SEHA

SEHA (Abu Dhabi Health Operator) – A journey to improve services for patients and families

…. A 2012 snapshot on how SEHA realises a journey to improve services for patients
on behalf of the people of Abu Dhabi and Abu Dhabi GSEC …

SEHA ITD leverages technology support with Cerner, Oracle ERP, Microsoft, Orion Rhapsody, Orbus iServer

Summary

SEHA (Abu Dhabi Public Health System Operator) operates 12 hospitals with 2,644 beds, 62 Primary and Ambulatory Health Clinics and 2 blood banks. It employs about 17,000 physicians, nurses, technicians, allied health and administrative personnel. SEHA is working to earn the trust of the public and be their healthcare partner for life. We are partnered with international healthcare leaders recognized for their outstanding performance in their markets. Our partners include Johns Hopkins Medicine, Cleveland Clinic, Fresenius Medical Care, and Dell.

IT plays a critical role in health care reform. Health IT includes front office services (doctor and nurse), traditional back office functions, quality reporting, patient safety systems and direct use by our customers, patients and families.

Many health locations worldwide have IT systems deployed in a fragmented manner, many instances of software located in many locations. Prior to 2007, SEHA had multiple stand-aloneHealth Information Systems, with different solutions in different facilities. This was a result of a strategy as directed by HAAD (Health Authority Abu Dhabi) to support individual facility autonomy and possible future private sale.

In 2009 the SEHA strategy was changedto a journey towards an integrated health system. SEHAgroup ITD was re-formed and alignedin 2009 to support this health business directive. ITD started a strategy to establish central enterprise solutions that support all facilities.

Today, all primary care facilities and all hospitals are serviced by a single Cerner domain. The Abu Dhabi Cerner ranking (data provided by Cerner) in 2011 compared to all Cerner AMS/OMS clients worldwide is:

  • 1st in total number of Power notes signed (physician documentation)
  • 1st in total number of PACs images
  • 2nd  in total registrations (~4.6 million/year)
  • 5th  in total transaction volume (~ 1.4 billion/year)
  • 7th  in total appointments (~5 million/year)

 

The profession of IT is more than technology components, it is the  job of improving and delivering IT itself. 2012 introduced the next evolution of SEHA ITD (Information Technology Division), recognizing the need to expand SEHA IT footprint from physician experience to increased support of the patients’ direct experience, to continue standardizing and to systematically guide the department’s ITD maturity.

To support this direction a new ITD function of Enterprise Architecture was established. An RFP was issued for the acquisition of an EAMS (Enterprise Architecture Management System), with Orbus Software’s iServer Enterprise Architect with TOGAF 9 being selected.

The Challenge

“It is fundamental for Information Technology to take as close a view of how it delivers technology as it does to the technology itself. This has to start by taking a close look at what does SEHA require moving forward and where is IT trying to progress the company.”

ROBERT PICKTON
SEHA  Group Chief Information Officer
enterprise architecture and improving the Patient Experience

A program in 2012 was planned to look at the ITD (Information Technology Division) maturity and approach towards enterprise systems management. In relation to assessing the ITD maturity some specific challenges facing SEHAITD in 2012 needed to be addressed. These included:

  • Identifying the role of IT to help transform the patient experience and support a healthy society (Vision and Role of IT: Improve Our Patient Centered eHealth Strategy)
  • How do we promote awareness of the contribution of IT (Improve ITD Promotions, Malaffi Marketing)
  • Supporting revenue management to minimize lost revenues (Improve Revenue Management System)
  • Implement IT Infrastructure Operations service desk and ITIL (Implement ITIL)
  • Establishing a new EA function to support standardization (Establish EA).

 

1) The role of IT in patient experience and self-help is described by the term eHealth. eHealth is a global movement that is happening as we speak. eHealth is the use of internet technologies used directly by patients, families and care givers with their health and wellness. The use of   eHealth IT can help to transform the patient experience and offers new opportunities for provider assisted patient centered care options

2) Communicating IT value is often a challenge in many organizations. At SEHA we recognized how public appreciation can assist executives understand how IT can be a strategic differentiator. SEHA ITD looked for ways that IT communication could support SEHA brand awareness and positive community messaging

3) Revenue management required transformation at SEHA, to adapt to the regulatory and economic environment. Revenue management also needed to be adding value by maximizing revenue generation and capture, and avoid leakage. Some challenges in developing a revenue management program included:

  • Some 7,800 ICD 9 codes to drive billing at over 70 locations and up to 3 million transaction/patient interactions a day
  • Numerous coding rules and interactions allowable between codes
  • Economic sustain ability in a newly established health insurance market
  • Reduction of government block funding
  • New market entrants and increased competition
  • Compliance with new regulatory requirements, a DRG (Diagnostic Related Group codes based on ICD9) based reimbursement
  • Ensuring our Clinical and RCM applications are enabling the complete capture of charges, claims and collections

4) It was determined that a refresh to the service desk was required for IT Infrastructure Operations.

5) It was determined that an Enterprise Architecture (EA) function was to be established to assist the Office of the CIO with IT Strategy, Governance and Standardization and eHealth planning. Previously technology was often were run as individual projects but as many of us have learned the hard way, launching new technology initiatives in isolation, no matter how promising they may seem, is a recipe for disaster. You have to have a master plan. This is why SEHA decided to start an EA approach to managing the Enterprise IT Package / Solution set.

The Solution

The solution for assessing the ITD maturity was to start the CIO analysis and Enterprise Architecture with a review of the business architecture, an in depth look of where SEHA IT was targeting to support over a three year and a five year journey. Within this context, solution components focused on the following four tactics:

1)   Role of ITto help transform the patient experience, support a healthy society

When developing the IT strategic role of IT, SEHAincludes the following factors:

  • Structure/methodology and governance
  • Information quality
  • Outcomes targeted and measurement
  • Process and operations support
  • User satisfaction and needs analysis
  • Technology implementation
  • Infrastructure support

Supporting this objective component, the solution was delivered in two broad initiatives.

Initiative 1:  HIMSS

To give validity to IT programs, people must trust the solutions and services provided. The approach by SEHA to instill trust in the integrated internal (health provider) IT system is for SEHA to utilise the international healthcare information accrediting organisation, HIMSS. HIMSS is a global organization that collects and analyses healthcare organization data relating to IT processes and environments, products, IS department composition/costs, IS department management metrics, healthcare delivery trends and purchasing related decisions.  HIMSS accreditation covers the use of IT in hospitals for Quality, Safety & Efficiency improvements.

Initiative 2:  eHealth Strategy

To initiate the strategy and planning of patient experience and community care as a health system. Providing community-wide systems is much more complex than deploying smaller or short-term pilot projects, since, to avoid fragmentation, poor communication and poor interoperability, integration with existing systems becomes vital. Systems intended to work in large settings need to embody an architecture that supports unique identifiers for patients, as well as open standards for data coding and exchange, to make it possible to integrate the novel systems with existing information systems and other new initiatives.

2)   Promote awareness of the contributionof IT

SEHA has successfully built an integrated clinical support system that combines Cerner technology and a three year program to customise Cerner for local conditions. The solution for IT awareness and communication was to establish a new brand and marketing campaign to communicate the EMR (Electronic Medical Record, used by Physicians and Nurses) IT solution. A plan was built for SEHA to unify the EMR (electronic medical record, health information solution)under one brand. The IT marketing plan included the following:

  • Joint planning with ITD and Marketing departments
  • Understanding associations with SEHA
  • Understanding current level of awareness and associations with HIS
  • Reactions to HIS concept (post explanation)
  • Awareness and assessment of the existing names: associations, likes, dislikes and preferences
  • Criteria that would define ideal name for HIS (values conveyed…)
  • Concept testing, market testing different brands and tag lines;
    (This included extensive market research across Abu Dhabi, involving residents comprising UAE nationals, expats and employees from the healthcare sector)
  • Selection, governance and approval process of branding and messages
  • Graphic arts, templates, folders, promotional items designed
  • Marketing campaign execution including street signage
  • Press release

 

3)    Supporting revenue management to minimize lost revenues;
A revenue management system is a complex solution requiring cross enterprise change management in systems, processes and organization responsibilities. At a high level, the Revenue management systems transformation took a three step approach.

Step One:   Plan for New Systems

  • IT planning for a new Patient Accounting system integrated with  the Cerner Millennium HIS (Integrated solution approach) that included running historical systems in parallel, QA of results and fallback plans
  • Launch a comprehensive program to identify all clinical charge points across the SEHA catalogue
  • Augment the  RCM technology solutions with a Contract Management system, Claim Editor and Patient Liability estimator
  • Recruit an experienced operator to establish a Central Business Office entity  (CBO) for SEHA’s RCM operations (Patient Access, HIM Coding, Business Office)
  • Plan operational command centers to manage transition phases including testing, post go live QA and training

 

Step Two:   Clean Group Data

  • Establish a fit for purpose Clinical Charge Services Clean up (CCSC) team
  • Clean data across the following areas:
    • RadNet, Radiology service lines
    • Gen Lab, AP, Blood Bank & Micro
    • Cardiology, Gastroenterology
    • Women’s health, Nursing
    • OT, PT, RT, Podiatry
    • Pharmacy
    • Surgica
    • lSupply Chain

Step Three:    Implement an Integrated Patient Accounting solution

  • ERM, enterprise registration job function support
  • EBM/ABN, Benefits and allowances process
  • Clinical Coding
  • Patient Accounting (ProFit) system integration
  • Charge Services integration
  • All Clinical Solutions Integration
  • Reporting
  • Foreign system integration

 

4)    Implement IT Infrastructure Operations service desk and ITIL.

Selecting ITIL as a framework for IT Infrastructure operations and establishing a new ITIL based enterprise service desk tool. An RFP was sent to market to select a vendor and partner to assist configuration and implementation.

5)   Establishing a new EA function to support standardization.

Establishing the EA (Enterprise Architecture) started by hiring a lead Enterprise Architect aligned to objectives set by ADSIC (the Abu Dhabi government IT compliance body).

Stage One:  The first step was defining the boundary and scope for EA that would explain why SEHA decided to start an Enterprise Architecture Approach to managing an ICT Enterprise Package / Solution set. This scope for the role of EA as part of the CIO office is:

  • ICT managed as an integrated program
  • Development of the business architecture and ICT architecture
  • Sharing of information (between doctors, between systems)
  • To support improvements in business process management (BPM)
  • Identification of practical, achievable implementation plans and the appropriate functional focus (ICT and Clinical support) to meet the business goals
  • Revised governance strategies for balancing business needs with architecture design requirements
  • Systems Integration and delivery strategies guiding overall integration for information, infrastructure and operating platforms
  • High level funding estimates for near term initiatives
  • A platform for risk management strategies

 

Stage Two:   The second step evaluating some of the existing and new frameworks that would govern both EA and ITD. Aselectionof some of the artefacts and frameworks that governs IT management and maturity is included below.

diagram_1

Diagram: Example SEHA ITD Artifacts managed for achieving IT maturity

Stage Three:   The third step was to evaluate a suitable EAMS (Enterprise Application Management Tool) late 2012 for preparing the EA execution in 2013. For this purpose, a public RFP was prepared and was issued into the general market 4Q 2012.

Outcomes

ITD made significant progress in it planning and strategy function in 2012. Some of the specific outcomes that demonstrate SEHAS ITD

1)    Role of ITto help transform the patient experience, support a healthy society

For validity to IT programs (HIMSS accreditation), SEHA achieved three facilities accredited to Stage 6 HIMSS.

diagram_2

Diagram: Demonstrating HIMSS Adoption in the US. SEHA achieved 30% of all hospital reaching Stage 6 in 2012.

SEHA initiated a health sector conversation on the role of eHealth and included planning across business divisions, clinical affairs, and strategy division and with external stakeholders. Development of the eHealth concepts was progressed alongside discussions of primary health care transformation, for an integrated and coordinated approach towards World Class healthcare.

Awareness of opportunities to improve patient experience was established and an approval for developing an eHealth strategy was received.

2)    Promote awareness of the contributionof IT

The EMR (Electronic Medical Record, used by Physicians and Nurses) system will now be known as Malaffi in both English and Arabic. Meaning “my file” in English, the name ‘Malaffi’ preserves the essence of confidentiality and patient privacy.

  • Transition from different SEHA Hospital’s & Clinics are using their own Brand Name and Logo to a single brand
  • Reduces confusion amongst patients and people in the health sector who may not have been aware all SEHA facilities and clinics are using the same World Class Electronic Medical Record (EMR) system
  • A brand platform to standardize communication within SEHA and for external press releases
  • Removes vendor name from all communications
  • A new digital assetcrated that can be utilized to promote community awareness of SEHA brand, and its impact on the quality of patient care
  • Newspaper articles written recognizing the brand
  • Press coverage and interest raised awareness of ICT among various stakeholders

diagram_3

Diagram: The SEHA Malaffi IT brand and an example of newspaper article.

3)    Supporting revenue management to minimize lost revenues

The revenue management program executed and launched in one major facility for analysis of success before rolling out to all facilities. The launch and post analysis was successful and roll-out to remaining facilities in 1Q 2013 was given.

Some of the benefits and outcomes of the revenue management program were:

  • IT Systems Supports new Charge Services Function:
    • Capture all revenues from Cerner and non-Cerner applications
    • Cleansing of existing Charge related Attributes in the system
    • Minimize the leakage in the system
    • Automate the charge process by Implementing real time business logic
    • Recognition of revenue by Department
  • Patient Accounting
    • Conduct Insurance Eligibility checks online with Daman and ADNIC
    • Perform checks for Non-covered services and advise patient of liabilities
    • Mandatory Physician association of Diagnosis with Orders
    • Utilize advanced Patient Accounting functionality to streamline and standardize workflows and work processes, reduce errors and improve AR days
    • Integrate with Contract Management and Claim Editor applications to improve quality and accuracy of claims and reduce denials.

     

4)    Implement IT Infrastructure Operations service desk and ITIL.

An RFP was successfully completed for the selection of a service desk vendor and a consultancy to assist the implementation of ITIL in IT infrastructure operations. The project implementation started late 2012 for a 2013 delivery.

5)    Establishing a new EA function to support standardization.

The initiation of an EA function was successful. An RFP for an EAMS (Enterprise Architecture Management Tool) was successfully executed and completed. Orbus iServer was the selected winner of the tender. Some of the benefits that SEHA will look to develop within IT EA (Enterprise Architecture) and the Orbus iServer platform are:

  • Time to market
    • Where we can save time in a long journey to get to immediate deliverables
  • Collaboration
    • Abu Dhabi government partnership that promotes collective involvement on resolving problems/resources and making wiser/more durable decision
  • Shared Risk
    • Building approaches that understands and shares the risk
    • Improving the management of business process and information definitions to help manage IT risk
  • Experienced People
    • Understanding dynamics between technology skill sets, capacity demands and human resource skills. To enhance IT by staff ability to work on the standard platforms
  • Contract and Financial Benefits
    • Planning around existing enterprise contract and solution running in different operations environments (e.g., Cloud). We can investigate if this can be directly leveraged in some way to fast-track implementation.
  • Contract and Financial Benefits
    • Supporting different software packages, look at the integration required to create an Enterprise Platform that is tailored to local needs of Abu Dhabi.

     

Conclusion

In conclusion, some of the lessons we have learned includes:

  • Governance is the key to making change:
    • Key stakeholders in Operations, Clinical Affairs, Finance and IT need to be aligned, represented and fully committed to the program
    • Effective structures for collaboration, communication and training are needed
  • Investment:
    • The investment in human resources is significant for participation in project work, testing and training
    • The spend on systems is high but produces justifiable ROI
  • Partners:
    • The right partners with the skills, expertise and experience are vital to manage the organizational, process and system changes
    • It will take time, transformation is a journey not a destination

     

 

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