Health IT SharePoint Digital Transformation SBAR

Topic:______Collaboration Tools_____ Total Cost: __$/yr__

Sponsors: _____TBD ______________
Project Leaders: ____Derrick Stone_________
Funding Source: ___________________________

Discussion Points

Situation
To allow for effective and efficient collaboration around data and improvement projects, UVA
Health System needs to enable a digital workplace. A digital workplace enables access to
information along with the ability to share and collaborate with others.

The research group Gartner describes core competencies of a collaboration platform as:
 Mobile access to content
 File synchronization across devices and cloud respositories
 File sharing with people inside or outside of the organization
 File search and retrieval across multiple file repositories
 Collaborative document creation and teamwork

UVA Health System employees to not currently have access to modern collaboration
software.i

Microsoft SharePoint is the de facto tool for collaboration across teams for an enterprise
employing Microsoft productsii. SharePoint will allow teams to work together on MS Office
documents, create shared workspaces for cross-department teams, create ad hoc shared
calendars, as well as many other features.iii

Background

Collaborating on initiatives and sharing information is a need across the Health System.

 The Medical Center and School of Medicine use a web publishing tool for over 200
departmental intranets, most of which are department-specific repositories of
information, some of which are cross-team. The purpose of many of these sites would
be better met with a specialized tool over a simple publishing tool because web
publishing tools are cumbersome for collaboration tasks.iv
 All Health System divisions have access to a collaboration tool offered by academic IT

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 – Collab. This site is a step beyond the web publishing and network storage offerings
offered by Health System IT departments as it provides applications for the creation
of discussion boards, online quizzes, etc. Despite the name Collab, this tool is
intended for teaching and instruction and is lacking business collaboration featuresv.
 The School of Medicine Dean’s Office desires but currently lacks an intranet site to
provide operational guidelines and procedures, announce events and deadlines, etc.
across their administrative support and business office users. The Dean’s Office is
currently looking at using a Department of Medicine SharePoint installation, an older
version of the software. The SOM has access to their own web publishing tool,
WordPress, which would as be problematic for collaboration as any other web
publishing tool.
 The School of Medicine Department of Medicine has an installation of an earlier
version of SharePoint used by their department for storing documents, but the site
does not have an active owner and is used as a departmental intranet, not for
collaboration.
 Be Safe Quality coaches have access to SharePoint with a limited feature set. For a
total quality approach to scale to the size of the entire organization, standardized and
scalable tools for collaboration are required. This need is a sweet spot for SharePoint-
temporary project and working group sites with standardized tools can be quickly
deployed with minimal intervention. The current installation, however, is not
supported by a support team, and is simply a repository for project documents rapidly
growing absent an information architecture.
 The Program Management Office has an installation of SharePoint that it uses
internally for some collaboration on project documents. As there is no Health IT
support for SharePoint, the PMO is only able to share this tool with project
participants in a very limited fashion, and is unable to take advantage of any of the
newer features. This installation is primarily serving as an archive.
 Several departments such as Nursing and Administration are currently using
SharePoint team sites with a limited feature set and no official support. These are
experimental sites with the ability to create task lists, document libraries, shared
calendars and a few other things. Because there is no SharePoint support staff, these
teams cannot call the Health IT HelpDesk for support and are therefore unable to
capture full benefit.
 Users and teams spanning organizations, for instance the School of Medicine and the
Medical Center, have the additional challenge of separate authentication domains.
Network storage resources are not available across domains, e.g., logging in with a
School of Medicine account will not allow you to access your Medical Center provided
O: drive. Further, a user who spans organizations may have access to resources in
both domains, but is unable to access them with both accounts.

Multiple authentication domains poses a significant user experience challenge. There are

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three basic approaches available for authentication.
Option
Authenticate using HS Active
Directory, allow
authentication against
Eservices
Authenticate SharePoint
using Eservices Active
Directory, all other MS
resources authenticate using
HS Active Directory
Authenticate using only
Eservices Active Directory
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Advantage(s) Disadvantage(s)
 All users can access  The site would want
sites. No to treat a user
administrative account ‘abc1a’ from
changes need to be the HS directory as a
made. different account
from that same
account in Eservices.
There may be a
technical solution,
but it could be a
source of user
confusion.
 All users have an  Shared governance
eservices account. model would need to
User accounts would be worked out as HS
be atomic – no cross security would need
directory confusion. to be provisioners of
Resources would be access, and Eservices
future proofed account rules do not
against a currently match HS
consolidation. account rules.
 HS Users may not
know their Eservices
password
 HS computers would
not automatically log
them in.
 Resources would not
span domains- ie.,
calendar events
would only post to
Eservices calendars.
 Reduced user  Shared governance
frustration. would be required,
 Resources could be as above.
shared/collaborated  Huge cost in the
with any other user effort required to
@ UVA. convert the HS
Page 3 of 10
  Best oversight is domain to Eservices
possible, as -would require
authorization and converting all
monitoring comes accounts, access etc
from one place. to the Eservices
domain.

Assessment

As evidenced by the number of workarounds for collaboration as listed in the Background

section, the Health System is in desperate want of collaboration tools. Users today have the
option to collaborate using unwieldy, error-prone methods, such as

 emailing the same document back and forth

 using tools poorly suited to the task such as a web publishing tool, network storage,
or an instructional support system
 or using an external, possibly prohibited method such as Google Documents.

In some cases, SharePoint has been installed and made available, but without a fully
integrated installation and adequate support, the organization is unable to claim the full
benefit. Most importantly, by reducing steps and complicated process required to work
together on electronic assets, these collaboration tools will improve the speed of change.

Current tools used for collaboration were developed with a desktop computing model in
mind – working remotely or on mobile devices is a recent development for most of the
Health System. Users may store confidential data on a removable hard drive or storage
device, they may use an online cloud service such as Google Drive or DropBox, or they may
email information to a personal account. Approved and unapproved workarounds to make
information more portable introduce waste in the form of reduced copies of the same
information and the risk of unintended dissemination of data. Providing an easy to use,
officially supported solution will reduce this exposure as well as the storage space required,
as documents will no longer need to be copied.

The business of healthcare requires use and access of regulated protected health
information. One barrier to implementing a collaborative system, is the need to limit
exposure of confidential data to unintended access. Our users, however, are telling us that
they want to have their information wherever they want to work, and that inaccessible data
is a huge dissatisfier.vi

Option Advantage(s) Disadvantage(s)

Allow no PHI  Least restrictive  The key benefit –

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 security makes the
site overhead less.
 Less risk.
 Uniform security
policies are easier to
implement.
Allow PHI everywhere  Uniform security
policies are easier to
implement.
 Users will be satisfied
as they will be free to
work with any and all
information.
Allow PHI in specially  Allows some team
provisioned spaces sites to have the
least restrictive
features.
This implementation requires investment to stand up and support a new service – key
lessons learned in the background section indicates that simply providing the software does
not allow for collaboration. This project would provide value in three key areas:
1. Increased productivity and user satisfaction on collaborative projects.
2. Reduced waste by
a. reduction in number of the collaborative tools used
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allowing users to
work together on
healthcare data, will
not be realized,
reducing the value of
the investment.
 Increased user
frustration.
 Experience with our
intranet shows us
that users will add
PHI regardless of the
policy.
 Increased exposure
in the event of a
breach.
 Least restrictive team
sites may prove
frustrating for users
who want to work
with PHI. (eg, they
see what is possible,
but get told no)
 Experience with our
intranet shows us
that users have a
difficult time keeping
this straight.
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 b. reduction in the number of workarounds used by staff for data access
c. reduced risk of unintentional disclosure of information
d. improved control of data (data within SharePoint can be centrally managed
and access revoked, data on a thumb drive cannot be)

3. Reduced cost by replacement of systems currently in use - this installation could

replace SharePoint installations for the PMO, BeSafe, the Department of Medicine, as
well as many of the intranet sites that are intended solely for collaborative purposes.
A system designed for collaboration would also reduce the volume of copies of files
on shared network storage and in email by an order of magnitude. For example, in
our current systems a document emailed to ten people creates eleven copies of that
document, one for the sender’s outbox, and one for each of the ten inboxes.

Recommended approach

1. Over a planned implementation period that targets groups of SharePoint users,

purchase Microsoft Office 365 licenses for all Health System staff.
2. Deploy a hybrid implementation of cloud services that utilize services from Azure
along with email locally-hosted by Health IT. Hybrid installation tradeoffs noted
below.
3. Develop a set of procedures and policies that permit use of PHI within the system
without adding visible burdens to the users.
4. Create a development team within Health IT Software Development to target:
a. Development of a UVA “team site” template to permit the creation of ad hoc
teams across departments with a standardized set of features such as shared
calendar, document library, etc., to meet the needs of Medical Center, School
of Medicine and UVA Physicians Group departments, as well as Be Safe Quality
teams and Program Management Office working groups. These sites would
have certain designed-in limits for storage space, branding, etc., but would be
completely self-managed and have a built-in lifespan.
b. Development of a SOM Dean’s Office intranet to house standards and
procedures for that office.
c. Providing for support and training on use of SharePoint.
5. Create positions within Health IT/ Infrastructure for SharePoint administration
including the technical configuration and management of cloud services with Azure.
6. Create positions within Information Security for the provisioning of access to
SharePoint and other cloud services through MS Office 365.

SharePoint is licensed as part of the Office 365 Suite. There are three fundamental options
for installation of SharePoint.

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 Option Advantage(s) Disadvantage(s)
Install fully on site  Most control over  Increased capital
security. cost
 Access to file  Health IT staff takes
collaboration on operational
features support cost
 No access to team
site features enabled
by the cloud
 No access to ‘flow’
features, Machine
learning features
Install fully in the cloud  Automatic new  Control of
feature release infrastructure
 Operational support security (server
is covered by access, patch
Microsoft Azure application) ceded to
team Microsoft
 Access to ‘flow’ and  Requires moving
Machine learning, email to the cloud
systems that collate  Loss of Internet
incoming connectivity creates
information for users a loss of service
 Maximum portability  Most potential
of data exposure to recent
 All features of Office processor
365 are realized, vulnerabilities such
including additional as Spectre in a cloud
apps such as DataViz enviornment
Hybrid installation with  Allows access to key  Full set of team
some applications on site features without features, such as
and some in the cloud making mission skype/video chat,
critical items such as one drive, power BI,
email dependent on planner,
Internet connectivity comprehensive
search, are
hampered by this
installation – some
will not work in a
hybrid environment

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  Both operational and
capital costs are
required

Metrics

Cuing off the work already developed in the Information and Communications technologies
study, questions governing collaboration tools should be identified/added to the
communication survey, and non-essential questions removed.

Capital Equipment Needed (Capital Sequence Number Required)

Required capital is dependent on the preferred implementation approach. The new version
of Microsoft SharePoint is offered as a cloud service, as part of MS Office 365, which means
that no equipment is required- all the processing and storage is handled by Microsoft’s Azure
service.

PROVIDE CAPITAL COST OPTIONS HERE FOR HYBRID VARIANTS

Operational Resources Needed (PTAO Required)

Acquiring the MS Office 365 licenses for 8000 users @ __.__per month = $/yrvii
SharePoint development and support team = $/yr
 2 Cloud Services Provisioning (Security)
 3 SharePoint Administrators (Health IT/Infrastructure)
 4 SharePoint .NET developers (Software Development)
Effort Required:
Department Est. Hours Department Est. Hours
Analytics   Epic Ambulatory  
Business Systems   Epic Beacon  
Clinical Engineering   Epic Beaker  
Clinical Informatics (CMIO)   Epic Cadence  
HIS   Epic Cupid  
LAN Team   Epic Grand Central  
Network/Telephones   Epic Home Health  
PC/Desktop Services   Epic Inpatient  
PMO   Epic Optime  
Strategy   Epic Resolute  
Software Development (WDC)   Epic Willow  
Telemedicine      

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Assumptions:

Schedule:

Recommendations

Recommend approval of this Effort for Implementation in FY____

 Capital Funds Required: ____
 Operational Funds Required: ____
 Level of Effort Required: ____ Hours
 Recommended Start Date: _________
 Priority:_________
 Size: ____________
 Recommended PM Support: ___________________________

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i
Electronic tools used for collaboration at UVA HS are commonly focused on sharing information
within a department. Available tools include a department intranet website and shared network
storage. Commonly referred to as the O: drive, network storage is designed to allow one-at-a-time
access to an electronic document. Department intranets are provided by a web publishing tool,
designed to allow a contributor to write a message once to be read by many people. Neither tool is
optimally suited to collaboration – collaboration being defined as the bi-directional exchange of ideas
and information.

Teams working across departments in our current environment have further barriers because access
controls are designed around reporting structures. Cross-team access is an exception to the default
configuration, and such tools as shared calendars and network storage requires additional
intervention and setup by support staff.
ii
Gartner.com, “Magic Quadrant for Content Collaboration Platforms”, July 25, 2017.
iii
Shared document repositories allow users to access and work on the same document without
creating multiple copies, even if they are different departments. Microsoft SharePoint also offers a
range of installation options permitting customers to fully use the cloud or take a hybrid approach, in
which some services are in the cloud and others are hosted on-premise. A full set of features can be
found on the Microsoft website: https://products.office.com/en-us/sharepoint/sharepoint-server
iv
For example, to collaborate on a document using a web publishing tool – meaning two users edit the same
document- requires that the most recent document be retrieved by each user, edited and re-published to the site. If a
user publishes an updated document while a second user is editing the document, their changes will be overwritten
and lost when the second user publishes.
v
Collab does not offer options like document sharing.
vi
See the study: Perceptions of Information and Communication Technologies at UVA, Burns, Central Michigan
University, 2015
vii
MS Office 365 includes a suite of office applications beyond SharePoint and basic email services,
and all are licensed for use on an annual basis rather than being acquired with an indefinite license.
The various services are tied together in one license because the functions are tied together – for
example, your SharePoint team site may have events in a shared calendar that could also
conveniently appear in your personal Outlook calendar. Buy the single MS Office 365, the user is
allowed to use any of the available services. (Services are subject to provisioning by the cloud
administrator.)

The Academic IT support team is implementing Office 365 as a cost-saving and feature-enhancement
measure for their standard offering, currently focusing on email, with the intention to offer additional
services in the future. Microsoft has targeted corporate consumers that must have extremely reliable
service availability and security, producing an average of 99.98% uptime in 2017, at a cost priced
below typical on premise costs. In consultation with the Health System Infrastructure and Information
Security teams, based on experiences with other cloud services, UVA’s connectivity to the Internet
becomes a key point of consideration. That is, if UVA HS were to experience a loss of connection to
the Internet, all of the MS Office 365 would become unavailable, including email.