1. Clinical Information System Implementation Project Prepared for Clinical Affairs Committee December 4, 2002

2. Clinical Information System Outline • Objectives • Clinical Systems Overview • Critical Success Factors • CIS Implementation Plan • Project Committee Structure • Next Steps Information Technology Department

3. Objectives • Implement a Clinical Information System that complements our leadership role in healthcare delivery • Meet or exceed all Leapfrog requirements • Improve effectiveness and quality of care delivery • Regularly quantify medical, financial, and patient satisfaction benefits • Deliver high quality care that achieves the best outcomes in the most cost-effective manner. • Develop and maintain a controlled medical vocabulary (CMV) • Implement a Computerized Physician Order Entry (CPOE) process • Ensure compliance with HIPAA information security and privacy mandates • Build and populate an online, real time computerized patient record (CPR) Information Technology Department

4. Clinical Systems Overview Location Specific and Distributed Transaction Systems Users • Clinical Reporting • Management EIS • Regulatory Agencies • Performance Report Card Enterprise Applications • Scheduling, • Case Management Archive INTEGRAT I ON TOOLS Order Entry / Results Data Warehouse Pharmacy USERS METADATA Clinical Documentation ClinicalData Repository Archive • Archived • Lightlysummarized • Highlysummarized ADT/Registration Radiology Clinical Decision Support STOR Surgical Scheduling Clinical Decision Support EMPI Interface Engine Information Technology Department

5. Computerized Patient Record (CPR) Information Technology Department

6. Information Security Elements of CPRs • Availability - when and where needed • Authentication - a person or system is who they purport to be • Access Control - only authorized persons, for authorized uses • Confidentiality - no unauthorized information disclosure • Integrity - information content not alterable except under authorized circumstances • Attribution/non-repudiation - actions taken are reliably traceable Information Technology Department

7. Critical Success Factors • Close ties between the organization’s strategic plan and the CPOE project • Continuous executive support • Getting the right people involved at the correct level • Focus on implementing people and process changes needed to support improved care, rather than on implementing a new computer system; technology is important but the organizational challenge is greater • Strong physician leadership and communication in all aspects of the project • Flexibility and willingness on the part of the vendor and Information Technology to tailor the system as needed to support the organization Information Technology Department

8. CIS Implementation Plan Information Technology Department

9. CIS Implementation Process • Eliminate Duplicate Patient Numbers (9/02 – 6/03) • Cleanup of duplicate medical record numbers throughout UCSF. This process includes the combining of all electronic patient records as well as all paper records. • Admitting Module (9/02 – 2/03) • Implementation of IDX LastWord Admitting module. Transfer of inpatient admission process from using IDXtend Outpatient Visit application to true inpatient admitting application. Includes use of barcoding technology for patient identification. • Pharmacy Module (9/02 – 5/03) • Implementation of IDX LastWord Pharmacy module. Conversion of inpatient pharmacy from current Mediware Pharmacy system to integrated IDX application to enable meeting Leapfrog requirements. • Emergency Department (9/02 – 5/03) • Implementation of IDX LastWord Emergency Department module. This task will provide ED with the ability to care for and track patients in an emergency medicine environment. Information Technology Department

10. CIS Implementation Process • Order Entry / Results Reporting (9/02 – 7/04) • Implementation of IDX Order Communication and Results Reporting module. This process includes all orders for all ancillary departments and their corresponding results. • Physician (9/02 – 7/04) • This process primarily involves physicians and focuses on the design, development, testing and implementation of Computerized Physician Order Entry (CPOE) throughout UCSF. • Nursing (9/02 – 7/04) • This process primarily involves nurses and focuses on the design, development, testing and implementation of nursing orders and results reporting throughout UCSF. • Ancillary (9/02 – 7/04) • This process primarily involves ancillary departments and focuses on the design, development, testing and implementation of ancillary orders and results reporting throughout UCSF. Information Technology Department

11. CIS Implementation Process • Leapfrog Compliant (7/04) • At this milestone event in the CIS implementation, UCSF will be compliant with all Leapfrog requirements. • Stor Conversion (4/03 – 7/04) • Conversion of all patient data from the in-house developed STOR application to LastWord's Computerized Patient Record. • Clinical Decision Support (1/04 – 11/05) • Establishment of a Clinical Decision Support System to provide a clinical and business data repository for research and analysis. Includes the implementation of a data warehouse to store and process all data. • Nursing Care Plans and Charting (7/04 – 6/05) • Implementation of the IDX Nurse Care Plans and Charting module. This task will provide Nursing with an automated tool for entering and utilizing acute care plans throughout the organization. This does not include critical care. Information Technology Department

12. CIS Implementation Process • Critical Paths (6/05 – 5/06) • Implementation of IDX Critical Paths module. This process addresses the development of critical pathways for all medical and surgical patients. • Physician Critical Paths (6/05 – 5/06) • This process primarily involves physicians and focuses on the design, development, testing and implementation of physician critical paths throughout UCSF. • Nursing Critical Paths (6/05 – 5/06) • This process primarily involves nurses and focuses on the design, development, testing and implementation of nursing critical paths throughout UCSF. • Ancillary Critical Paths (6/05 – 5/06) • This process primarily involves ancillary staff and focuses on the design, development, testing and implementation of ancillary critical paths throughout UCSF. Information Technology Department

13. CIS Implementation Process • CIS Foundation Implementation Complete (5/06) • At this milestone event, the initial implementation of the Clinical Information System is complete. Information Technology Department

14. Project Committee Structure Information Technology Department

15. Next Steps • Approve 5 year project funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . • IDX customer site visits for key stakeholders . . . . . . . . . . . . . . . . . . • Begin UCSF-wide communications regarding CIS project . . . . . . . . • Hire CIS Program Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • Appoint physician leader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • Finalize implementation plans with IDX . . . . . . . . . . . . . . . . . . . . . . • Identify and schedule IDX staff resources . . . . . . . . . . . . . . . . . . . . . • Identify and schedule other consulting resources . . . . . . . . . . . . . . . . • Identify space and furnish CIS Program Office . . . . . . . . . . . . . . . . . • Establish CIS Steering Committee and subcommittees . . . . . . . . . . . • Perform Readiness and Risk Assessments . . . . . . . . . . . . . . . . . . . . . • Develop job descriptions for CIS Project Team . . . . . . . . . . . . . . . . . • Hire CIS Project Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • Present CIS Implementation Plans to IT Steering Committee . . . . . . Completed Started Not Started Completed Started Started Not Started Started Started Started Started Completed Started Completed Information Technology Department

16. Summary and Questions Information Technology Department