network approaches to health information technology

NETWORK APPROACHES TO HEALTH INFORMATION

TECHNOLOGY

HEALTH CHOICE NETWORK, INC.

OUTLINEOVERVIEW OF HCN

HIT IMPLEMENTATION

RESOURCES AVAILABLE TO CHCs

INFORMATICS

OUR MISSION

To provide high quality service, support and expertise to member organizations and to act as a vehicle for strategic efforts that strengthen our community health partners.

HCN GOVERNANCE & MEMBERSHIP

Coalition formed and governed by CHCs, CMHCs and Homeless Health Centers501c(3) not for profit organization CHC CEOs serve as HCN Board of DirectorsAffiliation Agreement with twelve CHCs for IDSAffiliation agreements with New Mexico Health Choice Network (6 centers, Utah Health Choice Network (7 centers), Kansas Health Choice Network (3 centers) and West Hawaii Community Health CenterManagement agreement with InConcert Care, a CHC Network providing support to 15 CHCs throughout Iowa and NebraskaEarly decision for commitment and financial support by CEOs

EHR IMPLEMENTATION - HISTORY

Received 2002 grant for BPHC EHR pilot project Integrated Communications Technology (ICT) Grant Awarded in 2003

12 million dollar project (4 million from Grant / 8 million from Centers)206 Medical Providers and 36 Dental Providers

Move to full electronic record for all centers by 2007Additional CHCs have joined the paperless movement

EHR IMPLEMENTATION BENEFITS BY CLINICIANS

• Ease of access to records electronically

From home, out of state, in clinic, satellite sites, during outreach

• Improved Safety of Medical Record

• Legibility of Writing• Modest Increase in Productivity

Ease of access & documentation

• More Comprehensive Documentation

• E-RX – med list, med history• Coding assistance via suggestion

of E&M level• Utilization Review

• Improved Security for access limitations

• Timely review of labs• Reduction in Medical Errors

(labs, meds, legibility, etc)• Ease of Access to web sites for

treatment guidelines and patient education forms

• Participation in state wide registries e.g. Florida shots

• Reduction in Duplicate orders• Reduction in Chart Pulls• Efficient Time Management• Data aggregation and analysis

for disease management

Lessons Learned Implementing an EHR

Status QuoSuccessfullyimplemented

EHR3. Change Management

1. BOD Strategic Plan2. Implementation Team3. IT Infrastructure4. Project Plan 5. Sr. Implementation Mgr.6. Live Stakeholder Demo7. Definition of Measures of

Progress/Success

8. Provider Champion9. Exec. Director’s

Leadership and Support

10. Communication Plan11. Training Plan12. IT/Clinical Integration13. Workflow adaptation

14. Job Descriptions15. Performance Evals16. Compensation Plan17. New Staff Orientation18. Standing agenda item

2. Innovative EHR System

KEY FACTORS FOR SUCCESSFUL EHR ROLL-OUT

1. Underscore dissatisfaction

Adoption StrategiesVALUE

IMPORTANCE

VISION

EXPERTIS

Must understand this is the direction the organization is going

Change Management - IT, Clinicians, Senior Management, etc.

E

Providers, staff etc must believe inpotential value of planned changes

Must perceive the importance to the organization’s leaders

LEVERAGING NETWORK RESOURCES

KEY NETWORK STAFF WITH HIT FUNCTIONS

Chief Information OfficerDirector of Information TechnologyDirector of Regional IT ServicesProject ManagersNetwork System AdministratorsIT Hardware and Software Support StaffIT Regional ManagersEHR TrainersProject Implementation Team


HCN EHR PROJECT IMPLEMENTATION TEAMCreates and Monitors Implementation PlanIdentifies pertinent HCN and CHC contacts needed for the ProjectProvides Live Demos to Stakeholders Coordinates hardware, connectivity & patient flow assessmentsCoordinates training for CHC StaffDirects Go-lives and Post Go-Live Support Ensures Project deliverables, time-lines and budgetary constraints are metProvides regular updates to Board of Directors and Senior ManagementCoordinates communication between the HCN, CHC and vendors


HCN FORMS AND CLINICAL COMMITTEEMonthly meeting comprised of CHC Medical Directors/Provider ChampionsPrimary function: Template Development

Centralization of Template Design and Maintenance to ensure Network-wide Consistency and Reporting capabilityOver 200 + forms available by specialty, disease and most common diagnoses

Other HIT related functions:Feedback from Center Providers Best Practices / Policies and Procedure development

32 Best Practices21 EHR Policies and Procedures


HCN SERVICE DESKNot the Typical Help Desk:

Training IntegrationProject Management for Billing and EHRPilot testing on new software releasesProvide support to HCN committeesProvide on-site support and trainingParticipate in center go-livesImplementations hand-off to support desk process

Escalation process includes CIO, CEO and HCN BoardPolicies and Procedures are approved by Centers Supported


ACCESS, TELECOMMUNICATIONS & BACKUPProviders require access from anywhere/anytime

Downtime prevention (93% downtime incurred by telecommunication within the first 75 yards of center)Deployment of MPLS solution via BellSouth and QwestWireless Access Points deployed for mobility

Secure WAN communications - HIPAA compliant128bit encryption from internal/external access (WAN vs. Internet)

Data transfer speeds = ProductivityImage transfer and bandwidth calculationsGrowth options for all Centers

Backup solutions for WAN accessIOS with IPSEC T1 to ADSL auto switching


ACCESS, TELECOMMUNICATIONS & BACKUPSunGard Disaster Preparedness Contract

Hardware coverageSoftware and data recovery

HCN HQ SetupPhase 3 Power on Priority GridGenerator Power

300KW / 1000KW Transfer2,500 gallons of diesel fuel (14 day uptime)FEMA priority list

Dark Fiber Access for TelecommunicationsBellSouth Remote Terminal (RT) located onsite

24 hour surveillance systemVideo and access monitoring


SERVICE LEVEL AGREEMENTSEHR Issues are Top PriorityProviders require instant solutions to reported issuesProvider Champions and Power Users at each CenterEscalation Process:

Provider to IT ManagerIT Manager to HCN Support Service DeskService Desk to Vendor

Vendor participation in SLAsCommunication, Communication, Communication

Documentation and UpdatesRegular emails on progress

24 hour Support on all levels HCN and VendorUpgrades, Patches, and Workaround timelines

No acceptable downtime or maintenance windowsDowntime procedures and communications methods

LEVERAGING NETWORK RESOURCESINVOLVEMENT IN KEY INITIATIVES

Behavioral Health EHR DevelopmentHealth Information Technology (HIT) Exchange

Regional Health Information Organization (RHIOs)

LEVERAGING NETWORK RESOURCESINVOLVEMENT IN THE FHIN

HOW WILL IT WORK?FHIN is the Master Patient Index (MPI)Record Locator SystemRHIO Interoperability ensured across Florida

LEVERAGING NETWORK RESOURCESINVOLVEMENT IN THE SFHII

SFHII = South Florida Health Information Initiative

LEVERAGING NETWORK RESOURCESIN SUMMARY

Economies of scaleNetwork Infrastructure provides framework to secure dollars for CHC EHR deployment Ability to Access CapitalAbility to attract/retain strong IT teamManagement ReportsIT/Fiscal Integration Averages 1.8% of CHC BudgetsPositions centers for Health Information Technology Initiative

INFORMATICS

LEVERAGING NETWORK RESOURCES- DATA MANAGEMENT

HCN Serves as a CHC internal IT Department CIO RoleMonthly CEO Reports

UDS, Billable Visits, HMO Analysis, Demographics, Missing Encounters, Error Reports, A/R, Cash Receipts, Training Reports, Support Call Log, Dental Reports and Claims Denial

Quarterly Clinical Committee Reports

EHR: Capture of Data from Point of Care Documentation

Medications

Vitals Labs

Encounter Documentation

MANAGEMENTREPORTS

MANAGEMENT REPORTS

Utilization Management ReportsAre Clinicians fully utilizing a specific component of the

EHR?If so, are they doing this in a timely fashion?

Quality Management ReportsIs the organization providing quality care? How does the organization’s quality of care compare with

others?

Encounter ReportsProductivityRVUs

Clinical Committee Reports

Report Name FrequencyRVU Analysis -Productivity Report Quarterly

E&M Coding Pattern by Center/ Graph Quarterly

E&M Coding Percentages by Center/Provider Quarterly

E&M Coding Pattern by Provider/Graph Quarterly

Average HgbA1c for all patients with Diabetes Quarterly

Percentage of Diabetic with HbA1C's in a rolling year Quarterly

Average LDL for all patients with Diabetes Quarterly

Percentage of Diabetics with LDL less than 130 in a rolling year Quarterly

Percentage of Diabetics with LDL in a rolling year Quarterly

Patient Listing of Diabetics w/ 3+ Visits w/ HbA1C &/Or LDL Lab Reporting Deficiencies in a rolling year Quarterly

Top 100 diagnosis Semi Annually

ICD-9 Error Report Semi Annually

EHR Utilization by Center Monthly

Summary of Diagnosis Code Entry Every 3 Mo

Average HbA1C Lab ResultPatients w / 3+ Visits

Feb 2005-Jan 2006

7.50

7.60

7.70

7.80

7.90

8.00

8.10

8.20

8.30

8.40

Feb-

05Mar

-05

Apr-0

5May

-05

Jun-0

5Ju

l-05

Aug-

05Se

p-05

Oct-05

Nov-05

Dec-05

Jan-0

6

HbA

1C L

ab R

esul

t

BC

CA

CH

EO

FM

HB

MBCHC

HCN

Thank You

network approaches to health information technology

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