1. Trinity Health Advancing Clinical Quality and Patient Safety with Health IT
Paul Conlon, PharmD, JD

2. Trinity Health Fourth Largest Catholic Health System in the U.S.
45 Hospitals (33 Owned and 12 Managed) Across the Nation
8,074 Active Staff Physicians
45,000 Full-Time Equivalent Employees
Revenue of $7.0 Billion
$400 Million in Community Benefit Ministry

3. Trinity Health Mission Core Values Vision Guiding Behaviors
We serve together in Trinity Health in the spirit of the Gospel, to heal body, mind and spirit, to improve the health of our communities and to steward the resources entrusted to us. Respect Social Justice Compassion Care of the Poor and Underserved Excellence Inspired by our Catholic faith tradition, Trinity Health will be distinguished by an unrelenting focus on clinical and service outcomes as we seek to create excellence in the care experience. Trinity Health will become the most trusted health partner for life. We support each other in serving our patients and communities We communicate openly, honestly, respectfully and directly We are fully present We are all accountable We trust and assume goodness in intentions We are continuous learners
Mission Core Values Vision Guiding Behaviors
Copyright 2007 Trinity Health – Novi, Michigan

4. Trinity Health’s clinical and operations transformation initiative
Best-in-class clinical and administrative processes that are enabled by information systems on a common platform
Large-scale people, process, and technology advancement:
Enhanced Care/Clinical Experience
Implemented Electronic Medical Record (EMR)
Computerized Physician Order Entry (CPOE)
Unified Revenue management
Clinically-driven Supply Chain management
Improved productivity
Copyright 2007 Trinity Health – Novi, Michigan

5. Decisive and Focused System-Wide IT Investment
Trinity Health is using Genesis to standardize operational processes and information systems.
The vision to unite state-of-the-art information management systems in three areas: clinical, revenue and supply chain, was launched in 2000
Goal is to transform care delivery, increase patient safety and improve financial performance
Strategic investment in excess of $400 million capital over 10 years
Unified people, process, culture, and technology
Leveraged skill and scale to achieve efficiencies
Standardized evidenced based processes to improve quality of care, patient safety and financial performance
Provided critical transparency to data and processes
Reduced variability in processes and costs
Trinity Health’s bold vision and skillful execution of Genesis:
Copyright 2007 Trinity Health – Novi, Michigan

6. Trinity Health: Circa 2001…
Eastern Division
Western Division
Operating Units
Silver Spring, MD
Columbus, OH
Port Huron, MI
Mt. Clemens,
Pontiac, MI
Livonia, MI
Ann Arbor,
Battle Creek,
Grand
Rapids, MI
Muskegon,
South Bend, IN
Clinton, IA
Dubuque, IA
Mason City,
Sioux City,
Boise, ID
Fresno, CA
Patient Administration
Registration
Patient Accounting
Medical Records
DRG Grouper 3M
Quadramed
QuadraMed
APC/APG Grouper
HSS
Enterprise Resource Planning (ERP)
General Ledger
People Soft
Global
Payroll/Human
Resources
GEAC
Ceridian
A/P
Materials
Management
Cost Accounting
Self Developed
(Analysis &
DSS)
TSI Mainframe
TSI AS400
Self
Developed
Contract
SARMC
McKesson
HBOC
Clinical Systems
Physician Order
Eclipsys
Order Entry
HBOC STAR
SMS
MedSeries 4
HBOC Plus
2000
Series
SMS MedSeries4
Results Reporting
In-house/3M
CWS
Cerner
In-House
ADEs
Clinical
Documentation
HBOC Care
Manager
TDS
LifeServ
Petronics
Laboratory
Pathnet
Sunquest
Classic
HBOC ALG
Millenium
United
Labs
STAR
Pharmacy Hospital
MsMeds
Mediware
WORX
Surgery
RES-Q
Healthcare
Omni-server
Patient Scheduling
HBOC Pathways
Radiology
IDX
ADAC MARS II
ADAC MARS II
Per-Se'
Consort
Transcription
Softmed
Dolbey
Medrite
Dictaphone
SMS Med
Series4
Medline
Systems
MedSeries 4
ORSOS
Health-Quest
This represents the wide variation in hardware and software our hospital systems had deployed nine years ago.
We had an aging infrastructure, with diverse tools leading to wide diversity in processes, and therefore, wide variation in performance and clinical outcomes.
Needed to address this variation – and address increasing external expectations (regulatory and otherwise) related to quality and financial performance.
Copyright 2007 Trinity Health – Novi, Michigan

7. Trinity Health IT Unification 2012…
Consistent Tools + Best Practice Processes = Operational Excellence
Copyright 2007 Trinity Health – Novi, Michigan

8. Genesis Clinical Timeline
23 of 41 facilities are now live
3 ministries in readiness
Ann Arbor
Muskegon-Hackley
Boise
Genesis Standard Delivery Model (GSDM) in process
Muskegon-Hackley will come live with current Muskegon footprint with additional functionality to facilitate barcode medication administration and PowerPlans.
Chelsea will implement the Ann Arbor Genesis footprint
Fresno & Columbus will implement GSDM
Cadillac & Grayling TBD
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Clinton
Go-Live
Macomb
Go-Live
Chelsea
Go-Live
Dubuque
Go-Live
South Bend
Mishawaka
Plymouth
Ann Arbor
Go-Live
Muskegon
Go-Live
Cadillac & Grayling
Go-Live
Columbus
Go-Live
Genesis
Board
Approval
Battle Creek
Go-Live
Sioux City
Go-Live
Oakland
Go-Live
Port Huron
Go-Live
Mason City
Networks
Hackley
Go-Live
Grand Rapids
Go-Live
Mason City
Go-Live
Livonia
Go-Live
Silver Spring
Go-Live
Fresno
Go-Live
Boise
Go-Live
Copyright 2007 Trinity Health – Novi, Michigan

9. Project Genesis
Single design deployed across 23 hospitals since May 2003.
Identified deficiencies prioritized for correction and enhancements deployed across full system.
3 more hospitals in October 2009.
Standardized readiness assessment
Standardized deployment
Standardization of care delivery
Design heavily influenced by front-line care givers
Constant enhancement/refinement
Heavy focus on implementing evidenced based practices
Full deployment of order entry, results reporting, rules, alerts and advisories.
Over 75% CPOE rate
Copyright 2007 Trinity Health – Novi, Michigan

10. Accomplishments to Date on the Clinical Platform
Over 7 million patients within the EMR making it the 3rd largest repository in the nation.
Data is contained in a single location including clinical, financial, and administrative information across all facilities.
2 facilities have clinics managing inpatient & outpatient care in the same system
In 23 of the 41 hospitals scheduled for full implementation…
They are live on Computerized Prescriber Order Entry (CPOE) with physician entry rates average 74% and as high as 84% of all orders
100%% of the previous paper medical record is now electronic
More than 1,200 caregivers will use the system simultaneously during peak hours with over 300,000 chart openings per day.
Inpatient nursing care, pharmacy, and medication administration is documented directly by providers in the same electronic system. Lab and Radiology data also feeds from regional and hospital based systems.
Over 600,000 orders are placed, processed, and completed per day electronically from order to administration in the same system.
Over 700 physicians place orders each day.
Copyright 2007 Trinity Health – Novi, Michigan

11. Current Performance and Recognition
Severity adjusted mortality rate at 71% of expected
HCAHPS “Would Recommend” score at the 76th percentile
100% of core measure performance is greater than the national average
47% of hospital level core measures above the national top 10%
Trinity Health is one of the Thomson Reuters 100 Top Hospitals®: Health System Quality/Efficiency Benchmarks award winners
5 of our hospitals are recognized as Thomson Reuters 100 Top Hospitals
Trinity Health is the recipient of the 2004 National Health Care Quality Award
Copyright 2007 Trinity Health – Novi, Michigan

12. Genesis: Process Impact
Genesis has required fundamental changes to core patient care processes.
Clinicians access records and place orders at any place and time
Nurses spend 8% more time at bedside rather than with paper records
Emergent medications administered 40% faster
Comparative effectiveness eliminates clinical variation with 172 adopted standard order sets and over 2,500 standard drugs in our formulary
Computer-generated alerts prompt physicians to change medication orders, avoiding approximately 14,000 potential Adverse Drug Events per year
Automatic system alert on diabetes medication (Avandia) within 10 days of FDA warning
Clinical Process Re-design has resulted in benefits in Pressure Ulcers (45% reduction) and Patient Falls (31% reduction) and improvements in DVT and Pain management.
Copyright 2007 Trinity Health – Novi, Michigan

13. Key Implementations/Process Changes in FY09
Admit, transfer, and discharge Medication Reconciliation
System-wide formulary
Integrated electronic surgical record pilot
Urinary catheter rules/alerts
Universal protocol revision
Change patient satisfaction vendor
Phased in implementation of credentialing and privileging soft ware
Standardized concentrations of key IV solutions
Expansion of nurse witness functionality (double checks)
Standardized heparin administration and availability
OB program reviews
Implementation of Genesis at large teaching hospital and 8 rural access hospitals.
Surgical ‘tiger team’s’
Review of case management programs
Copyright 2007 Trinity Health – Novi, Michigan

14. Patient Medication List from ED

15. Patient Medication List from ED
New Rx’s
Home Meds
Copyright 2007 Trinity Health – Novi, Michigan

16. Patient Medication List from ED
Meds received in ED
Meds to hold
Copyright 2007 Trinity Health – Novi, Michigan

17. Drivers A Unified Enterprise Ministry approach
Relentless pursuit of improvement
Extensive readiness preparation
Frontline staff involvement
Transparency
Reliance on evidenced based care
Collaboration across disciplines
Strong technical and clinical expertise
Many, many, many groups….
Copyright 2007 Trinity Health – Novi, Michigan