eclinicalworks asp | 2009 medical summit
TRANSCRIPT
Adoption and Use of Electronic Medical Records (in Federally
Qualified Health Centers)and Supporting an ASP
Community Care Network of Virginia, Inc.
Outline
• Who is Community Care Network of Virginia (“CCNV”)• Technology Goals
• Efficient and Productive Use of EMR• Center for Data and Informatics – Quality• Medical Home and Health Information Exchange• Innovation
• eClinicalWorks Deployment• ASP Hosting• ASP Architecture• Challenges and Benefits
Disclaimer
Community Care Network of Virginia (CCNV)
• Provider Network Incorporated in 1996
• Owned by all of Virginia’s 24 Federally Qualified Health Centers
• Located in 90 sites across the Commonwealth
• 300 providers delivering primary care, dental and behavioral health services
Federally Qualified Health Centers
• Independent non-profit corporations• Mission to serve all members of a community
regardless of patient’s ability to pay• Operate in local communities• Over 1,200 across the country • Take most if not all third party insurances• Receive limited Federal grant dollars to cover the
cost of serving the uninsured• Commitment to quality
CCNV Business Purposes
2. Represent providers/practices in third party payer contracting - single signature authority
3. Provide cost effective management services information technology, medical and dental billing, NCQA certified provider credentialing, etc.
4. Performance Improvement – Center for Data and Informatics
CCNV Technology Goals
Goal 1: Efficient and Productive Use of EMR
• Shared purchase pricing• Multiple hosting options• Readiness evaluations • Workflow analysis and improvement• Training, training, and more training• Central support and ticket management• User group on line forums and twice yearly
meetings
Goal 2: Center for Data and Informatics
• Establishing clinical outcome measures
• Collection and aggregation of data
• Establishing data validity and reliability
• Reporting and benchmarking
• Network and local performance improvement activities
• Quality forums
Goal 3: The Medical Home and Health Information Exchange
Medical Home [Federally Qualified Health Center]
Specialists
Hospitals
Pharmacy Hospice
Payers
Home Health
Local Social Service
Agencies
Medical Home and HIE
Health Department
Labs
Patients
Goal 4: Innovation KIOSKS
• Network wide initiative to fabricate and install waiting room KIOSKS
• Kiosk content integrated into EMR in real time immediately prior to patient entering exam room
• Initial content limited to behavioral health assessment (PHQ-2 and PHQ-9)
• Additional content and functions over time• Streamlines total patient time in the office
eClinicalWorks Deployment
eClinicalWorks (eCW) Deployment
• Two year due diligence planning period• Negotiated network purchase agreement• Licenses owned by individual health center• Optional hosting infrastructure (individually or
ASP)• Master implementation schedule based on
individual organization readiness• Network based, eCW certified trainer and support
technician
ASP Hosting
ASP Hosting
• ASP hosting is optional• Our model is client owned not vendor owned• Software vendor accommodates both ASP
individually hosted architecture• Reasons for choosing ASP vary
• Small practices with limited capital resources and staff
• Large practices not wanting to make significant hardware investments
• timing
ASP Architecture
ASP Architecture
• Located in hosting facility in Richmond
• Corporate office approximately 6 miles from hosting facility
• Hosting facility secure, redundant systems, on site technical staff can provide optional services
ASP Architecture
• Currently have 14 servers• 15 out of 20 organizations are hosted• Currently installed in a single rack• Server types - application, data base, document
management, reporting• Fax servers hosted locally• All servers and drive configurations are redundant• All sites connect through VPN to data center• eCW software manages server\data access
ASP Architecture
• Local engineering support is outsourced
• Central (CCNV) help desk for triage of problems
• eCW handles all software issues
• Set weekly coordination and management calls with eCW
Challenges and Benefits
of an
ASP
Challenges and Benefits
• Internet connectivity issues• Hardware upgrades driven by growth, vendor specs, new
technology (virtualization), maintenance replacements• Lease vs. buy• Must have good communications with vendor (eCW) in
order to manage software upgrades and fixes• Individual practice growth must be accommodated by the
ASP• Technical Staffing and Support relationships are local and
long term• Troubleshooting centers on connectivity and performance
(latency) issues
Challenges and Benefits
• Eliminates human resources issues for practice• Technical expertise available to individual
practices that they might otherwise not have access to, or can afford
• The number and types of issues experienced by a large practice that individually hosts are similar to an ASP hosted configuration
• Most issues are not eliminated, the responsibility to address them are shifted
David SeligChief Executive Officer
Community Care Network of Virginia6802 Paragon Place
Suite 630Richmond, VA 23230