Usage + Extension (Mtg Notes)

Document created by swmorley on Jun 21, 2019Last modified by swmorley on Sep 20, 2019
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Action Items


Action ItemWhoDue
Share your organizations app:service mapping or review existing mappings and provide feedbackAll

Talk with your leaders (Lab, Pharmacy, Imaging) to determine what data would be most helpful in a first pass survey for each area. 


9/19 (Thursday)




White Paper


Win / Story
MCIS using the app:service mapping as business asks for more apps they're able to reference the list and say "we already have 3 of those."



Ongoing Notes


  • Next Meeting - 9/20 @ 11 AM (MT)
    • Discuss how organizations should use the app:service mapping to rationalize apps (steps to take) (is this the deliverable?)
      • Maybe we should list out all of the uses of this mapping - why use it
      • Maybe a 1 - 2 pager, descriptive of how we are using it then discuss with the workgroup - what should we do next year? 
    • Finalize survey questions
    • (If time) Talk about discussion topics for TBM Conference workgroup meeting in November.
      • How are they finding value in the tool
      • Email to the workgroup
  • App to Service mapping
    • Steve M. to hear back from Todd Tucker on who can help support this moving forward (vendors, etc.)
      • Follow-up with this
    • Have feedback from 4 organizations thus far.
    • Next steps are to develop use cases and develop out the "now what?"
  • Metrics


The Ask - check with your Pharmacy, Lab and Imaging leads to determine what the 1st level of questions they'd like answered would be if we fill this survey. Also, what information can they actually provide?

Next time we'll finalize and get the survey out. 


  • Survey - Who has $$ at this level? Can you break it down by Tower? Scope - Lab, Imaging, Pharmacy
    1. Total # of staffed beds (beds / $$ EHR)
    2. APD (Jan - June 2019 ?) (by location or type...acute (IP), ambulatory (OP), home health)
    3. Total # of Lab Orders (Jan - June 2019 ?)
    4. Average time to turnaround Lab order
    5. Total # of Imaging studies completed (not ordered)
    6. Total # of prescriptions filled (?)








Prior Notes


July 9th Agenda 

Attendees: Brad, Steve, Sara, Brad N., Tom, Gerrick, Paul


Areas to focus on:

  • Rationalization across the board
    • How to use the taxonomy to assist with this?
      • Mapping to app list?
      • Starting point for rationalization - make it tangible for those going through the process
    •      Create a list of all applications (inventory)

      a.       How:

      a.       Start with what is known in as many sources as can be identified.

      b.       Cannot just send a spreadsheet and expect others to document applications

      c.       Must meet with server teams, infrastructure teams, finance teams, etc.

      b.       Advice:

      a.       There is no easy button

      b.       You just have to do it

      c.       It won't be perfect

      2.       Assign each application using the taxonomy (categorize)

      • Next step to start a document where we can begin sorting through what organizations have currently done

      a.       How:

      a.       Assign to the service name or service category; do not assign just to service type if at all possible

      b.       Sometimes the service offering is used if the offering is defined at the lower level

      c.       Can use keywords for things that go beyond the service/taxonomy, which primarily aids in searching

      d.       Make assignments using what is known in IT - look up invoices, google the applications, figure out the vendor, categorize based on what you know.

      b.       Advice:

      a.       The business isn't going to care about being involved in this work; you will get validation later during rationalization if things aren't categorized correctly. The hook for the business is being able to use it, not working to create it.

      b.       Don't spend time trying to perfect it at this stage.

      c.       Getting everything assigned somewhere is the goal

      3.       Use a Cost Transparency tool to pull the application inventory and the taxonomy assignment together.

      a.       Advice:

      a.       Don’t map around this level/info - it is important to map through this detail

      4.       Rationalize

      a.       Gain credibility through fast, easy, transparent requests to support the business (pull from the business)

      a.       During capital request process - easily access applications of similar functionality/service name to prevent spend on a duplicate service

      b.       During business partner meetings - easily display to the business the volume of applications within the same service name or category. Many times they don't even realize they are paying for potential duplication.

      b.       Starting in areas with the greatest interest or passion for early rationalization, work on plans for proactive rationalization (push to the business)

      a.       Start in areas of highest overall cost or in areas of greatest potential for movement (heading into an RFP, transitions taking place with structure of the business, etc) and look for multiple solutions within those service name/categories

      b.       Discuss the value they are getting out of the application in light of other applications in the same service name or category

      c.       Rationalization doesn't always mean removal of applications - the act of reviewing and validating value and need is key

  • Lab (Brad)
    • Use Case - 
      • $$ / Unit per Lab procedure
      • TCO (interfaces, shadow costs)
      • Pre/post upgrade support costs (was the upgrade worth it?)
      • What will come - benchmarks, levers
    • What common metrics do we want to start compiling? Here is an initial list. (What if we focus on the top 10 from a $$ perspective)
      • Ask is to look at the list below, clean it up, prioritize and document what level we should go to for each 
      • - Number of Beds
        - Adjusted patient days
        - lab procedures (do we need to split this out, become more granular)
        - appointments
        - pharmacy scripts filled
        - radiology procedures
  • Telehealth (Steve M.)
    • Use Case -
      • Fixed vs variable to determine build/buy
      • Referrals from visits
      • P & L from a technology standpoint of each visit
    • Deliverable
      • White Paper on the power of technology in healthcare accompanied with people skill/knowledge (a true digital asset)
        • Cost savings vs in-person visit (comprehensive & just the technology cost to deliver)
        • Referral impact from outreach
        • Green initiative due to people not driving 
        • How technology has impacted clinical outcomes 
        • Other benefits to draw upon from our organizations (Marketing + Communication)
        • Simple P&L comparison of physical vs virtual visit - help show our organizations the power of technology and drive a conversation of how can do this in other areas?
      • Modeling Standards + Platform evaluation (build vs buy template & benchmarked costs)
        • Question: Is this just a package of End User Services? Yes, but combined with unique applications it resonates with the business and therefore is a unique service.
        • Dedicated versus shared components
        • Data used to differentiate what is used for Telehealth vs other. Next level would be to understand resources used for each patient encounter. From there, look at all resources to determine what is F vs V.
      • ·         Customers/patients

        ·         End points (this could be the telehealth units used within remote site clinics or mobile units such as mobile mammo or mobile primary care units or units deployed into businesses or homes)

        ·         Cost

  • EMR - customization, OOTB, how to better leverage resources (Paul)
    • Use Case - 
      • Optimizing Infrastructure consumption of EMR (does each instance drive value)
        • Perhaps some benchmarking at this level
      • $$ / unit of EMR (license beds, APD, system transaction, visits)
        • Need to be consistent across ambulatory/acute/homecare, etc.
      • Customizations - what is being asked for within EMR and is it tied to value add?
        • Rationalization within the EMR - cost, outcome, risk
    • May need/want to define what this is (standard definition) + how it's categorized



June 21st Agenda 

Attendees: Paul, Gerrick, Tom, Brad, Steve


  1. Introductions 
  2. What we hope to achieve –  
    1. For ourselves and others to see the possibilities of using the extension
    2. Increased adoption of the extension
    3. Seeing examples of the extension in use (show it in action)
      1. Ways to tailor and support conversations around why invest in TBM and how to help push TBM forward in our individual organizations
    4. Ways to measure business centric value, not just technology centric
  3. What use cases are of interest to you? 
    1. Benchmarks (what areas are of immediate need to your organization?)
    2. Service Consumption (providing more levers)
      1. $$ / unit (from an App + Service perspective) 
    3. Business Value KPIs
    4. Other Applications (org charts, application categorization, capability development, BRM alignment)
      1. FWIW, the one thing I planned to bring up today is that we're looking at adjusting the IT org chart to be more customer focused, and I'm trying to use the Services layer of ATUM including the Healthcare Provider extension as a starting point.  I'm guessing others are already organized along those lines - would be great to hear about benefits or challenges with this approach.
    5. Areas to focus
      1. Lab
      2. Cardiology
      3. Imaging
      4. Ambulatory / Acute ($$ / unit of ADP or some other measure)
      5. Pharmacy
      6. Research - looking at tail end of these research projects
      7. EMR Optimization - using the right infrastructure, how to better leverage these tools, how to represent this within the taxonomy
      8. Telehealth - fixed costs vs variable
      9. Preventive Care
      10. Home Care



Action Items

  • Discuss with your teams specific areas that would be of help to you & add them to this list hear.
  • List out potential measures for each area that we can discuss as a group to see what might fit best