Save on Electronic Medical Records With IT Consortiums

www.TheNationalCouncil.org

Benefits of Multi-AgencyMembership Consortium Discussion

MTM Services, LLCP. O. Box 1027, Holly Springs, NC 27540Phone: 919-387-9892 Fax: 919-773-8141E-mail: [email protected] Web Site: mtmservices.org

Presented by: Scott C. Lloyd, Vice President

mailto:[email protected]


Topics for Today:> Who we are and What we do> Advantages of forming a Consortium > How do Consortiums Work? > How do I form a Consortium? > Case Studies: Consortium Success

Stories

Benefits of Multi-Agency Membership Consortium


MTM Services Consultation History and Team:

As a result of providing service delivery process change management consultation to over 400 community behavioral healthcare centers nationally, M.T.M. has developed specific assessment and consultation/training processes that have proven successful to support restructuring the service delivery processes to facilitate a more efficient work flow and/or EMR integration. The consultation efforts are focused on designing and implementing service process solutions to support timely movement from a narrative intense documentation model with multiple styles or genres of forms and service delivery flow processes across programs/units/populations/locations to a more objective and uniform service delivery documentation and flow process.

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Previous Statewide/Regional Initiatives Managed by M.T.M. Services

> 1996 – North Carolina MH/DD/SA Providers> 1996 – Alabama Statewide MH/MR/SA Boards> 1999 – Georgia Statewide MH/DD/SA Community Service Boards> 2000 – Northern Affiliation of Six MH/DD/SA Provider Boards in Michigan> 2001 – Three MH/DD/SA Provider Agencies in Allegheny County,

Pennsylvania> 2001 – Three MH/SA Provider Agencies in Southern Indiana> 2001 – 2004 Ohio Department of Mental Health and Ohio Department of

Alcohol and Substance Abuse Services Statewide Standardized Documentation Initiative (SOQIC)

> 2004 – 2005 DuPage County Public Health Department> 2004 – 2005 Mental Health Council of Arkansas Statewide

Documentation Initiative> 2007 – 2008 Statewide Massachusetts Standardized Documentation

Project (MSDP) > 2009-2010 Statewide New York State Clinical Record Initiative (NYSCRI)

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Advantages of Forming a Consortium



Provides Quality of Care Benefits • Promotes consistent assessment, planning & service

documentation• Person-Centered and Strengths focus• Recovery/Resiliency focus• Promotes Information Sharing

• Promotes effective collaboration with other providers & shared terminology for use by different disciplines

• Less room for error; Decision support• Helps avoid common first-generation “enterprise” system

error of automating current practice Vs. best practice

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Provides Clinical Practice Benefits • Compliant with Federal Mandate for Electronic Health Records

by 2014 & a wide variety of regulatory and payer requirements

• Assists in protection against federal/state audit paybacks

• Wide array of funders/payers support this initiative• Enhances Measurement & Outcomes Focus

• Local Benchmarking (Pros & Cons)• Ultimately individual agencies are able to access a more

sophisticated software system (with a higher level of consulting and implementation support) as a consortium member.



Financial Benefits • Standardized training to reduce costs

• 2/3 of Implementation Services can be jointly delivered

• Compliant with a wide variety of regulatory and payer requirements

• Some protection against federal audits• Saves time and money

• Reduces cost of individually developed EMR capacity at each provider agency

• Reduces redundancy in collecting information• Concurrent documentation possible

• Standardized revisions and updates in future



$1,000,000.00$1,000,000.00Was the difference/savings over 5 year

period for the GA Consortium to create and utilize an ASP system as an IT Consortium.



Delivery System Decision

Service Delivery Process

(ex. – Repetitive Paperwork, Meetings,

long wait times, etc.)



Quality Care

Service Delivery Process

(ex. – Non Repetitive Paperwork, Fewer Meetings, Shorter Wait Times,

etc.)

Delivery System Setup



Form Reduction Examples:

Case Study – Organization in Georgia:> After the mapping process, the organization was able to

remove 66% of their assessment questions as they were not required by any funding source or accrediting body.

Case Study – Organization in Illinois:> Was asking 252 questions of every client seen as a

crisis event> After the mapping process, crisis workers will now only

ask 35 questions, unless the client needs to be hospitalized.



Access Redesign Grant Change Points -

Concurrent Documentation: Eradicating post session documentation time while increasing client buy-in for their care by involving them more and creating documentation that is much more compliant to assist with auditing concerns.

Walk-In Models: Offering more expedient access to care which helps increase engagement by reducing wait times and works to eradicate/greatly reduces no shows.

No Show Management: Work through policy changes and counseling clients to increase show rates/client engagement.

Maximizing Staff Productivity: Helping direct service staff maximize their time with clients by reducing the amount of time they spend performing non-billable activities.

Employee Engagement: How providers were able to get staff buy in to changes




> Extrapolating this savings across all organizations who started the pilot would equate to an annual savings of $9,599,492.56

Total Number of Processes

Total Staff Time (Hrs)

Total Client Time without Wait-time

(Hrs)Cost for Process Total Wait-time

(Days)

Old Process Averages: 5.70 5.06 3.65 (331.63) 49.25 New Process Averages: 5.04 3.34 2.99 (210.20) 29.31

Savings: 0.66 1.73 0.65 $121.43 19.94 Change %: 12% 34% 18% 37% 40%

3,843 $466,642.00

$5,599,704.00

Avg. Number of Intakes Per MonthMonthly Savings:Annual Savings:

Represented: 28 Organizations of 48 Organizations who started the Access Redesign Grant from Florida (7), Ohio (12), & Wyoming (9). The average annual savings for these 28 organizaitons if $199,989.43 per agency.

www.mtmservices.org© Copyright 2008

www.TheNationalCouncil.org Days Wait

Assessment Appointment Trends by Days of Wait for all Centers (Over 16,000 Events)


How do Consortiums Work?



Consortiums work to create a standardized practice model that utilizes a standardized form set to capture the data elements needed across multiple service delivery areas within an individual agency and/or multiple agencies in a regional or statewide standardization effort.

Having this standardization work completed upfront represents 80% of the configuration associated with an EMR implementation and creates a much more favorable environment for the layout and design phases to go smoothly.

Having the tough decisions made before coding starts works to ensure that the consortium’s members do not have to make a significant number of decisions that will affect their service delivery system on the fly; which effectively works to help combat some of the EMR implementation challenges that we have seen nationally.

Example: An organization in Oregon worked to create 17 separate and unique interfaces for it’s new EMR to accommodate the paper model previously in place.

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Who should form a Consortium?



All service delivery disciplines are eligible for this kind of effort. Form sets have been created and are currently in use every day around the country that encompass multiple service delivery areas like:

• Mental Health • Substance Abuse/Detox• Emergency Care• Psychiatric Treatment• Community Support • Residential• Respite• Supported Employment• DD/MR• Transitional Services



How Do I Form a Consortium?



> Ideal Traits for a Consortium Partner?> Structure of the Consortium> What type of agency should I avoid?> Entrepreneurial Opportunity?

• ASO (larger provider provides administrative services to smaller agencies in your region)

> What about inter-operability?• RHIO opportunity• The right software makes all the difference



> The right software makes all the difference• Get to know all of the players• Seek a lot of feedback from current users• Know what kind of functionality will work best for

your organization – • Onsite Install vs. Internet Based: “The wave of the

future is software delivered over the Internet rather than installed on company owned desktops and servers.” (Source: Money Magazine, January/February 2010 Issue) – but what works best for you?



Single Setup Current CountCurrent 1st Year Cost

New CountNew 1st Year

CostSub-Total Grand Total: $789,600.00

One Location (Cost Per Month) 12 $3,000.00 $36,000.00 $36,000.00

Personnel to Operate: 10

Management: 1 $65,000.00 $65,000.00

Server Maintenance: 2 $40,000.00 $80,000.00

Data Base Administrator: 1 $65,000.00 $65,000.00

Report Writing: 1 $40,000.00 $40,000.00

IT Support: 5 $40,000.00 $200,000.00 $450,000.00

Cost for Optimum Hardware:

Application Servers: 8 $2,500.00 0 $8,000.00 $20,000.00

Billing Application Servers: 3 $2,500.00 2 $8,000.00 $23,500.00

Test Application Servers: 1 $2,500.00 0 $8,000.00 $2,500.00

Clustered or Replicated SQL Servers: 0 $29,000.00 2 $29,000.00 $58,000.00

Data Warehouse Server: 2 $6,000.00 0 $29,000.00 $12,000.00

Terminal Servers: 8 $2,000.00 0 $7,500.00 $16,000.00

Billing Terminal Servers: 3 $2,000.00 2 $7,500.00 $21,000.00

Test Terminal Servers: 1 $2,000.00 0 $7,500.00 $2,000.00

External Data Backup (LTO 4): 0 $26,000.00 1 $26,000.00 $26,000.00

Automation Manager: 1 $2,000.00 0 $7,500.00 $2,000.00

Data Communications (T1+ = 800X12=$9,600): 0 $9,600.00 6 $9,600.00 $57,600.00

Security (Cisco Self Defending): 0 $6,000.00 5 $6,000.00 $30,000.00

AD Servers: 0 $4,500.00 2 $4,500.00 $9,000.00

Data Switches: 0 $12,000.00 2 $12,000.00 $24,000.00

0 $0.00 0 $0.00 $0.00

0 $0.00 0 $0.00 $0.00 $303,600.00



Case Studies: Consortium Success Stories


www.TheNationalCouncil.org 2

PresenterMichael Earl, President/CEO

Oakland Family Services February 9, 2010


The Alliance: Who We Are

2


External Environment - 2005

Private,

non-profit

agency

Time to think and act differently!

Economic Issues in SE Michigan

• Struggling automotive sector

• Rising unemployment

• Forecasted economic contraction

Issues Affecting Non-Profit

Sector

• Fewer grants & donations

• Increased demand for services

• Increasing pressure on existing resources


Internal Environment of a Non-profit Organization

Increased operating complexity; do more with less


Now Multiply That Complexity by Four!

• Redundancy

• Inefficiency

• Resource drain

• Limited access

• Mission creep


Efficiency: Consolidated Purchasing and Elimination of Redundancies• Example: joint purchase and implementation of an Electronic Client Records System

Cost Savings

56.45%

$120,000

$52,250

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

Individual Rate Consolidated Rate

Savings for Alliance

$271,000

ECR Start-Up Cost Comparison

Shared FTE for systems

administration

Standardized processes and

forms to support behavioral

health practices

Cost Per Agency

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Efficiencies & Features

Administrative

RiskManagement

Service

QI

Utilization


GEORGIA GEORGIA INFORMATION INFORMATION

TECHNOLOGY TECHNOLOGY CONSORTIUMCONSORTIUM

GAIT


A presentation by:

Glyn Thomas, Executive Director, Satilla Community Services

www.satillacs.org


Topics for today

> History and origins of GAIT Consortium> What worked well, and what didn’t> The challenges> Lessons learned> Recommendations


History and evolution

> Six Georgia agencies all on the same electronic medical record (client server)

> Common experiences• Good reports and billing modules• Non-intuitive and cumbersome clinical work-flows• Slow and inefficient for clinical end-users• Technically challenging to set up and maintain

> Search for solutions via vendor’s user group


History and evolution> Non-intuitive and cumbersome clinical work-flows were the

biggest problem• Creating an authorization request for batch submission took 2

hours in the EMR versus 40 minutes on payor’s website• EMR was “unforgiving” – data entry errors were easy to make,

and time-consuming to fix.• Many items of data had to be entered multiple times.• Complex system navigation requirements discouraged

concurrent documentation> Different set-ups across agencies restricted opportunities to

share resources


History and evolution> Brief discussion of options confirmed that

collectively agencies lacked expertise to make informed choices

> RFP for consulting services to:• Determine our minimum data requirements for clinical and

business operations• To standardize our work processes• To optimize our use of our electronic medical record

> MTM Services selected as consultants


History and evolution> Clinical work flow team defined data

requirements and optimum work flows> Technology team identified hardware options:

• Software as a service – (ASP model)• Client server• Consortium server

> Reached agreement on GAIT Consortium requirements for EMR


History and evolution> Issued RFP to the current vendor we were using

at that time along with five alternate vendors.> Reviewed proposals for pricing and goodness-of-

fit to GAIT Consortium’s clinical work flow requirements.

> Selected Qualifacts as vendor for CareLogic system and software-as-a-service

> Contracts signed February 2009- Go Live July 2009


What worked well> MTM Services Consultant Scott Lloyd

provided good facilitation, helped set objectives, and provided needed information

> Splitting into two work teams:• Technology • Clinical Work Flows

> Setting and keeping to a timeline> Shared vision, goals and objectives


What worked well> Building “social capital”> Having the right people with the right skills on the

work teams> Defining data requirements before addressing

software questions> Brainstorming for solutions> Allowing graceful exits – 2 agencies left the

consortium for lack of ‘organizational readiness”


What worked well> Clinical workflows well-received by clinicians> Evident efficiency gains for direct care staff> Qualifacts easier to learn and easier to use

than previous system> System is more accessible in the community or

for staff working from home> System is fast (given good internet connection)


The challenges> Different accreditation requirements across

agencies (CARF and JCAHO) complicates standardization of work processes

> Changes of personnel in the Consortium work teams very disruptive

> Governance Boards may be skeptical of the consortium’s potential benefits – weakens agency engagement


The challenges> Aggressive timeline allowed set-up mistakes> Billing module and reporting currently less

powerful (more labor intensive) than desired – enhancements “in the works”

> Debugging some of the Georgia-specific components for authorizations and claims took some time


Lessons learned

> The importance of “social capital”> Organizational “readiness”> Adequate resources (personnel and financial)

for Consortium activities> The value of good consultation services> Leadership commitment


Recommendations> Assess your organizational readiness> Engage your Board> Prioritize the needs of direct care personnel> Pick your team carefully with regard to

expertise and temperament> Be patient> Engage a consultant to facilitate the process> Focus on the long-term benefits


The prize!

> A more efficient and user-friendly system for direct care staff (the majority of your users)

> Cost and resource sharing> Efficiencies of well-planned and standardized

work-flows> Leverage with vendors and with state


Growing your consortium> Benefits:

• Greater leverage with state• Stronger negotiating position with vendors

> Challenges:• Integrating new members• Sharing already acquired collective experience

> Some ideas:• Screen potential members for “organizational readiness”• Use new member fees to pay for Consortium “project expeditor”• Require new members to implement the system “as is”, but allow

new members equal status once implemented


www.gaitconsortium.org

http://www.gaitconsortium.org/


Presenter Contact InformationMichael S. EarlPresident/CEOOakland Family [email protected]

Glyn Thomas, Ph.D.Executive DirectorSatilla Community Services1007 Mary StreetWaycross, GA [email protected]

David KlementsPresident & [email protected]

Scott LloydVice PresidentMTM [email protected]






Save on Electronic Medical Records With IT Consortiums

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