DOQIT Electronic Health Record Defining Functional Specifications Michael J' Mytych Principal Health

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DOQ-ITElectronic Health Record Defining
Functional SpecificationsMichael J.
MytychPrincipalHealth Information Consulting,
LLCwww.hicllc.com262-253-9110
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Agenda

• Purpose of Functional Requirements in selecting
  an EHR
• EHR Certification
• Major components of the EHR
• Functional Requirements Definitions
• Utilizing Functional Definitions
• Application in the Vendor Selection Process
• IOM Gold Standard
• QA

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Michael J. Mytych

• 30 Years Health Care Industry Experience
• 15 Years in Sales Marketing with Health Care
  I/T vendors
• 15 Years Consulting Experience with Hospitals,
  Clinics, Vendors
• National Speaker on EHR, EMR, Physician Clinical
  Automation, RHIOs
• Adjunct professor at UWM Health Care Informatics
  Graduate Program on Healthcare Technology
  Procurement

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Purpose of Functional Requirements
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Selection Process
Vendor Selection Steps
Readiness Assessment
Selection Committee Education
Functional Requirements
Vendor Screening
Educate
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Selection Process p. 2
Vendor Selection Steps
Vendor Demonstrations
Vendor RFP Response
Vendor Site Survey
Vendor Site Visits
Educate
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Selection Process p. 3
Vendor Selection Steps
Vendor Finalist Reference Checks
Vendor Finalist Report to Committee
Vendor Finalist Selection
Vendor Contract Negotiation
Educate
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Vendor Selection Process Tools

• Initial high level EMR attributes
• Initial vendor profiles for those vendors that
  would have a good probability of meeting your
  needs
• Detailed requirements lists including
• Vendor profiles
• EMR detailed functional requirements
• Technical requirements
• Support service requirements
• Budget
• RFP w/ specific review criteria
• Vendor demonstration scenario scorecards
• Vendor site visit scorecards
• Master budget template Contract Terms
  Conditions
• Key contract criteria know what you are and
  what you are not buying

Define Requirements
Validate with Vendors
Cover in Contract
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EHR Certification ONCHIT
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CCHIT Background

• Certification Commission for Healthcare
  Information Technology CCHIT
• Commissioned by David Brailer
• Accelerate the adoption of healthcare information
  technology by creating a mechanism for
  certification of healthcare IT products
• Participating organizations
• AHIMA
• HIMSS
• Alliance for HIT
• Additional Organizations
• AAFP
• AAP
• ACP
• California Health Foundation
• Others
• Create Certification of Ambulatory EHR products
  mid 2006
• Purchasers of EHRs will be able to see if they
  are certified by the end of 2006

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Major EHR Components
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EHR Components

• Master patient index ID management
• Patient scheduling support, locator
• Patient registration
• Patient Clinical Summary Snapshot
• Workflow management, in-box
• Patient Problem management
• Patient History
• Clinical documentation nursing physician
• Document management
• Patient specific instructions

• Medication management
• Orders for services diagnostic testing
• Results management
• Consents, authorizations, advance directives
• Care plans, guidelines, protocols
• Automated alerts and reminders
• Coding support / practice management system
  linkage
• Report generation
• Health record export management
• Privacy Security management

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Functional Requirements
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EHR Functional Definitions - p.1

• 1. Master patient index
• Supports the link to the practice management
  account number
• Supports other system patient identifiers, i.e.
  lab, radiology, Quest etc.
• Supports old medical record numbers
• Links patient records that may have been
  duplicated
• Links to provider numbers
• Supports patient search by name, birthdate,
  insurance
• 2. Patient Scheduling link
• Links from POMS scheduling module to EHR
• Enables the use of patient clinic locator
• Reason for visit
• 3. Patient registration link
• Links to POMS registration and scheduling system
• Reason for visit
• On-top messages regarding the patient (sticky
  note)
• Links payer profile in POMS to EMR

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EHR Functional Definitions - p.2

• 4. Patient clinical summary snapshot
• Tailored to the specific needs of the clinician
• Shows current medications, med history,
  allergies, adverse reactions, open orders,
  problem list
• Lists pertinent results usually in reverse
  chronological order
• Drill down from that to complete result
• Graph test results, i.e. lab
• Links key clinical indicators to problem /
  diagnosis
• Shows care plan and current status for health
  maintenance
• 5. Workflow management
• Tasks that can be created and assigned to any
  member of the clinic
• Open tasks by type
• Results inbound especially labs that need to be
  reviewed
• Medication refill requests (automated from retail
  pharmacies in some markets)
• Provider to provider communications
• Triage support from nursing to physician back to
  nursing
• Past due result reminders

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EHR Functional Definitions - p.3

• 6. Patient Problem Management
• Active problem list and link to diagnosis
• Past inactive problems
• Problems by provider multispecialty
• Onset date of problem
• Identification of who entered the problem and or
  made changes
• 7. Patient History structured data
• Surgical history digital images, anatomical
  drawings
• Procedural history
• Family history
• Social history
• Update, modify and inactivate parts of any
  history record
• Enable self reporting history via structured
  forms

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EHR Functional Definitions - p.4

• 8. Clinical documentation
• Templates that are pre-defined for common medical
  conditions
• Links to standard medical terminology
• Review of systems with links to coding
• Patient assessment
• Patient plan
• Patient instructions
• Links to transcription where used
• 9. Document management
• Receives documents electronically via in-bound
  e-fax
• Results documents can easily be sorted by header
  and result type
• Allows for document review prior to placement in
  the electronic record
• Supports on-site scanning and indexing of
  documents
• Classifies documents by type and allows for
  sorting by patient, by type, by source
• Records date of scan, date of source and date of
  event
• Produces referral letters

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EHR Functional Definitions p.5

• 10. Patient specific instructions
• Tailor instructions for each patient
• Easy print out or conveyance to patient portal
• Medication instructions are easily maintained
• Record that instructions and/or education were
  given
• 11. Medication management
• Supports medication history management with
  updates to the record
• eRx new refills
• Drug utilization review DUR
• Drug to drug interactions
• Drug to allergy
• Drug therapeutic duplication
• Drug to diet
• Drug to formulary for compliance
• Non prescription med support
• Nutraceuticals
• Ability to load self reported medications and
  indicate in the record that they are SR

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EHR Functional Definitions p.6

• 12. Orders Management Order Sets
• Orders for labs to external sites such as Quest,
  Labcor and local hospitals
• Captures appropriate detail such as provider,
  diagnosis etc.
• Provides for routing management including
  electronic fax
• Contains specific instructions
• Ability to combine multiple common orders into an
  order set
• 13. Results Management
• Indicator for normal or abnormal results
• Display numerical results in flow sheet and/or
  graphical form
• Ability to import results from outside labs via
  HL7 interface
• Filter or sort results by date, test type,
  encounter, diagnosis
• Forward result to other providers
• Enter free text to annotate a test result
• 14. Consents, Authorizations Advance Directives
• Capture scanned paper consent document
• Store and display administrative authorizations
• Indicate that a patient has completed advance
  directives, by type and date of review

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EHR Functional Definitions p.7

• 15. Care Plans, Guidelines Protocols
• Provide access to standard care plan
• Provide access to protocols and guidelines at
  point of care via web if needed
• Create specific care plans and store them for
  future use
• Modify standard care plans and save by provider
  and/or clinic
• Capture variances from care plans
• 16. Automated Alerts Reminders
• Establish time sensitive reminders for specific
  conditions
• Alerts for abnormal results
• Alerts for past due health maintenance items
• Ability to link alerts to disease management
  protocols, health maintenance protocols, wellness
• Link to patient notification
• 17. Coding Support
• System allows for tracking components and levels
  for CPT EM Coding
• Provides for review coding selection process
  before being dropped to POMS
• Links to current ICDx tables

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EHR Functional Definitions p.8

• 18. Report Generation
• Generate reports of clinical and administrative
  data using industry standard reporting tools
• Produce reports for all or parts of a patients
  record
• Map data across selected populations of patients
  or the entire patient file
• Produce reports on the absence of data, e.g.
  where patients have not had specific health
  maintenance test
• 19. Health Record Management
• Provides for patient record archive and retention
  according to federal and state standards
• Ability to correct errors in records with
  complete audit trails
• Ability to export a patients record to another
  provider or to create a CCR summary
• Ability to export data to a Personal Health
  Record PHR
• 20. Privacy Security Management
• Provides date and time for chart access and
  printing
• Ability to designate certain note types,
  medications, tests etc. as confidential
• Identifies all users who have accessed a chart
  and which pages were opened

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Utilizing Functional Definitions
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Matching the EHR toPhysician / Clinic specific
requirements

• Systems that fit specific needs and wants
• Systems that are intuitive to use
• Systems that are flexible and are easy to modify
• Systems that fit the style of practice
• Vendors that support their products with
  effective implementation and training
• Desktop / device integration of common
  transaction types both outbound and inbound
• Example of necessity to use multiple imaging
  centers
• Multiple retail pharmacies laboratories
• Multiple hospitals
• Need to have training available whenever there
  are major changes to the system applications
• Multi clinic locations
• Multi specialty

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Application of Functional Requirements in the
Vendor Selection Process
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Vendor Differentiators

• Maturity of the Product
• Alpha, Beta, Custom
• Clinical Knowledge Base
• Primary care specialty
• Chartless opportunity
• How many sites do they have
• Internet / ASP modes of distribution
• Integrated Options
• PMIS, Scheduling, Patient internet access
• Price and total cost of ownership
• Service reputation

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IOM Gold Standard
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IOM Gold Standard Attributes

• Problem Lists
• Automated links from the chart
• Measures Health Status
• Documents the clinical outcome
• Documents Clinical Reasoning
• Reason codes for procedures, orders etc.
• Provides Longitudinal Linkages
• Enterprise inter provider link
• Protects from Unauthorized Access
• Must comply with current regulations
• Supports Continuous Access
• Up time matches the clinic operation

• Supports Simultaneous Multi-user views
• Physician Nursing view
• Supports Other Clinical Resources
• PDR, Library References etc.
• Facilitates Clinical Problem Solving
• Decision Tree Support
• Supports Physicians direct Entry
• Pen-tablet, Voice, Other
• Supports Patient Care Management
• Measures costs and quality
• Provides Flexibility and Expandability
• Specialties, PCP, others

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Summary Conclusions
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Whatever the criteria

• Start with basic EMR knowledge and drill down to
  the requirements
• Know what an EMR can do and what it cannot do for
  you
• Know how and why it will meet the practice goals
  and objectives
• Know that it will change how you operate your
  clinic / practice
• Know that it will require a change in behavior on
  the part of everyone in the clinic
• Know that the EMRs of today are successful and
  that you are not going to be a pioneer
• Know that there will be bumps in the road, but in
  the end, it will provide better quality and cost
  of care

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Understand the clinical operations impact

• Physician Nurse Assistant
• Charting the patient visit
• Who does what, when and where
• Appending the chart
• Closing the chart
• In Box Management
• Patient activity is routed through the in-box
  rather than sticky notes and phone message pads
• Triage of message box
• Equipment access that is convenient and available
• Medication management
• Results retrieval remote access
• Operations
• HIPAA
• Document management
• Scanning procedures and protocols

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Understand the impact on your business

• Define your clinical objectives
• List the EMR applications are important to your
  clinic
• Identify the EMR applications will improve
  clinical quality and / or make it more efficient
• Define how much you want to spend
• Be realistic in assessing how much time do you
  have to spend on the implementation
• Define what processes need to change
• Define and prepare new policies and procedures
• Identify who will monitor the effectiveness of
  the EMR
• Review every three to six months

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Be careful to identify all cost factors
resource requirements

• Installation Planning Time
• Implementation Training
• Table Conversions / Set Up
• Template building training
• POMS Conversion (or interface)
• Hardware
• User devices
• Servers
• Communications hardware
• Infrared Devices
• Disaster recovery

• Software License Fees
• or/ Monthly Per Seat Fees
• Software Maintenance
• Customization Fees
• Interface Fees PMIS, Lab, Rad etc.
• Conversion Time
• Practice Productivity Down Time

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Prepare for the vendor selection process

• Pre Screen the vendors
• Ability to handle your specialty requirements
• Ability to offer practice management option if
  needed
• Ability to meet rough budget constraints
• Ability to meet technical requirements
• 2. Set up Vendor Demonstrations at your site
• a.m. or p.m. demonstrate practice management
  system
• demonstrate clinical system (evenings?)
• 3. Have vendor update required information
• Installed features
• Costs
• Timelines
• 4. Set up site visits with top one or two vendors
• Ease of access and time constraints for the visit
• Who will attend?

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Q AThank YouMike Mytych262-253-9110mmytyc
h_at_hicllc.com