Information Technology Service Process
Help Desk Institute Sacramento Regional Meetingi i f C lif i i l h S
University of California Davis Health System
April 18, 2012
Mike Minear, CHCIO, CPHIMS
Chief Information Officer
Speaker Disclosure
I have no personal financial relationships or interests in any entity producing, I have no personal financial relationships or interests in any entity producing, marketing, re-selling, or distribution health care technology or goods and
services consumed by, for clinical care, or used on patients.
Michael N. Minear,
CHCIO, CPHIMSProfessional Affiliations
Chief Information Officer – University of California -Davis Health Systemy y
Associate Faculty - Johns Hopkins Bloomberg School of Public Health
C rrent Associations Current Associations
- Co-Chair of the Board – California Telehealth Network (CTN) (2012 – current)
Member - Steering Committee - Group on Information Resources (GIR) of AAMC - (term 2012 to 2014)
Co-Chair - California Hospital Association’s (CHA) Informatics and Technical Committee (2010 – current)
Member - California Hospital Association’s (CHA) Informatics and Technical Committee (2008 – current)p ( ) ( )
Member - Healthcare Information & Management Systems Society (HIMSS)
Member - American College of Healthcare Information Administrators (CHIME)
Member - American Medical Informatics Association (AMIA)
‘Improving lives and transforming health care’
Clinical Care
Clinical Care
Among the top 50 hospitals in America and also ranks as the top hospital in Sacramento
Research
$200+ million in annual funding 37th ranking NIH research funding37th ranking NIH research funding
Ed
ti
Education
Ranked 35th among US Medical Schools
(ranked 62nd in 2001)
UC Davis Health System
UC Davis Medical Center ranks among the top 50 hospitals in America and also ranks as the top hospital in Sacramento with nine high-performing medical specialties
UC Davis ranks among the nation's top medical schools for rural medicine, primary care and research
National Cancer Institute ‘comprehensive’ designation cancer center, one of only 41 in the country
one of just eight U.S. hospitals receive a Kidney Transplant Excellence Award for 2012 from HealthGrades for superior outcomes and survival rates for kidney transplants
UC Davis Health System: Key Statistics
Budget
• $1.7 billion in revenue
• $200 million in research funding$200 million in research funding
People
p
• 7,646 staff; 1,259 faculty and academic employees • 871 residents, fellows and 816 students
Major economic engine for region
UC Davis Health System – Information Technology
Electronic Health Record $160 million
Investment Over 11 years 2002 2013
Epic is now used to support 35% - 45% of all American healthcare 2002 - 2013 American healthcare encounters Epic EHR 100% EHR use
ONC-ATCB Certified EHR Software
2.1 million patients in EHR
Stage 6-HIMSS Analytics EMR Adoption
Most Wired award
USN&WR Most Connected Hospital
295 + 45 Physicians meeting EHR meaningful use
requirements – 247 have registered and attested . ll o pat e ts
91% CPOE usage
eg ste ed a d attested (January 2012)
EMR Adoption Model Stage 6
195 Organizations
UC Davis Health System – Clinical Software Infrastructure
Specialty Clinical Software Digital Clinical Images Secondary Use EHR Content
NIH i2b2 Cohort Discovery
p y
Radiology information System Transcription / Voice Recognition
Radiation Oncology
Pathology
Dietary
Pulmonary Function Holter
Digital Clinical Images
Radiology – Philips PACS
Outside Clinical Images loaded to Radiology PACS via PACSGear
Ophthalmology PACS - Anka
Non Radiology PACS images
TeleHealth Store & Forward
NIH i2b2 Cohort Discovery Many disease Registries:
Cardiology Burn Trauma Cancer Many others… Holter Muse EKG Echo EMG – orders
Respiratory care – orders Treadmill
CAPS TPN pharmacy admixture Clinical Equipment Pyxis Drug cabinets
Digital Endoscope PACS - nStream
Rad Oncology PACS - Teremedica Pathology PACS - Aperio
y
Tethered Meta Registry Radiology Dose Registry
p y
Electronic Health Record Pyxis Drug cabinetsHemodynamic monitors
Telemetry
EKG
Fetal monitoring
Echo
Glucose Point of Care
Health Information Exchange
Tethered PHR – over 57,000+ patients using web portal or iPhone to access PHR
2,564+ community physicians have secured remote access to UCDHS EHR 27 858+
Cardiac Cath Monitors
Bar code medication admin Digital Infusion pumps Bladder Scanner Ventilators remote access to UCDHS EHR, 27,858+
patient records have been shared
6,600+ EHR records shared with other care providers –connected to over 70 Epic customers via Care Everywhere All 5 federal mandated ePresccribing
interfaces in use over 2 million
Paper Medical Records Scanned and Linked into EHR
Consent forms
Outside paper medical records
interfaces in use – over 2 million ePrescriptions shared
66,000+ outside clinical images loaded to UCDHS PACS using PACSGear
TheraDoc reportable infections interface to CDC
Interface to eHealth Global Technologies in place to load outside scanned records and DICOM images to EHR and PACS
UCDHS Information Technology Division
460 IT staff 460 IT staff
$80 million operational budget
$15 - $40 million annual capital budget
IT staff manage a large and sophisticated technology infrastructure that
includes; 2 data centers, over 1,000 servers running a variety of operating
systems, 12,000+ client computers, 2,500+ network attached printers, over 125 interfaces, storage area networks, and a large IP network with integrated voice interfaces, storage area networks, and a large IP network with integrated voice and data transmissions
Supports over 410 major software applications in production use
HP OpenView system to manage IT assets the technology service process HP OpenView system to manage IT assets, the technology service process,
change management, and technology probes & monitors
Provides technology customer support to UCDHS via a 24 hour x 365 day modern
technology operations center that receives over 6 000 customer service technology operations center that receives over 6,000 customer service requests per month
Growth in Mobile Technologies
Bar Code
M di ti Ad i i t ti Medication Administration iPad Version of EHR for clinicians Sigma infusion pumps
Smiths Medical
iPhone Version of
EHR for clinicians iPhone version of iPhone support of email Syringe infusion pumps
Accu Check iPhone version of
PHR for patients ‘Personal’ iPhones
Accu Check Wireless
Tethered Personal Health Record (PHR)
50000 60000
UC Davis Health System
MyChart Active Patients February 2009 through March 2012
20000 30000 40000
Health Information Exchange (HIE)
UC D i H l h S
70,000
UC Davis Health System
Patient Clinical Data Shared with other Care Providers November 2008 through March 2012
CAIRS (CA Immunization
50,000 60,000
CAIRS (CA Immunization Registration System) 'Shots for Tots'
eHGT - Exchange EHR Content
PACSGear -Load clinical
30,000 40,000
PACSGear Load clinical images to PACS from other providers
Epic Physican connect - EHR Patient Records Remotely Accessed
Allscripts - Share Clinical
10 000 20,000
Content - Support Discharge & Transition of Care
Epic Care Everywhere -Exchange EHR content Epic and Surescripts
-P i ti R d Sh d
0
IT Service Process in 2007
Current State
Current State
3 different IT divisions
Multiple Processes
Multiple technologies / databases used to support serviceMultiple technologies / databases used to support service
Few measures to assess and manage customer service
Many Silos
Few tools to manage technology – poor use of existing toolsg gy p g
Not able to support ‘mission critical’ technology used by organization# System Name Primary Type Technology Used By? Replace
1 Incident Management Problem Lotus Notes IS and CRS Yes
2 S C ? SQ SO & S
2 ISMED request system All Cold Fusion ? MySQL SOM & basic Sciences
3 EMR Defect tracking Problem Old crappy DB CIS
4 EMR issue tracking Problem Mantis open source JAVA CIS
5 CIS report request tracking DB Req Service MS Access DB CIS
6 Access request system Request Access Lotus Notes IS, HIM, security officers
7 MAC database - service requestq All Lotus Notes IS, HIM, CRS, CIS
8 Teledat All Informix Telecom
9 Card key system Request Access Johnson Controls Prop Telecom
10 Vocera database All MS Access DB Telecom
11 Kerberos access Request Access ? IET
Creation of New IT Service Process
Make customer service a priority
Make customer service a priority
Take a holistic / total view
Focus on mission and process
Assess and document the IS process (current state) Design the SHOULD process (optimal state)
Design the SHOULD process (optimal state)
Organization all resources and staff around the SHOULD process
Deploy and use tools
Create metrics and a culture of measurement
Create metrics and a culture of measurement
Strongly manage to mission and goals (use metrics)
E IT g h ‘ t i ’ l t t th i j b
Every IT manager has a ‘customer service’ element to their job descriptionTools
I
t d i d d l
d th HP O
Vi
d t it
Invested in and deployed the HP OpenView product suite
ITIL based
Service manager (with self service option) Configuration Management database (CMDB)
Configuration Management database (CMDB)
Asset manager
Probes and monitorsIT Service Guidelines
P ti R ti
Proactive vs. Reactive response
Created BEFORE the request or need occurs…
Define every reason a customer would need help from IT Define the BEST and proven way to resolve the issuep y
Create the guideline - actual workflow / tasks to resolve the issue Verify the guideline works and it is complete
Keep the guideline up to date
N i f ft h d
New versions of software or hardware
Current guideline needs updating, or a better way to resolve issue foundHow to Create Guidelines
1. Define the population of issues that requires a guideline 1. Define the population of issues that requires a guideline 2. Prioritize the list
3. Start with the highest priority (most used)
4. Gather data
d t f t t d
data from past customer needs
Vendor documentation
Inventory error messages
Ask vendor for their service guidelines
Ask staff, ask customersAsk staff, ask customers5. Create initial version of guideline
6. Have others in team with expertise to review
7. Make changes and edit as needed
8. Put into ‘production’ use
9. Monitor Collect data from system – and feedback from customers
Is it working?
Is it being used?
How can it be improved?
Respond to new versions or changes in technology
Support new technologies deployedIT Service Guideline Trend
UC Davis Health System
IT Service Guidelines Jan 2012 started w ith 4228 Guidelines 4000 4500 2009 ‐2012 April 2012 982 Guidelines w ere retired 2500 3000 3500 3,246 1000 1500 2000 Service Manager Go Live May 2009 0 500 2009 2010 2011 2012
Technology Operations Center – During Construction
Technical Operations Center – Current Day
New dedicated technology call center established in May 2008 New dedicated technology call center established in May 2008
Open 24 x 7 x 365 Staffed all 3 shifts with additional staffing during Peak Periods Uses Industry Standard approach to manage technology serviceUses dust y Sta da d app oac to a age tec ology se v ce
IT
Walk
‐
up
Express
The Information Technology Walk up The Information Technology Walk‐up
Express is easy to access touch point for
customers
Open from 7:00 am to 4:00 pm Monday‐
Open from 7:00 am to 4:00 pm Monday Friday
Parking is available in a specially identified
reserved spacep in front of the buildingg
IT Walk‐up Express Services
Pagerg dropp‐off and pickp ‐upp Pager exchanges
Vocera device exchange
Cell Phone drop‐off and pick‐up
Laptopp p dropp‐off and ppick‐upp ( (Loaners
available)
Vendor registration and badging Short‐term parking for quick service Walk‐upp kiosk for campusp visitors
Service Measurement
Can’t manage what you don’t measure
Make measurement a priority
Ma e easu e e t
a
p o ty
Service process and tools defines what is possible to measure
Morph measures over time
Learn how to measure better
Address new problemspIT Weekly Service Measures / Reports
1 Technical Failure Log 16 MyChart Incoming Calls by Hour (patient calls for support)
2 Weekly Total Service Interactions and High Impact Incidents 17 MyChart Requester Type (patient calls for support)
3 Total Incoming Calls and Available Staff 18 MyChart Guideline Usage (patient calls for support)
4 Call Abandonment Activity 19 Desktop Support Daily Ticket Overview
5 Total Incidents by Hour 20 Desktop Support Daily Ticket Overview (Education)
6 Call Abandonment Rate by Hour 21 Desktop Services ‐ Status of Incidents
7 Average Time to Answer Call 22 Educational Technology Desktop ‐ Status of Incidents
8 Total Escalations by Team Name 23 Desktop Services Siste Visit or Solved Remotely
9 Level 1 Warm Transfer 24 Desktop Services Siste Visit or Solved Remotely (Educational Technology)
10 First Call Fix Percentage and Average Handle Time 25 IT Walk Up Center ‐ Service Type
11 First Call Fix Percentage ‐ Excluding Hardware Escalations 26 Weekly iPhone and iPad Requests
12 Total Successful and Unavailable Guidelines ‐ Team Name 27 Customer Satisfaction Overall Weekly Score By Team
13 Incident Aging and Backlog 28 Customer Satisfaction Survey ‐ Average Score Per Question
14 Incidents Aged > 72 Hours By Team 29 Primary Functions of the IT Division
Cover / Summary of Weekly IT Service Measures
Reviewed by IT management team Every Tuesday morning
Routinely shared and discussed in all IT teams
Shared with customers and Health System leadership
Average Time to Answer Call
5.00
Average Time to Answer Call 2008 ‐ 2012 Service Process Go Live 5/2009 3 00 4.00 o nds EMR Upgrade 8/2010 Storage Corrupted Mail Server 05/2011 2.00 3.00 Mi n u te s. Se co Storage issues 11/2010 1.00 0.00
Total Incoming Calls, Staffing, and Abandoned Calls
12000 30
Total Incoming Customer Calls (Demand) Available IT Staff (Supply)
2008‐2012 Corrupted Mail Server 8000 10000 20 25 and o n ed Ca lls Service Process Go Live 5/2009 EMR Upgrade 8/2010 Storage issues 11/2010 05/2011 4000 6000 10 15 al In co m in g and Ab a To ta l St af f 0 2000 0 5 To ta 0 0
Total Calls/Incidents by Hour of the Day
14000
Total Incidents by Hour
March 2011 ‐ March 2012 10000 12000 6000 8000 2000 4000 0 00:00‐ 01:00 01:00‐ 02:00 02:00‐ 03:00 03:00‐ 04:00 04:00‐ 05:00 05:00‐ 06:00 06:00‐ 07:00 07:00‐ 08:00 08:00‐ 09:00 09:00‐ 10:00 10:00‐ 11:00 11:00‐ 12:00 12:00‐ 13:00 13:00‐ 14:00 14:00‐ 15:00 15:00‐ 16:00 16:00‐ 17:00 17:00‐ 18:00 18:00‐ 19:00 19:00‐ 20:00 20:00‐ 21:00 21:00‐ 22:00 22:00‐ 23:00 23:00‐ 24:00
Technology Failure Trend
10 Average
40
UCDHS Information Technology
Technical Failure Event
2008‐2012 10 Average 29 Maximum 1 Minimum 30 20 10 0
CDC Global Services Service Desk Assessment Model
Data for UC Davis Health System
Service Desk process and best practice implementation 24
Organization integration 20
Service
Desk
Assessment
Data for UC Davis Health System
Organization integration 20
Technology optimization 22
Staff development 18
Inforamtion management 18
Overall Service Desk Maturity Score 102
HDI Performance Metric Comparison
Service
Metric
All
Industries*
Healthcare
Industry*
UCDHS
Average
First
‐
68% 66% 61%Call
Resolution
Target
Average
First
‐
Call
73% 75% 80%
Resolution
Rate
Average
Speed
to Answer
11‐20 seconds 170 seconds 120 seconds
to
Answer
Customer
Satisfaction
Cliff Notes - UCDHS Information Technology Service Process
Leadershipp
Key focus of the IT management team and CIO
New customer service manager hired Process
Health System-wide - all Information Technology functions and teams
Health System-wide - all Information Technology functions and teams
Single process for all service support issues
Process redesign for optimal efficiency and customer support Service Response Guidelines
Cross divisional teams formed to create & maintain ‘optimal problem resolution’
Will start with hundreds and grow to thousands of guidelines Tools
HP OpenView suite – fully integrated functionality to manage IT technology and p y g y g gy service, ITIL based Facility
New Operations Center and retail support area
Call center function and key Level 1 2 and 3 staffingCall center function and key Level 1, 2, and 3 staffing
24 x 7 x 365 - Integrate all technology teams and support functions Measurement
Create in-depth service measures and integrate into daily work Communication
