EHR Implementation Plan Presentation


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Electronic Health Records Implementation Plan for a fictitious community clinic based on implementing MedSphere OpenVista.

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  • David
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  • Kal – Fill in Missing Content***************BREAK AFTER THIS SLIDE***********
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  • CarmenThis table allows me to: *Introduce Community Health Connections opted to go with Medicaid EHR Reimbursement Plan. *Reimbursement Period starts Jan 2011. EHR reporting period: First year requires 90 days MU data to qualify. Subsequent years require full 12-months of data. A payment year = calendar year.*Highest incentives will be available between 2011-2013. *Incentives for MU end after 2016.*CHC employs 39 EPs (16 MDs and 23 RPN)*To receive Medicaid incentive payments, CHC will attest to CMS that the EHR system in use meets the statutory definition of a qualified EHR and has been “tested and certified in accordance with certification program established by the National Coordinator.“ *In additional to regular scheduled payout under Medicaid, providers qualify for a one time, start up incentive where the State will pay up to 85% of average allowable cost not to exceed $25K. After receiving start up funds, EPs providers that prove MU can receive additional funding for up to a 6 year period.
  • Carmen
  • This allows me to explain the stages, time periods, the important objectives, goals & 5 major categories stages have been grouped into & expectations. The next slide is a continuation of this slide.
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  • EHR Implementation Plan Presentation

    1. 1. Community Health Connections<br />Electronic Health Records (EHR)<br />Implementation<br />
    2. 2. Panel 1 – Introduction<br />2<br />
    3. 3. Implementación del Sistéma de Records Médico ElectrónicoImplementing EHR<br />Beneficios en la implementación del EHR<br />Los costos administrativos generales pueden reducirse,<br />Los errores de datos puede reducirse, y <br />Los resultados adversos pueden ser más rápidamente identificados <br />3<br />
    4. 4. CHC Story<br />Founded 30 years<br />Federally Qualified Health Center<br />3 Clinics Providing<br />Adult Medicine, Women’s Health, Mental Health & Pediatric services<br />Mobile clinic for school programs<br />Laboratory (LAB), Pharmacy (PHM) & Radiology (RAD) at the 3 clinics<br />$1.6 million grant to implement & EHR & meet MU<br />4<br />
    5. 5. EHR Benefits<br />Decreased charting/prescribing errors<br />Improved work-flow<br />Immediate access to<br />Radiology<br />Lab results<br />Patient charts<br />More satisfying work conditions for our employees <br />Freeing up space now used to store charts<br />5<br />
    6. 6. Central Clinic Layout<br />6<br />
    7. 7. West/East Clinic Layout<br />7<br />
    8. 8. Scope & Deliverables<br />Develop Plan to install EHR System <br />Must meet meaningful use<br />Capable of information exchange with National Health Information Network (NHIN)<br />Use OpenVista<br />Realistic plan ready for review on 3/25/2010<br />Final Deliverables<br />Detailed Implementation Plan with narrative & supporting documents<br />Presentation of Implementation Plan for the Review Committee<br />8<br />
    9. 9. Critical Success Factors<br />Full C-suite support <br />Clinical champion - Chief Medical Officer will lead the Implementation project<br />EHR is a clinical project<br />Organization is stable with quality improvement in place<br />We will achieve a positive return on investment in an EHR<br />9<br />
    10. 10. Assumptions & Constraints<br />Implementation project to begin March 30, 2010, clinic-by-clinic, using Plan Do Study Act (PDSA) process, & completed by February 2011 <br />CHC is compliant with Federal & State regulations, including meaningful use<br />CONNECT Gateway will be used for patient access, Uniform Data System (UDS) reporting & updating the County Immunization Registry <br />Existing use of the Patient Electronic Care System (PECS) registry will migrate to the EHR <br />CHC has at least 30% patient volume enrolled in the Medicaid program<br />A train the trainer approach will be used to minimize vendor-related expenses<br />10<br />
    11. 11. Project Management Office<br />11<br />
    12. 12. Process Team<br />12<br />
    13. 13. Hardware Team<br />13<br />
    14. 14. Software Team<br />14<br />
    15. 15. Stakeholders<br />Management<br />Board, Steering committee, Chief Medical Officer<br />Implementation team<br />PM, Application & clinical specialist, process analysts & Consultants<br />IT Team<br />Integration Architect, DB, Networking, System Admin, Application Development<br />Functional Departments<br />Clinical Team, Billing, Training, Medical records, quality, Pharmacy, Radiology & Libratory departments<br />External<br />Patients, insurance companies, community volunteers, media, Medsphere, government agencies; HHS, NHIN…..<br />15<br />
    16. 16. Communication Plan<br />Purpose<br />Vision<br />What could happen<br />Communication Methods<br />16<br />
    17. 17. Communication Plan -Accountability<br />17<br />
    18. 18. Compliance<br />18<br />
    19. 19. Regulations CMS - Security/HIPAA<br />Strong organization culture of security:<br />Documented processes to protect ePHI <br />Confidentiality, availability, integrity<br />Training<br />All individuals are personally responsible with severe penalties<br />Roll-out, new hire training, refresher training<br />Real-life case discussions in monthly department meetings<br />Top management priority<br />Talked about often<br />Known organizational auditing<br />19<br />
    20. 20. Security Standards<br />Administrative<br />Security Officer ultimate responsibility<br />Risk Analysis required<br />Roles & privileges process including termination<br />Business relationships<br />Physical<br />Facility controls<br />Media access<br />Workstation access<br />Technical<br />Audits<br />Access control <br />Transmission, firewall, virus security<br />Remote access<br />20<br />
    21. 21. Risk Analysis<br />Methodology<br />Full analysis in Implementation Plan<br />Higher Risk Areas<br />Poor adoption rates<br />Process improvements required<br />Inappropriately used ePHI data<br />Disaster recovery plans<br />21<br />
    22. 22. Current System State<br />22<br />
    23. 23. Future System State<br />23<br />
    24. 24. Medsphere OpenVista<br />EHR Software: OpenVista<br />Leverage billions of dollars of VA software development<br />Open source fosters software enhancements<br />Close relationship with government officials for meaningful use<br />Local company resources<br />Medshpere management understands “open source“<br />Track Record<br />Hundreds of reference sites including ambulatory sites<br />Proven & quick Stage 6 implementations<br />24<br />
    25. 25. Implementation Schedule<br />25<br />
    26. 26. Panel 2 - Workflow<br />26<br />
    27. 27. Process Workflow<br />PatientCare<br />&HealthRecords<br />PatientRegistration<br />& <br />Scheduling<br />Billing&<br />Payment<br />27<br />
    28. 28.
    29. 29.
    30. 30. Clinical Decision Support Tools<br />ORDER SET<br />30<br />
    31. 31. Clinical Decision Support Tools<br /><ul><li> Improve patient safety
    32. 32. Improve quality of care
    33. 33. Identify drug-drug interactions
    34. 34. Identify drug allergies
    35. 35. Increase patient compliance
    36. 36. Improve patient self-care
    37. 37. Meet Meaningful Use</li></ul>31<br />
    38. 38. Templates & Flowsheets<br /><ul><li>Record &</li></ul> communicate care<br /><ul><li> Create uniformity
    39. 39. Ability to abstract data</li></ul> for research<br />32<br />
    40. 40. Templates<br /><ul><li>ADULT
    41. 41. Diabetes
    42. 42. Hypertension
    43. 43. WOMEN
    44. 44. Initial History & Physical Exam
    45. 45. Trimester Assessments
    46. 46. PEDIATRICS
    47. 47. Preventive Health
    48. 48. Upper Respiratory Infection</li></ul>33<br />
    49. 49. Flowsheets<br /><ul><li>ADULT
    50. 50. Asthma
    51. 51. Obesity
    52. 52. WOMEN
    53. 53. Prenatal: blood pressure, fetal heart tones, etc.
    54. 54. Preventive Care
    55. 55. PEDIATRICS
    56. 56. Age-Specific: body </li></ul> measurements,<br /> immunizations, developmental <br /> milestones<br />34<br />
    57. 57. Patient Portal<br /><ul><li> Increased patient satisfaction
    58. 58. Timely access to current:
    59. 59. Medications
    60. 60. Lab results
    61. 61. Patient education</li></ul> materials<br /><ul><li> Email correspondence</li></ul> with physician<br /><ul><li> Appointment requests
    62. 62. Prescription refill requests</li></ul>35<br />
    63. 63. Next Steps<br /><ul><li> Modify post-EHR workflow</li></ul> as needed after go-live<br /><ul><li> EHR clinical team
    64. 64. Learn the application
    65. 65. Assess what the system</li></ul> lacks for our needs<br /><ul><li> Create gap analysis</li></ul>36<br />
    66. 66. Next Steps<br /><ul><li> QUALITY ASSURANCE TEAM </li></ul>Metrics to track best practice protocols & business practices<br /><ul><li>Practice protocols
    67. 67. Meeting hemoglobin A1C goals for </li></ul>diabetics<br /><ul><li>Peak flows for asthmatics
    68. 68. Blood pressure control for hypertensive </li></ul> patients<br /><ul><li>Business practices
    69. 69. Patient wait times
    70. 70. Percentage of physician CPOE utilization
    71. 71. Meet Meaningful Use criteria</li></ul>37<br />
    72. 72. Next Steps<br />CONTINUE RAND HEALTH’S <br />PATIENT <br />SATISFACTION<br />QUESTIONNAIRE<br />18 questions completed after visit<br /><ul><li> Paper option
    73. 73. New online kiosk option</li></ul>38<br />
    74. 74. Financial Process/Workflow<br />Front & Back Office Workflow Coordination<br />Interoperability / Coding & Billing Integration<br />Documentation<br />Payer-specific Requirements<br />Processes<br />E&M Calculator at point of care<br />Data flow from system to system<br />39<br />
    75. 75. Billing Workflow<br />& Medical Records/Abstracting<br />Workflow - with EHR<br />Practice Management System (PMS) in Place<br />Medical<br />Records<br />Add Pt name to <br />“To be scanned”<br />Worklog <br />MR abstractor locates<br />Record, scans, & abstracts for NEXT DAY Patients.<br />- Patient records verified complete/approved. <br />- Chart sent to long term storage.<br />Abstracted Chart sent to PSR at Clinic.<br />PSR<br />PMS is utilized.<br /> - PSR schedules an appoint.<br /> - Demographics & Insurance info input into PMS <br />PSR performs tasks in PMS:<br />- Convert master ID to a patient Medical record #.<br />- Updates, Collects Deposit/Co-Pay & payer information. Posts in PMS<br />- Scans ID & insurance card.<br /><ul><li> PSR Logs into PMS to review daily schedule.
    76. 76. EHR automatically populated with schedule information.</li></ul>- List of Patients for next day is generated.<br />Patient<br /> Patient is processed as per Adult patient Work-flow sheet.<br />Patient checks in with PSR to verify Insurance or self-pay.<br />If Self pay referred to social workers, etc. for Financial assistance.<br />PROVIDER<br />Using CPOE :<br /> - Orders & procedures are entered for auto processing into PMS<br /> - E&M calculator suggests OV level<br />Review & approves<br />Abstracted & <br />Scanned items<br />Signs off paper chart <br />Chart sent to Medical Records<br />Chart reviewed for<br />accuracy of codes & <br />Documentation.<br />Toward end <br />of Patient <br />encounter.<br />NURSE<br />Completes & confirms all provider orders then<br />Flags orders as completed in EHR <br />BILLING<br /><ul><li> EOB scrutinized & if necessary chart is electronically pulled, notes sent electronically. Bill resubmitted or adjusted</li></ul>NO<br />Bill paid?<br />- Bill generated & checked for accuracy <br />- Electronically submitted<br /> to insurance or patient <br />Bill reconciled A/R adjusted.<br />- End<br />YES<br />Lab, Rad<br />Pharm<br />Code for billing & diagnosis from the<br /> PIS, RIS & Pharmacy auto migrates to PMS<br />40<br />
    77. 77. Data Migration Strategy<br />The Challenge<br />Pre-populate the EHRwith useful data day 1<br />145,000 annualpatient visits<br />Over 30+ years to be scanned & abstracted<br />41<br />
    78. 78. Data Migration Strategy<br />Solution for Existing Electronic Data<br />Mirth Connect integration engine to develop channels between old & new databases<br />Automate on-going data transfers: Updates, additions & deletions<br />Solution for Paper Records<br />Pre-Rollout: Migrate records of patients most likely to be seen soon<br />Post-Rollout: Migrate records on a “go-forward” basis – patient who make appointments or appear at the clinic<br />42<br />
    79. 79. Data Migration Table<br />43<br />
    80. 80. Panel 3 - Hardware Operation Environment<br />44<br />
    81. 81. Implementation Strategy<br />Current environment<br />Network, Servers/Storage<br />Applications, operations <br />Upgrade plans<br />Upgraded technical architecture<br />Fiber Ring network<br />Thin client deployments<br />45<br />
    82. 82. Technical Architecture<br />46<br />
    83. 83. Fiber Ring Topology<br />Current T-1 connectivity<br />Legacy copper connectivity at 1.544 MPS<br />Fiber Ring Topology<br />Providers: AT&T & Cox communications<br />Why Cox<br />Supporting Health Care providers<br />Discussion of data/fact gathering with Sharp IT, & Family Health IT<br />Fiber connectivity redundancy<br />Dual connectivity from each router to Fiber ring <br />Access & Security-High Level<br />Patient/PHR-Web Portal<br />IT support & Physician VPN & RSA/Token security<br />47<br />
    84. 84. 48<br />
    85. 85. Server Hardware - Location & Features<br />Location<br />Store in special server rooms, Central & East clinic (backup)<br />Server Rooms Features<br />Secure entrance<br />Temperature controlled<br />Redundant Power w/ Spike & Surge protection<br />Monitoring – cameras, sensors<br />Qualified staffs<br />Server Hardware Features<br />Intel Xeon processor – multiple processor<br />RAID with hot swappable HD<br />Redundant connections – multiple Ethernet / fiber ports<br />Tape backup system<br />49<br />
    86. 86. Server Software - Operating &Application<br />Windows server 2008/R2 Standard, business,data center<br />Features of server Operating Systems<br />Robust – even during hardware failure <br />Multiple security features including firewalls & intrusion detection<br />Remote administration<br />Extensive audit trail<br />Special features of application servers & database<br />Cache Clustering<br />Virtualization (VMware) for development, demo, training, & QA<br />Terminal services <br />50<br />
    87. 87. Failover Clustering<br />Key Benefits<br />Protects against data loss& service interruptions<br />Automates failover to reduced downtime, lower complexity of disaster recovery plan<br />Reduces administrative overhead by automatically synchronize application & cluster changes, easier tokeep consistent than unclustered servers<br />Updating server without service interruption<br />51<br />
    88. 88. Multi-site Clustering<br />Key Benefits<br />Protects against loss of an entire datacenter such as power outage, fire, hurricanes, floods, earthquakes, terrorisms<br />Automates failover to reduced downtime, lower complexity of disaster recovery plan<br />Reduces administrative overheadby automatically synchronize application & cluster changes, easier to keep consistent than unclustered servers<br />Updating server without service interruption<br />52<br />
    89. 89. Terminal Services Benefits<br />Windows Server 2008/R2<br />Terminal Services gateway enables the creation of a scalable SSL-based remote access solution<br />Terminal Services Session Broker enable the creation of simple & effective Load-balancing a terminal server farm<br />53<br />
    90. 90. Software Installation<br />Environments<br />Non-production<br />Development<br />Quality Assurance (QA)/Test<br />User Acceptance Testing (UAT)<br />Demonstration<br />Training<br />Production<br />54<br />
    91. 91. Infrastructure - Security & Privacy<br />Password policy enhancements<br />SSL Configuration<br />Client Side certificates<br />Audit Control<br />Data Integrity<br />HIPAA Compliant<br />VPN Access – Two Factor Authentication (RSA Token)<br />55<br />
    92. 92. Remote Access<br />Provider can access EMR using VPNover the Internet<br />56<br />
    93. 93. Workstation & Peripherals<br />Thin Client Stations<br />Work Stations<br />Laptops<br />Monitors<br />Carts<br />Printers<br />All-in-Ones<br />Peripherals<br />57<br />
    94. 94. Computer Operations<br />Service Support<br />Service Desk<br />Incident Management<br />Client Surveys<br />Service Delivery<br />Service Level Management<br />Service Level Agreements<br />Production Review Board<br />58<br />
    95. 95. Panel 4 - Software Aspects<br />59<br />
    96. 96. Current System State<br />60<br />
    97. 97. Future System State<br />61<br />
    98. 98. Current Data Flow State<br />62<br />
    99. 99. Future Data Flow State<br />63<br />
    100. 100. OpenVista<br />Install OpenVista & InterSystems Cache<br />Convert & migrate sample patientdata from PMS to OpenVista<br />Support clinical team in system configuration tasks<br />Test activated features of OpenVista& interface connections <br />Test Health Information Exchange (HIE) connections...<br />64<br />
    101. 101. InterSystems Cache<br />OpenVista Database Selection<br />InterSystems Cache<br />Proprietary software<br />Extension of MUMPS<br />Graphical User Interface (GUI) interface<br />Window, UNIX, Linux, Mac OS X, & Open VMS server<br />High performance object database<br />Web gateways access to web browser interface<br />Rapid integration & development platform <br />GT.M<br />Open Source <br />MUMPS language<br />MUMPS database<br />Linux & Unix operating system<br />65<br />
    102. 102. OpenVista Database<br />InterSystems Cache<br />66<br />
    103. 103. Interoperability - Mirth & NHIN CONNECT <br />Add OpenVista outbound & inbound channels<br />Admit, Discharge, Transfer, Scheduling, Financial Transaction<br />Create new inbound & outbound channels for Order Messages (ORM) & Order Results (ORU) <br />Create new outbound channel to National Health Information Network (NHIN) CONNECT Gateway <br />Create inbound & outbound Continuity of Care Record (CCR) & Continuity of Care Document (CCD)<br />Install Cache Java Database Driver for the Mirth database reader<br />Configure NHIN gateway connector in Mirth<br />Test & deploy changes<br />67<br />
    104. 104. Software Development<br />Implement Rapid Prototyping<br />Fits well into PDSA philosophy<br />Application Lifecycle Management<br />Microsoft Team Foundation Server 2010 <br />OpenVista<br />Patient Portal<br />68<br />
    105. 105. Configuration Management<br />Framework<br />Identification<br />Control<br />Reporting<br />Audit <br />Benefits of Configuration Management<br />Legal Obligations – Meaningful Use, HIPAA <br />Process & approach<br />Software Configuration Management<br />Team Foundation Server 2010<br />Configuration Management Database<br />Definitive Media Library<br />69<br />
    106. 106. Configuration Management<br />Manage changes to all Configuration Items in Production<br />Server & network components, Software programs, Signed contract documents, etc.<br />70<br />
    107. 107. Downtime Procedures<br />GOAL <br />CHC clinics remain operational during planned or unplanned events<br />Plan is created/approved by internal committee<br />METHOD<br />Use approved paper methods to maintain workflow during downtime<br /> All paper records must be “back-chartered” into the electronic record in a timely fashion<br />BOTTOM LINE<br />Ensure downtime episode does not pose a threat to patient safety & integrity of clinical practice<br />71<br />
    108. 108. Panel 5 - UAT, Training & Go Live<br />72<br />
    109. 109. User Acceptance Testing (UAT)<br />Failure to conduct UAT will result in finding more problems after release.<br />UAT should confirm whether the software supports the existing business process, not whether or not the software works.<br />UAT will compare user expectation to actual results very early in the implementation.<br />User requirements that evolve during UAT will be part of the post-EHR implementation.<br />Key: Super-Users acceptance will influence community acceptance of the EHR.<br />Steps for UAT<br />Run Test Cases<br />Mock-go Live<br />Super-Users sign-off , Go-No Date(readiness for go-live)<br />73<br />
    110. 110. Training<br />Purpose (Why)<br />Who, What, Where, How<br />Effectiveness<br />Afterwards – What’s Next<br />74<br />
    111. 111. Training V1<br />75<br />
    112. 112. Training V2<br />76<br />
    113. 113. Project Monitoring & Control<br />Data to be collected & reviewed during the implementation<br /> Meaningful Use<br /> Financial Return on Investment<br /> Quality Measures<br /> Compliance<br /> Patient Satisfaction Surveys<br />Post Implementation Review<br />Outstanding Issues<br />Maintenance & Support<br />77<br />
    114. 114. Panel 6 - Financial Impact<br />78<br />
    115. 115. Meaningful Use<br />79<br />
    116. 116. Meaningful Use<br />80<br />
    117. 117. 81<br />
    118. 118. Meaningful Use Stage 1<br />Progress to Meeting Criteria<br />82<br />
    119. 119. Procurement Plan<br />Initial Understanding:<br />HW, SW team needs<br />Defined process<br />Potential suppliers <br />Budget for investment<br />Vendor Evaluation<br />Scorecard <br />Criteria & weights<br />Technology, quality, responsiveness, delivery, business, environment<br />RFQs<br />Delivery without negatively impacting go-live<br />Tracking Spending & Performance<br />83<br />
    120. 120. Major Expenditures<br />Hardware Capital Expense = $330K<br />Servers<br />WAN<br />SAN<br />Fiber ring<br />Thin clients<br />High speed copiers<br />Software Capital Expense (1st year) = $ 73K<br />Elite licensing (80 to 115 users increase over 6 years)<br />84<br />
    121. 121. Timing<br />Go-Live<br />Oct 2010<br />Training<br />Nov-Dec 2010<br />Savings from Implementation<br />Mar 2011<br />MU payments<br />May 2011<br />Increased demand<br />During Year 2012<br />85<br />
    122. 122. Benefits<br />MU Medicaid incentives ($3.5M)<br />One time incentive<br />2011-2016<br />Transcription savings ($29K/mo)<br />Increased number of visits:<br />Labor efficiencies ($38K/mo)<br />Word of mouth<br />Riddance of flow charts, superbills, H&Ps, etc.& other administrative costs ($5-10K/mo)<br />Reduction of labor costs ($18K/mo)<br />Reduction of storage expenses<br />86<br />
    123. 123. Cost Drivers<br />Anticipate loss of productivity during training& initial deployment period<br />Hardware $330K<br />Software <br />$73K first year<br />$444K over 6 years<br />Staffing $4M over 6 years<br />87<br />
    124. 124. Staffing Assumptions<br />Temporary<br />2 Trainers<br />2 Hardware Engineer Contractors<br />1 Contractor – OpenVista<br />4 Abstractors <br />Backfill – MDs, RNPs, Nurses<br />Permanent<br />1 Process Analyst<br />2 Technologists<br />1 Meaningful Use Specialist<br />Providers<br />Overtime Costs<br />PSRs during training<br />88<br />
    125. 125. Cost Breakdown<br />89<br />
    126. 126. Cost & Benefits<br />90<br />
    127. 127. NPV Analysis<br />91<br />
    128. 128. Cumulative Cash Flows<br />92<br />
    129. 129. What It’s All About<br />93<br />
    130. 130. Additional Questions<br />Thank You<br />94<br />
    131. 131. UCSD Extensions HIT Spring 2010 Class<br />95<br />
    132. 132. UCSD Extensions HIT Spring 2010 Class<br />96<br />
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