SLFC Healthcare EMR Biography

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A collection of detailed EMR implementation engagements

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SLFC Healthcare EMR Biography

  1. 1. Ambulatory andAcute CareImplementationBiographiesSteven L FritzNovember 2012
  2. 2. Acute Care Hospital ImplementationsSouth Nassau Communities HospitalMeaningful Use and enterprise data modeling. Allscripts was a green field (new)implementation encompassing acute care, ambulatory EMR, and Emergency Departmentsolutions.Responsible for the development of the tactical planning to install the full Allscripts application suite. Theengagement was accomplished in one phase.The initiative targeted the primary hospital functions. Additionally the emergency department was included toprovide a seamless information patch into the hospital. The entire group of ambulatory clinics were deployed andintegrated into the enterprise solution. AllScripts EMR utilized at the MOB and Clinic level including independentpractices with admitting privileges – Allscripts MyWay (a.k.a. Aprima). Access to the data repository hosted by theLong Island Patient Information Exchange (LIPIX) was made available to the provider community.Significant workflow analysis was required to support the new applications and business objectives of the executivemanagement team.Continuum Health PartnersMeaningful Use, Multiple version catch ups, Patient Safety Initiatives, and enterprise datamodeling all culminated in this full scale project.The largest GE Healthcare CentricityEnterprise implantation in North America.Responsible for the development of the strategic and tactical planning to upgrade the GE Centricity Enterpriseapplication from 4.x to 6.7. Four distinct phases guided the management of the initiative.Phase ones target was to develop a technical environment that would endure jumping three version of the GEapplication. Primarily to provide a platform where meaningful use features and functions of the application could belaunched. De-customize the current implementation into one where GE’s professional support team could takeownership of the core. Seamlessly integrating AllScripts EHR utilized at the MOB and Clinic level, into theHospital solutions.Phase two provided an enterprise view of the care and accounting transactions as the corporation managed itsportfolio of applications, and their individual twilight and transformation agendas and timelines. Fully engaging aPMO approach towards the GE implementation.Phase three implemented a disaster recovery, downtime, and business continuity environment. Utilizing real-timetransaction capture and cloning technology, co-location infrastructure, downtime procedures datasets and training,and rigorous SLA, Performance monitoring, and predictive stress analysis.Phase four provided a sound set of interface standards to enable device integration directly into the patient MPI.Middleware remodeling, traffic management, time-of-day peak analysis, coupled with nightly process schedulingprovided a well communicated base of expectations.1|Page Steven L Fritz
  3. 3. University Physician AssociatesThe Centricity Initiative was coordinated with the deployment of AllScripts Enterprise EHRUsing a pilot deployment model the endeavor accomplished three objectives. First was the re-deployment of thecore practice management function of the GE Centricity application. Customizations established an unstablesupport environment. Executive management was realigned to support a closer adherence to an out-of-the-boxconfiguration.Second was the implementation of additional modules to allow better account controls such as the Bad Debtsystems. Revenue Cycle management processes in concert with data mining and business intelligence dashboards(via Cognos) provided Line of Business and executive tool sets.Lastly was the development of a rollout / deployment framework to meet merger & acquisition and internalexpansion strategies. Long term technology growth forecasts became reliable, predictable, and achievable.The 80 ambulatory clinics were re-deployed within the 12 month timelineWorking interactively and collaboratively with the AllScripts Enterprise HER team, the collective team workedsynergistically to achieve reduced implementation costs and resources, lower projected sustaining supportrequirements and an enterprise view of records data as they meet meaningful use targets.Dignity Healthcare (p.k.a Catholic Healthcare West)The Centricity Initiative was managed in three phases.Phase One:Implement the EWS environment – 1.1. Transitioning to the Web involved extensive regression testing and a lightamount of process workflow remodeling. Most of this work centered on the development of an enterpriseworkspace. I architected one workplace for each role to minimize the customizations needed in security plus.Permissions to scripts, screens, HTBs, VTBs, and functions were encapsulated in one secure place. Exceptions wereheld to a minimum and provided a cleaner support platform.The rollout was divided into front office and back office. Prior to real-world performance metrics and to allow thedeferral of training, the back office staff remained on the character cell system until phase three.Screen flow customizations were kept to a minimum to provide for a cleaner set of regression tests for phases twoand three.Implement the PCM system 1.2. The Payer Contract Module focused on the six core payers representing 80% of therevenue stream. The remaining twenty payers were added at a slower pace – three months. The fee scheduleupdates were changed from manual entry to updates using GE’s semi-automatic service.The catalyst for implementing PCM was the CFO’s desire to have more tools and controls on reimbursement rulesand timelines. We went from 85 days to the sub-50 range in three months.Phase I time line – 4 months from launch through transition to production.Phase Two:Upgrade to version 4. This phase required an extensive study of the as-is configuration. A clean up andsimplification sub-project was initiated to lower the regression test failure rates.Ninety percent of the testing issues were associated with the GE applications functionality between 3 and 4. Wefound several compatibility problems which were resolved by GE.The use of a third party forms printing company required the upgrade of oneancillary system – Global Works.2|Page Steven L Fritz
  4. 4. Phase Three:Implement ETM 3.1. The Task Management system was chosen to provide for a singular control prompter.Extensive analysis of as-is workflow and manual task management provided the foundation to the dictionary andconfiguration work of this module. The complexity of other enterprise applications in this clinical environmentmade interfaces (20+) a key success factor. This project came on the heels of the implementation of theAllScriptsTouchWorks EMR solution. Data flows between 8major applications, and the core MPI, Enterprise Index(EI) provided measurable ROI from ETM. Well managed tasks provided very swift drops out of TES into BAR.Organized rejection /denial workflows were controlled my ETM.Implement AVM 3.2. The Visit Management system was integral to the changes in the company’s practicemanagement structure. With 22 clinics using the Centricity application, patient visits and scheduling became acritical control point. To meet the objectives of acquisition and expansion plans without a parallel expansion of ITinfrastructure, AVM and ETMwerecrucial.Module InventoryAP BAR BAR-NPI BAR-PCM DBMS EDIEDI-BAR EDI-MCA EDI-NPI EDI-270/271 ICWEB MCAPCS Security+ TES EWS PCM ATMETMSub System Inventory for SHClaims/Rcpt Open Referrals Statements InterfacesMedtronic Corporation – MiniMed Division - Durable Medical EquipmentThe Centricity Initiative was an applicationreplacement and operations remodel projectDesign the DME module. The insulin pump division ofa DME company - embarked on an initiative creating anew module for GE Centricity. The Durable MedicalEquipment (DME) module was surrounded by the fullsuite of Centricity modules, including Informatics. Atthe core of the system is the TES module controlled byETM. A complete interface-based coupling ofCentricity and SAP was design, build, and deployed.My team of interface and applications experts completedthis endeavor.The business objective was to provide a seamless, singlesourced, order-to-cash solution across the entireorganization.In addition to complex design and configuration of theCentricity system, sophisticated data transport systemswere required. This diagram illustrates the applicationlandscape upon which the DME module was rooted.Module InventoryAP BAR DBMS DME * ETM EWS MCAPCS Security+ TESSub System InventoryClaims/Rcpt Open Referrals Statements Informatics Interfaces* Durable Medical Equipment (DME)3|Page Steven L Fritz
  5. 5. Module detailsDME The Order-To-Cash initiative at Medtronic led to the creation of a new module for the Centricityapplication suite. Durable Medical Equipment (DME). A deep understand of the functionality and architecturalcore of Centricity (p.k.a. IDX,FlowCast) was required to engineer this system. The general description of thismodule is that it provided for the sale of equipment to patients. Prospecting, sales, manufacturing, warranties,returns, upgrades, continuation of therapy, and shipping logistics are all business functions of this module. Oneextension to the DME module is the recurring pharmaceutical products module. The automated replenishment ofconsumables to the end user. Ties to the SAP ERM system provides a closed-loop supply chain. One additionalextension provided a web portal for customer based order placement and management tools.Informatics (BI, Data Warehouse) A key component of the DME Centricity implementation was the ability to implement management toolsthat measured against the business realization metrics. Two extensions were implemented to broaden the use of Business Intelligence (BI) data. First was theintegration of Business Objects resident in the Data Warehouse. The cubes were remodeled to change from the datamart in SAP, to the databases in Centricity. Second was the implementation of the full Cognos application. Thelimited Cognos provided by GE too narrowly focused on GE data. With several other enterprise applications in use,a broader data pool was required.ETM SH as well as DME focused on the functionality of task management. A great deal of configurationthrough dictionaries was completed. In the revenue cycle arena; claims to contract to payment to reconciliation toGL posting required sophisticated workflow analysis.AVM With a number of clinical locations in the greater Sacramento area, managing provider schedules, crossfacility appointments, and complex patient-payer-guarantor relationships, AVM play a key role in achieving a goodeconomy-of-scale with the scheduling and reception staffs.EDI The EDI module played a key role at SH in building interface data models. Eligibility and claimsmanagement assisted in the revenue cycle.DBMS Many reports and data pulls were extracted using the DMBS module. The sustaining support team incollaboration with the project teams cataloged and fine-tuned the report library.MPI (EI) I was on the MPI consul for SH. I have a deep knowledge of clean-up initiatives. I’ve implementedsophisticated patient registration and check-in systems to reduce duplicates, errors, and John Doe’s.4|Page Steven L Fritz
  6. 6. Ambulatory EMR/EHR ImplementationsClient: Community Hospital (450 bed) and Ambulatory Practices – NewYorkSponsors: Ambulatory DO Chief VP of HIM & EMR Chief Information Officer Vice President of Clinical Care Physician Advisory GroupProject SubManagers: Hospital Practice Management EMR deployment manager Behavioral Health Director Physician Billing Director Desktop deployment and management Level 2/3 sustaining operations support managerPrimary Objective: Deployment for the Allscripts Enterprise EHR solution across the enterprises ambulatory practicesSecondary Objectives: Develop a model implementation of EHR at three sites Collaborate with the inpatient deployment of Allscripts Eclipsys Create a deployment / rollout model for independent PC’s on LongIsland Develop forms management and workflow interaction department Document all charge and claim systemsBudget: $30M. Rollout modeling, Training curriculum development, Helpdesk support planning, Infrastructure upgrade and deployment (Practice sites, LAN, Desktop)Timeline – 13 Months: Enterprise deployment planning, layered in two phases, Go-live and 30 day fine-tuning, Transition to production, sustaining support.5 |Page Steven L Fritz
  7. 7. Staff Levels: Strategic planning: 3 Tactical planning: 4 Deployment and training planning: 4 Deployment: 6 Transition to sustaining support: 6 FTE SME headcount – front-end and back-end: 14The data interchange complex was redesigned from its prior state (shown below) to an enterpriseview (not shown). This allowed for lowered error log management requirements and correctiveactivities.The institution utilized a semi-centralized billing landscape. The prior state (shown below) wasre-engineered to a streamlined, scalable, resilient, and optimized CBO. The benefits realizationand return on investment was achieved by lowering the manual processing, adding fail-over toelectronic transfer engines, and enterprise standards for structure and timing. Built-in rejectionanalytics provided self-learning re-submission process management6 |Page Steven L Fritz
  8. 8. Client: Practice Healthcare Organization – Suburban Philadelphia PennsylvaniaSponsors: Office of the CIO Enterprise Applications ManagerProject SubManagers: Data Center Director Practice Management Practice Administration Director Desktop deployment and management Level 2/3 sustaining operations support managerPrimary Objective: Strategic and tactical planning for the enterprise rollout of the Siemens NextGen EHR solution across the 120 ambulatory practices and clinics for Practice Healthcare OrganizationSecondary Objectives:  Study the pilot implementation of the NextGen EHR at three practices  Research the enterprise deployment of the NextGen practice management Create a deployment / rollout model for enterprise wide utilizationBudget: $10M. Rollout modeling, Training curriculum development, Helpdesk support planning, Infrastructure upgrade and deployment (Practice sites, LAN, Desktop)Timeline - 3Months: Enterprise deployment planning, layered in four groups, Go-live and 30 day fine- tuning, Transition to production, sustaining support Service Level Agreement management.Staff Levels: Strategic planning: 2 Tactical planning: 6 Deployment and training planning: 4 Deployment: 25 Transition to sustaining support: 4 FTE SME headcount – front-end and back-end: 27 |Page Steven L Fritz
  9. 9. Client: Clinical Healthcare Organization – Sacramento California RegionSponsors: Scott W. – OCIO Sue H. – CFO Dag J. – COOExecutive Team: Mark M. – Site Executive Dr. L. S. – Hospital physician consultant Dr. M. K. – Foundation physician consultantProject Sub Managers: Loretta S. – Practice Management – Workflow reengineering Jeff E. – Interface and integration management Mike W. – Desktop deployment and management Randy B. – Regional Server Farm management Joe F. – Server Farm management Ryan M. – Regional LAN / WAN management Patricia A. – Level 2 sustaining operations support manager Trisha R. – Level 2 sustaining support Eduardo A. – Level 2 sustaining supportPrimary Objective: Implement the AllScripts TouchWorks EMR solution across the 22 ambulatory clinics for the Clinical Healthcare Organization in the Greater Sacramento regionSecondary Objectives: Link the clinical data to 5 hospitals via the regional MPI database Develop a disaster recovery / fail over strategic plan Create and deploy a user interface integrating all front end systems Engineer an enterprise data model through the middleware ELT toolset Create a deployment / rollout model for enterprise wide utilizationBudget: $4.3M. Application Deployment, Workflow development, Rollout modeling, Infrastructure upgrade and deployment (WAN, Storage, Server, Desktop, Scanner)Timeline - 18Months: Needs analysis, vendor selection, pilot deployment, enterprise deployment planning, layered deployment in 6 groups, Go live and 30 day fine-tuning, Transition to production, operational performance deployment, sustaining support SLA management: Jan 2006 through June 2007Staff Levels: Needs analysis through vendor selection: 8 Deployment and training planning: 12 Application configuration and interface development (Core): 26 Deployment: 20 Transition to sustaining support: 10 FTE SME headcount – front-end and back-end: 6Project milestones8 |Page Steven L Fritz
  10. 10. The original needs analysis was performed by the Clinical Healthcare Organization Sacramentomanagement groups. A consul of people created the RFP materials along with the decision analytics forthe vendor selection. This process took approximately 6 months.Following the selection of AllScripts as the vendor, the team transitioned into an applicationconfiguration and deployment strategy group. They created a project success matrix to grade theeffectiveness of the applicationsdeployment. It was used as the root ofthe scope management documentationset.A key success factor of deploying theEMR application across 22 clinics andintegrating with 5 hospitals was thetechnology infrastructure. WANbandwidth, desktop performance,application monitoring, and storageplanning were the basis of thetechnology infrastructure initiative.This resulted in the deployment of1500 high performance desktops and400 document scanners. The LANwas upgraded to a gigabit network.The WAN was upgraded to a 45 mbpipe. Additionally, the server farm processor set was expanded by 11 servers, each averaging 8 processorswith 32 gb of memory. Redundancy was provided by wireless and split sub-net management, servicingcritical work centers. Two independent WAN providers were acquired for each major hub, one in adormant state awaiting failure. The primary application servers were set up in a clustered configuration.The Network Attached Storage (NAS) was configured to stay pace with the disk consumption projections– 35gb a week. Monitoring tools to track application, WAN, and server utilization were implemented aspart of the original tactical plan.A model office was established to draw on the subject matter experts within the many diverse operatingareas. They made up the core development consultants interfacing with the vendor’s technical team. As acollective, they ensured that the application met the scope criteria. Additionally, they were responsible forthe UAT activities and the go-live support group.Scope management proved to be critical to keep rework to a minimum, timelines manageable, and costcontainment possible. There was approximately 15% overruns due to initial requirements oversights.Strong management of vendor performance and sub-contractor utilization allowed the overall budget tostay below the $4.3 cap.The total inventory of interfaces numbered 22. Merger and acquisition activities while the project was in-flight posed significant challenges, but were met within budget guidelines and delivered on time. Mostnotably was the purchase of an imaging center which needed to be integrated into the workflows and datamovements. This one collection point replaced 5 smaller dissimilar systems. The net impact to thetimeline was negligible.Weaknesses surfaces with the selection of the document scanning equipment. Additional homework couldhave been performed with regard to the scanning strategy. Initial go-live scanning requirements exceededequipment failure (Mean Time Between Failure) thresholds. The remedy was to purchase higher capacity,9 |Page Steven L Fritz
  11. 11. better duty-cycle equipment. Long term planning recommended the establishment of scanning centersspecifically suited to one-time bulk document management.Vendor management was important in controlling deliverables and deadlines. With 22 interfaces to bewritten, HL7 specifications along with custom extensions provided an enterprise view of the data. Extratime was invested to allow simpler future modifications possible. Approximately 30% data growthimpacted development. This planed-to-actual was expected, and was represented in the project plan. Anenterprise middleware redesign initiative was spawned from this project.The main lesson learned was the amount of time required for the laboratory integration points. It shouldhave been 300% of the original estimate. Additionally, coordination with a separate server/applicationupgrade team could have been more transparent. They added 2 man-months of effort but did not affect theAllScripts go-lives.The total population of providers (concurrent seats) was set at 700. The supporting staff accounted for anadditional 1800 people. The benefits realization metrics was to quantify a 30% increase in patient visitcounts with no appreciable increase in patient-facing headcount. That was achieved. Additionally,significant intra-clinic data shareability, reduced duplicate MRN creation, and single applicationintegrated records access was accomplished.A rollout model was authored to act as a new-site deployment kit. The technology and application costswere optimized to approximately 75% of expected. Standards for users, desktops, workflows, andbackend turnover allow exceptional return on investment for new clinics, new builds or acquisition.Enterprise data models provided smother data migration plans.The project plan used to tract the tasks contained 1577 WBS items.10 |Page Steven L Fritz

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