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University of Missouri Health Care News Releases
The Tiger Institute for Health Innovation: frequently asked questions

What is the Tiger Institute for Health Innovation?
The Tiger Institute is a wholly-owned subsidiary of the University of Missouri formed to promote innovative health care solutions to drive down cost and dramatically increase quality of care for the state of Missouri. Cerner and the University of Missouri have entered into a strategic alliance to provide unique support for the Tiger Institute to enable it to accomplish these goals.

Why are Cerner and the University of Missouri entering into an alliance?
The University of Missouri and Cerner have had an existing relationship since 1996. As the state’s only land-grant, public research university, the university and Cerner share a common mission: to transform health care for Missourians. By creating the Tiger Institute, the university will be able to accelerate health care innovations to reduce costs and modernize health care for Missourians, create jobs in Missouri in health science and technology, create new sources of revenue and sustain the university’s mission, and work toward positioning itself among the top 5 percent of health systems for health care information technology.

How will the alliance between the University of Missouri, the Tiger Institute and Cerner work?
The University of Missouri and Cerner have signed a Memorandum of Understanding in which both parties agree to complete a series of related definitive agreements to fund and govern the Tiger Institute. The institute itself will be a wholly owned entity of the University of Missouri. As soon as an official contract is signed, more detail will be available.

What will be some early Tiger Institute initiatives?
Initially, the Tiger Institute will work to achieve “meaningful use” to receive stimulus funding for federal government-mandated IT compliance requirements for electronic health records; expand R&D collaboration between Cerner and the University that already has produced a “Medical Home” model of care, an innovative solution for the remote treatment of chronically ill patients; develop analytical tools that can optimize hospital, clinic and pharmacy workflows, patient scheduling and other operating efficiencies; and provide a digital infrastructure that connects all of the University of Missouri Health System hospitals, clinics and pharmacies—and then extends to health care providers in the Columbia area and across the state of Missouri.

What financial impact will the Tiger Institute have on the University of Missouri?
The Tiger Institute is expected to have a $100 million positive impact to the University through Cerner’s investment, savings and future expected revenue through innovations created in the institute.

What cash investment is the University of Missouri making in the Tiger Institute?
UMHC will not provide any cash investment beyond what has already been budgeted for UMHS to spend on IT. An essential premise in establishing the Tiger Institute is that the university’s investment will be cash-flow neutral. “Cash-flow neutral” means that the University’s cash expenditures will not exceed University Health System existing IT budget, or with respect to future years for which a budget is not available, UMHC’s forecasted IT budget. In other words, the University will not be investing any more in the Tiger Institute than what it has already budgeted to spend on IT and what it is expected to budget in future years on IT. In fact, a significant annual savings is anticipated by using an automated health information system, which can be reinvested in the Tiger Institute.

How does Cerner’s investment in the university compare to other capital investments by other corporations?
Cerner’s investment is the largest capital investment by a corporation in university history.

How can MU afford to make this investment if there is a budget shortfall?
The University of Missouri has been successful at containing costs and increasing operating efficiencies during this financial downturn. It will use money in its existing IT budget to initially fund the Tiger Institute. This amount and future amounts will be cash-flow neutral, such that the University will not spend any more on the Tiger Institute than what is in the University Health System’s existing budget for IT and what would have been anticipated to be in future budgets for IT.

How will the University and Cerner be reimbursed for their contributions?
Tiger Institute earnings will be allocated and distributed to the University and Cerner based upon their proportionate contributions of cash and in-kind investments, intellectual property and other contributions. A percentage of funds will continue to be reinvested by each party in the Tiger Institute to support ongoing initiatives. 

How will the Tiger Institute position the university for federal stimulus dollars?
Under the ARRA, stimulus incentive payments will be made to who show “meaningful use” of HIT. Hospitals in the MU Health Care System will use their stimulus incentive payments to reimburse the Tiger Institute for investment in helping such hospitals achieve stimulus-ready status.

Are tax payer dollars being spent on the Tiger Institute?
No tax dollars will be used to fund the Tiger Institute.

How will the Tiger Institute be structured?
The Tiger Institute for Health Innovation will be governed by a board that will be appointed by the University. The University and Cerner will oversee the strategic alliance and individual initiatives through a board of governors that will consist of an equal number of senior executives from each entity. The board of governors will nominate a person to serve as executive director of the institute, who will report directly to the board of governors and the board of directors.

In addition, the board of governors will appoint the Tiger Institute Leadership Council comprised of an equal number of leaders from the University and Cerner, which will govern the institute on a day to day basis.

Are any jobs being eliminated in the creation of the Tiger Institute?
There will not be any jobs eliminated in this process. Eventually, the Tiger Institute expects to create jobs across the state of Missouri.

How will current University Health System jobs change with the creation of the Tiger Institute?
To ensure that this ambitious undertaking is successfully completed and that deadlines for federal stimulus funds are met, the parties believe that it is essential for the IT staff at Cerner and the University of Missouri be aligned into one Tiger Institute team. The team would be formed first by a contract arrangement permitting Cerner to manage certain employees, and if sufficient progress is made, by allowing Cerner to hire these employees. Both organizations recognize that the University’s IT team’s expertise is essential to the success of the Tiger Institute. Eventually, the parties anticipate that the Tiger Institute will generate more jobs in Columbia and across the state.

How many people will be employed by the Tiger Institute?
Associates who will be assigned to the Tiger Institute will be employed by either Cerner or the University of Missouri. A small staff will be assigned to the Tiger Institute by Cerner or the University of Missouri.

Why is it necessary for University Health System IT staff to be Cerner employees?
These are big goals, we need to have a single, cohesive team. Through the alignment of the workforces, we expect to innovate the IT delivery process itself, evolving from traditional waterfall implementation and support process to a more agile delivery organization. Applying Cerner’s 7x24 scale and ability to staff for peak demands without delay will free up the current staff with deep contextual knowledge of the organization to be more aligned directly with healthcare providers, innovating at the edges of healthcare delivery.

What are the salaries associated with the Tiger Institute?
The details of the contract are still being finalized. Cerner and MU may both contribute to the compensation package of certain employees working for the Tiger Institute.

What will happen to the benefit/retirement packages of university employees transitioned to Cerner employees? Compensation will at least be equal to the pay employees are receiving now, and benefit packages will be addressed on an individual basis.

What is the duration of the agreement between Cerner and the university?
The initial agreement between Cerner and the University is 10 years, and may be extended by mutual agreement of the parties.

How will the Tiger Institute impact clinicians at the University of Missouri?
Information technology continues to play an increasingly essential role in the practice of medicine in the future. The Tiger Institute promotes innovation where new ideas can be applied in clinical practice within Missouri’s clinics, hospitals, laboratories and classrooms. The Tiger Institute provides a fundamental change to the way health care is delivered by providing access to real-time information that enhances patient outcomes through evidence-based medicine and saves health professionals time by automating workflows.

How will the Tiger Institute improve clinician satisfaction?
Over the past 13 years, the University and Cerner have collaborated on a number of projects, including the successful launch of an electronic health record system. The Tiger Institute will create a dedicated team that is made up of academics, health professionals and engineers to automate not only the Health System, but other providers in Columbia and across the state of Missouri. In the future through the Tiger Institute, health professionals will be able to develop solutions alongside engineers that match specific clinical workflows and preferences. Health care information technology has been proven to save providers time, improve patient interactions and ultimately impact patient outcomes.

How will the Tiger Institute impact students in the health sciences at the University of Missouri?
The Tiger Institute will enhance the University of Missouri’s position as a national leader in innovative, high-tech teaching and training in the health professions. As the Tiger Institute transforms the delivery of health care, new collaborative health care roles will be created to support a patient-centered model. Future physicians, nurses and other health professionals from the University of Missouri will be among the leaders in transforming health care in the U.S.

What assurance do university physicians have that improvements in the electronic health record system will actually be made?
The agreement between the University and Cerner sets very specific goals and deadlines for meeting those goals.

How is the $1 billion savings to the state of Missouri calculated?
The Tiger Institute has the potential to save the state of Missouri $1 billion in several ways, including automating physician workflows, better management of chronic diseases and reduction of preventable deaths; increased quality of care; reduced drug abuse and reactions; better administrative services and decreased amounts of litigation and malpractice suits. According to a 2005 RAND study, the U.S. could save between $77 and $100 billion annually by automating the current health care delivery system with health care IT. Missouri has about 2 percent of the nation’s population, which can be extrapolated to estimate about $1.7 billion could be saved in Missouri alone. The Tiger Institute believes that it has the potential to help many of Missouri’s physicians adopt electronic health records and work toward achieving a significant portion of these savings.

What is the objective of the Tiger Institute? What are some key project milestones?
A fundamental goal of the Tiger Institute is to exchange and leverage the University and Cerner core competencies to improve the health of Missourians. Key milestones include the development of solutions that can optimize hospital, clinic and pharmacy workflows, patient scheduling and other operating efficiencies and provide a digital infrastructure that connects all of the University of Missouri Health System hospitals, clinics and pharmacies.

What part of the EMR does MU have now?
The University Health System has achieved significant progress in converting the paper record to the electronic health record, which will help to improve patient care, increase efficiency and improve the quality of patient care. The relationship with Cerner will propel MU to an integrated electronic health record system, and allow them to be the prototype for advanced care delivery for the next decade.

How do the Tiger Institute and the strategic alliance with Cerner support University Health System core mission to heal, teach and discover?
A core component of the Tiger Institute’s mission is to improve patient care, advance patient outcomes and enhance patient safety in University Health System’s hospitals and clinics. It will provide medical residents, fellows and students in the medicine, nursing and the allied health professions with training in a leading-edge automated health care delivery system. It also will provide a living laboratory to develop new health care solutions and test ideas for ways to improve the way health care is delivered. Innovations jointly developed between the University and Cerner can be made commercially available to other health care providers, and the revenues from such innovations will be shared by the University and Cerner.

How will this alliance help to continue the university’s role as a leader in driving economic growth through health sciences and technology sector jobs?
Information technology continues to play an increasingly essential role in the practice of medicine and the delivery of health care. The Tiger Institute’s goal is to develop a health care information model that can be used by hospitals and clinicians throughout the state of Missouri and beyond. Through incentives in the American Recovery and Reinvestment Act, the University Health System could qualify for an estimated $10 million in incentive payments through 2014 for achieving meaningful use of an electronic health record system. The University of Missouri is an ideal environment to bring together the best and the brightest public and private sector minds to develop new ideas and practices, which should lead to revenue and job growth. Other innovations in the areas of clinical training, chronic disease management, biomedical device integration and connectivity between consumers and providers will be funded and explored through this initiative.

How will this alliance help the state of Missouri improve health care for all citizens, lower the state’s health care costs and serve as a model for the rest of the nation?
One initiative that is a high priority for the Tiger Institute is developing an automated health information system that can be used to improve care for Missouri’s Medicaid patients. Medicaid spending currently accounts for 30 percent of Missouri’s total state budget. Most of that money is spent treating people with chronic health conditions. A pilot project developed by Cerner and the University of Missouri School of Medicine, the Medical Home project, is already in use and has been recognized as a national model for management of patients with chronic diseases such as diabetes and asthma. The Tiger Institute plans to use the success of the Medical Home project to develop new care improvements through its living lab.

What is a medical home?
The patient-centered medical home is an approach to providing comprehensive primary care for children, youth and adults. Medical home is a health care setting that facilitates partnerships between individual patients and their personal physicians, and when appropriate, the patient’s family. A medical home allows consumers to better manage their health through resources such as education and secure messaging with their care provider. The Medical Home also helps physicians quickly and easily review patients’ essential data to make better care decisions with the latest evidence-based medicine standards.

What is the “Medical Home” project? Are there any measured benefits?
The Medical Home project at the University is a program developed by Cerner and the University of Missouri School of Medicine to manage patients with chronic diseases. The project has saved physicians an estimated four minutes per visit for chronic condition visits.

What is an Electronic Health Record (EHR)?
An Electronic Health Record (EHR) is owned by the patient and has both patient and clinician provided information. It contains health information that spans beyond a single care event and across multiple care delivery organizations within a community, region or state (and even in some countries like the UK).

What is the American Recovery and Reinvestment Act?
In February 2009, President Barack Obama and the U.S. Congress passed the American Recovery and Reinvestment Act of 2009 (ARRA) in response to the economic crisis. The “stimulus act” is expected to create 3–4 million jobs and provide incentives for the adoption of health care information technology. The ARRA has made available up to $50 billion nationally for health information technology (HIT) adoption and use. In order to be eligible for stimulus incentive payments for electronic health record systems, hospitals and providers must achieve the yet-to-be-determined “meaningful use” requirements.

What does “meaningful use” mean?
Currently “meaningful use” is still being defined by the Office of the National Coordinator for Health care IT and the Department of Health and Human Services. The most recent recommendations for “meaningful use” include a stair-step approach for automating a provider organization. Requirements include computerized physician order entry (CPOE) and standards for interoperability. A final definition is expected by Dec. 31, 2009.

What is the benefit of the Tiger Institute to the community of Columbia? Missouri? The nation?
Most importantly, for Columbia and central Missouri, the Tiger Institute means improved patient care and patient safety. It also means more jobs and economic development spurred by the federal stimulus funds. Greater automation of medical records will allow health care data to be more transparent and accessible to consumers. For Missouri Medicaid consumers, automation of electronic health information has the potential to save the state millions in health costs through chronic condition management and increased access to evidence-based medicine. Nationally, the Tiger Institute’s innovations could serve as the model for automated health care. The Tiger Institute also has the capability to create a statewide health information exchange that has multiple applications and benefits, such as tracking the spread of infectious diseases like the Influenza virus.

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