Integrating the EMR into SBHC Settings:

Local and National Perspectives

Objectives for today…Objectives for today… The Participant will be able to evaluate

opportunities and challenges for SBHCs to convert to Electronic Health (Medical) Record (EHR) and determine the basic requirements for an EHR system within a SBHCs

The Participant will identify resources, training and the infrastructure needed by SBHCs and sponsoring organizations to respond to the need to convert to EHR.

The Participant will be able to assess education and health care policies and finance mechanisms that support the conversion to EMR systems, including community, state, and regional networks.

What is happening now? What is happening now?

The national health IT agenda is moving forward and there will be widespread adoption of EHRs with in the next decade.

SBHCs are asking for information, networking opportunities and support around data collection and the EHR.

“Electronic health records and other information technology tools have the potential to speed advances in medicine and help doctors make more rapid and informed decisions about medical care for their patients. Health information technology is expected to fill major gaps in medical knowledge and help doctors learn on a real-time basis what works and what doesn’t for their patients.”Health Affairs Briefing: Health Information Technology and Rapid Learning, Friday, January 26, 2007

Current State of TechnologyCurrent State of Technology

Management Information System/Clinical Fusion

Electronic Health (Medical) Records

Clinical Fusion (MIS Software developed for Clinical Fusion (MIS Software developed for SBHCsSBHCs by Dr. David Kaplan)by Dr. David Kaplan)

• We are not certain how many SBHCs are currently using Clinical Fusion or what other software programs they are using.

• We are aware that in some states the Health Department has required the use of Clinical Fusion in order to facilitate reporting and evaluation.

• There have been no major changes in Clinical Fusion for some time.

• Clinical Fusion does not support billing

Data Collected by SBHCs (Census Data Collected by SBHCs (Census 2001, N=959)2001, N=959)

En

rollm

en

t

Vis

it

Dat

a o

n D

iag

no

ses

Fin

anci

al

Info

/Co

st a

nal

ysis

0

20

40

60

80

100

120Process

ER Use 15%

School Attendance 36%

Contraceptive Use 18%

Health Behaviors 36%

Pregnancy Rates 34%

STI Rates 25%

Impact

What SBHCs do With Their Data What SBHCs do With Their Data (Census 2001, n=956)(Census 2001, n=956)

0102030405060708090

Report toSchool

Parents Funders Media PolicyMakers

Publish inProfessional

Journal

Other

0 20 40 60 80 100

Gender

DOB Provider Type

Race/Ethnicity

Insurance Status

Enrollment/Registration

ICD CodesGrade

CPT Codes

Lab Tests

Referrals

Length of VisitDSM IV Codes

Student Sent back to Class

Communication with Parents

Electronic Data Collected (n=1252)

Do you Collect These Data Elements? Do you Collect These Data Elements? (Census 2004-05)(Census 2004-05)

Accountability: Types of Data Accountability: Types of Data Collected by States (State Policy Collected by States (State Policy Survey, 2006)Survey, 2006)

0 10 20 30 40 50 60 70 80 90 100

Cost per visit

Cost per user

Billing/collections

Budgets

diagnosis

enrollment

staffing

SBHC users

number of visits

States that Fund SBHCs (n=20)

SBHCs that Bill and CollectSBHCs that Bill and Collect2004-05 Census of SBHCs2004-05 Census of SBHCs

0

10

20

30

40

50

60

70

% o

f al

l S

BH

Cs

Medicaid SCHIP Private Self Pay

Bill CollectCen

sus

2004

-05

Cen

sus

2004

-05

Electronic Health (Medical) RecordsElectronic Health (Medical) Records

Currently, sponsoring organizations of SBHCs are moving forward with new MIS and EHR systems

The sponsoring organization may not have considered the SBHCs thus resulting in MIS and/or EHR systems that do not meet either the reporting or billing needs

SBHCs have shared their belief that they will be left out of any information technology improvements occurring in the sponsoring agency or will be the last to receive the technology

Constraints are financial, technical and legal

ChallengesChallenges Data collection

– Practice Management– Billing– Collection and Reporting

Confidentiality Staffing Change in the clinic culture Cost

– Software– Additional costs:– Hardware– Remodeling– IT support– Training

Maintenance“The number of hours both needed administratively and pulling

staff out of clinics to prepare for the EMR, so there is a loss in productivity”

Opportunities Opportunities

Improved Quality of CareNever having lost charts Improved communication between

health care sites and increased opportunity of cross coverage

Ability to close the gap between the medical literature and the medical field

Minimum Data Elements for Minimum Data Elements for SBHCsSBHCs

DOB Gender Race/Ethnicity ( needs to be compatible with how

education data is reported) Provider type CPT codes ICD 9 codes Insurance status at visit Referrals (internal or external) Sponsors registration information (may include

some of the other elements such as DOB) Student disposition (sent back to class, home, ER,

other))

Minimum Data Elements for Minimum Data Elements for SBHCsSBHCs

Communication with parent (elementary and middle school) Primary language spoken in the home Risk Factors (list needs to be generated for those not already ICD or CPT

Codes) Enrolled Student

– Only children in our schools are eligible

– Students from other schools

– Out of school youth

– Faculty/School Personnel

– Family of student users (siblings/parents)/infants of students

– Other people from the community

– Other (describe):____________ If SBHC is PCP or not and if communication occurred

Concluding Recommendations:Concluding Recommendations: There is a definite need for Clinical Fusion

however billing capabilities need to be developed

NASBHC needs to publish an overview of the current state of SBHCs and HIT (issues/opportunities)

NASBHC needs support sharing information & experiences of SBHCs with the selections of and development of HIT related products i.e. LA, ME, NM. MI

State Health Departments are central to discussion on this topic.

“we need to support clinics in continuing to collect data that documents their work”

Changing the Face of SBHC: Integrating Changing the Face of SBHC: Integrating EMR into SBHC settings a local and EMR into SBHC settings a local and national perspectivenational perspectiveA primer on Methodology and Vendor A primer on Methodology and Vendor Selection Selection

Gaurav Nagrath, MBADirector, Division of Information Services

Louisiana Public Health Institutegnagrath@lphi.org

504.301.9810

OutlineOutline1. LPHI & a vision for strategic health information

focus2. The National Health IT Agenda3. Methodology: Coordinated Health Information

Systems4. Vendor selection life-cycle

Stakeholder Analysis & Management

Purchasing Lifecycle Overview

The Users Requirements

Value For Money

The Request for Proposal (RFP)

The Evaluation Plan

Contract Management

5. Q&A/Discussion

The Louisiana Public Health InstituteThe Louisiana Public Health Institute

LPHI’s mission is to promote and improve the health and quality of life in Louisiana through public-private partnering at the community, parish and state levels. Public health programming Broker of traditional and non-traditional partnerships Fiscal agent Technical assistance (including health information

services) Research and evaluation

LPHI builds capacity among communities, providers, and decision-makers.

LPHI and Health Information ServicesLPHI and Health Information Services

Vision - Develop the capacity to provide innovative solutions, guidance and TA to health policy-makers, healthcare organizations, and Louisiana communities based in current and emerging Public Health/Bio-Medical Informatics best practices.

Goal - Design, Plan & Enable Health Information Services and supporting platforms to positively impact population level health outcomes in Louisiana

National Health Information Technology National Health Information Technology AgendaAgenda

1. Widespread adoption of interoperable Electronic Health Records within a decade

2. Medical Information follows the consumer

3. Clinicians have complete, computerized patient information

4. Quality initiatives measure performance and drive quality-based competition

5. Public Health & bio-surveillance are seamlessly integrated into care

Source: Office of National Coordinator for Health IT (ONCHIT)

Methodology: Coordinated Health Methodology: Coordinated Health Information Systems Information Systems

(the how)(the how)

Health Information Services strategies involve taking our partners through the entire systems development life cycle and include following services:

Information technology strategic planning Business process analysis Selection and assessment of EHR product compliant

with national standards Workflow redesign Change management System implementation Ongoing Health IT support & training

LPHI Information Services LPHI Information Services Vendor selection life-cycleVendor selection life-cycle

1. Stakeholder Analysis & Management2. Purchasing Lifecycle Overview3. The Users Requirements4. Value For Money5. The Request for Proposal (RFP)6. The Evaluation Plan7. Contract Management

245/30/2008

SBHC Stakeholder  AnalysisSBHC Stakeholder  Analysis

StakeholdersIdentify:1. Direct  or  indirect relationship2. Leadership  structure3. Draft  Stakeholder  matrix,  level,  influence

 +/_etcPrioritize:1. Understand  level  of  involvement

Incentives/RiskExisting  relationships?

SBHC  Stakeholder  ManagementSBHC  Stakeholder  Management

1. Stakeholder  profile2. Engagement  strategy – Key  Issues3. Communication/Action plan – Unified

 Message4. Support/Project  Role5. Follow‐up

Purchasing CyclePurchasing CycleIdentify Need

Financial Approval•Option Appraisal•Business Case

Develop•Specification•Contract Strategy•Evaluation Criteria

Identify Suitable Suppliers•Source the Market•Appraise Vendors

Compose Request for Proposal

Specification•Terms and Conditions•Pricing Schedule

Invite Proposals

Receive Proposal•Open Proposal•Evaluate Proposal

Post Proposal Negotiation

Award Contract

Manage Contract

Vendor Rating

• Evaluation

275/30/2008

1. Is the primary purpose of selection process2. Should be expressed in terms of outputs, not

solutions3. Must be tested for business fit with existing and

strategic business model

The Users RequirementsThe Users Requirements

285/30/2008

1. status of vendors involved – undertake the necessary due diligence for oversight

2. equipment offered – does it adhere to best industry standards, latest technology not always best solution

3. immediate cost of acquisition4. delivery method – options to look at include outsourcing

delivery, building in-house team5. operating costs – be aware of any hidden costs over

lifetime of product/service, e.g. Product support

The optimum combination of whole life cost and quality to meet the customer's requirements.Some elements to take into consideration include:

Value For MoneyValue For Money

295/30/2008

Request For Proposal (RFP)Request For Proposal (RFP)RFP Could Include –

1. Project Overview2. Software Billing Capability3. Software ability to Interface with existing/legacy

systems4. Software Reporting Attributes5. Company Customer Service & Infrastructure -> SLA6. Software capability in areas of Clinical Care Protocols,

Behavioral Health, Patient Management

Vendor evaluationVendor evaluation

1. Create an RFP2. Have a demo scripted to give each vendor (easier

comparison)3. Video tape demos (review later)4. Visit sites that currently use product5. Ask for trial software for hands-on comparison6. Interview vendor leadership/support team7. Negotiate contract (enhancement requirements/payment

terms) Some Cost considerations1. Data conversion2. Interfaces3. Upgrade costs

1. ensuring the contract requirements are met within timescales and budget

2. maintaining a positive relationship between parties to the contract

3. measuring and assessing performance (ours and the contractor’s) against the contract requirements

4. providing constructive feedback to the contractor and/or your own staff involved in the contract

5. being proactive about problem solving6. resolving contract disputes should they arise7. contracts should include agreement about how

customer/vendor relationship is to be managed e.g.

a. decision points - could be linked to payment

b. quality reviews

c. changes to requirements, associated costs

Contract Management ObjectivesContract Management Objectives

335/30/2008

Plant your EMR & Nurture its growth

Simply selecting an EMR for your organization is not enough to make it’s implementation successful. Much like a tree, before you plant the seed you must prepare the ground. After the seed is planted you must make sure that the roots are strong and the tree continues to grow. Simply, placing the seed in the ground and walking away will not successfully produce a thriving tree.

Plant your EMR & Nurture its growth

Tips on How to Plant & Grow your EMR… The Facts

What is an EMRTypes of Electronic RecordsWhy should I plant my EMR tree

The Right OneKnowing what is out thereOrganization needsStaff needsFunctionality

The Game PlanPreparationPlanningTraining

Changing the Face of SBHC: Integrating Changing the Face of SBHC: Integrating EMR into SBHC settings a local and EMR into SBHC settings a local and national perspectivenational perspective

Contact InformationContact Information

Gaurav Nagrath, MBADirector, Division of Information Services gnagrath@lphi.org

Summer CreasyInteractive E-Solutions LLCsummer@iesolutions.us

Tiffany Clarke, MPANASBHC tclarke@nasbhc.org

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