CHNWV and RPMS - Presentation to Indian Health Service

7/29/2019 CHNWV and RPMS - Presentation to Indian Health Service

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The W.Va. Experience with RPMS

Jack L. Shaffer, Jr.

CIO Community Health Network ofWest Virginia

The trials and tribulations of the 1storganization outside of IHS and theTribal Sites to use the RPMS-EHR


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A word about The Community HealthNetwork of West Virginia

The Network is a tax-exempt, non-profit health center-controlledWest Virginia corporation formed in 2000.

The Network is primarily an application service provider (ASP)delivering centralized practice management, electronic medicalrecords (EMR), and technology services for its members.

The nineteen Network member health center organizationscollectively provide services to over 120,000 patients in 32 ofWest Virginias 55 counties each year, with 78 delivery sitesand nearly 400,000 patient encounters annually.

Our member health centers provided over $40 million in healthcare services last year, with 70% of this care to Medicare,Medicaid and uninsured patients.


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Topics to Cover Today -

Decision to pick RPMS Our Experiences Implementation

Challenges User Acceptance Return on Investment

Future Plans


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CHNWVs Open Source Odyssey

2002-Former Secretary of the Department Health and HumanServices Tommy Thompson began touting the transformativepower of electronic health information systems, along with thenNational Technology Coordinator David Brailer, a West Virginia

native. Much of the literature about electronic health informationsystems highlighted the accomplishments of the Department ofVeterans Affairs (VA) through use of its Veterans HealthInformation Systems and Technology Architecture (VistA)software system as a health improvement tool.

2003, the Bureau of Primary Health Care made grant fundingavailable for electronic health information systems under itsIntegrated Communications and Technology (ICT) grantprogram.


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The Network submitted an application and was awarded anICT grant, one of six nationally for this program by BPHC.

The Network application was unique, in that it was the first topropose an open-source or public domain solution based

upon a VistA-supported platform. 2004 2005 the Network collaborated with the BPHC in a

number of meetings with representatives of the Centers forMedicare & Medicaid (CMS) concerning the potentialadaptation of Vista for use in ambulatory care settings. As a

result of these meetings, the Network joined with BPHC andCMS in becoming members of the collaborative team fortesting and development ofCMS VistA-Office EHR (VOE). (Later to become WorldVistA-VOE)

VOE was not ready at that time based upon our review and

our specified timetable.


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In the evaluation of VistA and the work on the VOE project, theNetwork staff and members of the Clinical Committee becamefamiliar with the Resource and Patient Management System(RPMS) which is a VistA-based system utilized within Indian

Health Services. 2005, the Network entered into an informal agreement with IHSto use the FOIA version of RPMS and to become the firstorganization in the country to use RPMS outside of the IHSsystem.

This informal agreement was memorialized in a formalcollaborative agreement between IHS and the Network that wasexecuted in the spring of 2006.

Currently with 45+ clinical locations in production using thesystem 80 FTE providers 250 concurrent users.

6 More clinics to implement this year.


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Unfortunately, humans are visual creatures.

Our Experiences / UserAcceptance

RPMS has a great personality,but.

We had a lot of problems with user acceptance

of the RPMS-EHR mainly because it looks oldand clunky.


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Well, whats ugly about the RPMS-EHR?

General look and feel is way90s. Heavyclient install

Had to use Citrix to deploy

Too many hiddenfeatures Right click here, left click there Clicking on labels and headers Just not intuitive

Templates and Provider Notes fixed fonts Big impediment for providers RPMS-EHR Needs HTML font on notes!

Printed prescriptions Way too much roll and scroll

Context sensitive help is not helpful


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RMPS-EHR Clinical Notes


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Compared to eClinicalWorks.


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Even VistA can now do HTML chart notes..


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When you adopt someone elses system you also adopt their

business logic good or bad.

RPMS was designedfor.well, IHS! (not us!)

There were many features andfunctions of the RPMS-EHR whichwork fine in the IHS world;however, they cause majorproblems outside of the IHSenvironment.

Our Experiences / User

Acceptance


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Business logic differences? Why is that bad?

Medication management - #1 problem No Auto-finish!

RPMS-EHR designed where a pharmacist

finishes the medication order. Doesnt work in our world. Period. Custom code or we would have sunk

Lack of trade names

Pharmacies rejected printed prescriptions Had to completely redesign this Nurse practitioner and physician assistants had

different requirements No faxing capability


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Medication Management Problems

These caused serious patient safety issues andprovider backlash: Medication errors associated with unfamiliarity with

generic names so we added trade name todisplay

Renewed prescriptions were not beingdiscontinued

Prescriptions were finished without a drug nameto display when in the Medication tab Users had problems and wanted only active

prescriptions to display when a patient is firstaccessed


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No drug name displaysbecause no dispense

drug has been selected

Medication Management Problems


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We were also somewhat alonethats bad

We really cant get direct help from IHS Hard to get into IHS CAC training even with

special MOU

Had to compete for scarce resources with very limitedbudgets Competition forCACs heating up

Patch management is tough

Had to develop our own implementation and trainingmanuals along with procedures around the RPMS-EHR

Labcorp interface continues to be a chronic issue


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Open Source allows for the tool to evolve faster in arapidly changing environment than top down

development because of the diverse community of

developers.

The fact that we could crackopen the hood and work on

the engine was invaluable.

RPMS being a mostly open

source application makes it a veryaffordable solution fororganizations with limited budgets

Our Experiences / User

Acceptance


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You mean theres good things about RPMS??

(you beat it up pretty bad)

Very stable system from an IT perspective Highly configurable

Very little we cannot do with the system

Reminders/health factors, etc Focused on clinical outcomes Focused on chronic disease management Open source (for the most part)

Allows for rapid customizations Great for an industry in a disruption

CHNWV has proven that it WILL work, and work very welloutside ofIndianCountry

Great Value from a cost perspective


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Open Source enhancements


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This option has aPharmacy Dispense

Drug automatically

selected. This selectionmay not always be themost appropriate.Therefore the disclaimer isnecessary.


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EHR Implementation Cost Comparison

Implementation CHNWV Health Affairs Commercial CHC installation in WV

Costs RPMS EHR Total Avg Cost Commercial EHR Total Cost for EHR

Hardware Estimated $49,700.00 $136,176.00 $155,554.67

Total Software $10,005.00 $125,576.00 $208,888.00

Installation, Training $80,570.67 $95,992.00 $100,000.00

Productivity Loss $36,000.00 $54,104.00 $111,110.67Internal Staff Time $60,680.00 $37,945.00

Other $0.00 $33,312.00

Total EHR Cost* $236,955.67 $483,105.00 $575,553.33

Total RPMS Savings vs. CommercialEHR - $246,149.33 51%

*Calculations based on 8 FTE Providers


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EHR Implementation Cost Comparison


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EHR Operations Cost Comparison


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EHR Cost Comparison ARRA funds

CHNWV RPMS Health Affairs

Costs EHR Total Avg Cost Commercial EHR

RPMS Avg Health Affairs

ARRA Funds (Medicare) $352,000 $352,000Implementation Cost $236,955 $483,105

Money in (or OUT) of your pocket $115,045 -$131,105


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Future Plans-

Roll out RPMS to 6more clinics iCare 2.0 Offer RPMS-EHR as

part of WVRHITEC Certification and

Meaningful use!

Enhance theapplication further New apps

New controls


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Introducing the

iRPMS beta


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iRPMS-EHR


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Thank you!!

(Questions)

CHNWV and RPMS - Presentation to Indian Health Service

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