In 2000, Trinity Health faced an IT crossroad. An infrastructure that better supported a collaborative business model and an upgrade to aging information systems were needed. Furthermore, there were increasing external expectations (regulatory and otherwise) related to quality and financial performance. In response to these business challenges, the “Genesis” project launched, with the goal of standardizing and consolidating clinical, financial and ERP systems across the 44-hospital system and completion expected in 2012.
Genesis was organized into three phases. Phase one, the clinical data repository with adverse drug event alerts, is live in all hospitals. Phase two, consisting of multiple clinical systems, including computerized physician order entry and nursing documentation, along with registration and billing systems, is completed in 75% of Trinity hospitals. The second phase is by far the most complex, involving the redesign of over 300 business and clinical processes impacting 80% of hospital associates and the simultaneous implementation of over 20 IT systems. The final phase, consisting of supply chain management systems and independent of the first two phases, is also complete. To date, phase two has required approximately 3,000,000 hours of effort, with one-third technology-related and two-thirds for process redesign and training in the hospitals.
Genesis capital cost is approximately $409 million with annual support costs of $41 million. In addition to our capital investment, the operational costs to a hospital during implementation are significant. Our hospitals have spent 2% to 4% of their annual operating budget on implementation activity during the year they activate. For example, our small community hospitals (less than 200 beds) spent from $1.5 million to $2.0 million in implementation operating expenses, while large hospitals spend over $8.5 million.Research conducted by several national organizations confirms Trinity's leadership position in HIT adoption. The Agency for Healthcare Research and Quality has found that despite the advantages of CPOE, “less than 5% of U.S. hospitals have fully implemented CPOE.” There are fewer than 100 hospitals in the U.S. that currently have CPOE systems with significant usage rates. Of those, 20 are Trinity Health facilities. Management believes that a key differentiator for Trinity is the ability to influence physicians and other providers to utilize the computer systems through systemic focus on resolution of people, process, and culture barriers to adoption. The integration and acceptance of computer-supported processes in the care delivery process by physicians continues to be essential.
Dozens of Genesis-related benefits studies have been completed. For example, one study measures the six-month period starting nine months prior to activation against the six-month period starting three months following activation, avoiding the time period most disrupted by training and go-live. In this controlled study, 17 of 25 care process measures showed statistically significant improvements, and severity adjusted mortality decreased by 22%, meaning an estimated 1,600 and 2,600 lives per year are saved across the system.
Another study showed emergent medications are delivered 40% faster and nurses spend 8% more time at bedside. Finally, Trinity has quantified significant savings with pharmacy department costs, liability expenses, physician dictation and transcription costs, and accounts receivable reduction.
According to a recent study cited in U.S. News & World Report, “The more ‘wired' a hospital is, the lower its rate of patient deaths and complications.” While this premise has been generally accepted to apply broadly in healthcare, Trinity is one of the first to demonstrate the positive impact of HIT across a multistate health system, in the community hospital setting where 90% of Americans receive their inpatient care.
American Recovery and Reinvestment Act of 2009 contains HIT-related actions required by law, as well as potential opportunities that management will assess for alignment with Trinity's goals and objectives.
Compliance with the yet undefined standard of “meaningful use” provides the potential for $120 million to $160 million in additional Medicare payments over a five-year period (2011-2016) if the deployment of Genesis can be completed by 2013. An additional $20 million to $25 million in Medicare payments is possible if all employed Trinity physicians have implemented physician office HIT by 2013. Trinity will incorporate strategies to complete Genesis by 2013 to avoid a potential 40% reduction in HIT bonus payments. Finally, the legislation changes a number of patient information privacy and security provisions requiring increased efforts to protect patient data.
Additional opportunities identified in the legislation involve potential revenue for Trinity for HIT activities through various grant programs, actions that support business development through commercial provision of HIT services, and increased advocacy and healthcare industry influence on key HIT directions.
While Genesis has clearly achieved planned objectives, there were many challenges. Enterprise-level, scalable, integrated clinical information systems are still relatively immature. Many day-to-day, ease-of-use issues challenge the clinicians to integrate the technology into their workflows. While the systems improve each year, it is likely some time before they are fully mature. Higher clinician adoption of the systems, coupled with increased investment by vendors and health systems, will drive continued improvement.
In addition to software maturity issues, the operational disruption created by implementing new technology is a considerable barrier to more rapid progress. The implementation like Genesis can be all-consuming effort to hospital management for at least three months prior to go-live and longer afterwards. In the current economic environment, it is increasingly difficult to balance real-time operational focus with the business transformational work; however, Trinity has found the benefits to be worth the effort.
Mark Kueber
Senior IT manager
Trinity Health Systems
Novi, Mich.
