhancing the experience for 50% of patients

o Dashboard will provide real time tracking of orders/patient’s activity
▪ Did they arrive at a THS outpatient site – when/where
▪ Outstanding orders – patients that did not yet visit THS outpatient site; Trending and

predictive modeling of patient activity based on real time data allowing leakage

notification, focused patient follow-ups (patients that have not arrived within defined

timeframes for tests/procedures.

• The dbMotion normalized clinical data will be ready to be utilized by Population Health
solutions. Claims based solutions are not being considered until appropriate partnerships
are developed for claims-based Population Health initiatives.

5. Strategic Performance Index (SPI) GOALS FY2016:

Patient Portal – Health Link Goal ……………………………………………. 10,000 new enrollments
Clinician Use of Clinical Connect HIE Goal …