Selecting the best HIT product
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Selecting the best HIT product






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Selecting the best HIT product Selecting the best HIT product Presentation Transcript

  • Selecting the best HIT product Rural Health Group, Inc.
  • About us
    • Rural Northeastern North Carolina
    • Founded in 1974
    • Medical: Seven sites
      • Electronic medical record: EClinicalWorks
    • Dental: Two sites
      • Electronic dental record: Daisy
    • Integrated behavioral health
    • Onsite pharmacy
  • 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 RFP
      • No formal process
    • Vendor driven
      • 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
      • FQHC experience
        • 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?
      • Reality:
        • 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.
  • The Truth:
    • 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”
    • STEP ONE:
    • 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:
        • Charts
        • Lab results
        • Hospital reports
        • Consultant reports
        • Referrals
      • 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
    • STEP TWO:
    • The Team & Project
    • EMR/PM is NOT an IT project
      • Clinical and Operations Project
    • EMR/PM Task Force
      • EMR/PM Project Manager with:
        • Clinical Leader
        • Operations Leader
        • IT Leader
        • Senior-level Leader
    … 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
    • Beg, borrow and steal examples from other FQHCs and primary care practices
      • Rural Health Group: E-mail me at with “EMR RFP” in subject line.
        • We created our own & “borrowed” liberally from: OCHIN, BPHC, CHCF
    … RFP Process
    • Develop RFP – (Team of clinicians, nurses, operations, IT, finance)
      • Integrated solution EMR/PM
      • FQHC experience
        • How many, how long, which are using integrated solution
      • FQHC quality and UDS functionality
      • Training
      • Support
    … RFP Process
    • Customize the RFP to fit your needs
      • Know your processes & systems
      • Make sure the RFP captures what you need currently to operate
      • Use the real and vision steps from Step 2.
        • Write, modify and evaluate to make sure you are not missing anything essential
      • Get it in writing
        • Prioritize the MUST HAVES in each section
    … RFP Process
    • STEP FOUR:
    • Evaluate RFP
    • Send RFP to CCHIT-certified vendors
    • Evaluate the RFPs
      • Use the MUST-HAVES list as your evaluation tool:
        • Show it, prove it and test it
        • Do NOT trust the vendor
    … RFP Process
    • Onsite demos for top 3-5 vendors
      • Providers and staff get chance to view & evaluate each vendor using MUST-HAVES tool.
    • Narrow down to top two vendors & VISIT FQHC clients using solution
      • MUST-HAVES: make sure that the client can show that your MUST-HAVES are functional; test drive it!!!
    … RFP Process
    • STEP FIVE:
    • Decision
    • Purchase Decision:
      • Use RFP, onsite vendor evaluations, client site visit evaluations & MUST-HAVES list
      • Training, clinical decision support, flexibility, support, company rep, price, etc.
        • Each organization determines weight
    … RFP Process
    • Contract:
      • Training plan, implementation plan, support, & customizations.
      • GET IT IN WRITING – do not accept promises
      • Plan the divorce before the wedding
    … RFP Process
  • Lessons Learned
    • Training plan
      • Do NOT short-change training
        • At least one week of Super User Training with the following representation REQUIRED:
          • Doctor, nurse, front desk, billing, IT, senior management
        • One week of onsite training at EACH clinic with 40% patient schedule
    • Communication with staff
    • Interfaces
      • Lab: generally not live at GO-LIVE
    • EMR/PM is a relationship:
      • One bad experience – pressure sales: NO!
    • THANK YOU…..
    • Brian O. Harris
    • [email_address]
    • Rural Health Group, Inc.
    • (252) 536-5871