Community Health Connections
Electronic Health Records (EHR)
Implementation
Individual Role
David Montanez Project Manager
Luis Perez Clinical Analyst
Keri Vogtmann Project Manager
Sarah Leake Clinical Analyst
Lynda Flower Clinical Analyst
Elizabeth Wellner PMS & Billing Analyst
Warren Goldberg Risk, Regulation & Stakeholder Analysis
Carmen Matthews Training Specialist
DeEtte Trubey Project Manager
Mona Naoum Project Coordinator
Ann Winclair Graphics Designer
Panel 1 – Introduction
2
Implementación del Sistéma de Records Médico ElectrónicoImplementing EHR
Beneficios en la implementación del EHR Los costos administrativos generales pueden
reducirse, Los errores de datos puede reducirse, y Los resultados adversos pueden ser más
rápidamente identificados
3
CHC Story
Founded 30 years Federally Qualified Health Center
3 Clinics Providing Adult Medicine, Women’s Health, Mental Health
& Pediatric services Mobile clinic for school programs
Laboratory (LAB), Pharmacy (PHM) & Radiology (RAD) at the 3 clinics
$1.6 million grant to implement & EHR & meet MU
4
EHR Benefits
Decreased charting/prescribing errors Improved work-flow
Immediate access to Radiology Lab results Patient charts
More satisfying work conditions for our employees
Freeing up space now used to store charts
5
Central Clinic Layout
6
West/East Clinic Layout
7
Scope & Deliverables
Develop Plan to install EHR System Must meet meaningful use Capable of information exchange with National Health
Information Network (NHIN) Use OpenVista
Realistic plan ready for review on 3/25/2010 Final Deliverables
Detailed Implementation Plan with narrative & supporting documents
Presentation of Implementation Plan for the Review Committee
8
Critical Success Factors
Full C-suite support Clinical champion - Chief Medical Officer will lead
the Implementation project EHR is a clinical project Organization is stable with quality improvement in
place We will achieve a positive return on investment in
an EHR
9
Assumptions & Constraints
Implementation project to begin March 30, 2010, clinic-by-clinic, using Plan Do Study Act (PDSA) process, & completed by February 2011
CHC is compliant with Federal & State regulations, including meaningful use
CONNECT Gateway will be used for patient access, Uniform Data System (UDS) reporting & updating the County Immunization Registry
Existing use of the Patient Electronic Care System (PECS) registry will migrate to the EHR
CHC has at least 30% patient volume enrolled in the Medicaid program
A train the trainer approach will be used to minimize vendor-related expenses
10
Individual Role
DeEtte Trubey Project Manager
Keri Vogtmann Project Manager Process
Kal Shenoy Project Manager Hardware
David Montanez Project Manager Software
Mona Naoum Project Coordinator
Ann Winclair Graphics Designer
Project Management Office
11
Process Team
Individual Role
Keri Vogtmann Project Manager
Luis Perez Clinical Analyst
Jean Frazier Clinical Analyst
Sarah Leake Clinical Analyst
Regina Pizarro Practice Management System (PMS) & Billing Analyst
Carmen Valladolid Meaningful Use Analyst
Elizabeth Wellner Practice Management System (PMS) & Billing Analyst
Linda Flower Clinical Analyst
Carmen Matthews Training Specialist
Eric Smith User Acceptance Testing (UAT) Analyst
12
Hardware Team
Individual Role
Kal Shenoy Project Manager
Chris Vu System Engineer
Michael Tegardine Network Engineer
Josie Aguinaldo Security Administrator
Ben de Rosales Jr. Software Engineer
Thomas Hoffman Service Desk Manager
Victor Cecena Desktop Manager
Mona Naoum Project Coordinator
13
Software Team
Individual Role
David Montanez Project Manager
Sheldon Penner Software/Database Engineer
Ras Desimone Software/Database Engineer
Laurelle Palmer Software/Database Engineer
Warren Goldberg Risk, Regulation & Stakeholder Analysis
Nga Anamosa Engineer Senior Analyst
Jacqueline A. Harris Process Analyst
14
Stakeholders
Management Board, Steering committee, Chief Medical Officer
Implementation team PM, Application & clinical specialist, process analysts & Consultants
IT Team Integration Architect, DB, Networking, System Admin, Application
Development Functional Departments
Clinical Team, Billing, Training, Medical records, quality, Pharmacy, Radiology & Libratory departments
External Patients, insurance companies, community volunteers, media,
Medsphere, government agencies; HHS, NHIN…..
15
Communication Plan
Purpose Vision What could happen Communication Methods
16
Communication Plan - Accountability
Type of Communication Responsible Stakeholder Communication Method
Community Clinic Marketing & Information Meaningful Use Compliance & PromotionPatient Care Improvement
Public Relations EmailWebsiteNewsletterPublic Service AnnouncementsGovernment Agencies
Communicating Key Project StatusAssuring Support for ProjectCompliance & RegulationsPress ReleasesIncentive & Recognition Programs
C Suite/Senior Management EmailAll-hands MeetingGovernment Agency Conferences
Project Status & ScheduleMaintain Organization Chart & ResponsibilitiesProject Milestones (Go/No Go)Issues & Resolutions
Project Manager EmailMeetingsProject Website
Implementation Advocate Healthcare Rules, PoliciesClinical Information
Clinicians EmailMeetingsVerbal communication
17
ComplianceRegulatory Level
Name Legal & Regulatory Requirements Description
Federal HIPAA Health Insurance Portability & Accountability Act of 1996 Privacy Rule & Security Rule
Federal PSQIA Patient Safety & Quality Improvement Act of 2005 Patient Safety Rule
Federal ARRA American Recovery & Reinvestment Act of 2009 Meaningful Use Reimbursement
Federal HITECH Health Information Technology for Economic & Clinical Health Act
Initial Set of Standards & Certification Criteria Interim Final RuleHHS Authority & Breach Notification Interim Final RuleCertification Programs – Notice of Proposed Rule (NPRM)State Health Information Exchange Cooperative Agreement ProgramHealth Information Technology Extension Program
Federal CFR Code of Federal Regulations Title 42 – Public Health Federal Office for Human Research Protections (OHRP) Compliance Oversight
State CCR California Code of Regulations Title 16, Title 17, & Title 22State CHSC California Health & Safety Code Access Laws on Health & Safety Regulations for
Health Facilities & Medical Services
National JC Joint Commission of 2004 Documentation & Medical Record Requirements
Federal FRCP Federal Rules of Civil Procedure Federal Rules of Admissibility & Electronic Discovery Civil Rule - 2006
State COAL California Office on Administration Law Additional Discovery Rules for Legal Records, both Paper & Electronic
18
Regulations CMS - Security/HIPAA
Strong organization culture of security: Documented processes to protect ePHI
Confidentiality, availability, integrity Training
All individuals are personally responsible with severe penalties
Roll-out, new hire training, refresher training Real-life case discussions in monthly department
meetings Top management priority
Talked about often Known organizational auditing
19
Security Standards
Administrative Security Officer ultimate responsibility Risk Analysis required Roles & privileges process including termination Business relationships
Physical Facility controls Media access Workstation access
Technical Audits Access control Transmission, firewall, virus security Remote access
20
Risk Analysis
Methodology
Full analysis in Implementation Plan
Higher Risk Areas Poor adoption rates Process improvements required Inappropriately used ePHI data Disaster recovery plans
Threat Prob Impact Plan Adequacy
1 Low Med > Plan 1
2 Med High > Plan 2
21
Current System State
22
Future System State
23
Medsphere OpenVista
EHR Software: OpenVista Leverage billions of dollars of VA software development Open source fosters software enhancements Close relationship with government officials for
meaningful use Local company resources Medshpere management understands “open source“
Track Record Hundreds of reference sites including ambulatory sites Proven & quick Stage 6 implementations
24
Implementation Schedule
25
Panel 2 - Workflow
Individual Role
Luis Perez Clinical Analyst
Jean Frazier Clinical Analyst
Keri Vogtmann Project Manager
Sarah Leake Clinical Analyst
Lynda Flower Clinical Analyst
Elizabeth Wellner PMS & Billing Analyst
Regina Pazarro PMS & Billing Analyst
Sheldon Penner Software/Database Engineer
26
Process Workflow
PatientRegistration
& Scheduling
PatientCare
&Health
Records
Billing&
Payment
27
Clinical Decision Support Tools
ORDER SET
30
• Improve patient safety
• Improve quality of care
• Identify drug-drug interactions
• Identify drug allergies
• Increase patient compliance
• Improve patient self-care
• Meet Meaningful Use
Clinical Decision Support Tools
31
Templates & Flowsheets
• Record & communicate care
• Create uniformity
• Ability to abstract data for research
32
Templates
• ADULT• Diabetes• Hypertension
• WOMEN• Initial History & Physical Exam• Trimester Assessments
• PEDIATRICS• Preventive Health• Upper Respiratory Infection
33
• ADULT• Asthma• Obesity
• WOMEN• Prenatal: blood pressure,
fetal heart tones, etc.• Preventive Care
• PEDIATRICS• Age-Specific: body
measurements, immunizations, developmental milestones
Flowsheets
34
• Increased patient satisfaction
• Timely access to current:• Medications• Lab results• Patient education
materials
• Email correspondence with physician
• Appointment requests
• Prescription refill requests
Patient Portal
35
• Modify post-EHR workflow as needed after go-live
• EHR clinical team• Learn the application• Assess what the system
lacks for our needs• Create gap analysis
Next Steps
36
• QUALITY ASSURANCE TEAM Metrics to track best practice protocols & business practices
• Practice protocols• Meeting hemoglobin A1C goals for
diabetics• Peak flows for asthmatics• Blood pressure control for hypertensive
patients
• Business practices• Patient wait times• Percentage of physician CPOE utilization
• Meet Meaningful Use criteria
Next Steps
37
CONTINUE RAND HEALTH’S
PATIENT SATISFACTION
QUESTIONNAIRE
18 questions completed after visit
• Paper option• New online kiosk option
Next Steps
38
Financial Process/Workflow
Front & Back Office Workflow Coordination Interoperability / Coding & Billing Integration Documentation Payer-specific Requirements
Processes E&M Calculator at point of care Data flow from system to system
39
PMS is utilized. - PSR schedules an appoint. - Demographics & Insurance info input into PMS
PSR performs tasks in PMS:- Convert master ID to a patient Medical record #.- Updates, Collects Deposit/Co-Pay & payer information. Posts in PMS- Scans ID & insurance card.
Patient is processed as per Adult patient Work-flow sheet.
Billing Workflow& Medical Records/Abstracting
Workflow - with EHRPractice Management System (PMS) in Place
• EOB scrutinized & if necessary chart is electronically pulled, notes sent
electronically. Bill resubmitted or adjustedBill reconciled A/R adjusted.
- End
Completes & confirms all provider orders then
Flags orders as completed in EHR
PS
RP
RO
VID
ER
BIL
LIN
GN
UR
SE
NO
Lab,
Rad
Pha
rm
Bill paid?
YES
Patient checks in with PSR to verify Insurance or self-pay.If Self pay referred to social workers, etc. for Financial assistance.
Using CPOE : - Orders & procedures are entered for auto processing into PMS - E&M calculator suggests OV level
Chart reviewed foraccuracy of codes &
Documentation.
Toward end of Patient encounter.
Review & approvesAbstracted &
Scanned itemsSigns off paper chart
Chart sent to Medical Records
Code for billing & diagnosis from the PIS, RIS & Pharmacy auto migrates to
PMS
- Bill generated & checked for accuracy - Electronically submitted to insurance or patient
Pat
ient
- List of Patients for next day is generated.
Med
ical
Rec
ord
s Add Pt name to “To be scanned”
Worklog
MR abstractor locatesRecord, scans, &
abstracts for NEXT DAY Patients.
- Patient records verified complete/approved. - Chart sent to long term storage.
Abstracted Chart sent to PSR at
Clinic.
• PSR Logs into PMS to review daily schedule.
• EHR automatically populated with schedule information.
40
Data Migration Strategy
The Challenge Pre-populate the EHR
with useful data day 1
145,000 annualpatient visits
Over 30+ years to be scanned & abstracted
41
Data Migration Strategy
Solution for Existing Electronic Data Mirth Connect integration engine to develop channels
between old & new databases Automate on-going data transfers: Updates, additions &
deletions Solution for Paper Records
Pre-Rollout: Migrate records of patients most likely to be seen soon
Post-Rollout: Migrate records on a “go-forward” basis – patient who make appointments or appear at the clinic
42
Data Migration Table
TYPE SOURCE METHOD TIMEFRAMEDemographics PMS Bulk HL7 Interface CurrentAppointments PMS Bulk HL7 Interface FutureAllergies Face Sheet Abstract ActiveMedications Face Sheet Bulk HL7 Interface / Abstract CurrentProblems Face sheet, PMS Bulk HL7 Interface
AbstractActive
Medical, surgical, family & social History
Chart Abstract Current
Measurements Chart Abstract Last 3 visitsLab resultsOutside Lab Lab, Chart Bulk HL7 Interface Last yearInside Lab Chart Bulk HL7 Interface Last yearProcedures PMS, chart Bulk HL7 Interface
AbstractLast year
Therapies Chart Abstract Last yearHistory & Physical Chart Scan LastVaccinations Immunization Registry, Chart Bulk HL7 Interface
AbstractLast given (includes all categories) Lifetime for children.
Progress notes Chart Scan Last 3 visitsPreventive & Health Screening
Chart, Lab Abstract all.Scan any abnormalities
5 years
Referrals Chart Abstract Active, allGoals Chart Abstract Last yearAdvance Directive Chart Abstract/scan CurrentPatient Education Chart Abstract Last yearFlow sheets Chart Scan Last yearConsultation/correspondence Chart Scan Last year / Active
43
Panel 3 - Hardware Operation Environment
Individual Role
Kal Shenoy Project Manager
Chris Vu Hardware Engineer
Michael Tegardine Network Engineer
Josie Aguinaldo Security Administrator
Ben de Rosales Jr. Software Engineer
Thomas Hoffman Service Desk Manager
Victor Cecena Desktop Manager
44
Implementation Strategy
Current environment Network, Servers/Storage Applications, operations
Upgrade plans Upgraded technical architecture Fiber Ring network Thin client deployments
45
Technical Architecture
46
Fiber Ring Topology
Current T-1 connectivity Legacy copper connectivity at 1.544 MPS
Fiber Ring Topology Providers: AT&T & Cox communications Why Cox
Supporting Health Care providers Discussion of data/fact gathering with Sharp IT, & Family Health IT
Fiber connectivity redundancy Dual connectivity from each router to Fiber ring
Access & Security-High Level Patient/PHR-Web Portal IT support & Physician VPN & RSA/Token security
47
48
Server Hardware - Location & Features
Location Store in special server rooms, Central & East clinic (backup) Server Rooms Features
Secure entrance Temperature controlled Redundant Power w/ Spike & Surge protection Monitoring – cameras, sensors Qualified staffs
Server Hardware Features Intel Xeon processor – multiple processor RAID with hot swappable HD Redundant connections – multiple Ethernet / fiber ports Tape backup system
49
Server Software - Operating &Application
Windows server 2008/R2 Standard, business,data center
Features of server Operating Systems Robust – even during hardware failure Multiple security features including firewalls &
intrusion detection Remote administration Extensive audit trail
Special features of application servers & database Cache Clustering Virtualization (VMware) for development, demo,
training, & QA Terminal services
50
Failover Clustering
Key Benefits Protects against data loss
& service interruptions Automates failover to reduced
downtime, lower complexity of disaster recovery plan
Reduces administrative overhead by automatically synchronize application & cluster changes, easier tokeep consistent than unclustered servers
Updating server without service interruption
51
Multi-site Clustering
Key Benefits Protects against loss of an entire
datacenter such as power outage, fire, hurricanes, floods, earthquakes, terrorisms
Automates failover to reduced downtime, lower complexity of disaster recovery plan
Reduces administrative overheadby automatically synchronize application & cluster changes, easier to keep consistent than unclustered servers
Updating server without service interruption
52
Terminal Services Benefits
Windows Server 2008/R2 Terminal Services gateway enables the creation of a scalable SSL-based remote
access solution Terminal Services Session Broker enable the creation of simple & effective Load-
balancing a terminal server farm
53
Software Installation
Environments Non-production
Development Quality Assurance (QA)/Test User Acceptance Testing (UAT) Demonstration Training
Production
54
Infrastructure - Security & Privacy
Password policy enhancements SSL Configuration Client Side certificates Audit Control Data Integrity HIPAA Compliant VPN Access – Two Factor Authentication
(RSA Token)
55
Remote Access
Provider can access EMR using VPNover the Internet
56
Workstation & Peripherals
Thin Client Stations Work Stations Laptops Monitors Carts Printers All-in-Ones Peripherals
57
Computer Operations
Service Support Service Desk
Incident Management Client Surveys
Service Delivery Service Level Management
Service Level Agreements Production Review Board
58
Panel 4 - Software Aspects
Individual Role
David Montanez Project Manager
Sheldon Penner Software/Database Engineer
Ras Desimone Software/Database Engineer
Laurelle Palmer Software/Database Engineer
Warren Goldberg Risk, Regulation & Stakeholder Analysis
Nga Anamosa Engineer Senior Analyst
Jacqueline A. Harris Process Analyst
Kal Shenoy Project Manager (Hardware)
59
Current System State
60
Future System State
61
Current Data Flow State
62
Future Data Flow State
63
OpenVista
Install OpenVista & InterSystems Cache Convert & migrate sample patient
data from PMS to OpenVista Support clinical team in system configuration
tasks Test activated features of OpenVista
& interface connections Test Health Information Exchange (HIE)
connections...
64
InterSystems Cache
OpenVista Database Selection
InterSystems Cache Proprietary software Extension of MUMPS Graphical User Interface
(GUI) interface Window, UNIX, Linux,
Mac OS X, & Open VMS server
High performance object database
Web gateways access to web browser interface
Rapid integration & development platform
GT.M Open Source MUMPS language MUMPS database Linux & Unix
operating system
65
OpenVista Database
Advantages/Features Benefits
24 x 7 support Provides high comfort level to high-risk businesses such as medical clinics
High performance - runs SQL 5x faster Uses multi-dimensional DB technology
Scalability Enterprise Cache Protocol increases app performance
VA uses it along with many other clinics & hospitals
Stable product, continuously supported & upgraded
On-line documentation & e-learning access Reduced cost to upgrade developer skills
Multidimensional storage, journaling mgt., lock mgt.
Tracks physical, logical DB updates; reduces conflicts between transactions trying to access same data
Tools to work with it exist Supports Java, EJB, VB, .Net, etc.
InterSystems Cache
66
Interoperability - Mirth & NHIN CONNECT
Add OpenVista outbound & inbound channels Admit, Discharge, Transfer, Scheduling, Financial Transaction
Create new inbound & outbound channels for Order Messages (ORM) & Order Results (ORU)
Create new outbound channel to National Health Information Network (NHIN) CONNECT Gateway
Create inbound & outbound Continuity of Care Record (CCR) & Continuity of Care Document (CCD)
Install Cache Java Database Driver for the Mirth database reader
Configure NHIN gateway connector in Mirth Test & deploy changes
67
Software Development
Implement Rapid Prototyping Fits well into PDSA philosophy
Application Lifecycle Management Microsoft Team Foundation Server 2010
OpenVista Patient Portal
68
Configuration Management
Framework Identification Control Reporting Audit
Benefits of Configuration Management Legal Obligations – Meaningful Use, HIPAA
Process & approach Software Configuration Management Team Foundation Server 2010 Configuration Management Database Definitive Media Library
69
Configuration Management
Manage changes to all Configuration Items in Production
Server & network components, Software programs, Signed contract documents, etc.
70
Downtime Procedures
GOAL CHC clinics remain operational during planned or
unplanned events Plan is created/approved by internal committee
METHOD Use approved paper methods to maintain workflow
during downtime All paper records must be “back-chartered” into
the electronic record in a timely fashion BOTTOM LINE
Ensure downtime episode does not pose a threat to patient safety & integrity of clinical practice
71
Panel 5 - UAT, Training & Go Live
Individual Role
Eric Smith UAT Analyst
Carmen Matthews Training Specialist
Nga Anamosa Engineer Senior Analyst
Laurelle Palmer Software/Database Engineer
Lynda Flower Clinical Analyst
Thomas Hoffman Service Desk Manager
DeEtte Trubey Project Manager
72
User Acceptance Testing (UAT)
Failure to conduct UAT will result in finding more problems after release.
UAT should confirm whether the software supports the existing business process, not whether or not the software works.
UAT will compare user expectation to actual results very early in the implementation.
User requirements that evolve during UAT will be part of the post-EHR implementation.
Key: Super-Users acceptance will influence community acceptance of the EHR.
Steps for UAT Run Test Cases Mock-go Live Super-Users sign-off , Go-No Date(readiness for go-live)
73
Training
Purpose (Why) Who, What, Where, How Effectiveness Afterwards – What’s Next
74
Training V1
75
Training V2
76
Project Monitoring & Control
Data to be collected & reviewed during the implementation Meaningful Use Financial Return on Investment Quality Measures Compliance Patient Satisfaction Surveys
Post Implementation Review Outstanding Issues Maintenance & Support
77
Panel 6 - Financial Impact
Individual Role
Keri Vogtmann Project Manager
Luis Perez Clinical Analyst
Carmen Valladolid Meaningful Use Analyst
Sarah Leake Clinical Analyst
78
Meaningful Use
Maximum Incentive Payment Amount for Medicaid Professionals
Cap on Net Average Allowable Costs, per the HITECH Act
85% Allowed for Eligible Professionals
Maximum Cumulative Incentive Over 6 - Year Period
$25,000 in Year 1 for most professionals$21,250
$10,000 in Years 2-6 for most professionals$8,500 $63,750
$16,667 in Year 1 for pediatricians with a minimum 20% patient volume, but less than 30% patient volume, Medicaid patients
$14,167
$6,667 in Years 2-6 for most professionals pediatricians with a minimum 20% patient volume, but less than 30% patient volume, Medicaid patients
$5,667 $42,500
79
Meaningful Use
Payment Scenarios for Medicaid EPs Who Begin Adoption in the First Year
Calendar Year Medicaid EPs who Begin Adoption in:
2011 2012 2013 2014 2015 2016
2011 $21,250
2012 $8,500 $21,250
2013 $8,500 $8,500 $21,250
2014 $8,500 $8,500 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500 $21,250
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
2017 $8,500 $8,500 $8,500 $8,500 $8,500
2018 $8,500 $8,500 $8,500 $8,500
2019 $8,500 $8,500 $8,500
2020 $8,500 $8,500
2021 $8,500
Total$63,750 $63,750 $63,750 $63,750 $63,750 $63,750
80
Unpacking the “Meaningful Use” Requirements
Major Components of Meaningful Use Proposed Rule & Recommendations
Adoption Year Improve Quality, Safety & Efficiency
Engage Patients & Families
Improve Care Coordination
Improve Population & Public Health
Ensure Privacy & Security for PHI
Stage 1 (2011) Achieve 80% CPOE
75% electronic submission of eRx
Implement 5 clinical decision support rules
Report quality measures to CMS/State
Digitally Record Key patient data
Provide Patients with electronic copy & access to health information within mandated time
Provide clinical summaries for each office visit
Exchange key clinical information among authorized care providers
Perform medication reconciliation for 80% of all relevant encounters, transitions
Submit data to immunization registries
Provide electronic syndrome surveillance data
Exchange key clinical information among authorized care providers
Perform medication reconciliations for 80% of relevant care encounters, transitions
Stage 2 (2013) Use CPOE for all orders
Manage chronic conditions using patient lists & decision support
Provide clinical decision support at the point or care (e.g. alerts, reminders)
Ensure patient access to PHR populated with real time health data
Produce & share electronic summary care record
Reconcile medications between settings
Receive health alerts from public health agencies
Submit anonymized electronic syndrome surveillance data
Ensure compliance with HIPAA privacy regulations
Conduct or review a security risk analysis & implement security updates
Stage 3 (2015) Establish medical device interoperability
Develop multimedia support
Implement clinical decision support for national high priority conditions
Provide self-management tools
Enable electronic reporting on care experience
Access comprehensive patient data from all available sources
Use epidemiologic data
Share automated, real-time surveillance data
Provide on-request accounting of treatment, payment & operations disclosure to patients
81
Meaningful Use Stage 1
Health Outcomes Policy Priority Objectives MetricsCollaborative Teams Throughout Meaningful Use Stages
Improve quality, safety efficiency & reduce health disparities.
(Objectives 1-16)
CPOE; Drug-drug Interaction; Active problem list; e-RX; Active medication/allergy list; Demographics/vital signs & smoking status, incorporate lab test results into EHR, Generate lists of patients by specific conditions, Report ambulatory quality measures; Patient Reminders; 5 clinical decision support rules; Check insurance eligibility & submit claims electronically.
Recording of structured data, Attestation, Generation of Reports, Electronic submission/transmittal, patient reminders
Required percentage measures:50%, 75%, 80%
Physician & Nursing Staff, Medical Records Staff, Application Support Analyst, QU/MU Specialist
Engage patients & families
(Objectives 17-19)
Provide patient with copy of electronic health information & clinical summaries within federally mandated time limit
Access provided via patient portal or printed copy. Perform test of systems capability.
Required percentage measures: 10% & 80%
Mandated timeframes: 48 hrs., 96 hrs.
Physician & Nursing Staff, Medical Records Staff.
Improve care coordination
(Objectives 20-22)
Electronically exchange key clinical information among providers of care & patient authorized entities.
Medication reconciliation.
Medication reconciliation, clinical information exchange performed.
Perform test of systems capability.
Required percentage measure 80%.
Physician & Nursing Staff, Medical Records Staff.
Improve population & public health
(Objectives 23-24)
Submit electronic to immunization registries; Provide & transmit electronic surveillance data to public health agencies.
Submit & transmit electronically to registries.
Perform test of systems capability.
Physician & Nursing Staff, QA/MU specialist.
Ensure adequate privacy & security protection for PHI
(Objective 25)
Conduct & Review security risk analysis; Implement security updates as necessary; Ensure full compliance with HIPAA Privacy & Security Rules
Conduct or review security risk analysis & implement security updates as necessary.
Perform test of systems capability.
IT Support/Security Officer
Progress to Meeting Criteria
82
Procurement Plan
Initial Understanding: HW, SW team needs Defined process Potential suppliers Budget for investment
Vendor Evaluation Scorecard
Criteria & weights Technology, quality, responsiveness, delivery, business, environment
RFQs Delivery without negatively impacting go-live
Tracking Spending & Performance
Expenditure
Excellence
83
Major Expenditures
Hardware Capital Expense = $330K Servers WAN SAN Fiber ring Thin clients High speed copiers
Software Capital Expense (1st year) = $ 73K Elite licensing (80 to 115 users increase over 6 years)
84
Timing
Go-LiveOct 2010
TrainingNov-Dec 2010
Savings from ImplementationMar 2011
MU paymentsMay 2011
Increased demandDuring Year 2012
85
Benefits
MU Medicaid incentives ($3.5M) One time incentive 2011-2016
Transcription savings ($29K/mo) Increased number of visits:
Labor efficiencies ($38K/mo) Word of mouth
Riddance of flow charts, superbills, H&Ps, etc.& other administrative costs ($5-10K/mo)
Reduction of labor costs ($18K/mo) Reduction of storage expenses
86
Cost Drivers
Anticipate loss of productivity during training& initial deployment period
Hardware $330K Software
$73K first year $444K over 6 years
Staffing $4M over 6 years
87
Staffing Assumptions
Temporary 2 Trainers 2 Hardware Engineer Contractors 1 Contractor – OpenVista 4 Abstractors Backfill – MDs, RNPs, Nurses
Permanent 1 Process Analyst 2 Technologists 1 Meaningful Use Specialist
Providers Overtime Costs PSRs during training
88
Cost Breakdown
0
200
400
600
800
1000
1200
Thousands
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Staffing
Software
Hardware
89
Cost & Benefits
0
500
1000
1500
2000
2500
3000
3500
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Th
ou
san
ds
Benefits
MU
Costs
90
NPV Analysis
MU 100% MU80%
MU 60%
MU40%
8% $8.9M $8.7M $8.5M $8.2M
10% $7.8M $7.6M $7.4M $7.2M
12% $6.9M $6.7M $6.6M $6.4M
14% $6.1M $6.0M $5.8M $5.7M
16% $5.4M $5.3M $5.2M $5.1M
IRR 5.8% 5.5% 5.1% 4.7%
91
Cumulative Cash Flows
($2)
($1)
$0
$1
$2
$3
$4
$5
$6
$7
Millions
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Cum. CF
92
What It’s All About
93
Additional Questions
Thank You
94
UCSD Extensions HIT Spring 2010 Class
95
Name/URL E-Mail
Josie Aguinaldo [email protected]
Nga Anamosa [email protected]
Victor Cecena [email protected]
Ras Desimone [email protected]
Lynda Flower [email protected]
Jean Frazier [email protected]
Warren Goldberg [email protected]
Jackie Harris [email protected]
Thomas B. Hoffman [email protected]
Sarah Leake [email protected]
Carmen Matthews [email protected]
David Montanez [email protected]
Mona Naoum [email protected]
Laurelle Palmer [email protected]
UCSD Extensions HIT Spring 2010 Class
96
Name/URL E-Mail
Sheldon Penner [email protected]
Luis Perez [email protected]
Regina Pizarro [email protected]
Ben de Rosales, Jr. [email protected]
Joel Salgado Jr. [email protected]
Kallya Shenoy [email protected]
Eric Smith
Michael Tegardine [email protected]
DeEtte Trubey [email protected]
Carmen Valladolid [email protected]
Keri Vogtmann [email protected]
Thuan (Christopher) Vu [email protected]
Elizabeth Wellner [email protected]
Ann Winclair [email protected]
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