Selecting the best HIT productPresentation Transcript
Selecting the best HIT product Rural Health Group, Inc.
Rural Northeastern North Carolina
Founded in 1974
Medical: Seven sites
Electronic medical record: EClinicalWorks
Dental: Two sites
Electronic dental record: Daisy
Integrated behavioral health
Why did OHIT invite me?
School of Hard Knocks!!
One-site CHC (25,000 visits)
1997: MDX to HealthPro
Regional Network (>1 million visits)
2000: HealthPro to Epic
Multi-site CHC (80,000 visits)
2005-2008: Misys to EClinicalWorks
I have made the mistakes, learned from them and made new mistakes.
Not an expert, just a guy who has been beaten up enough by the IT gods to know a little
1997: Single site CHC
Small committee of finance, executive director, medical director, nurse manager and IT coordinator (me)
No formal process
Promises made – believed the salesman
Never test drove the system before buying
2000: Regional Network
Formal RFP process – sent to a list of vendors meeting the RFP qualifications
Practice management first priority with EMR as a future.
Integrated EMR/PM not required
RFPs evaluated based upon “objective” criteria
Only three vendors chosen for on-site
Onsite demonstrations attended by clinical and operation staff
Formal scoring process
Site visit to vendor to evaluate financial performance & stability of vendor
Site visit to clients using IT solution
2005-2008: Multi-site CHC
RFP developed by 3 clinicians, 2 billing mgrs, 1 RN and 1 IT mgr.
Integrated EMR/PM solution requirement
Quality measures, UDS reporting, etc.
RFP sent CCHIT-certified vendors
RFPs evaluated by EMR task force
Four vendors invited to on-site
All providers and staff attended; each product scored by staff.
Top two vendors: client site visits to evaluate functionality, support
Why Invest in HIT
Ask PATIENTS, board, providers and staff:
Are we providing quality health care that is making a positive impact on our patients? How do we know?
Without an integrated, well-designed health information solution we don’t know if we are providing high quality, effective care.
Information is power; it should not be locked in a disorganized, incomplete paper chart.
Purpose of HIT
To improve the quality of patient care & health outcomes through patient-centered care.
Better quality begins with the accessibility of accurate patient information when and where it’s needed.
Better quality means providing evidence-based medicine at the point of care so providers can choose the best treatment plan for the patient.
We do NOT know if we provide evidence-based care
Brutally honest workflow analysis will absolutely reveal:
Impossible to provide quality health care without a health information system to track, organize and present the information in an useable format.
Health care is all about information but we under invest in health information technology.
Efforts to Implement Health Information Technology in Six Countries, 2003 U.S. Australia Canada Germany Norway U.K. Initial year of national IT effort 2006 2000 1997 1993 1997 2002 Expected year of complete implementation 2016 Undefined 50% by 2009 2006 2007 2014 Estimate of total investment (as of 2005)* $125M $97.9M $1.0B $1.8B $52M $11.5B Total investment per capita (as of 2005)** $0.43 $4.93 $31.85 $21.20 $11.43 $192.79 *In U.S. dollars. Exchange rates as of September 2005: $1 U.S. = $1.31 AUS; $1.19 CAN; $0.80 EURO; $6.21 NOR; $0.54 U.K. ** In U.S. dollars. Per capita is based on 2003 population numbers from the Organization for Economic Cooperation and Development (OECD). Source: Adapted from G. F. Anderson et al, "Health Care Spending and Use of Information Technology in OECD Countries," Health Affairs, May/June 2006 25(3):819–31.
RFP Process: Or “Oops should have done that first”
Most Important Part
EMR is only a tool, not a panacea.
Standardizing work flows and practices MUST occur before EMR implementation.
Analyze all the systems in the current environment through flow diagramming (include time!!).
Workflow analysis will reveal:
Time spent looking for:
Overtime as a result of inefficient workflows (i.e. faxing Rx, phone calls)
Missed opportunities to provide EBM
… RFP Process
Get the process right, outcomes will follow
Provider and staff EMR readiness survey
Develop pre-training program
General Computer skills
RHG filled out its IT department (3.0 FTE) & hired 1.0 FTE clinical informatics specialist
… RFP Process
The Team & Project
EMR/PM is NOT an IT project
Clinical and Operations Project
EMR/PM Task Force
EMR/PM Project Manager with:
… RFP Process
Project management is ESSENTIAL
Use tools like MS Project to plan/track
Regular EMR/PM task force meetings
Communication plan with all staff about project progress and next steps
Be real and visionary
What you need and what you would like.
… RFP Process
WRITING THE RFP
Beg, borrow and steal examples from other FQHCs and primary care practices
Rural Health Group: E-mail me at firstname.lastname@example.org with “EMR RFP” in subject line.
We created our own & “borrowed” liberally from: OCHIN, BPHC, CHCF