of Workstation Single Sign-On George A. Gellert, MD, MPH, MPA - - PowerPoint PPT Presentation

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of Workstation Single Sign-On George A. Gellert, MD, MPH, MPA - - PowerPoint PPT Presentation

Mar 25, 2024 313 likes •593 views

Clinical Impact and Value of Workstation Single Sign-On George A. Gellert, MD, MPH, MPA Associate CMIO, CHRISTUS Health San Antonio, Texas The Challenge: Providers using EHRs must maintain the security of protected health information and

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Clinical Impact and Value

  • f Workstation Single Sign-On

George A. Gellert, MD, MPH, MPA Associate CMIO, CHRISTUS Health San Antonio, Texas

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The Challenge:

  • Providers using EHRs must maintain the security of protected

health information and HIPAA compliance

  • What makes passwords effective – complexity and frequent

change – also makes them difficult to remember

  • Clinicians often must recall/regularly refresh 8-20+ passwords
  • Time lost by clinicians entering multiple passwords and

resetting them when forgotten diverts from patient care

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The Solution:

  • Single Sign-On (SSO) facilitates clinicians’ use of EHR technology,

including CPOE and digital documentation

  • Provides clinicians expedited access to EHR and clinical

applications; eliminates password confusion and time wasted in password management; enhance info security via authentication

  • Once logged in, clinicians need only tap or swipe enabled ID

proximity badge on workstation card readers

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  • Across hospital, “tap and go” enables users to pick up exactly

where left off -- conveys rapid access to EHR/other functionality as location changes

  • When clinician changes workstation, tap on badge reader

brings most recent screen used to new screen

  • SSO automatically locks workstations when care providers leave

and re-authenticates when return

  • Eliminates need to manually lock sessions or (unreliable)

inactivity timers; prevents loss of work; reduces repetitive, manual logins

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  • Expedites authenticated access to clinical applications used

during a 12 hour shift, after which usual login must be repeated to enable another cycle

  • SSO provides support for all types of applications including

terminal, client server and cloud-based applications

  • Password administration enables automated application

password change, eliminating this task for clinicians

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Impact Evaluation Methods:

  • Quantitative evaluation of SSO impact in 6 CHRISTUS Health
  • hospitals. CH is a mid-size IDN in 6 U.S. states & 4 nations; > 350

services, 50 hospitals, 15,000+ physicians

  • EHR = MEDITECH Client Server Version 5.67 (also 3 others)
  • SSO product = Imprivata OneSign Version 5.1
  • Reports on clinician SSO use: # deployed users; # active users;

# logins; frequency of app access; average logins/user; average application events/user

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  • Required migration from workstation PCs to a thin client and

Cloud processing

  • Migrated to a virtual desktop infrastructure (VDI) to enable

clinician roaming across service lines

  • 45 clinical software applications profiled and enabled
  • SSO provided to MDs, RNs, mid-levels and roaming ancillary
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SLIDE 8
  • 7 day observation period of SSO usage in May 2016
  • Measured mean login duration to workstations pre-SSO and

compared to post-SSO implementation

  • Post-SSO involved 2 logins: 1st login of day to desktop (slightly

longer time than pre-SSO) and subsequent EHR logins using card reader/swipe technology (less time per login than pre-SSO)

  • Mean login durations were multiplied by # of total initial and

subsequent logins

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  • Assessed total time required for clinicians to login pre- and post-

SSO; quantify benefit from decreased clinician login times

  • Utilized national median hourly pay rates to translate hourly/shift

time savings into dollar/cost savings for:

  • MDs
  • RNs
  • RTs
  • PTs
  • Dieticians
  • Estimated cost savings by replacing PC hard drives with thin client
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Results - Saved Time Analysis:

  • There were 65,202 logins to the enterprise EHR by clinicians in 6

facilities over a 7 day period post-SSO

  • Potential 5078 SSO clinical users; 2256 active users (44.4%)
  • Pre-SSO, manual keyboard login required 29.3 seconds = a total

530.7 hours of clinician login time (over 7 days assessed)

  • First of shift is 2 step login: access to Windows desktop required a

mean of 30.1 seconds, then 4.5 seconds to EHR; total = 34.6 seconds

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Results - Saved Time Analysis:

  • Post-SSO - 12,936 first of shift logins (at 34.6 seconds each) = 124.3

hours of clinician first login time over 7 days

  • Over 12 hour shift, clinician reconnect to EHR required 16.4 seconds

per login = a reduction of 12.9 seconds from pre-implementation

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Results - Saved Time Analysis:

  • No. subsequent clinician logins was 52,266 = total of 238.1 hours of

reconnect time to the EHR over 7 days

  • Total post-SSO clinician login time over 7 days is sum of initial login +

subsequent login hours = 362.4 hours total

  • Reduction of clinician login time over 7 days was 530.7 hours pre-

minus 362.4 hours post-implementation

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Login Performance Parameter Frequency Cost Savings

Total number logins to enterprise EHR over 7 days (6 hospitals) 65,202 Active clinical users of Single Sign-On (6 hospitals) 2256 Mean pre-SSO manual keyboard login total time required per facility (7 days) 88.5 hours [7.4 shift equivalents] Mean post-SSO clinician login time per facility (7 days) 60.4 hours [5.0 shift equivalents]

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Results - Saved Time Analysis:

  • A gain of 168.3 hours of clinician time liberated over 6 hospitals (or

14 shifts of 12 hours)

  • Equals 28.1 hours (2.3 shifts) per facility per week
  • Per annum, 1461.2 hours or 121.8 shifts of mixed clinician time

liberated per facility

  • First phase implementation of 18 hospitals will yield 2192 shifts or

26,302 hours of clinician time saved

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Login Performance Parameter Frequency Cost Savings (USD)

Mean post-SSO reduction in clinician login time per facility (per week) 28.1 hours [2.3 shift equivalents] Mean post-SSO reduction in clinician login time per facility (per year) 1461.2 hours [121.8 shift equivalents]

$ 92,146

Expected total post-SSO clinician login time savings when 18 hospitals implemented (per year) 26,301.6 hours [2191.8 shift equivalents]

$1,658,745

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Results – Financial Analysis:

  • Calculated the dollar cost savings of time for 3 clinician categories –

MDs, RNs, ancillary (PTs, dieticians and RTs)

  • 28% of users were MDs, 54% were RNs, and 18% ancillary
  • For RNs, used national average hourly wage = (USD) $34.50
  • Collapsed PTs, dieticians and RTs into a single category, average

hourly wage = $32.20

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Results – Financial Analysis:

  • Estimating MD hourly wages complex, income varies by specialty
  • Divided MDs into 4 groups of highest EHR users issuing greatest

volume of orders thru CPOE: hospitalists; EM physicians; general surgeons; all other MDs collapsed

  • Estimated each group = 25% of EHR/applications use, thus SSO use
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Results – Financial Analysis:

  • Used multiple MD specialty wage estimates: US Dept Labor,

Becker’s Hospital Review, Salary.com, Medscape Physician Compensation Report

  • Hourly mean wage of USD $108 for hospitalists, $144 for EM

physicians and $170 for general surgeons

  • Averaging hourly wage of 4 categories = generic physician hourly

wage of USD $138 -- conservative estimate

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Results – Financial Analysis:

  • Mean reduction in clinician login time per facility per year (1461.2

hours) translates into facility savings (value of clinician time liberated) = $92,146 USD per year, per facility

  • When 18 hospitals have SSO, 26,301.6 hours of clinician time saved

will produce a recurrent enterprise annual savings of $1,658,745

  • If underestimate by 10% savings = $1,824,620; if by 20% savings =

$1,990,495

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Login Performance Parameter Frequency Cost Savings

Mean post-SSO reduction in clinician login in time per facility (per week) 28.1 hours [2.3 shift equivalents] Mean post-SSO reduction in clinician login time per facility (per year) 1461.2 hours [121.8 shift equivalents]

$ 92,146

Expected total post-SSO clinician login time savings when 18 hospitals implemented (per year) 26,301.6 hours [2191.8 shift equivalents]

$1,658,745 (all USD)

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Professional Category Percentage of All SSO Users [Annual Hours Liberated 8 Facilities] Estimated Hourly Wage Annual Value of Liberated Time/Cost Savings Per Facility Annual Value

  • f Liberated

Time/Cost Savings 18 Facilities Physicians (Hospitalists, Emergency Medicine Physicians, Surgeons and all others) 28% [7364.5 hours] $138.00 $56,456 $1,016,301 Nurses 54% [14,202.9 hours] $34.50 $27,222 $490,000 Ancillary (Physical Therapists, Dieticians and Respiratory Therapists) 18% [4,734.3 hours] $32.20 $8,469 $152,444 All Professional Categories 100%

  • $92,146

$1,658,745 (all USD)

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Results – Financial Analysis:

  • Migration to WYSE devices achieved savings in averted new PC

purchases

  • Estimated USD $2.7 million over next 4 fiscal years ($675,000/year)
  • Estimate the net total cost of SSO implementation approximately

$700,000 (including WYSE device virtualization, but excluding other system elements already in place or serving other utilities)

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Results – Financial Analysis:

  • Annual maintenance cost for SSO is $219,000
  • With savings rendered by SSO in clinician shifts at $1,658,745 per

annum, additional savings on new PC purchases brings the annual total recurrent savings to USD $2,333,745 across 18 facilities

  • SSO has achieved a substantial recurrent annual ROI, value delivery

and net cost savings to our hospital system

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Results – Other:

  • SSO has been a strong “clinician satisfier” - clinicians report SSO

enabled them to focus attention on patient care rather than IT

  • Clinicians reported high satisfaction with the improved ease/speed
  • f access to clinical workstations and applications
  • SSO can facilitate physician EHR adoption: Our implementation of

digital documentation overlapped with SSO; physicians reported SSO enabled adoption of documentation and made CPOE use easier

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Conclusions:

  • SSO is an effective & cost-effective method to liberate clinicians

from repetitive, time consuming logins to clinical applications

  • SSO = significant and meaningful savings of clinician time and

improvement in clinical workflow, clinician efficiency and productivity in these 6 hospitals

  • SSO recommended in hospitals where clinician use of EHRs is

substantial, and where clinical workflow involves substantial facility roaming

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Conclusions:

  • SSO can save time, improve security, reduce IT equipment costs

and increase clinician productivity and satisfaction in today’s complex healthcare organizational workflows For further information, please contact: ggellert33@gmail.com