Vince Willoughby Director: John Smith Director: Sally Jones Director: Bob Johnson Director: Mary Williams Director: Tom Brown Director: Sue Davis Director: Jim Clark Director: Ann Taylor Director: Bill Adams Director: Chris Wilson Director: Donna Miller Director: Franklin Jones Director: Greg Miller Director: Henry Lee Director: Jackie Brown Director: Kathy Green Director: Lisa Martin Director: Mark Wilson Director: Nancy Wilson Director:

1. IT Transformation
Tim Tarnowski & Vince Willoughby
March 2013
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2. Conflict of Interest Disclosure
Tim Tarnowski, CIO
Vince Willoughby, Strategy Development
Has no real or apparent
conflicts of interest to report.
© 2013 HIMSS

3. Learning Objectives
• Define the process to align IT strategies with
medical and business strategies
• Explain one approach on how IT Governance can
prioritize potential IT investments against medical
and business metrics
• Describe how UK HealthCare transformed their IT
function by using a framework to define Key
Attributes of a World Class IT Organization

4. UK HealthCare
Overview
Lexington, Kentucky
March 2013

5. University of Kentucky
Lexington,
Kentucky

6. Ranked No. 1 Hospital in Kentucky
Nationally ranked in the top 50 for Orthopaedics
Ranked high-performing
in 10 specialties
Cancer › Diabetes & Endocrinology › Ear, Nose & Throat › Gastroenterology › Geriatrics ›
Gynecology › Nephrology › Neurology & Neurosurgery › Pulmonology › Urology
6

7. Information
UK HealthCare Five Focus Areas
Technology
• Academic Medical • Strengthen • 200+ FTEs
Center Subspecialties
• Hybrid FTE Model:
• State, Not for Profit • Expand Geographic – Central
Reach – De-Central
• Three Hospitals
• Improve Cost • Best of Breed
• 80+ Sub Specialty
Effectiveness
Clinics
• Patient Safety &
• 1,500 Physicians
Satisfaction
• 8,000 Employees
• Maintain Financial
• Key Statistics: Strength
– 825 Beds
– 34,453 Discharges
– 448,673 O/P Visits

8. Dedicated to Patient Care
Hospitals Outpatient Services
• UK Albert B. Chandler Hospital • Kentucky Clinic
• UK Good Samaritan Hospital • UK Polk-Dalton Clinic
• Kentucky Children’s Hospital • Kentucky Clinic South
Areas of Excellence • UK Family Care Center
• Gill Heart Institute • 80 specialized clinics
• 150 outreach programs
• Kentucky Children’s Hospital
• Kentucky Neuroscience Institute Six Healthcare
Colleges
• Markey Cancer Center
• Dentistry
• Maternal-Fetal Medicine Program
• Health Sciences
• Orthopaedic Surgery & Sports Medicine
• Medicine
• UK Transplant Center
• Nursing
• Pharmacy
• Public Health

9. Benchmark on Discharges
UK HealthCare - Benchmarked against COTH Median Teaching Hospital
10,200
9,200
8,200
7,200
6,200
5,200
4,200 Shaded area includes
Good Samaritan & Chandler
3,200
2004 Q1 2004 Q3 2005 Q1 2005 Q3 2006 Q1 2006 Q3 2007 Q1 2007 Q3 2008 Q1 2008 Q3 2009 Q1 2009 Q3 2010 Q1 2010 Q3 2011 Q1 2011 Q3 2012 Q1 2012 Q3
UK HealthCare Median Teaching Hospital
75th Percentile Teaching Hospital 25th Percentile Teaching Hospital

10. Our Strategic Priorities
IT will be a fundamental organizer in
relationship development and making
improvements to care delivery.
Michael Karpf, MD
EVPHA, UK HealthCare
June 2011

11. IT Transformation
Using World Class
IT Attributes
UK HealthCare, Lexington, Kentucky
March 2013

12. 2009 Current State Assessment
• Internal Data Collection/Information Gathering
– Nov/Dec-08 Interview Summary
– I.T. Staff Survey (73% Response Rate)
– I.T. Senior Management Group Reviews
– Walkthrough I.T. Areas
– Feedback from Colleagues/Peers
– Customer Satisfaction Survey
• External Advisory Services
– Review 2007 I.T. Assessment/Strategic Plan
– Participated in Benchmarking
– Analyze/Benchmark I.T. Structure

13. Current Healthcare IT Industry Trend
Source: Healthcare Advisory Board, Innovation Center, 2010

14. The Challenges – Evolution of HIT
Focus Decade Computing Type
Billing 1960 Mainframe
Clinical 1970 Minicomputer
Billing/Clinical 1980 Computer for Masses
Healthcare Reform 1990 Internet
Healthcare Reform,
ACO, Medical Home, 2000 to
HIT Arrives
etc. Today
Source: Healthcare Information Systems,
Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4

15. Conclusions of 2009 Current State Assessment (CSA)
Customer IT Staff
• I.T. is Critical to Success of UK • Silos/Lack of Teamwork
HealthCare
• Fragmented Org. Structure
• Need “Enterprise” Focus &
Integration • Confusing Roles & Resp.
• Current Level of I.T. Services is • Lacking Tools & Methods
Sub-Standard
• Not Addressing Low Performers
• Lacking Overall Strategies/Plan
• Poor Communication
• Upcoming Major I.T. Projects
• Reactive/Not Proactive
• Weak Infrastructure

16. Future State Needs – From 2009 CSA
• Industry is Rapidly Transforming
• I.T. is Critical to Success of UK HealthCare
• Prepare to Meet Healthcare Industry Trends
– Immediate Tactical Plans for Major I.T. Projects
– Improved I.T. Governance
– High Performing I.T. Function
• Overall I.T. Vision, Strategies & Roadmap

17. I.T. Assessment Conclusions (Updated 2010)
Focus Decade Computing Type
Billing 1960 Mainframe
Clinical 1970 Minicomputer
Billing/Clinical 1980 Computer for Masses
Healthcare Reform 1990 Internet
Healthcare Reform,
ACO, Medical Home, 2000 to
HIT Arrives
etc. Today
Source: Healthcare Information Systems,
Concept: Our Anticipated Focus Areas 2010 + Wager, Wickham Lee & Glaser, 2009, p. 89-101, Chapter 4
Performance
Excellence, Always On
Improvement & Value Forecast 2010 +
Computing
Creation

18. Transformational Change
Denial Commitment
Confusion Teamwork
Apathy Satisfaction
Numbness Clear focus and plan
“If I ignore this, it will go away.” “Sign me up!”
“Yeah, right, they’ve said this Acceptance
before.”
Resistance Exploration
Anger & Fighting Brainstorming new ideas
Withdrawal Frustration
Can’t sleep at night Have a lot to do
“I gave my all and look what I Trouble focusing
get.” Open to new things
“I don’t like it.” “How can we do things
Loss of morale, productivity and differently?”
communication
Source: Unknown

19. Transformational Change – “White to Blue”
Totally Transform Our DNA:
• Gradual Process
• Allows Acclimation
• Organized/Documented Transition
• Walkthrough Changes Over Periods of Time
• Repeated Messages & Themes
• Learning Cycles

20. Transformational Change
Directly Addressing the Tough Issues
is the Work of Leadership
•Maintaining Status Quo/Avoiding the Issues
•Appears to be Easier in the Short Term
•Outdated Job Descriptions
•Lack of Infrastructure Investments
•Immature Methods, Tools, Processes
•Creates Very Difficult Long Term Issues
•We Are Here
•Very Uncomfortable
•Leading Transformational Change is Very Hard Work

21. Transformational Change – Year One Roadmap
Topic Current State First 4 Months Middle 4 Months Last 4 Months Future State
Acclimation New Employee • Orientation, SuperVISION • Meet Key Customers • Meet Key Customers • New Exec. Director
Session Acclimated
• Meet Key Customers
• Tour/Visit Common
Sep – Dec 2010
Conference Rooms &
Buildings
• Discuss How Obtain Health
Services
Assessment of Inconsistent • Review Operations, • Initial Recommendations • Obtain Approval for • Improvement Method as
Operations, Methods & Policies & Procedures • Initial Goals Recommendations & Goals Std. Operations &
Processes, Processes • Learn Current Processes, • Final Assessment • Road Map to World Class Measurement Scorecard
Methods, Tools Methods, Tools • Draft of Performance I.T. Service Delivery • Scheduled Rounding
• Clear & In-Depth Scorecard, Service Level • Final Performance with Key Customers
Understanding of Current Agreements Scorecard • Professional IT
State • Establish Rounding • Implement Rounding for Operations Methods
• Assessment First Draft, Process & Schedule for Key Key Customers (ITIL, SLAs, etc.)
Opportunities for Customers and Staff • World Class I.T. Service
Improvement, Options- Delivery
Pros-Cons-Recommend • Improve UK HealthCare
HR Fragmented • Meet Staff • Market Wage Survey • Lean Training Program for • Organization Structure
Structure, • Review Job Descriptions • Career Ladders Areas of Responsibility • HR Programs
Unclear Roles & (JAQs), Roles & • Succession Plans • Improvement Method
Responsibilities Responsibilities • Development Plans Development Program
• Develop Organization • Lean Training • Internship Program
Structure
• Participate in Shaping I.T.
Restructuring
Budget Current Budget • Learn Capital & Operating • Identify Cost Savings • Implement Cost Savings • Cost Savings
Budgets
Projects Projects • Review Key Projects • Work with PMO to Record • All Projects Managed
Managed • Collect Inventory of all Projects in PMO Registry Through PMO & In PMO
Differently to Projects in Area of Registry
Varying Degrees Responsibility
of Success

22. World Class IT Attributes
• Service Strategies
• IT Governance
• World Class Attributes
• Passport
• IT Strategies
Used by Permission; Corporate Executive Board, Key Attributes of the World-Class Information Technology Organization.

23. Add Reference

24. IT Transformation Using World Class Attributes
USING WORLD CLASS ATTRIBUTES:
• Provides a Framework for a New Team
• Creates a Common Language
• Good Tool to Build Teamwork
ADDITIONAL COMMENTS:
• This is One Approach
• Other Frameworks Can Be Used
• Pick Something & Stick With It

25. IT Alignment
UK HealthCare, Lexington, Kentucky
March 2013

26. • Aligned ITSP Interview
Teams with Org Chart
• Questions:
• Strategies
• Activities
• How Can IT Help?

27. Eight IT Strategies
• Foundation for IT
Approaches
• Very Long Term

28. IT Strategic Plan
• Service Strategies
• IT Governance
• World Class Attributes
• Passport
• IT Strategies

29. IT Strategic Plan
• Service Strategies
• Ambulatory Services
Strategy
• What Ambulatory
Services is Doing
• How IT Can Help

30. Benefits of IT Alignment
MAIN BENEFIT:
• Ensure IT Investments are Directly Contributing to
Medical & Business Strategies
ADDITIONAL BENEFITS:
• Align Strategic Plans (IT & Business)
• Market Your IT Function
• IT Governance Participation/Ownership

31. IT Governance
Prioritization Process
UK HealthCare, Lexington, Kentucky
March 2013

32. Add Reference

33. IT Governance
IT
Governance
•World Class I.T.
Service Delivery
Physician IT Infrastructure &
Project Priorities Data Warehouse Service Requests
Advisory Security
•Growth/Outreach •Data as Strategic •Usability •Usability •Always On
•Unified Comm. Asset •EMR •Interoperability Computing
•EMR
MD Clinical Decision IMPACT
(Improving Pt. Care
Documentation Support Using IT)

34. ONEList – Demand Management

35. ONEList – Rate vs. Signature Metrics
e
n
l lenc
dati o
e
ty
l enc
p act
Safe
y
Exce
m en
IT Exec. Council Rating: IT Governance Rating:
xcel
ienc
th I m
0 = No Impact L = Low
l ity &
re
ecom
ice E
Effi c
emi c
1 = Little Impact M = Medium
l Sco
Gr ow
3 = Moderate Impact C = Critical
Qua
Serv
R
Acad
9 = Significant Impact
Tota
ITG
# Ref Request Name 807 519 73 817 127 Totals by
1 1 Patient Access & Registration/Revenue Cycle 9 9 0 9 9 36
2 40 Ambulatory EMR (Single Patient Record) 9 3 3 3 9 27
3 174 Central Telemetry monitoring (cockpit) 9 9 0 9 0 27
4 4 Closed Loop Barcode Med Administration 9 9 0 9 0 27
5 5 CPOE-OR-Co-Path/SCM 9 9 0 9 0 27
6 155 Intraoperative CPOE (SCM Orders to OR) 9 9 0 9 0 27
7 6 Intrapartum utilization of GE 9 9 0 9 0 27
8 193 BCMA-Bar Coded Medication Administration 9 9 0 9 0 27
9 181 Co-location Data Center Space 3 3 0 9 9 24
10 14 Core Measure / NSI Hardwiring 9 3 3 9 0 24
11 11 Develop Data Center Strategy 9 3 0 3 9 24
12 3 Develop Integration Engine Strategy 9 3 0 9 3 24
13 15 EMR Completion 9 3 3 9 0 24
14 13 Order set clean up 9 3 3 9 0 24

36. ONEPage – Executive Summary
How will requested item relate to signature metrics?

37. ITSP – How IT Can Help
10 Year Funding Model
Project Name FY13
FY14 FY14
FY15
Single Patient Record $0
$0 $0
$0
Remote Clinic Access 0
100 100
100
Referring Physician Access 00 00
Clinic and Building Growth 0
250 250
250
Standardization of Clinic Systems 00 00
Practice Management System 00 00
Patient Access 00 0
500
Role-based System Access 00 00
Standardized Model Clinics 050 50
50
GRAND TOTAL $400 $400
$900
Sample Amounts

38. Benefits of IT Governance Prioritization
MAIN BENEFIT:
• IT Governance Decides Which IT Investments Meet
Medical and Business Strategies.
ADDITIONAL BENEFITS:
• IT Governance Participation/Ownership
• Organize Approved/Unapproved Requests

39. Results
UK HealthCare, Lexington, Kentucky
March 2013

40. UK HealthCare
IT Leadership Structure Assoc. V.P. & CIO CMIO
Tim Tarnowski Carol Steltenkamp, MD
January 2013
I.T. Service Line
Director - COM
Steve Welch
Architects: I.T. Portfolio Mgt Applications Technology Executive I.T. Security Director Informatics Executive
Michelle Gerding Executive Director Executive Director Director Doug Fee Director
Ben Nicholls Michelle Cassin Doris Miller Mark Eimer Cecilia Page
Strategy Analyst:
Vince Willoughby

41. UK HealthCare
IT Leadership Structure Assoc. V.P. & CIO CMIO
Tim Tarnowski Carol Steltenkamp, MD
January 2013
I.T. Service Line
Director - COM
Steve Welch
Architects: I.T. Portfolio Mgt Applications Technology Executive I.T. Security Director Informatics Executive
Michelle Gerding Executive Director Executive Director Director Doug Fee Director
Ben Nicholls Michelle Cassin Doris Miller Mark Eimer Cecilia Page
Strategy Analyst:
Vince Willoughby
Support (Apps, Tech, Security)
Architecture
Strategy &
Stabilize
Select &
&
Implement Optimize (Informatics)
Transition
(PMO)
(All)
Innovate (Innovation)

42. IT Team Composition
All Staff 2009 All Staff 2010 All Staff 2011
2%
3% 6%
33%
65%
97% 94%
Leadership 2009 Leadership 2010 Leadership 2011
17% 3%
3%
49% 48%
97% 83%
UK HealthCare UK External

43. Results: IT Governance Top Priorities
ITG Top Priority 2009 2010 2011 2012 2013
Assessment
IT Transformation
New Hospital
Community Hosp.
Ambulatory EMR Selection Rollout
Data Center Move Apps
ARRA/MU
ICD-10/Regulatory

44. http://ukhealthcare.uky.edu/IT/

45. Passport for Our Improvement Journey

46. Passport for Our Improvement Journey

47. UK HealthCare IT Capital Spend (2002 – 2012) & Forecast (2013 – 2023)
(Figures in $000s)
TCO Avg. $43M
Capital Avg. $26M

49. Lessons Learned
UK HealthCare, Lexington, Kentucky
March 2013

50. Lessons Learned
• Restructuring:
– Does Not Equal Team Building
– Challenge to Maintain Service Delivery While In Process
– Need to Develop Common Language/Understanding
• Customer Demand Always > IT Supply
– Critical Success Factors are:
• ONEList
• Customers Prioritize Requests Against Signature Metrics
• Customer Turnover Impacts Priorities
• Over Communication is NOT Possible

51. Lessons Learned
• IT Strategic Plan:
– Help Areas Without Documented Strategies
– Alignment is a Very Difficult & Repetitive Process
• World Class Attributes
– Multiple Years to Build
– Establishes a Common Language/Understanding
• IT is All About the TEAM

52. “Transformation without work
and pain, without suffering,
without a sense of loss is just
an illusion of true change.”
Source: Cross Roads, by William Paul Young

54. Thank You!
Tim.Tarnowski@uky.edu
Vincent.Willoughby@uky.edu
www.ukhealthcare.uky.edu
www.ukhealthcare.uky.edu/IT
March 2013