Cleveland's University Hospitals Health System (UHHS) is ambitious and profitable with a billion-dollar plan to expand over a five-year period. UHHS gives credit for its positive turnaround to its leaders, who are running the major health system like a competitive enterprise. According to UHHS' Vice President of Transformational Strategies Liz Novak, a key decision was to select Oracle as the strategic partner for corporatewide business systems. UHHS also decided to standardize on Oracle E-Business Suite running on the Solaris Operating System. Another strategic move was to consolidate the UHHS IT staff and to outsource IT operations. The benefit of this move is that the 170-member IT staff is now managed and paid by a firm whose expertise is in IT service rather than healthcare. Read how UHHS continues its successful results with its recent introduction of Oracle Employee Self Service, as well as plans to improve its business processes by integrating an Electronic Health Record with its Oracle infrastructure.

As Published In August 2006

Healthy and Lean
By Jeff Erickson

A regional healthcare delivery system performs like a Lean enterprise.

Managing a major healthcare system can feel less like running an enterprise than governing a bunch of independent states. That's what the new leadership found when it took over Cleveland, Ohio's money-losing University Hospitals Health System (UHHS) in 2002. UHHS spent the next three years shuttering outdated facilities, shedding unprofitable lines of business, and standardizing business processes across the entire organization. Today, UHHS is profitable and ambitious, with a US$1 billion expansion planned over the next five years.

"When we started the turnaround process in 2002, we asked ourselves, 'What if we run this institution like a competitive enterprise?'" says Liz Novak, UHHS' Vice President of Transformational Strategies, who reports directly to the CIO. "We wanted to take the fact that we were in the healthcare business out of the equation and implement industry-agnostic best practices whenever feasible."

That was easier said than done. UHHS is northeast Ohio's largest network of physicians' offices, outpatient centers, and hospitals. The system employs more than 14,500 people—from parking attendants to heart surgeons—and has been developing business processes piecemeal throughout its 140-year history. "Our hospitals had disparate business systems, process inefficiencies, data integrity issues, and redundant resources," says Novak. "We employed nearly 300 IT specialists across the organization, and yet most of our processes were paper-based."

Choose Partners, Reduce Complexity

Snapshot University Hospitals Health System www.uhhs.com Employees: 14,500 Oracle products and services: Oracle E-Business Suite 11i, including General Ledger, Accounts Payable, Accounts Receivable, Fixed Assets, iExpenses, Property Manager, Human Resources, Advanced Benefits, Training Administration, Payroll, iRecruitment, Manager Self Service, Employee Self Service, Grants, Labor Distribution, iProcurement, Purchasing, Order Management, and Inventory; Oracle9i Database; Oracle Discoverer Other products and services: Sun Solaris Operating System; Sun Fire V480 servers for administration and backup, Sun Fire E6900 servers for production database and testing environment, Sun Fire V880 server for production reporting and application server, Sun StorEdge L100 tape library

"One of the first things we did was select strategic partners and commit to leveraging the technology of those partners to create less complexity in our environment," says Novak. UHHS chose Oracle as its partner for corporatewide business systems and standardized on Oracle E-Business Suite running on Solaris.

Next, Novak and the Oracle implementation team worked with UHHS business owners to improve business processes one by one, streamlining and educating as they went. They have been wildly successful. UHHS went live on Oracle E-Business Suite 11i in April 2003. Jason DeSantis, director, Business Systems group, took on a leadership role for the Oracle support team at UHHS in 2004 and, by May 2006, had 19 Oracle applications in production, including Financials, Human Resources (HR), and Procurement. "We continue to try and redefine business processes and implement them as they are done in a competitive enterprise, which is how they are handled within Oracle," says DeSantis. "That can be a challenge in a healthcare provider organization."

As UHHS took complexity out of its IT infrastructure, the company was able to consolidate its IT staff. Then, in another bold move, UHHS shifted the entire IT department to an outsourced IT company, First Consulting Group. "Every IT function in the organization, such as field engineering, help desk, network, LAN, and all application support, including business systems and clinical applications, are all supported by 170-plus employees of the First Consulting Group," says DeSantis. "Many of us have our same desks at UHHS that we did before the shift, but now we are managed and paid by a company whose expertise is IT service, not healthcare."

"We have a team of 16 responsible for support, maintenance, and enhancements of the Oracle Applications environment. I am proud of the fact that this team handles all application and database upgrades internally," says DeSantis. "We have not had to engage external resources to assist with upgrades." In 2005, the Business Systems group upgraded the database to Oracle9i and the applications to Oracle's latest version, Oracle E-Business Suite 11.5.10.2, saving the organization more than US$500,000 in professional services expense. This team is also responsible for the support of more than 200 application interfaces for everything from HR to finance to order processing, as well as more than 300 custom reports for those lines of business.

Surveying Health Information Network Readiness Oracle is on track for the National Health Information Network. President Bush's 2004 call for a National Health Information Network (NHIN) by 2010 set technology providers jockeying for position to supply the underlying technology, and Oracle has been at the forefront. When the U.S. Department of Health and Human Services (HHS) sent a Request for Information (RFI) for technical and business advice regarding the establishment of an NHIN, Oracle joined IBM, Microsoft, CSC, Accenture, Intel, and Cisco in a consortium to provide detailed answers. The consortium members agreed on an interoperable standard that Oracle has been using in its Oracle Healthcare Transaction Base for nearly five years. In 2005, when HHS issued a Request for Proposals (RFP) and awarded four major pilot projects, Oracle won two. Surveying the Landscape "We're going to be putting a lot of time, resources, and energy into developing an interoperable Electronic Health Record [EHR] infrastructure for the NHIN," says Mychelle Mowry, Oracle's vice president of strategy and marketing for health industries. "We thought it was wise to review the market and ask some basic questions regarding the viability of NHINs and Regional Health Information Organizations (RHIOs). "We're trying to understand for ourselves where the EHR is, relative to implementations: who is working on current projects, who is championing them, and furthermore how many provider organizations are actually involved with the National Health Information Network," Mowry says. She and her team received 364 completed surveys from a variety of health provider organizations. Key Findings The vast majority of healthcare providers plan to implement EHR systems, project multiple resulting benefits, and plan to engage in RHIOs. Providers express confidence in the nation's ability to meet HHS' EHR implementation timelines, however . . . . . .the majority of providers report less optimism or no change in optimism about America's EHR transition prognosis for 2006. IT issues are cited as major stumbling blocks to EHR implementations. Providers recommend incentives to encourage increased EHR adoption.

Introduce Self-Service, Web-Based Technology

A recent success for DeSantis, his team, and UHHS HR was rolling out Oracle Employee Self Service to 14,500 healthcare employees. "We took a pilot group of about 1,000 people with various skills, from a cafeteria employee to a physician, and asked them to use the Web-based system to check their pay stubs, make a demographic change, and enroll in benefits. We asked them for feedback after they used the system for a month or two," says DeSantis. "We took that feedback and enhanced our training and made improvements to the application."

The Oracle Employee Self Service project team set up a series of open-door auditorium learning sessions at its main campus and community hospitals, and followed up with additional training opportunities and reminders. "We did online Web-based training instead of complex manuals to walk someone through a business process," says DeSantis. "We developed easy, video-based lessons for specific components of a transaction. So if you want to change your address, there's a specific video called Change Your Address that you can click on. Instead of a manual or a half-hour video, it's a 10-second clip you watch immediately before processing your transaction."

DeSantis and his team made the application and the video clips externally facing so employees could get into them from their home computers. And because not everyone has access to a computer, they rolled out computer kiosks across the organization to accommodate all employees. "As we continue to aggressively expand the Oracle Applications footprint at UHHS, the organization bears additional weight because we're not simply moving from one application to another one," DeSantis says. "We're introducing Web-based application technology to formerly paper-based processes."

Tailor Enterprise Applications for a Clinical Audience

"Not surprisingly, most of our managers are clinically focused," says DeSantis' partner, Mike Kelly, divisional information officer and one of the few IT strategists retained within UHHS to manage business systems application strategy. "Clinicians do not enjoy going into an application if it's not directly helping them provide care for patients, and because our Oracle applications are not clinical in nature, many of our employees are only 'casual' users who require a longer time to become proficient. This can lead to user dissatisfaction and frustration when trying to query the system for information."

The solution that Kelly and DeSantis envision is to push information instead of asking front-line staff members to pull it. "Our vision is that a nurse manager will be able to enter his or her user ID and password into Oracle and get a series of metrics that have already been generated and loaded onto a dashboard," says DeSantis. "It won't be necessary to log in to the application and run six reports to get data. It will be right there upon logging in. The user does a onetime setup, and it's a done deal."

Integrate Enterprise Applications with Healthcare-Specific Applications

As UHHS maintains its healthcare-specific applications, such as patient billing and patient financial systems, and moves forward with an Electronic Health Record (EHR), it will continue to improve its business processes by integrating them with its Oracle infrastructure to improve business intelligence and financial reporting. "The EHR is a very significant investment. We're looking at four to five years for an enterprise rollout. We do have a computerized clinician/physician order entry system at our main academic medical center, but it is in need of replacement," says Kelly. "The EHR will provide our clinicians with a state-of-the-art, fully integrated clinical information system and standardize our clinical processes across the enterprise. The experiences we gleaned from our enterprise Oracle rollout will be invaluable and leveraged during our EHR implementation."

Moving Forward

For More Information Oracle Solutions for Healthcare Oracle E-Business Suite

Standardizing on enterprise applications from Oracle has helped UHHS make a financial turnaround in several ways. It took complexity out of its systems and allowed the company to streamline IT staff. It also gave leadership a better view of the enterprise to help with difficult business decisions, and gave them a platform on which to improve business processes across the enterprise. "The decision to implement Oracle came at a time when UHHS was running in the red," says Kelly. "Oracle helped us bring the system together to gain economies of scale and other efficiencies. We've squeezed cost out of this system. Now we're ready to focus on growth."

DeSantis agrees. "Liz Novak brought the organization live on Oracle in April 2003 and created the infrastructure. The Business Systems group has maintained that momentum and continues to partner with business leaders to aggressively expand the applications footprint," he says. "I am very passionate about UHHS' continued success in leveraging Oracle technology."