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

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 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

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

 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

 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

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

 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

 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

 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

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

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

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

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

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

Login Performance Parameter Frequency Cost Savings (USD) Mean post-SSO reduction in clinician login 28.1 hours time per facility (per week) [2.3 shift equivalents] Mean post-SSO reduction in clinician login 1461.2 hours $ 92,146 time per facility (per year) [121.8 shift equivalents] Expected total post-SSO clinician login 26,301.6 hours $1,658,745 time savings when 18 hospitals [2191.8 shift equivalents] implemented (per year)

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

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

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

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

Login Performance Parameter Frequency Cost Savings Mean post-SSO reduction in clinician login 28.1 hours in time per facility (per week) [2.3 shift equivalents] Mean post-SSO reduction in clinician login 1461.2 hours $ 92,146 time per facility (per year) [121.8 shift equivalents] Expected total post-SSO clinician login time 26,301.6 hours $1,658,745 savings when 18 hospitals implemented [2191.8 shift equivalents] (per year) (all USD)

Professional Percentage of All Estimated Annual Value of Annual Value Category SSO Users Hourly Wage Liberated of Liberated [Annual Hours Time/Cost Time/Cost Liberated Savings Per Savings 18 8 Facilities] Facility Facilities Physicians 28% $138.00 $56,456 $1,016,301 (Hospitalists, [7364.5 hours] Emergency Medicine Physicians, Surgeons and all others) Nurses 54% $34.50 $27,222 $490,000 [14,202.9 hours] Ancillary 18% $32.20 $8,469 $152,444 (Physical Therapists, [4,734.3 hours] Dieticians and Respiratory Therapists) All Professional 100% -- $92,146 $1,658,745 Categories (all USD)

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)

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