Case Study: For WellSpan Health,

It’s ITIL To the Rescue

By Phil Britt

Wellspan health, an integrated health care system serving two counties in southeastern Pennsylvania, started moving to a system of electronic health records nearly 15 years ago as part of its evolution from a hospital-based healthcare provider to a multi-point supplier of medical services.

WellSpan was expanding from a single hospital to a system that included a hospital, a medical group (of doctors), a home health agency and a retail hospital.

The early foray into digitizing patient information helped WellSpan better manage its growth in the mid-1990s and has since led to silos of information among its burgeoning system. WellSpan now includes two hospitals with a total of 614 beds, six retail pharmacies that fill more than 400,000 prescriptions each year, 10 outpatient health centers, 47 primary care and specialty physician practices and a home health and hospice provider, each with its own silo of information regarding processes, within information services, applications, technology and operations. WellSpan also works closely with third-party referral services, further exasperating the problem.

While the increasing technology throughout the health care system provided better efficiencies, it also caused some unnecessary headaches for the information services team. Every time a system needed to be replaced or updated, the project had to start from scratch, even if a similar project had taken place in another location within the WellSpan system, meaning duplicated expenses and time delays.

With declining budgets hitting the health care industry, including WellSpan, it was necessary to eliminate this waste of resources. Another driver was the 2009 federal stimulus package, which promises $30 billion in funding for health care providers making “meaningful use” of electronic health records. WellSpan is ahead of the curve of implementing electronic medical records, according to William “Buddy” Gillespie, WellSpan vice president and chief technology officer. He says WellSpan sits between 5 and 6 on a seven-stage level of electronic health records implementation achievement on a scale established by the Healthcare Information and Management Systems Society (HIMSS).

“We needed a common set of practices for our implementations,” says Gillespie. “It was too expensive. We wanted to be proactive rather than reactive.”

ITIL to the Rescue
They decided that The Information Technology Infrastructure Library (version 3.0) (ITIL) would provide the centralized implementation knowledge base that WellSpan sought. ITIL offers a systematic best practice approach to the delivery of cost effective and quality IT services.

“We wanted to standardize our service delivery, beginning with incident management,” says Gillespie, explaining that the goal of ITIL is providing service in a way that IT customers across the organization should not recognize a difference in engagement, delivery, commitment or quality between different information systems teams. The plan was for ITIL to enable information services to have quicker and more seamless engagements throughout the WellSpan organization, be it in biomedical, home health services, retail pharmacies or even outside partners.

ITIL service level management includes inquiries from customers, project reports and updates from IT, with details on information security management; availability management, capacity management, IT financial management and IT continuity service management. Customers and users report all IT project information, including questions, requests, difficulties, workarounds, incident status and updates, service reports, audit reports, schedules of changes and similar information through the configuration management database (CMDB).

In mid-2008, WellSpan’s manager of operations production quality took ITIL training, with additional staff following, so that now the health care organization has 25 ITIL-trained staff and executives.

Implementation Process
The idea was to start small to ensure that the ITIL implementation and use delivered the promised benefits rather than just being a waste of time and resources. The first step was to establish a change advisory board, then educate the staff and select a CMDB toolkit.

The ITIL-based service delivery included four main components: the service catalogue, operational level agreements, underpinning contracts, service level agreements and CMDBs.

The service catalogue includes a listing of services provided to the customer. Many application catalogue entries encompass entire application “platforms.” The operational level agreements between the respective informational service areas were necessary, Gillespie explains, because “we must be able to commit to each other before committing to the customer.”

Operational level agreements provided the foundation for building service level agreements (SLAs), which came with penalties for non-compliance in order for the contracts to be effective.

To ensure that SLAs and operational level agreements met their goals it was important to include ROI measurements, according to Gillespie. Among the measurements he recommends are average turnaround time, total number of daily projects, customer surveys, customer service follow-up action plans, change order management and update expectations.

“You need to make the processes work for you,” Gillespie says, explaining that WellSpan had to understand its own procedures, handoffs and current status of processes, using these tools for continual service improvement. In order to implement ITIL, WellsSpan needed to have a common understanding of service processes.

WellSpan also designed “swim lanes,” a flow chart including different “lanes” and flows for customers, IT operations, managers and executives as well as the interconnections between these different lanes and how they flow together.

Success of the ITIL implementation was measured by looking at technology metrics, process metrics and service metrics. The technology metrics included data center utilization compared to total capacity for items like server racks, cooling, electrical distribution and UPS power; forecasting and improvement analysis.

Process metrics included the percentage of jobs done manually, those that were cancelled or failed and degrees of compliance and quality. Service metrics also looked at time to deliver.

ITIL Payoff
Though there are measurements within ITIL to ensure that specific projects are meeting goals, some of the benefits of the overall ITIL implementation are difficult to measure or haven’t fully been measured yet, according to Gillespie. But even without solid metrics to back it up, it’s easy to see that ITIL is already providing benefits, even with its limited implementation to date. Trouble tickets are being handled much more quickly. The time to provision a server has dropped from months to days.

The biggest payoff will be the continued march to level 7 of the HIMSS ratings, ensuring that WellSpan meets the stimulus fund rules for meaningful use of electronic health records.

Looking Ahead
WellSpan’s ITIL implementation is still a work in progress, Gillespie admits. He wants to approve and implement the updated OLA documents, including the on-call policy and common expectations for information services.

Gillespie expects WellSpan to derive more benefits from ITIL as the implementation becomes more fully integrated within the organization. The next steps will be to continue to expand ITIL foundation training. Gillespie also plans to collaborate with the finance department on establishing ITIL financial management best practices for the health care organization and on integrating ITIL best practices with WellSpan’s project management office.

Gillespie recommends that other organizations looking to implement ITIL educate and get buy-in from the staff, and, like WellSpan, approach ITIL in incremental stages, rather than trying to fully implement it across the enterprise all at one time.