april 17, 2012 selecting the right vendors for your health it projects
TRANSCRIPT
April 17, 2012
Selecting the Right Vendors for Your Health IT Projects
Tuesday, April 17, 2012
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• This webinar will be recorded and available on
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• The slides will also be available for download
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• Type your questions in the box as we go
Tuesday, April 17, 2012
Outline of Webinar
Goals for today
Lincoln Lancaster County Health Department (NE)
Cabarrus Health Alliance (NC)
Questions
NACCHO ePublic Health Upcoming Events
Tuesday, April 17, 2012
Goal of Webinar
By the end of the webinar you will know the following:
• Strategies LHDs can use to select vendors for health IT
projects
Lincoln-Lancaster County Health DepartmentLincoln, NE
April 17, 2012
Understand your business What are the core guidelines or principles
that need guide investments for your business?
What will an IT solution offer?
We adopted these principles
Support staff at the “point of service” – when and where they work
Eliminate paper-based reporting & documentation Off the shelf to assure taking advantage of new
features and technology
Guiding Principles
Not every health department is the same A business case analysis of the cost benefit
of IT investments is important What services do you provide today? What
services will you provide in five years?◦ Example: Full Service compared to small
department with Immunizations and Access to Care
Business Process Analysis◦ Do you want or need to make changes in the way
you currently do business? What are your core partners doing? What are the goals of your director,
supervisors and front line staff? What are other health departments like you
doing? What are your investment options?
Funding strategies?
What are your options?◦ Advantages and disadvantages of each type◦ For example:
Public Health System that supports mandated reporting
Electronic medical record or other point of service system that focuses on documentation and record keeping for services
Use / share software provided by another (State Immunization Systems
Support direct service efficiently Reduce errors, promote consistency and quality of
care Support quality assurance and improvement efforts Facilitate transfer of information needed to provide
care Eliminate paper records Communicate accurately and quickly Measure outcomes and monitor performance Take advantage of technology advancements and
conveniences
Designed for Physician / physician extender as providers
Need to create templates and routines to support public nurse as provider
Vocabulary for community-based and case management services is more limited compared to medical
Key staff from users from all program areas that will be impacted
Obtain buy-in / sponsorship county
Include:◦ Legal ◦ Purchasing◦ Finance◦ Technical
This is going to be a major
investment of time and money—Involve your stakeholders
from the beginning.
What are the steps you propose for making this decision?
Clarify roles and responsibilities of your team and team members
Outline the “products or outcomes of the work”◦ Business Process analysis and flow charts◦ Request for Proposals◦ Evaluation and selection◦ Decision-making process
Are you satisfied with your current structure and processes?
Opportunity to examine Business processes and practices and refine and improve
Are there specific improvements that you hope to make with the right software or tool?
Our Core RequirementsCCHIT certifiedMaster patient indexOff the shelfNo or very limited customizationTraining / Informatics competencies of front line staffTools to adapt to work processes and work flow in software Medical record vs. reportingStandard Processes
Research the vendors and products most likely to meet your needs
Talk to them and encourage them to submit a proposal once you issue an RFP
Use consultation / technical expertise to reach the vendors who will be able to meet your needs– Regional Extension Center
Use varied approaches to get vendors to submit proposals
We sent our RFP to more than 80 vendors and received 6 proposals
Analyzing work flow and processes Developing / reviewing requirements Reviewing and prioritizing criteria for
evaluation Reviewing and evaluating proposals
(including / especially demos) If you don’t receive proposals that meet
your needs—don’t be afraid to try again. Take what you learn and revise your RFP / criteria / vendor search
Our implementation came after our third effort
Document carefully We went from a complex tool to a very
simple form And then assigned individuals to teams to
evaluate specific capacities Scoring – the numbers never make the final
decision Review and follow-up—it is never apples to
apples
Functional Area Team MembersOn-site Demo 1
Vendor, Date, PlaceTBA: T-F, 12thth – 15thth
IntroductoryScenario
All 8:00 to 9:30 a.m.
Your supervisor mayrequest that you attendall of the next 4sections
Bernice Afuh*Geri Rorabaugh*Shirley Terry*Sharla Griess*Carol Kukuk*
Jane Linsenmeyer*Barb Martinez*Brenda Monroe*Cindy Peters*Kris Saunders*
Customer ServiceIvonne De La TorreJann DouglasJanette Johnson
Gwendy MeginnisJanet Rose 9:40 to 10:40 a.m.
Information &Referral
Annette SturtzAnita King
10:50 to 11:50 a.m.
Clinical
Shirley AchordJean PearsonKris SaundersAnnette Sturtz
Tim TimmonsLisa TruaxShannon Williams
12:30 to 1:30 p.m.
Case Management
Deb EdelmaierAli HettenbaughMarilyn JamesJean KrejciKim Rettig
Chris RiffleAnh TranLisa TruaxNicky TurnerCheryl SchulteTammy Weihe
1:40 p.m. to 2:40 p.m.
System/ GlobalRequirements
Charlotte BurkeMary ChristensenKathleen CookAnn FetrickTrudy Franssen
Judy HalsteadMagdalena KrynskyAndrea MasonJim WalkenhorstZhong Xu
All day, particularly 2:50 to 4:30 p.m. orwhenever finished
1. Comprehensive response that clearly tracks to the RFP.
Is the proposal written to LLCHD or is it just a set of canned forms and templates? Is the proposal clear and easy to follow or are there errors that show sloppiness or lack of care?
0 1 2 3 4 5
2. Overall price.
Are pricing estimates included? Is the pricing estimate based on each nurse as equivalent to a physician or PA/Advance Practice Nurse provider? (This would not be expected.)
0 1 2 3 4 5
3. Red flags
# of things that raised red flags as you reviewed the proposal, for example, implementation plan timeframe, years company has been in business, # of & experience of employees, etc. Note: 5 means no red flags, 0 means lots of red flags. Please clarify what the red flags are in the note section below.
0 1 2 3 4 5
4. References in Midwest.
0=no references within 8 hour drive (500 miles) 1=references within 500 miles, 8 hour drive 2=references within 200 miles, 4 hour drive 3=references within 50 miles,1 hour drive
0 1 2 3 4 5
5. General impression the product will meet all functionality needs.
Are all requirements addressed and discussed? For example, does the product clearly indicate the ability to do the practice management/billing as well as clinical functions?
0 1 2 3 4 5
While reviewing the proposals please use the following evaluation criteria: This first review will develop the short list for further consideration. Rate 0 as very poor or non-existent and 5 as the HIGHEST
Use ScenariosUse ScenariosBackground information:We call this patient a “presumptive” and will generally follow her through pregnancy, childbirth, and afterward for about two months. We will include visits to the baby for as long as needed, possibly for a number of years. “Following her” includes clinic nurse assessment, education, and community referrals, including referring her to a doctor (external) forprenatal care, and to the LLCHD nurse home visitation program (internal).CLINIC1. Woman, Juanita Hernandez, thinks she is pregnant so has her friend, who speaks English, call the clinic to find out when she can come to clinic to find out if she is pregnant. She comes to the clinic.2. Lab work is done that confirms pregnancy.3. Mrs. Hernandez is assisted by the interpreter to complete the application for Medicaid and other needed paperwork. She is seen in the LLCHD WIC Clinic.4. An appointment is made for her to see a doctor (not at our clinic) in 3 weeks. Cab transportation and an interpreter are arranged.5. Nursing Assessment is done, including risks that indicated need for nurse home visitation. Nurse doing presumptive opens chart record and refers client for Home Visitation services by the Maternal Child Health (MCH) section of CHS.
Project Management tools Business Process / Flow Chart tools Sample Requests for Proposals Evaluation tools Scoring methodology
Ask for references from the vendor for use of their product in a business like yours
Phone references with a team so you verify:◦ Did they stay within cost parameters?◦ Did they implement within time parameters?◦ Does it work the way you hoped?◦ How responsive was the development/ implementation
team to your needs? If it is feasible visit a current user of the product If you still aren’t sure – see if you can “take a
test drive” -- some vendors provide a “playground” that you and your staff can try some of the features
Work with your legal and purchasing departments Negotiate payment terms and time frames Make sure that you retain some payments for
“final” when everything is completed—incentive to complete
This can take up to several months to finalize through all the approvals
Don’t try to skip this—if for any reason, the project goes bad—you need the support from legal and purchasing
This can be a major investment—take the time to get it right—you will likely have to live with it for the next twenty years
SuccessEHS – Electronic Medical Record◦ Practice Management (July 2009)◦ Clinical (October 2009)
Dentrix – Dental Electronic Record◦ Practice Management and Chair side charting
(2008)◦ Digital radiography (2009)
Selecting the Right Vendors for your Health IT Projects
April 17, 2012
Tracy LockardBusiness Process DirectorCabarrus Health Alliance
Background• Awarded grant (12/2006-12/2009) from the Robert Wood Johnson
Foundation entitled, Common Ground: Transforming Public Health Information Systems
• Goal: Have public health electronically communicate with a health information exchange (HIE), community health care partners and consumers
• Project: Practice Management (PM)/ Electronic Medical Record (EMR) Evaluation Project
• Objectives: Develop requirements for evaluating and selecting an PM/EMR system
• Develop efficient and effective best practice workflows for clinic processes, case management and practice management
Collaborative Requirements Development Methodology
PM/EMR Evaluation Project Timeline3/2008
11/2008
1/2009
7/2009
9/2009
Business Process Analysis Business Process Redesign
•Redesigned 46 Business Processes
Requirements Definition•Defined 680 Requirements•Determined over 4000 Data Fields
Eligible Providers[EP]
HospitalsInpatient = [IP]
Outpatient = [OP]
1 • Use CPOE for all orders2 • 10% of all orders (any type) directly entered by authorizing provider (e.g., MD, DO, RN, PA, NP) through CPOE2
• % of orders (for medications, lab tests, procedures, radiology, and referrals) entered directly by physicians through CPOE
• Lab - #1-#8• Maternal Health - #21• Global - Education - #1-#8• Global - Immunizations - #2, #20• Global - Medication - #29-#34• Global - Referral - #1-#6
• Lab - #1-#7, #12-#13, #15-#16• Global - Education - #1-#10• Global - Immunizations - #1-#4• Global - Medication - #28-#53• Global - Plan of Care - #1-#7• Global - Referral - #1-#34
2 • Implement drug-drug, drug-allergy, drug-formulary checks
• Implement drug-drug, drug-allergy, drug-formulary checks
• Global - Medications - #15-#19, #21-#23
3 • Maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED
• Maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED
• % patients at high-risk for cardiac events on aspirin prophylaxis [EP]
• % eligible surgical patients w ho receive VTE prophylaxis [IP]
• Global - Progress Notes - #1-#5
4 • Generate and transmit permissible prescriptions electronically (eRx)
• Global - Medications - #20, #24-#26, #28, #29-#34 • Global - Medications - #28-#53
5 • Maintain active medication list • Maintain active medication list • % of all medications, entered into EHR as generic, w hen generic options exist in the relevant drug class [EP, IP]
• Use of high-risk medications (Re: Beers criteria) in the elderly
• Global - Medications - #1-#14 • Global - Medications - #1-#11
6 • Maintain active medication allergy list
• Maintain active medication allergy list
• Global - Allergies - #1-#8 • Global - Allergies - #1-#4
7 • Record demographics: ◦ preferred language ◦ insurance type ◦ gender ◦ race3
◦ ethnicity
• Record demographics: ◦ preferred language ◦ insurance type ◦ gender ◦ race3
◦ ethnicity
• Stratify reports by gender, insurance type, primary language, race ethnicity [EP, IP]
• Registration/Checkout - #18, #20 • Registration/Checkout - #30-#34, #134, #137-#138, #141• CSC - #30, #33-#35, #43• IHV - #49-#51, #78• MCC - #30, #33-#35, #43
Improve quality, safety, efficiency, and reduce health disparities
• Provide access to comprehensive patient health data for patient’s health care team
• Use evidence-based order sets and CPOE
• Apply clinical decision support at the point of care
• Generate lists of patients w ho need care and use them to reach out to patients (e.g., reminders, care instructions, etc.)
• Report to patient registries for quality improvement, public reporting, etc.
Requirements Defined
2011 - Objectives & Measures - Goal is to electronically capture in coded format and to report health information and to use that information to track key clinical conditions
Care Goals Data Fields DefinedHealth Outcomes Policy Priority
Measures Objectives
12/2009Selected and Acquired a PM/EMR System - Insight
Evaluation Phase• Evaluated Vendors with Tools & Scoring System• Site Visits• Gap Analysis of Meaningful Use Criteria
PM/EMRImplementation
Timeline
12/2010
2/2010
3/2010
4/2010
5/2010
6/2010
7/2010
8/2010
9/2010
10/2010
11/2010
Upgrades to IT Infrastructure•Installed shared storage at primary and disaster recovery data centers• Moved to VMWare for critical servers•Implemented Citrix for deployment of EMR and related applications
Document Imaging Project•Scanned 60,000 paper charts •Developed workflows to automatically file documents created and scanned daily•Deployed the digital chart to CHA staff as well as labor and delivery staff at the local hospital
Go-Live with Practice Management Modules
Implement Practice Management• Patient Registration• Appointment Scheduling• Encounter Processing• Immunization Tracking & Inventory• Patient Tracking• Lab Tracking• Patient Accounts• Event Management
Migration to WIC State System
Practice Management interface with new state public health system
HIT Project Team Goals & Objectives
• Implement a Practice Management & EMR system • Have representatives from each department gain a
broader and deeper understanding of the entire PM/EMR system (and other systems)
• Improve quality and efficiency of health care, access to care, preventive care, care process, patient safety, and provider or patient satisfaction
• Obtain Medicaid EHR incentives and demonstrate meaningful use
• Support Beacon Community grant efforts
PM/EMR Implementation
Timeline
12/2010
1/2011
2/2011
3/2011
4/2011
5/2011
6/2011
7/2011
8/2011
9/2011
10/2011
11/2011
Implement Additional PM Features & Processes• Registration Speed Forms• Integration with Laserfiche• Patient Identification• Electronic Billing
Implement EMR Modules (Phase 1) for:• Child Health
Go-Live with EMR Modules (Phase 1)
Go-Live with Practice Management Modules
Define Modifications to Lab Module
11/2011
1/2012
2/2012
3/2012
4/2012
5/2012
6/2012
7/2012
8/2012
9/2012
10/2012
11/2012
Implement EMR Modules (Phase 4) for:• Family Planning• Maternal Health
Go-Live with EMR Modules (Phase 4)
PM/EMR Implementation Timeline
12/2011
Implement EMR Modules (Phase 3) for:• ePrescribing (OrderConnect)• Pharmacy Go-Live with EMR Modules (Phase 3)
Implement EMR Modules (Phase 2) for:• STD/HIV• TBDigital Signatures (CoSign) for Consents/Forms
Go-Live with EMR Modules (Phase 2)
11/2012
1/2013
2/2013
3/2013
4/2013
5/2013
6/2013
7/2013
8/2013
9/2013
10/2013
PM/EMR Implementation Timeline
12/2012
Implement EMR Modules (Phase 5) for:• Lab Modifications• LIMS• Hospital Lab Interface (CareConnect)
Go-Live with EMR Modules (Phase 5)
TBD• Supplies Inventory• State Lab Interface• Lab Instrument Interface
Implement EMR Modules (Phase 6) for:• Health Information Exchange (CareConnect)
Go-Live with EMR Modules (Phase 6)
Implement EMR Modules (Phase 7) for:• Patient Portal (Consumer Connect)
Go-Live with EMR Modules (Phase 7)
Meaningful User
What are the major tasks for each module rollout – Tasks and Resources
• Project team meetings• Train-the-trainers• Tables • EMR Notes• Define Reports/EMR Dashboards• Process/Workflow Changes• Staff Training• Practice/Mock Clinic• Go Live
Resource Planning
Milestones Major Tasks
Estimated # of Clinical Team Man
Days
Estimated # of IT Team Man Days
Estimated # of Weeks
Proposed Schedule
1 Develop EMR NotesTrain-the-Trainers Project team x 1 week x 4 hours Project team x 1 week x 4 hours March 2011EMR Notes - Education (All programs) 4 persons x 2 weeks x 5 hours = 40 hours 40 2 persons x 3 weeks x 24 hours = 144 hours 144 June 2011EMR Notes - Referral (All programs) 2 persons x 2 weeks x 3 hours = 12 hours 12 2 persons x 2 week x 12 hours = 48 hours 48 April 2011
TOTAL 52 6.5 192 24 52 Implement Child Health
EMR Notes - Child Health - Environment
April 2011
EMR Notes - Child Health - HEEADSSS (ages 15-21)
April 2011
EMR Notes - Child Health - PEDS (ages 1 month - 6 years)
April 2011
EMR Notes - Child Health - Pediatric Sympton Checklist (ages 6-16 years)
May 2011
EMR Notes - Child Health - MCHAT (ages 18-24 months)
May 2011
EMR Notes - Child Health - Newborn Home Visit
2 person x 1 week x 6 hours = 12 hours 12 1.5 days 1 person x 1 week x 24 hours = 24 hours 24 3 days April 2011
Test Custom Development of Module 1 person x 2 weeks x 8 hours = 16 hours 16 1 person x 2 weeks x 16 hours = 32 hours 32 March 2011Train-the-Trainers Project team x 1 week x 4 hours Project team x 1 week x 4 hours April 2011Tables 1 person x 2 weeks x 20 hours = 40 hours 40 1 person x 2 weeks x 20 hours = 40 hours 40 April 2011Define Reports 1 person x 1 week x 8 hours = 8 hours 8 1 person x 1 week x 16 hours = 16 hours 16 May 2011Staff Training 1 person x 3 weeks x 26.67 hours = 80 hours 80 1 person x 3 weeks x 26.67 hours = 80 hours 80 May/June 2011Practice/Mock Clinic 1 person x 1 week x 18 hours = 18 hours 18 1 person x 1 week x 18 hours = 18 hours 18 June 2011Go Live 1 person x 1 week x 40 hours = 40 hours 40 1 person x 1 week x 40 hours = 40 hours 40 June 2011
TOTAL 274 34.25 370 46.25 153 Implement Patient Tracking for Child Health
Tables 1 person x 2 weeks x 4 hours = 8 hours 8 1 person x 2 weeks x 4 hours = 8 hours 8 May 2011Define Reports 1 person x 1 week x 2 hours = 2 hours 2 1 person x 1 week x 4 hours = 4 hours 4 May 2011Staff Training 1 person x 3 weeks x 3.5 hours = 10.5 hours 10.5 1 person x 3 weeks x 3.5 hours = 10.5 hours 10.5 May/June 2011Practice/Mock Clinic 1 person x 1 week x 3 hours = 3 hours 3 1 person x 1 week x 3 hours = 3 hours 3 June 2011Go Live 0 0 June 2011
TOTAL 23.5 2.9375 25.5 3.1875 9
GRAND TOTAL 349.5 43.69 588 73.44 29
2.8125 days 3.0625 days 7 weeks
120 15 days
15 weeks
2 persons x 3 weeks x 20 hours = 120 hours
25.25 days 28.25 days
1 person x 3 weeks x 12 hours = 60 hours 60 7.5 days
Estimated Clincal Team Resources Needed = Total Hours
Estimated IT Team Resources Needed = Total Hours
6.5 24 days 5 weeks
Role Name# of Man
DaysActual Task & Type of Work # of Man
DaysTask & Type of Work
Project Team1
Bobbie Seabolt Bobbie Seabolt1.5 EMR Notes - Child Health - Environment 1.5 EMR Notes - Child Health - Pediatric Sympton
Checklist (ages 6-16)
Bobbie Seabolt1.5 0.375 EMR Notes - Child Health - HEEADSSS (ages 15-21) 1.5 EMR Notes - Child Health - MCHAT (ages 18-24
months)
Bobbie Seabolt1.5 0.125 EMR Notes - Child Health - PEDS (ages 1 month - 6
years)3 EMR Notes - Referral
Bobbie Seabolt0.375 EMR Notes - Child Health - MCHAT (ages 18-24
months)1 Tables - Patient Tracking for EMR
Bobbie Seabolt 0.25 EMR Notes - Child Health - Newborn Home Visit 0.5 Define Reports - Patient Tracking for EMRBobbie Seabolt 1 Staff Training - Patient Tracking for EMR
Sub-Total 4.5 1.125 8.52 Jason Hada Jason Hada 1.5 0.75 EMR Notes - Child Health - Newborn Home Visit
Jason Hada 0.5 EMR Notes - Child Health - HEEADSSS (ages 15-21) Jason Hada 0.625 EMR Notes - Child Health - PEDS (ages 1 month - 6
years)Jason Hada 0.25 EMR Notes - Child Health - MCHAT (ages 18-24
months)Sub-Total 1.5 2.125 0
3 Ryan McGhee Ryan McGhee Integrate Laserfiche & Insight PM 1.5 EMR Notes - Child Health - MCHAT (ages 18-24 months)
Ryan McGhee 0.25 EMR Notes - Child Health - MCHAT (ages 18-24 months)
1.5 EMR Notes - Child Health - Pediatric Sympton Checklist (ages 6-16)
Ryan McGhee 0.4375 EMR Notes - Child Health - HEEADSSS (ages 15-21) 3 EMR Notes - ReferralRyan McGhee 0.125 EMR Notes - Child Health - PEDS (ages 1 month - 6
years)Ryan McGhee 0.125 Tables - Child Health
Sub-Total 0 0.9375 64 Tracy Lockard Tracy Lockard 3 Test Custom Development of Module - Child Health 1 Tables - Child Health
Tracy Lockard 1.5 EMR Notes - Child Health - Environment 2 Define Reports - Child HealthTracy Lockard 1.5 0.25 EMR Notes - Child Health - HEEADSSS (ages 15-21) 3 Staff Training - Child HealthTracy Lockard 1.5 0.125 EMR Notes - Child Health - PEDS (ages 1 month - 6
years)Tracy Lockard 1.5 0.25 EMR Notes - Child Health - Newborn Home Visit
0.25 EMR Notes - Child Health - MCHAT (ages 18-24 months)
Tracy Lockard 4 4 Tables - Child HealthSub-Total 13 4.875 6
Total 19 9.0625 20.5GRAND TOTAL 30 11.25 33
April 2011 May 2011
Resource Planning
Lessons Learned in Adopting EHR
• Lots of process change• Focus on cross-department processes• Billing – Can’t test until live• Productivity/Revenue decrease• Never done! EHR is an integral part of your
operations efficiency and effectiveness
Reference Materials
• PM/EMR Evaluation Project Web site – www.cabarrushealth.org/commonground
Tuesday, April 17, 2012
Questions
Please type your questions in the box
Tuesday, April 17, 2012
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Vendor Portal
Tuesday, April 17, 2012
Contact Information
Vanessa Holley, MPH
Program Analyst, ePublic Health
(202) 507-4239