April 17, 2012

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Selecting the Right Vendors for Your Health IT
Projects

• April 17, 2012

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• Listen only mode
• This webinar will be recorded and available on
  NACCHOs website
• The slides will also be available for download
• Please complete the evaluation when you receive
  the link
• Type your questions in the box as we go

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Outline of Webinar

• Goals for today
• Lincoln Lancaster County Health Department (NE)
• Cabarrus Health Alliance (NC)
• Questions
• NACCHO ePublic Health Upcoming Events

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Goal of Webinar

• By the end of the webinar you will know the
  following
• Strategies LHDs can use to select vendors for
  health IT projects

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Selecting the Right Vendors for your Health IT
Projects

• Lincoln-Lancaster County Health Department
• Lincoln, NE
• April 17, 2012

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IT Strategy that Supports the Business of Your
Health Department

• Understand your business
• What are the core guidelines or principles that
  need guide investments for your business?
• What will an IT solution offer?

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Focus on where the work is done

• We adopted these principles

• Support staff at the point of service when
  and where they work
• Eliminate paper-based reporting documentation
• Off the shelf to assure taking advantage of new
  features and technology

Guiding Principles

• Use standards
• Potential scalability
• Document for future
• Easily accessible and usable
• Integrated with partners

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Where does this fit in our Strategic Plan?
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Understand your business

• Not every health department is the same
• A business case analysis of the cost benefit of
  IT investments is important
• What services do you provide today? What
  services will you provide in five years?
• Example Full Service compared to small
  department with Immunizations and Access to Care

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Research Needed and Tools

• Business Process Analysis
• Do you want or need to make changes in the way
  you currently do business?
• What are your core partners doing?
• What are the goals of your director, supervisors
  and front line staff?
• What are other health departments like you doing?
• What are your investment options? Funding
  strategies?

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Research type(s) of technology will help you meet
your goal

• What are your options?
• Advantages and disadvantages of each type
• For example
• Public Health System that supports mandated
  reporting
• Electronic medical record or other point of
  service system that focuses on documentation and
  record keeping for services
• Use / share software provided by another (State
  Immunization Systems

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Decide what you want Why we chose electronic
medical record?

• Support direct service efficiently
• Reduce errors, promote consistency and quality of
  care
• Support quality assurance and improvement efforts
• Facilitate transfer of information needed to
  provide care
• Eliminate paper records
• Communicate accurately and quickly
• Measure outcomes and monitor performance
• Take advantage of technology advancements and
  conveniences

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Learn the Challenges

• Designed for Physician / physician extender as
  providers
• Need to create templates and routines to support
  public nurse as provider
• Vocabulary for community-based and case
  management services is more limited compared to
  medical

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Put a Team together
This is going to be a major investment of time
and moneyInvolve your stakeholders from the
beginning.

• Key staff from users from all program areas that
  will be impacted
• Obtain buy-in / sponsorship county
• Include
• Legal
• Purchasing
• Finance
• Technical

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Layout the Process

• What are the steps you propose for making this
  decision?
• Clarify roles and responsibilities of your team
  and team members
• Outline the products or outcomes of the work
• Business Process analysis and flow charts
• Request for Proposals
• Evaluation and selection
• Decision-making process

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Do you have related goals to consider?

• Are you satisfied with your current structure and
  processes?
• Opportunity to examine Business processes and
  practices and refine and improve
• Are there specific improvements that you hope to
  make with the right software or tool?

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Identify requirements Develop RFP and
Evaluation Rating Criteria

• Our Core Requirements
• CCHIT certified
• Master patient index
• Off the shelf
• No or very limited customization
• Training / Informatics competencies of front line
  staff
• Tools to adapt to work processes and work flow in
  software
• Medical record vs. reporting
• Standard Processes

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Learn about the Market

• Research the vendors and products most likely to
  meet your needs
• Talk to them and encourage them to submit a
  proposal once you issue an RFP
• Use consultation / technical expertise to reach
  the vendors who will be able to meet your needs
  Regional Extension Center
• Use varied approaches to get vendors to submit
  proposals
• We sent our RFP to more than 80 vendors and
  received 6 proposals

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Involve Users Intensively

• Analyzing work flow and processes
• Developing / reviewing requirements
• Reviewing and prioritizing criteria for
  evaluation
• Reviewing and evaluating proposals (including /
  especially demos)
• If you dont receive proposals that meet your
  needsdont be afraid to try again. Take what
  you learn and revise your RFP / criteria / vendor
  search
• Our implementation came after our third effort

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Review and Evaluation

• Document carefully
• We went from a complex tool to a very simple form
• And then assigned individuals to teams to
  evaluate specific capacities
• Scoring the numbers never make the final
  decision
• Review and follow-upit is never apples to apples

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(No Transcript)
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While reviewing the proposals please use the
following evaluation criteria This first review
will develop the short list for further
consideration.   Rate 0 as very poor or
non-existent and 5 as the HIGHEST
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Use Scenarios
Background information We call this patient a
presumptive and will generally follow her
through pregnancy, childbirth, and afterward for
about two months. We will include visits to the
baby for as long as needed, possibly for a number
of years. Following her includes clinic nurse
assessment, education, and community referrals,
including referring her to a doctor (external)
for prenatal care, and to the LLCHD nurse home
visitation program (internal). CLINIC 1. Woman,
Juanita Hernandez, thinks she is pregnant so has
her friend, who speaks English, call the clinic
to find out when she can come to clinic to find
out if she is pregnant. She comes to the
clinic. 2. Lab work is done that confirms
pregnancy. 3. Mrs. Hernandez is assisted by the
interpreter to complete the application for
Medicaid and other needed paperwork. She is seen
in the LLCHD WIC Clinic. 4. An appointment is
made for her to see a doctor (not at our clinic)
in 3 weeks. Cab transportation and an interpreter
are arranged. 5. Nursing Assessment is done,
including risks that indicated need for nurse
home visitation. Nurse doing presumptive opens
chart record and refers client for Home
Visitation services by the Maternal Child Health
(MCH) section of CHS.
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Resources

• Project Management tools
• Business Process / Flow Chart tools
• Sample Requests for Proposals
• Evaluation tools
• Scoring methodology

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Reference Checks

• Ask for references from the vendor for use of
  their product in a business like yours
• Phone references with a team so you verify
• Did they stay within cost parameters?
• Did they implement within time parameters?
• Does it work the way you hoped?
• How responsive was the development/
  implementation team to your needs?
• If it is feasible visit a current user of the
  product
• If you still arent sure see if you can take a
  test drive -- some vendors provide a
  playground that you and your staff can try some
  of the features

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Purchase and Contracts

• Work with your legal and purchasing departments
• Negotiate payment terms and time frames
• Make sure that you retain some payments for
  final when everything is completedincentive to
  complete
• This can take up to several months to finalize
  through all the approvals
• Dont try to skip thisif for any reason, the
  project goes badyou need the support from legal
  and purchasing
• This can be a major investmenttake the time to
  get it rightyou will likely have to live with it
  for the next twenty years

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Implementation

• SuccessEHS Electronic Medical Record
• Practice Management (July 2009)
• Clinical (October 2009)
• Dentrix Dental Electronic Record
• Practice Management and Chair side charting
  (2008)
• Digital radiography (2009)

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Selecting the Right Vendors for your Health IT
Projects

• April 17, 2012
• Tracy Lockard
• Business Process Director
• Cabarrus Health Alliance

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Background

• Awarded grant (12/2006-12/2009) from the Robert
  Wood Johnson Foundation entitled, Common Ground
  Transforming Public Health Information Systems
• Goal Have public health electronically
  communicate with a health information exchange
  (HIE), community health care partners and
  consumers
• Project Practice Management (PM)/ Electronic
  Medical Record (EMR) Evaluation Project
• Objectives Develop requirements for evaluating
  and selecting an PM/EMR system
• Develop efficient and effective best practice
  workflows for clinic processes, case management
  and practice management

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Collaborative Requirements Development
Methodology
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PM/EMR Evaluation Project Timeline
3/2008

• Business Process Analysis
• Business Process Redesign
• Redesigned 46 Business Processes

11/2008
1/2009

• Requirements Definition
• Defined 680 Requirements
• Determined over 4000 Data Fields

7/2009

• Evaluation Phase
• Evaluated Vendors with Tools
• Scoring System
• Site Visits
• Gap Analysis of Meaningful Use Criteria

9/2009
Selected and Acquired a PM/EMR System - Insight
12/2009
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PM/EMRImplementation Timeline
2/2010

• Upgrades to IT Infrastructure
• Installed shared storage at primary and disaster
  recovery data centers
• Moved to VMWare for critical servers
• Implemented Citrix for deployment of EMR and
  related applications

3/2010
4/2010
5/2010

• Document Imaging Project
• Scanned 60,000 paper charts
• Developed workflows to automatically file
  documents created and scanned daily
• Deployed the digital chart to CHA staff as well
  as labor and delivery staff at the local hospital

6/2010
7/2010
Migration to WIC State System
8/2010
Practice Management interface with new state
public health system

• Implement Practice Management
• Patient Registration
• Appointment Scheduling
• Encounter Processing
• Immunization Tracking Inventory
• Patient Tracking
• Lab Tracking
• Patient Accounts
• Event Management

9/2010
10/2010
11/2010
Go-Live with Practice Management Modules
12/2010
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HIT Project Team Goals Objectives

• Implement a Practice Management EMR system
• Have representatives from each department gain a
  broader and deeper understanding of the entire
  PM/EMR system (and other systems)
• Improve quality and efficiency of health care,
  access to care, preventive care, care process,
  patient safety, and provider or patient
  satisfaction
• Obtain Medicaid EHR incentives and demonstrate
  meaningful use
• Support Beacon Community grant efforts

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PM/EMR Implementation Timeline
12/2010
Go-Live with Practice Management Modules
1/2011

• Implement Additional PM Features Processes
• Registration Speed Forms
• Integration with Laserfiche
• Patient Identification
• Electronic Billing

2/2011
3/2011
4/2011
5/2011
6/2011

• Implement EMR Modules (Phase 1) for
• Child Health
• Go-Live with EMR Modules (Phase 1)

7/2011
8/2011
9/2011
10/2011
Define Modifications to Lab Module
11/2011
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11/2011

• Implement EMR Modules (Phase 2) for
• STD/HIV
• TB
• Digital Signatures (CoSign) for Consents/Forms
• Go-Live with EMR Modules (Phase 2)

PM/EMR Implementation Timeline
12/2011
1/2012
2/2012
3/2012
4/2012

• Implement EMR Modules (Phase 3) for
• ePrescribing (OrderConnect)
• Pharmacy
• Go-Live with EMR Modules (Phase 3)

5/2012
6/2012
7/2012

• Implement EMR Modules (Phase 4) for
• Family Planning
• Maternal Health
• Go-Live with EMR Modules (Phase 4)

8/2012
9/2012
10/2012
11/2012
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11/2012

• Implement EMR Modules (Phase 5) for
• Lab Modifications
• LIMS
• Hospital Lab Interface (CareConnect)
• Go-Live with EMR Modules (Phase 5)

PM/EMR Implementation Timeline
12/2012
1/2013
2/2013
3/2013

• Implement EMR Modules (Phase 6) for
• Health Information Exchange (CareConnect)
• Go-Live with EMR Modules (Phase 6)

4/2013
5/2013

• Implement EMR Modules (Phase 7) for
• Patient Portal (Consumer Connect)
• Go-Live with EMR Modules (Phase 7)

6/2013
7/2013

• TBD
• Supplies Inventory
• State Lab Interface
• Lab Instrument Interface

8/2013
9/2013
Meaningful User
10/2013
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What are the major tasks for each module rollout
Tasks and Resources

• Project team meetings
• Train-the-trainers
• Tables
• EMR Notes
• Define Reports/EMR Dashboards
• Process/Workflow Changes
• Staff Training
• Practice/Mock Clinic
• Go Live

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Resource Planning
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Resource Planning
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Lessons Learned in Adopting EHR

• Lots of process change
• Focus on cross-department processes
• Billing Cant test until live
• Productivity/Revenue decrease
• Never done! EHR is an integral part of your
  operations efficiency and effectiveness

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Reference Materials

• PM/EMR Evaluation Project Web site
  www.cabarrushealth.org/commonground

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Questions

• Please type your questions in the box

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Upcoming NACCHO ePublic Health Events

• Webinar Series
• Meaningful Use and Public Health
• Integration and Interoperability Across Public
  Health, Human Services, and Clinical Systems 
• http//www.naccho.org/topics/infrastructure/inform
  atics/resources/spring-2012-webinars_ephi.cfm
• Vendor Portal

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Contact Information

• Vanessa Holley, MPH
• Program Analyst, ePublic Health
• vholley_at_naccho.org
• [phone]