University of Michigan Health System

Michigan was looking for a fully integrated solution to collect & manage data for more than 1,200 medical residents, across 88 residency training programs & fellowships.

The Challenge

In 2002, The University of Michigan Health System began looking for a comprehensive residency management solution to address the increasing regulatory pressures related to training program management and physician training. On a completely separate path, what was to become MedHub was being developed within the University of Michigan Department of Surgery.

Working with Assistant Professor of Medical Education Paul Gauger and Assistant Director of the Integrated Surgery Education Program, Janice Davis, MedHub evolved from a collaborative web-based scheduling system to a robust residency management system. The fact that MedHub was partly developed within The University of Michigan didn’t automatically translate into a contract. MedHub responded to a detailed open RFP and competed against other residency management systems that had been in the market place much longer.

After more than a year of evaluation, deliberation and negotiation, MedHub was selected to implement its system across all 88 residency & fellowship programs, GME and Hospital Finance. Because MedHub was a newer system, Michigan considered its approach to workflow and emphasis on GME and finance routines novel and more robust than competitive systems. At the time, most residency management systems handled procedures, evaluations, conferences and work hours, but were much weaker when it came to institutional billing, IRIS, contracting and funding & budgeting tools – if they offered them at all.

University of Michigan Statistics:

• 6 Billed Affiliates and Veterans Affairs
• 88 Residency and Fellowship Programs
• 150 Visiting Residents/Special Purpose Trainees
• 300+ Administrative Users (Coordinators, GME, Finance, IT, Paging, Nurses, Read Only)
• 1,200 Unionized Residents & Fellows
• 2,145 Faculty Members with Direct MedHub Access
• Over $80 Million in Reimbursable Revenues

The most challenging aspects of the implementation were some of the political obstacles that MedHub needed to overcome:

• University of Michigan executive leadership had never sanctioned an external ASP to handle sensitive data
• MedHub would have to develop interfaces to essential internal legacy systems
• 88 residency programs operating with ad/hoc processes as 88 independent ‘fiefdoms’ weren’t sure they wanted the new oversight
• It was assumed residents would resist logging in to document activities and – above all – work hours
• Finance required over 11 different IRIS management reports that could be audited back to ½ day activity of the rotation schedules

It was imperative that the solution be comprehensive and extremely robust, yet easy for all stakeholder groups to understand and manage. It was also important to promote better communication across all stakeholder groups. Communication was an area which continued to erode as workloads increased and tempers shortened. It was critical for each group to understand the others’ mission and develop a symbiotic synergistic approach.

The Solution

In partnership with UM’s internal project manager, MedHub developed an implementation project plan and training schedule that emphasized customer service and satisfaction. MedHub continued to improve the system approaching the project from the assumption nobody would want to use a residency management system, then began to build in as much value to each stakeholder to decrease redundant effort, make data more visible and make MedHub an essential part of their daily routine.

GME wanted a non-punitive approach to attract residents and faculty to the system by making them want to login rather than forcing them. It was important the system return at least as much vital information to each user as they were being asked to input. MedHub enhanced the interface to make MedHub as intuitive as possible, understanding these residents and faculty were too busy to read a manual or attend formal training.

The result is an elegant interface with logical workflow that combines vital information from a single source of truth. Alerts & reminders, error checking and communications tools ensure tasks are completed, data is visible and each stakeholder has the essential information they need to manage their respective jobs.

The Result

MedHub has set the standard by which all other ASP’s are measured at The University of Michigan. In 2005, The University of Michigan renewed its contract with MedHub and spearheaded institution specific system enhancements that include:

• Comprehensive funding and budgeting tools
• GME initiated institutional evaluation forms
• LDAP single sign-on interface
• Direct interfaces with legacy systems
• Numerous functional GME enhancements

On the service side, MedHub has served its end users well. We are always available to respond to telephone and email requests. Our trouble ticket system has become an effective means to address training issues, general questions and enhancement requests. Response time for responding and closing trouble tickets is less than 6 minutes during business hours. Direct IT access to our trouble ticket system allows The University of Michigan Medical Center Information Technology Division to constantly monitor and measure MedHub Support’s effectiveness in responding to it’s customers.

The ASP model has effectively allowed UM’s internal Information Technology division to focus on other systems and issues. Decreasing operation costs and internal support. In five years of continuous use, the MedHub production environment has exceeded 99.99% availability.

MedHub has provided return on investment to The University of Michigan in a number of areas:

• MedHub supports its own system. Therefore there is almost zero internal IT resources devoted to the maintenance and support of this system
• Decreased redundant administrative effort
• Improved oversight and internal controls
• Enhanced resident/fellow ‘ownership’ of their own training
• Reduced possibility of training program sanction through improved documentation
• More effective audit response
• Improved billing and reimbursement opportunities
• Reduction of FTE’s necessary for administrative tasks
• Streamlined data collection and distribution

“MedHub brings a lot of data that was once tracked by many different systems or on paper under one umbrella. It streamlines workflow so stakeholders with little in common understand the importance of the others’ role and the big picture.” 

— Dr. Paul Gauger, M.D., Assistant Director of Medical Education and Associate Professor of Endocrine Surgery, University of Michigan Health System.