Allina Hospitals and Clinics is an integrated delivery system located in the metropolitan area of Minneapolis and St. Paul, Minnesota. Allina owns four large metropolitan hospitals and seven small regional hospitals. It manages one hospital, with a total of 1,721 staffed beds. The system also owns and operates 76 single- and multi-specialty clinics.
In an effort to make changes and improve its operations, Allina took on three major systems implementations and process improvement efforts, starting from way back in the mid-1990s: 1) implementation of Eclipsys Corporation systems at its metropolitan hospitals for acute-care units; 2) revenue redesign to remove waste, reduce cycle time, streamline workflow, reduce duplication, introduction of technology, and reduction of process variation; and 3) implementation of the Logician medical records system (Thompson et al., 2006, p. 55). In 2002, Allina had $1. 8 billion in net operating revenues.
Between 1997 and 2002, Allina measured $20 million in increased contribution margin due to the three process improvement efforts undertaken. By 2002, benefits were reported to include annual savings of $640 per provider in charts forms and jackets, annual spending reductions of $3,000 per provider on transcription costs, and 50% reduction in staff who previously handled paper charts.
In June 2002, Allina re-evaluated its IT strategy in order to select an enterprise-wide, integrated architecture from a single clinical and revenue-cycle vendor. It completed a clinical IT strategic plan, and it sent seven vendors a scenario-based request for the vendors to submit proposals. Finally, Epic Systems was selected in January 2003 to help Allina in the implementation and benefits planning activities. An Automated Medical Record and Revenue Cycle Services (AMR/RCS) became one of the organization’s top priorities.
The entire hospital was prepped for implementation of the new system which was designed to provide new workflow designs for an identified potential cost savings of $60 million (Thompson et al, 2006, p. 55). This $60 million thus represents Allina’s end goal. The system to be implemented in Allina is called the advanced clinical information systems (ACIS), which includes computerized provider order entry (CPOE), CPOE-driven decision support, automated clinical documentation, electronic medical records, and clinical data repositories (Thompson et al., 2006, p. 54).
Medical institutions have begun using this application since it has the potential to improve clinical quality and patient safety, maintain and improve competitive position, reduce waste by improving integration and communication, improve efficiency and reduce operating costs, and prepare for future regulations acquiring systems such as CPOE or electronic medical records. Unfortunately, the problem with the system is that it lacks verifiable evidence on the expected benefits it can produce (Thompson et al. , 2006, pp.54-55).
This is why hospitals nationwide have been hesitant about purchasing ACIS. As is common with many benefits realization program, there is just not enough evidence to allow the organization to measurement the benefits they may receive from such an investment. A review of ACIS implementation and its impact on hospitals’ IT benefit realization efforts usually shows the following characteristics: weak justification, delayed timing, lack of integration with implementation, disorganization, and limited or no measurement.
According to the study, these five characteristics, described thoroughly below, are the typical weaknesses of many benefits realization processes and programs (Thompson et al. , 2006, p. 55): ? Weak justification This means the benefit estimates used to measure the benefits realization process are high-level and literature-based, usually supported by soft, non-quantified benefits like “It’s the right thing to do”. ? Delayed timing Benefits realization efforts begin only after implementation is complete. ? Lack of integration with implementation.
Benefits are not explicitly considered in system design. The disadvantage of this, obviously, is that people are not on the same page, and are often unaware about their responsibilities and importance of their contributions. ? Disorganization Benefits realization efforts are ad hoc, with each function or department responsible for identifying and realizing their own benefits, without structure from a formal organization or process. In other words, instead of a common goal for the entire organization, benefits are segmented per work group. ? Limited or no measurement.
Each function or department may measure their own benefits if they choose without consistent, ongoing reporting Fortunately, from the early stages of its ACIS implementation efforts, Allina has been very focused on achieving measurable benefits and in plugging the inherent weaknesses of the system. It developed five strategies for its benefits planning approach. A survey of 12 recent ACIS implementations shows that no other healthcare provider has adapted all the five strategies that Allina utilized, even though these five strategies are hardly unique.
The five strategies Allina used for its benefits realization process are as follows (Thompson et al. , 2006, p. 56): ? Organizing for Benefits Allina formed a benefits realization team whose formal responsibility includes analysis, education, facilitation, and measurement. ? Designing for Benefits Allina’s system design includes explicit consideration of what requirements are necessary to realize benefits. More importantly, Allina explicitly outlined the benefits it intended to achieve, thus allowing the system to design around it. ? Planning for Benefits.
Allina integrated cultural, organizational, and process change plans with system implementation plans. ? Measuring the Benefits Allina’s implementation efforts are biased toward quantification of benefits. The measurement framework they have in place matches the organizational reporting and a multi-level sequential analysis of benefit achievement. ? Accountability for Benefits Allina ensured that every anticipated benefit is assigned to an individual and an operating group, and system and hospital executives and department manages are held accountable for achieving benefits within their scope of responsibility.
Financial benefits are factored into yearly budgets. The strength behind Allina’s benefits realization process is that results, as well as the process of achieving them, are not limited within departments and work groups alone. While it is true that departments and operating units are directly accountable for benefits, Allina’s formal benefits realization function and its detailed work plan allows linkages to key groups of executives, operating staff, and technical experts.
In other words, the formal benefits realization function pulls the entire hospital or clinic together, creating a common goal that defines clearly the roles and responsibilities that each unit is expected to perform to achieve that goal. The formal benefits realization function also allows better coordination and optimization of benefits for each function, department, or unit in Allina. This makes for a more rigorous and focused approach to benefits realization within the organization, and allows for a greater understanding and vision on the expected benefits for the entire organization (Thompson et al. , 2006, p. 56 & 61).