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EHR Implementation Plan Presentation

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

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

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  • David
  • Luis
  • Luis
  • Ann
  • Ann
  • Mona & DeEtte
  • Mona
  • Mona
  • DeEtte
  • Keri
  • Kal
  • David
  • Warren
  • Carmen
  • Carmen
  • DeEtte
  • Warren
  • Warren
  • Warren
  • David
  • David
  • Warren
  • David
  • Keri
  • Sarah
  • Sarah
  • Jean
  • Jean
  • Jean
  • Jean
  • Jean
  • Jean
  • Jean
  • Jean
  • Jean
  • Sheldon
  • Sheldon
  • Sheldon
  • Kal
  • Kal – Fill in Missing Content***************BREAK AFTER THIS SLIDE***********
  • David
  • David
  • David
  • David
  • Laurelle
  • Nga
  • Nga
  • Ras
  • David
  • Jackie
  • Jackie
  • Eric
  • Carmen
  • Carmen
  • Carmen
  • DeEtte
  • 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.
  • Carmen
  • Keri/Sarah
  • Keri
  • Keri
  • Keri
  • Keri
  • GO BLANK AFTER THIS SCREEN!!!
  • Luis
  • Transcript

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