Title Measuring the Costs and Benefits of Health Care Information Technology: Six Case Studies Prepared for CALIFORNIA HEALTHCARE FOUNDATION ALIFORNIA EALTH ARE OUNDATION by by James Fisher, Charles Shell, and David Troiano PricewaterhouseCoopers September 2004 Date About the Authors PricewaterhouseCoopers provides industry-focused assurance, tax, and advisory services for public and private clients primarily in four areas: corporate accountability, risk management, structuring and mergers and acquisitions, and performance and process improvement. More information is available at www.pwc.com. About the Foundation The California HealthCare Foundation, based in Oakland, is an independent philanthropy committed to improving California’s health care delivery and financing systems. Formed in 1996, our goal is to ensure that all Californians have access to affordable, quality health care. For more information about CHCF, visit us online at www.chcf.org. This paper was produced under the direction of CHCF’s Health Information Technology area. Visit www.chcf.org/programs for more information about CHCF and its programs. ISBN 1-932064-79-6 ©2004 California HealthCare Foundation Contents 4 Background 6 Case Studies Partners HealthCare Northwestern Memorial Hospital St. Joseph Health System Sharp HealthCare Sarasota Memorial Health Care System Central Valley Health Network Introduction THE PRESSURE NEVER STOPS FOR HEALTH CARE executives. Grappling with limited budgets, strict regulations, and intensive oversight, they must be able to demonstrate the expected business value of every decision. This includes the value of any proposed investments in information technology (IT). Simply asserting that IT “keeps the business running” is no longer enough; executives must clearly state IT’s contribution both to the bottom-line and clinical outcomes. Health care IT executives understand the difficulty of delivering accurate, relevant numbers to support a pure business case for IT investment. Standard IT performance measurements assess the efficiency of specific functions such as data center and network management, help desk, and application support services, but they fail to capture some of the real value of IT in a health care environment. Health care executives need to evaluate and measure IT investments from a perspective that goes beyond financial performance to look at all the ways IT affects health care. To help provide that perspective, the California HealthCare Foundation (CHCF) commissioned PricewaterhouseCoopers (PwC) to interview health care executives across the spectrum of the industry. PwC conducted more than 20 interviews, including six case study site visits to:  Partners HealthCare (Boston, Mass.)  Northwestern Memorial Hospital (Chicago, Ill.)  St. Joseph Health System (Orange, Calif.)  Sharp HealthCare (San Diego, Calif.)  Sarasota Memorial Health Care System (Sarasota, Fla.)  Central Valley Health Network (Sacramento, Calif.) These interviews yielded valuable insights into the IT decision process and how to make it a key part of an integrated financial and patient safety improvement strategy. Readers may find the resulting summaries useful in discussions of how to plan for IT investments and gain the most value from IT capital budgets. Background No one doubts that the health care environment will continue to become more complex. The Institute of Medicine’s reports 4 | CALIFORNIA HEALTHCARE FOUNDATION on medical errors, employer groups such and financial benefits from clinical information Leapfrog, “pay for performance” schemes, and systems, mainly computerized physician order increasing consumerism are external factors entry (CPOE). However, IT investments produce that are increasing the pressure to improve significant “soft dollar” and intangible benefits. IT capabilities as one way to enhance the Health care executives acknowledge this but have performance of health care providers. Couple not had a well-defined methodology to account these external factors with the internal dynamics for these benefits. of physicians building competing outpatient The lessons learned in the case studies that facilities, capital access issues, aging facilities, follow suggest that there are critical success rising medical equipment costs, and clinician factors to effective IT value measurement shortages, and the pressure on executives to use and management. The six organizations that technology effectively are apparent. participated in the studies were asked to identify Faced with these internal and external forces, these factors as they applied to their individual health care executives are changing what they sites, along with the philosophy they use in expect their IT investments and personnel to do. gauging the value of their IT investments. IT is becoming a key driver of effective business Although each example presents a slightly and clinical enterprises, playing an integral role different set of lessons, common themes include: in health care organizations’ efforts to enhance  The need to focus on outcomes and patients’ lives, comply with regulations, and performance, not just implementation operate profitably. Health care organizations milestones. that use IT to help meet these goals can create  The importance of physician acceptance, or competitive advantages in keeping patients, “buy-in.” blocking new market players, and satisfying stakeholders.  The value of involving all interested parties within the organization, rather than just those For most health care organizations today, IT connected with IT. value measurement and management begins and ends during the project approval cycle. Most health care organizations have conducted, for large projects at least, a traditional return- on-investment (ROI) study that projects cash flow along the IT value life cycle. However, ROI studies are typically used only to achieve project approval. After the project is launched, few organizations use the studies to guide implementation or to benchmark post- implementation results against the forecasted business and clinical benefit. Given that the purpose of traditional ROI studies is project approval, they focus only on “hard dollar” revenue enhancement and cost savings. Furthermore, many health care providers and health care information system vendors have published studies identifying tangible efficiency Measuring the Costs and Benefits of Health Care Information Technology: Six Case Studies | 5 Case Studies Partners considers when reviewing IT projects are: contribution to brand equity, potential Partners HealthCare improvement in patient safety and outcomes, Organization profile. Partners HealthCare and improved flexibility in IT or process (Partners) was founded in 1994 by Brigham and infrastructure. To assist in understanding and Women’s Hospital and Massachusetts General making capital allocation decisions, Partners Hospital. Today, Partners also includes primary informally stratifies IT projects into the following care and specialty physicians, community categories: 1) infrastructure, 2) mandated hospitals, specialty facilities, community health (e.g., regulatory), 3) economic gain, 4) service, centers, and other health-related entities, 5) new business, and 6) transformational. including Brigham and Women’s/Faulkner This categorization process accounts for the Hospital, McLean Hospital, Newton-Wellesley need to invest in infrastructure, flexibility Hospital, North Shore Medical Center, Partners improvement, experimentation (e.g., physician- Community HealthCare, Partners Rehabilitations patient communication), standardization, and Continuing Care Services, Dana-Farber/ and other types of IT projects where value is Partners Cancer Care, and the Harvard Clinical instinctive but difficult to quantify. In essence, Research Institute. As a non-profit organization, Partners considers factors beyond the traditional Partners is focused on developing an integrated ROI analysis, including strategic alignment, health care delivery system that offers patients a conversion effectiveness, and risks. continuum of coordinated high-quality care. A crucial IT question Partners considers is Clinical systems environment. Partners uses a whether to build or buy. Given its IT capabilities, best-of-breed clinical application suite, including Partners considers the following build-vs.-buy a well-known custom-developed clinical patient questions when evaluating an IT project: record and CPOE application. Individual entities  Can Partners be more effective than the are responsible for implementation of solutions, market (quicker or cheaper)? and their application portfolios are somewhat  Does the project provide a strategic different; however, Partners is moving toward a advantage? standardized set of core applications.  Is there uncertainty in the end-state process Defining value. Determining the value to domain and solution (e.g., ambulatory be realized from an IT solution necessitates a electronic medical record)? multifaceted value proposition and requires  Does the organization have “unique” wrestling with numerous intangible and requirements? interdependent aspects. Partners’ IT value Another basic tenet of Partners’ IT philosophy philosophy acknowledges that return cannot is the way in which it deploys applications and always be distilled into a typical financial technologies. In Partners’ view, the typical mantra ROI, although Partners does require rigorous of speed-to-value is only valid when the end- financial and process performance analysis for state process domain is stable and, therefore, the significant and certain types of IT investments. technology solution is fairly certain. Thus, many Although Partners does not try to quantify value of Partners’ strategic and significant IT projects attributable to intangible benefits, its executive are considerably longer than many would team believes intangible value is real, achievable, estimate. For example, the Partners electronic and worthy of investment. medical record (EMR) project has taken five and A few examples of intangible value that one-half years to deploy to 2,500 users and is 6 | CALIFORNIA HEALTHCARE FOUNDATION expected to take another four and one-half years  IT value is very real and significant. to deploy to 3,500 more users. Equating this to  IT value is very diverse, and much of the a typical community hospital might imply a one- value is intangible. year pilot and four-year rollout.  Value has to be managed; it does not just Critical success factors. Partners identified happen. the following factors as vital to the success  Be wary of large-scale IT projects where of managing and achieving value from IT there is questionable accountability and investments: the scope is unclear.  Establish an IT governance framework  Where possible, support the value anticipating difficult decisions regarding proposition with quantifiable periodic reprioritization of IT investments measurements during the business case and the IT project portfolio. and approval process, implementation  Do not try to quantify every IT process, and post-implementation investment into a financial return. validation process.  Build project management and  Be conscious of organizational change organization change capabilities across the factors that have to be managed through entire organization (not just within IT). an iterative learning process.  Do not treat IT investments differently  Factor in the risk of a “speed-to-value” than other organization investments. approach.  Define what success will be and how it  Recognize, that for large-scale projects will be measured. such as CPOE, you will never stop  Understand the fundamental reasons for implementing and the implementation making IT investments: infrastructure team will never disband. requirements, mandated (regulatory),  Provide abundant education and economic gain, service, new business, and transition support, especially to physicians transformational. and clinicians.  Functional champions, not IT leadership, Northwestern Memorial Hospital must fight for and defend IT investments. Organization profile. Northwestern Memorial  Deploy incremental change, controlling Hospital (NMH) is one of the nation’s pre- the pace to enable organizational learning. eminent academic medical centers and has  If there is a question about value, employ numerous centers of excellence. Its reputation an incremental approach and retain the is founded on a long tradition of leadership ability to “pull the plug.” in patient care, education, research, and  Obtaining physician buy-in and improving the quality of health care services in involvement is a must and is the key is to Chicago. NMH is affiliated with Northwestern make it easier/better for them to practice HealthCare Corporation, Northwestern medicine. Memorial Home Health Care, Northwestern Lessons learned. Throughout Partners’ long and Memorial Physicians Group and Northwestern well-known IT history, the company has gleaned Memorial Foundation. valuable information others can benefit from, Clinical systems environment. NMH views including: information systems, in particular advanced Measuring the Costs and Benefits of Health Care Information Technology: Six Case Studies | 7 clinical systems, as an essential enabling initiatives are linked to the organization’s mission technology to achieve its corporate strategic and strategy, to develop implementation plans, goals of the “Best Patient Experience” and “Best to resolve business and project issues, and to People.” NMH is in the process of implementing monitor project progress effectively. As a result, several advanced clinical information system NMH has developed four committees focused applications. Currently, online clinical on achieving the four strategic goals of the documentation at the point of care is performed organization. throughout the organization, and new systems Critical success factors. NMH identified have been implemented for surgery, anatomic the following factors as critical to the success pathology, and physician practice EMRs. Much of managing and achieving value from IT of the foundational work to date is a precursor investments: to achieving evidence-based clinical decision support and effective medication administration The executive leadership team must: processes.  Have a clear understanding of the Defining value. NMH has dedicated a difficulty involved in large-scale clinical significant amount of thought to IT cost-benefit projects and the related requirement for management, focusing on achieving the highest perseverance. level of value from IT investments. The hospital  Establish an IT governance framework has developed an approach that uses a process/ anticipating difficult decisions regarding value decomposition framework. First, NMH periodic reprioritization of IT investments has embedded IT vision and accountability and the IT project portfolio. into the organization, enabling IT to become a  Consistently apply a disciplined planning core competency of the senior leadership team process by appropriately chartering IT through a sponsorship model of execution projects. This includes identification of (described below). NMH does not produce a project sponsors, strategic alignment, separate technology strategic plan but rather problem definition and solution, identifies IT solutions necessary to achieve stated scope, deliverables, required resources, business strategies and objectives. This prevents desired outcomes, and key performance a differentiation between the success of IT and measurements. the corporate strategy and provides a direct link  Define the project time line focused on between strategic initiatives and IT planning. achieving desired outcomes and important Subsequently, IT initiatives are “owned” and performance measurements, not system driven by functional owners (sponsors), with implementation milestones. emphasis placed on appropriately chartering  Focus on managing organization change projects, including identification of expected and risk mitigation. outcomes and performance measures. Once the project has been appropriately chartered, NMH St. Joseph Health System manages the project to the planned outcomes, Organization profile. St. Joseph Health holding project sponsors and IT project leaders System, a ministry of The Sisters of St. Joseph accountable for reporting the results through of Orange, is a not-for-profit Catholic health regular monitoring of the performance measures. care system established in 1982. St. Joseph’s NMH has instituted senior level strategic vision is to be recognized as a leader in providing implementation committees to ensure that major regional integrated health care, promoting health 8 | CALIFORNIA HEALTHCARE FOUNDATION improvement, and creating healthy communities. recruiting and retention. In addition, advanced Serving communities in Northern and Southern clinical systems will provide visibility into California, West Texas, and East New Mexico, St. individual physician practice patterns, enabling Joseph consists of 15 hospitals, three home health intervention and education with fact-based, agencies, and multiple physician groups. All quantitative performance measurements. A key to hospital and home health entities are accredited realizing value from St. Joseph’s IT investments by the Joint Commission on Accreditation is understanding and improving IT capabilities. of Healthcare Organizations, and ten of their To measure, manage, and continuously improve entities received scores of 90 or higher, many IT capabilities, St. Joseph uses a monthly survey/ with commendation. St. Joseph employs about report card consisting of five primary IT delivery 19,000 full-time equivalents and has 3,559 categories, including service and financial value. licensed beds. This process allows St. Joseph to identify entity and enterprise performance as well as provide Clinical systems environment. Employing a guidance and corrective action. Using this best-of-breed approach, St. Joseph Health System report card approach has encouraged functional uses Meditech Healthcare Information System ownership of IT initiatives. (HIS) and CPOE systems while partnering and integrating with other vendors for ancillary St. Joseph uses a mature governance model systems. St. Joseph uses systemwide order sets that consists of structured health system and and alerts but allows some customization at the entity-level teams that guide and adjust IT entity level. priorities and spending. At the health system level, the IT Strategic Investment Council is Defining value. St. Joseph focuses on value responsible for determining IT strategy, exploring on investment, rather than the more traditional new IT investments, and integrating business ROI, and stresses that numerous quantitative and and technology planning. Each entity has an qualitative measurements need to be considered Information Services Planning Council that is beyond the standard financial considerations. responsible for local, tactical IT planning. A critical factor in St. Joseph’s approach is that care redesign is one of three primary strategic Critical success factors. St. Joseph identified initiatives across the health system; in other the following factors as critical to the success words, this technology-enabled business/clinical of managing and achieving value from IT initiative is very visible and well supported at the investments: executive level. This visibility and commitment  Identify, understand, and perform relevant is supported by accountability for benefits current state performance measurements. achievement through financial incentives for  Focus on improving patient care as health system and local entity executives. St. opposed to financial benefit. Joseph believes, and to some degree is beginning to demonstrate, that the value derived from  Use a structured and staged roadmap for clinical systems will include increased savings deploying care delivery transformation: in pharmaceuticals expense, reduced length  Foundation—Technology-enabled of stay, duplicate-test reduction, improved process redesign with heavy patient outcomes, and improved patient safety. involvement of clinical/business owners Furthermore, the health system expects to realize  Opportunity assessment—Identify, value through improvement in patient, physician, measure, and craft current state and and employee satisfaction, as well as in staff target performance measurements Measuring the Costs and Benefits of Health Care Information Technology: Six Case Studies | 9 based on business strategy and including Sharp Community Medical Group, objectives Sharp Mission Park Medical Group, and Sharp  Transformation—Physician and Rees-Stealy Medical Group. In addition to clinician-led care delivery process hospital and physician practice facilities, Sharp change includes the Sharp Health Plan, the largest locally based health plan in San Diego, covering more Lessons learned. Through its experience than 100,000 people. Recently, the University of implementing advanced clinical systems, St. Arizona and Sharp HealthCare were awarded a Joseph has gained these insights about what U.S. Department of Health and Human Services makes for a successful IT investment: Agency for Healthcare Quality and Research  Do not buy “bells and whistles”; focus grant of $1.3 million for a three-year study to on integration with ancillary information determine the impact of hospital computerized systems (i.e., pharmacy, lab, radiology) that provider order entry systems on adverse drug optimize current IT investments. events. This study will be one of the first  Use a highly collaborative approach to comprehensive CPOE studies performed in a attain buy-in and assign accountability for community health network setting. achieving projected benefits. Clinical systems environment. Sharp  Focus on changing culture and care delivery HealthCare uses a variety of clinical information processes first, then enable with technology. systems, employing a best-of-breed approach.  Ensure an adequate number and the right Sharp uses IDX Flowcast for order entry, patient mix of resources and competencies (e.g., accounting, medical records, and radiology. implementation, process facilitation, and Sharp is upgrading to IDX’s CareCast application organization change specialists). suite for order entry, pharmacy, and CPOE.  Do not be held captive by a time line; In addition, Sharp uses the Cerner Classic allow time for learning from incremental Laboratory and MSMeds pharmacy applications; implementation progress. CliniComp’s paperless chart; Fuji PACS, EmStat for emergency room management; and Lawson  Foster leadership, ownership, and for financials, human resources/payroll, and accountability at the local entity level materials management. To provide an integrated (which requires a strong leadership team, a desktop view of these varied applications, Sharp strong and involved board of directors, and is currently deploying the Sentillion product, a unified and well-understood vision). which is based on Clinical Context Object Sharp HealthCare Workgroup (CCOW) standards, and Identix biometric (fingerprint) authentication. Organization profile. Sharp HealthCare (Sharp) is an Integrated Delivery Network Defining value. Sharp has adopted six “pillars (IDN) consisting of four acute care hospitals of excellence” as the foundation for its vision and four specialty hospitals covering the greater to transform the health care experience, which San Diego area, including Grossmont Hospital, it dubs “The Sharp Experience.” The pillars— Sharp Cabrillo, Sharp Chula Vista Medical quality, service, people, finance, growth, and Center, Sharp Coronado Hospital, Sharp Mary community—are the basis for everything from Birch Hospital for Women, Sharp Memorial strategic planning, organization goal setting, Hospital, Sharp Mesa Vista Hospital, and Sharp priority setting, management performance Vista Pacifica. Sharp also has more than 1,500 evaluations, and meeting agendas. Targets are affiliated medical group physician members, 10 | CALIFORNIA HEALTHCARE FOUNDATION set for each pillar that align individual leaders’ in the outcomes planning and measurement goals with those of their department, division, process. Sharp plans to use the six pillars as entity, and, ultimately, with the entire Sharp the highest level of value for the organization, health system. With the pillars as a guide, determining appropriate performance communications and work planning are made measurements that bear on one or more pillars more manageable, and outcome measurements in order to achieve the desired outcome of IT are enhanced. Measurements used to determine projects. This approach will allow Sharp to performance targets under each pillar include: accurately identify, plan, construct, and realize  Quality—Accreditation and licensing the value of IT projects at each organizational scores, infection-control measures, patient level, as well as across the entire enterprise. safety, and measurements for disease Critical success factors and potential management in the areas of diabetes and barriers. To enable its organization to achieve cardiac care. the intended value of clinical systems, Sharp  Service—Overall patient and physician identified the following as critical success factors satisfaction in Sharp hospitals and medical and potential barriers: groups.  Any large-scale clinical process change  People—Increasing employee satisfaction and technology project must be driven and retention and reducing employee and owned by functional areas, not turnover. Information Services.  Finance—Increasing available cash on  Physician acceptance and buy-in is critical. hand to reinvest in operations and reducing In addition, it is essential to: workers’ compensation claims.  Deploy user-friendly solutions, which  Growth—Increasing total net revenue to “think” like clinicians and improve their reinvest in operations. workflow.  Community—Commitment by  Use a widespread cultural and operational management to donate at least 4,440 change-management program. hours annually toward community service programs.  Avoid a “watered down” effect from over- integration, causing decision support and As a symbol of commitment to these pillars, other reporting capabilities to be shallow nearly 1,000 Sharp leaders have signed eight-foot because of a lack of available detailed data. pillars that are now displayed in the lobby of Sharp’s corporate offices in Kearny Mesa.  Collect baseline process performance measurements and plan for ongoing Measuring and realizing value. Following measurement and reporting mechanisms. the six pillars approach, Sharp examines IT  Ensure uptime and system-response times investment through objective measurements. For through effective infrastructure design and example, during the rollout of the Fuji PACS capability. system, the project team used a standardized template to determine project goals before  Carefully develop an effective deployment commencement, and then developed tools strategy that includes physician to track performance. This is a relatively new and clinician input and provide process for Sharp, and the leadership recognizes comprehensive testing, abundant training, that there is a need to introduce even more rigor and frequent communication. Measuring the Costs and Benefits of Health Care Information Technology: Six Case Studies | 11 Sarasota Memorial Health Care System mandate to achieve 100 percent compliance with Organization profile. Sarasota Memorial CPOE. Health Care System (SMHCS) is a community- Defining value. To achieve success with its based health care system that encompasses clinical systems, SMHCS knew extensive Sarasota Memorial Hospital, Sarasota Memorial planning was necessary before implementation. Health Care Center at University Parkway, To that end, SMHCS identified areas of potential Sarasota Memorial Care Center at Blackburn improvement that could be enabled through the Point and the Clark Road Campus. There are use of clinical applications. Furthermore, the additional outpatient sites, as well as home executive and project team understood that both health and long-term care services, a network of SMHCS and physicians using the technology primary and specialty-care physicians, a health would realize the value of clinical systems and information and resource hotline, a Physician CPOE in particular. According to SMHCS, the Hospital Organization insurance network, and overall value of advanced clinical systems and, a primary care center and community medical specifically, CPOE is derived from: clinic for the uninsured and underinsured.  Supplying physicians with context- Sarasota Memorial Hospital, licensed for 828 sensitive and relevant clinical data at the beds, is the second largest public hospital right time, in the right format, and in the in Florida. As the second largest employer right place (e.g., at home or in physician in Sarasota County, SMH is staffed by 690 office). credentialed physicians and more than 3,000 employees.  Providing rules and alerts to warn doctors of potential issues with the desire to Clinical systems environment. In June reduce adverse medical events (AMEs). 1997, SMHCS installed the HealthVISION  Evaluating clinical practice patterns clinical suite, which was acquired by Eclipsys of physicians and comparing them Corporation and became part of the Eclipsys’ to accepted evidence-based medicine Sunrise Clinical Manger (SCM) product, standards. which is now part of Sunrise XA. The original installation included all major interfaces to  Improving patient care. ancillary applications (e.g., laboratory, radiology). Measuring and realizing value. Once SMHCS Using a cross-functional team consisting defined, at a high level, the value it wants to primarily of clinicians, SMHCS built the system derive from the clinical system, it has been able and conducted a trial. After the successful to effectively conduct and analyze discrete, pilot, SMHCS deployed the HealthVISION targeted studies. These studies are presented to application, by functional unit, beginning in various committees within the organization, January 1998. Each unit rollout took about six with the intent of continuous streamlining and weeks and included the construction of orders improvement of patient care processes, practices, and order sets to support specific unit function and outcomes. Furthermore, to evaluate the requirements. To date, physicians enter about long-term value and appropriateness of clinical 30 percent of all orders, with roughly 50 percent applications, SMHCS performs studies on the of the physician staff entering some orders. effectiveness of care alerts as well as efficiency Sarasota implemented SCM version 3.0 in 2000 studies to demonstrate the individual physician and currently uses version 3.03. In September value from computerized clinical information 2003, SMHCS will begin a unit-by-unit phased systems. For example, Figure 1 depicts results 12 | CALIFORNIA HEALTHCARE FOUNDATION Figure 1. Comparing Elapsed Time Between Written and Computer Pharmacy Orders and Pharmacy Verification 8:24 ________________________________________________________________________________________________ Written Orders  Written Average 7:12 ________________________________________________________________________________________________  Computer Orders Computer Average 6:00 ________________________________________________________________________________________________ Time 4:48 ________________________________________________________________________________________________ 3:36 ________________________________________________________________________________________________ 2:57 2:24 ________________________________________________________________________________________________ 1:12 ________________________________________________________________________________________________ 0:44 0:00 ________________________________________________________________________________________________ 0 5 10 15 20 25 30 35 Number of Patients Source: SMHCS from an SMHCS study regarding the variance in  Implement core and ancillary clinical elapsed time for pharmacy verification between systems first, with CPOE as the final written and computer medication orders. increment of functionality. Critical success factors and lessons learned. To  Provide remote access to clinical enable the organization to achieve the intended applications (access to clinical data from value of clinical systems, SMHCS identified the anywhere) because this is critical to following as critical success factors. The executive rapidly increasing value to physicians and, leadership team should: therefore, accelerating physician adoption.  Have a clear understanding of the  Identify, encourage, and foster physician difficulty involved in large-scale clinical “evangelists” who champion the new projects and the related requirement for processes and related technology; they are perseverance. critical to increasing the probability of success and physician adoption.  Realize that the implementation is never “complete” and, therefore, requires  Ensure that large-scale clinical process continuous commitment of clinical and change and technology project must be executive leadership. driven and owned by functional areas, not Information Services.  Anticipate and expect the need for flexibility when implementing large-scale  Pace the change; use an incremental clinical applications. rollout approach instead of a “big bang.”  Ensure that a robust and redundant  Recognize that for large-scale projects, technology infrastructure is in place. such as CPOE, implementation will never Measuring the Costs and Benefits of Health Care Information Technology: Six Case Studies | 13 stop and the implementation team will cost savings, and expense avoidance for records never disband. storage space. Initially, a small group of executives  Provide abundant education and and IT personnel developed a simplified business transition support, especially to physicians case, primarily identifying estimated costs and and clinicians. high-level, narrative value expectations. Early value studies were performed by individual Central Valley Health Network pilot affiliates. These studies will be used to Organization profile. The Central Valley project anticipated value upon installation at the Health Network (CVHN) is a consortium of 13 remaining affiliates. community health centers with 94 sites located in To achieve its vision, CVHN formed a wholly 18 counties throughout central and southeastern owned IT subsidiary, Community Health Tech, California. As safety net providers, member responsible for planning, implementing, training, affiliates largely serve a population of migrant and deploying the EMR solution. Furthermore, farmworkers and patients below 200 percent CVHN formed the Integrated Systems Steering of the federal poverty level. CVHN supports Committee (ISSC), which consisted of three member health centers to provide high-quality, chief medical officers, one assistant medical accessible health care while increasing efficiencies officer, one chief operating officer, once chief through collaboration and integration. CVHN financial officer, and three IT team members. is spearheading an innovative EMR project that The ISSC meets twice per month, focusing on will enable member health centers to access and planning and issue management, and works maintain accurate patient records and to collect closely with Community Health Tech leadership. epidemiological data. Additionally, member affiliates have their own Clinical systems environment. CVHN is in the super-user groups, acting as local application process of implementing Cerner’s ambulatory experts that buffer support and issue resolution EMR solution, piloting the system in two requirements. member community health centers. The model Critical success factors and lessons being deployed is a single database instance, learned. Throughout its implementation of an which will enable effective patient data gathering ambulatory EMR solution, CVHN has learned and sharing between member affiliates. CVHN these lessons: is an early adopter of EMR technology and is  Know your desired outcomes and what is considered a pilot for community health centers required to deliver them. across the United States.  Institute a strong governance structure Defining value. The goal of CVHN’s EMR that consists of operational, clinical, and project is to provide access to electronic patient IT team members. records for a primarily transient and migratory  Develop detailed work plans with clear population, enabling a continuum of patient expectations and milestones. care and effective chronic disease management. Additional specific value to be realized from the  Develop effective communication EMR project has been identified by CVHN, channels within the team and with the including physician and staff satisfaction, solution vendor. recruiting and retention enhancement, medical  Provide abundant application and process records and transcription expense savings, training. charge batch entry time savings, paper forms 14 | CALIFORNIA HEALTHCARE FOUNDATION