1. caBIG® Clinical Information Suite Deployment Approach September 29, 2010 Philip Gelda Ekagra Software Technologies

2. 1 9/29/2010 1 Agenda/Overview Introduction of deployment team Goals of caBIG® Clinical Information Suite Role of deployment team Deployment approach Deployment process and engagement Adaptation and adoption deployment options Wrap-Up – next steps

3. 2 Deployment Team Experience Adam Welsh – Deployment Customer Relationship Manager (CRM) – Over 15 years of health information technology experience across a diversity of domains – Successful leader and manager of systems implementations in the health domain across Federal and private-sector health systems, health plans, bio- pharmaceutical companies and health agencies – Particular expertise in information technology strategy and health IT stakeholder management and facilitation Gregory Thompson, MD, MSc – Deployment Subject Matter Expert – Over 20 years of health care experience including clinical practice in Internal Medicine – Served as Chief of Ambulatory Care for the Veterans Administration, Steering Committee Chair for CPRS implementation, and consulting medical informaticist – Training includes a fellowship and Master's degree in Biomedical Informatics 9/29/2010

4. 3 Deployment Team Experience Jeff Couch – Deployment Senior Software Engineer – Enterprise System and Data Integration Architect with over 10 years of experience in health care systems integration for industry leading clients including Mayo Medical Laboratories, University of Virginia Medical Center, Centers for Disease Control, and State of Florida Department of Health – Experienced leader that provides strategic guidance to clients and delivers tactical solutions that ensure client success Karen Hall – Deployment Analyst – 23 years in health care, including both Ambulatory and Hospital settings, participating in a variety of roles with an emphasis on training and implementation – Knowledge of both the clinical and revenue cycle workflows Shannon Brown – Deployment Technical Writer – Skilled technical writer with knowledge of health care and Federal HIT efforts, including standards harmonization and the NHIN – Coordinated and managed the publication of health standards interoperability specifications and has conducted literature reviews on the costs, benefits, and impacts of electronic health record implementation in various care settings 9/29/2010

5. 4 4 Goals and Success Criteria caBIG® Clinical Information Suite Project caBIG® Clinical Information Suite currently defined goals: Provide software components and specifications which will enable ambulatory oncology stakeholders to: – Provide access to and utilization of integrated information and coordinated system interactions across the Translational Medicine Continuum – Work more effectively within the broader research and oncology care environments – Help meet meaningful use criteria caBIG® Clinical Information Suite current success criteria: Clinical Community Adaptation or Adoption – Business Capabilities and/or Reference Implementation will be used in a daily production setting Service Specification Adoption by Industry – Industry consumption of platform independent level specifications Adoption by the Open Health Tools (OHT) or Commercial Vendor Communities – Business Capabilities and/or Reference Implementation consumption 4

6. 5 9/29/2010 5 Scope and supporting characteristics The overall caBIG® Clinical Information Suite project has defined core scope elements and characteristics for meeting short-term goals and realizing long-term goals and success criteria: Research/Treatment Setting – Focus on oncology research and care delivered in an ambulatory setting Business capabilities – Address only oncology-specific capabilities that yield high value and/or describe interactions that need to be specified for business capabilities Deployment Scenarios – Scope to be informed by deployment at several community cancer centers (NCCCP sites) Standards – Focus on relevant set of standards necessary for effective, integrated oncology- extensions 5

7. 6 9/29/2010 6 Deployment Support for caBIG® Clinical Information Suite Role of the Deployment Team Determining and planning how a site can adapt, adopt and share data Providing a feedback loop from the sites to overall requirements activities Driving successful market penetration of oncology extensions by collaborating with vendors of EMR/EHRs Supporting, in a wide range of roles, the execution of site deployment 6 Objectives of the Deployment Team Demonstrating how oncology-extended services can best serve the complex needs of oncology settings through: Adapting oncology extension services by integrating or deploying the service specifications into an existing (defined) environment Adopting an oncology-extended EHR by adoption of the service specifications and reference implementation in concert with an EHR platform implementation

8. 7 9/29/2010 7 Deployment Approach

9. 8 9/29/2010 8 A Readiness-based Assessment Approach Develop a baseline model for assessing the site-level feasibility of each deployment option The baseline will define the requirements to successfully execute a given deployment option The Deployment team will be primarily an outward facing team and the bulk of our activities will involve: – Processes – Personnel – Technology – Organizational structure 8

10. 9 9/29/2010 9 Deployment Approach Process: – Understanding current procedures and the development of new procedures to be used during and after the implementation are critical success factors – In a phased implementation, procedures will change several times. We will prepare adopters for such changes from inception to avoid any surprises – We will integrate site specific business workflows into the training process for the new oncology extension service

11. 10 9/29/2010 10 Deployment Approach People: – Leadership from all departments that will use/integrate with oncology extensions must participate and bring their expertise to the process – Deployment should be led by clinical staff – A “core team” must be assembled to make decisions, provide direction and ultimately be responsible for the success – Training, education and communication with staff are critical success factors – Provide single point of contact for site – Customer Relationship Manager 10

12. 11 9/29/2010 11 Deployment Approach Technology: – Operations workflow and processes will be the key drivers supported by technology – Work with Billings Clinic’s infrastructure group to ensure oncology- extended EHR technology aligns and integrates with enterprise systems and solutions 11

13. 12 9/29/2010 12 Deployment Process & Engagement with the Billings Clinic Cancer Center

14. 13 9/29/2010 13 Keys to Successful Deployment Smaller and targeted discussion around readiness and needs Precise and agreed upon definitions of Billings Clinic’s deployment options Detailed deployment test use cases/scenarios for the selected deployment option Focus on critical gaps in IT systems for oncology care that are addressed by caBIG® Clinical Information Suite Focus on achievable milestones Identify interim goals that can be achieved successfully, early in the project 13

15. 14 9/29/2010 14 Deployment Process – Slide 1 Requirements and Planning – Site business process mapping (can use prior documentation if valid) – Document site specific requirements – Develop deployment scenarios and map to business process map – Deployment team is the site’s advocate on the project – Deliver and review use cases and site-specific requirements for final review with site Readiness Assessment – Capabilities (Process, People and Technology) – Review of assessment with site 14

16. 15 9/29/2010 15 Deployment Process – Slide 2 Site Deployment Plan and Architecture – Define deployment architecture for IT systems – Specify integration of systems with oncology-extended EHR – Data Sharing Plan and Architecture – Deliver and review site integration and deployment plans with site for final input and approval 15

17. 16 9/29/2010 16 Deployment Process – Slide 3 Deployment – Confirm infrastructure – QA and testing with site Beta Test User Acceptance Testing – Training – Support – Go-live – Production and on-going support The Deployment team will work with the site through each step and be on-site to support throughout the process

18. 17 Adaptation Deployment Options OptionDescriptionBenefitsNeeds Specification Adaptation Integration of service specifications into existing EHR platform Seamless integration of oncology extensions into homogenous system Long term vendor support Process redesign, training and change management are part of overall EHR management Committed vendor relationship and support Homogeneous EHR environment Standalone Services Adaptation Oncology services are deployed independently from an EHR Less impact on personnel and non-IT resources Timelines can be shorter Process redesign, change management and training only needed for given services Technology environment that can support independent modules Services-oriented IT systems Bolt-on Services Adaptation Extension modules “bolted-on” to existing EHR platform(s) via interfaces Requires less vendor support and doesn’t require system reconfiguration Provides oncology extension into existing IT environment Supports integrated patient record with oncology extension Interface and data mapping activities can be complex Change management, process redesign, training extends beyond oncology extension 9/29/2010 17

19. 18 Adoption Deployment Options OptionDescriptionBenefitsNeeds Reference Implementation Adoption Deployment of reference implementation EHR with associated oncology extensions Open source EHR reduces reliance on vendor support for long term support Oncology extensions tightly integrated with reference implementation Suite of oncology extensions in process of development Can manage EHR environment to directly meet site needs Technology support in long term is managed by the facility Significant change management, process redesign and training needs Adequate site level IT support and resources Site level resource intensity can be high 9/29/2010 18

20. 19 9/29/2010 19 Partnership with the Billings Clinic Cancer Center Listen Understand Communicate Help to improve oncology workflow with oncology extensions Help to support improvement in patient care 19

21. 20 9/29/2010 20 Wrap Up – Next Steps Questions Breakout sessions 20