Transcript Practice Management Systems for CHCs

ELECTRONIC HEALTH RECORD
SYSTEMS FOR COMMUNITY
HEALTH CENTERS
Presented by
Diane Gaddis &
Steven D. Weinman
May 2008
SESSION DESCRIPTION
This presentation will cover the basics of what
constitutes an EHR system, and will provide practical
advice on how to identify, evaluate and choose a
suitable EHR system for a typical CHC. It will include
lessons learned by the presenters, who between
them have produced, chosen and successfully
implemented such systems in a CHC environment.
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DIANE GADDIS currently serves as CEO & President of
Community Health Centers Alliance, Inc. (CHCA), based in St.
Petersburg, Florida. Diane has more than thirteen years
experience in the Community Health Center environment, which
has included executive, information systems, and financial
management roles. CHCA provides acquisition services, project
management, implementation coordination, training, application
support, reporting, and system management services related to
electronic health records and practice management systems to
CHC members in Florida.
STEVE WEINMAN is currently the Executive Vice-President and
COO of Collier Health Services, Inc. (CHS), a large CHC serving
Collier County in SW Florida. Steve has been with CHS for 24
years starting as IT Director and moving up to CFO before being
promoted into is current position. He has designed and
implemented an extensive CHC practice management system
which was in use for 14 years. Over the years Steve has been
CEO of a new start CHC, as well as the founding CEO of CHCA.
Section 1
THE BASICS
WHAT IS AN ELECTRONIC HEALTH RECORD
SYSTEM (EHR)?
A comprehensive and robust system that not only supports the
collection of data and documentation of patient care
information, it also allows for flexible reporting and aids in
decision support for the provider. In addition, the system
includes:
1. Complete patient visit documentation: nurse triage,
histories, review of systems, progress notes, orders, printed
or electronic prescriptions
2. Real-time drug/allergy interaction
3. The capture and reporting of discreet patient data
4. Ability to interface labs, hospitals, other community
providers
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WHAT IS AN ELECTRONIC HEALTH RECORD
SYSTEM (EHR)? CONTINUED
5. Tools/triggers to aid in decision support and adherence to
evidence based medicine
6. Ability to scan paper documents and “file” into the chart
It is NOT:
• A disease registry
• Just a replacement for PECS
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HOW DOES AN EHR SYSTEM TOGETHER WITH
OTHER HEALTH INFORMATION TECHNOLOGY
(HIT) SYSTEMS?
1. In the not so distant past (and even today for most in the
ambulatory care sector), practice management systems
were the center of the universe.
2. Today, EHR is the center of the universe
3. The market is clamoring for clinical data. It is survival of the
fittest.
•
•
•
Pay for performance, HRSA, CMS all putting pressure to focus on
health outcomes.
Medicare Advantage plans now enhancing reimbursements for
chronic patients.
UDS reports shifting, looking for more clinical figures.
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OTHER DRIVERS FOR
ELECTRONIC HEALTH RECORDS
1. Reduction of medical errors:
•
Real-time drug/allergy interactions
•
“In-your-face” evidence based medicine triggers/reminders
2. Records more legible:
•
Reduces medical risks
•
Improves staff efficiency in trying to read notes
3. Medical records staff efficiency:
•
No more lost records!
•
No pulling a chart when the pharmacy or a patient calls
•
No more sticky notes
•
Routing charts between multiple locations eliminated
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OTHER DRIVERS FOR
ELECTRONIC HEALTH RECORDS, CONTINUED
4. Security and Privacy:
•
Security prevents unauthorized access
•
Audit trails provide details on who accessed what and when
•
Ability to back up data – prevents loss of records
•
Time and data stamping to prevent accidental or deliberate
misdating
5. Reduce lab and radiology orders:
•
Easily see labs ordered and results
•
No more lost results with an interface
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OTHER DRIVERS FOR
ELECTRONIC HEALTH RECORDS, CONTINUED
6. Other Efficiencies:
•
Provider chart review readily accommodated
•
QA staff reduced, over time, as reports produce metrics from data
•
Long term savings in record retention costs
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WHICH COMES FIRST:
THE BILLING/APPOINTMENT SYSTEM
OR THE EHR?
• If a new start – doing both at the same time, with the
right team and support mechanisms, is best
• Dependent upon funding availability
• What are the current business drivers?
• If already operational, do not do both at the same
time – too much impact
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MUST WE GET ALL OF OUR SYSTEMS FROM THE
SAME VENDOR?
• Potential Pros of Same Vendor:
1. One point of contact
2. Cross over accountability
3. Should play well together
• Potential Cons of Same Vendor:
1. May be weaknesses in one functional area
2. If vendor problems, affects both sides of the house
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MUST WE GET ALL OF OUR SYSTEMS FROM THE
SAME VENDOR? CONTINUED
• Potential Pros of Marrying “Best-of-Breed” (Two Vendors):
1. Quality products for both areas
2. Quality support
• Potential Cons of Marrying “Best-of-Breed” (Two Vendors):
1. Interface issues
2. Finger pointing
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SHOULD WE GET OUR OWN SYSTEM, OR
PARTNER WITH A NETWORK?
• Pros of doing it alone:
1. CHC is the sole decision maker
2. Needs of individual CHC always come first
• Cons of doing it alone:
1. All infrastructure costs (production server, redundancy, data lines)
born by CHC alone
2. Required depth of staffing and diversity of skillsets born by CHC
alone
3. No benefit of other expertise and collaboration
4. Costs of implementation (project management, training, go-live
support) born by CHC alone
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SHOULD WE GET OUR OWN SYSTEM, OR
PARTNER WITH A NETWORK? CONTINUED
Another option: Use a Network as a Vendor
• Pros:
1. Benefit from network CHC specific expertise and alignment with
CHC mission
2. Use in consultative role
• Cons:
1. May be more costly than collaborative Network model
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SHOULD WE GET OUR OWN SYSTEM, OR
PARTNER WITH A NETWORK? CONTINUED
• Pros of the Network Model:
1. Pooled financial resources enable the hiring of high quality staff
2. Pooled financial resources enable the hiring of depth
3. Two heads are better than one – typically, setup and
implementation higher quality and more successful
4. Pooled financial resources allow for server redundancy, disaster
recovery.
• Cons of the Network Model:
1. Collaboration takes time; lots of communication
2. Collaboration requires concessions
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WHAT IS ROI, AND WHY IS IT IMPORTANT TO
CONSIDER WHEN MAKING A DECISION??
ROI = “Return on Investment”
If there is no value, why do it?
Tangible costs vs. intangible costs
1. Factoring in acquisition and implementation costs
2. Personnel savings and resource shifts
3. Defining recurring costs
4. Quality improvement and market readiness – intangibles
to factor in
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SAMPLE EHR RETURN ON INVESTMENT
• Estimated staff hourly rate (with benefits) = $24
• Staff per Provider = 3
• Hours saved per staff per day = 1*
• Number of compensation days = 260
• Total Annual Savings Possible = $18,720
•*Conservative estimate – savings derived from staff not having to pull charts for visits or refile, look for lost charts, inter-office patient-related communications, quality review efforts, and
more
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JUST A FEW OTHER RETURN ON INVESTMENT METRICS TO
EVALUATE
Tangible Personnel:
Intangible:
• Chart pulls – Visits, QA, Billing
• Patient Safety Improvement
• Call to / from pharmacies
• Legibility
• Tracking / logs
• Improved Information
• Chart Routing (multiple
locations)
• Compliance
• Provider Recruitment
• Filing
Non-Personnel Costs:
• Paper
• Chart Space
• Transcription
• Chart Supplies
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TIME STUDY SAMPLE
Thomas E. Langley Medical Center found:
•
Time to locate, pull, and route a chart in their “paper”
environment is 2.5 minutes
•
Given the center’s average number of charts pulled per day
(365), 15.25 staff hours are spent per day in the paper chart
environment in this task alone
•
When charts are misfiled, the time study record jumped to
45 minutes (.75 hour) on average
•
Workflow benefits under electronic records for chart pulls
alone should recoup the cost of staff resources equaling two
full time equivalents (FTE) over the course of a year
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Section 2
PROCESS OF CHOOSING AN EHR
WHAT PLAYERS SHOULD BE INVOLVED?
• Should the process be driven by the IT
department?
• IT – support for the business departments / functions
• IT – infrastructure, communications, desktops
• Who should manage the project?
• Experienced project management (poor project
management can increase costs)
• Clinical leaders – must be clinician driven to be
successful. NOT an IT project.
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WHAT OTHER STAFF SHOULD BE INVOLVED,
AND WHAT ARE THEIR ROLES?
• Finance – the CFO or similar role must ensure a
clear understanding of the initial and recurring
costs. Must assist in development of a financial ROI
model.
• Operations – must understand operational and
patient flow and be able to assist in assess
workflow changes necessary to ensure success.
• Executive leadership – cannot just say “go forth
and do.” Must be part of the on-going reinforcement
to ensure that the return on investment occurs.
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WHICH SYSTEMS SHOULD WE LOOK AT?
1. Can any ambulatory electronic health record
system work in a CHC environment?
No:
• Most ambulatory primary care environments are not as
diverse as CHCs in the services they offer
• Many products are too specialized to one niche or another
• Product must be able to support the varied service
offerings of a CHC (i.e., pediatrics, chronic adult / family
care, ob/gyn, podiatry, behavioral health)
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WHICH SYSTEMS SHOULD WE LOOK AT?
CONTINUED
2. System must allow for customization, at a
reasonable cost, to meet data capture requirements
of HRSA (UDS, Health Disparities Collaboratives)
3. Current players include, but not limited to: GE
(Centricity), NextGen, eClinicalworks
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BEYOND THE BASICS OF AN EHR, WHAT
PRODUCT / VENDOR CONSIDERATIONS ARE
IMPORTANT FOR A CHC TO EVALUATE?
1.
Flexibility in form customization
2.
Ability to meet and continually comply with HRSA requirements
3.
Ability to annotate patients to certain programs, grants, or
studies
4.
Interface capabilities/vendor willingness to work with competition
5.
Vendor’s client list – CHC doesn’t want to be the lowest priority.
Also may be risking to be the only priority
6.
Reporting, reporting, reporting – data is useless if it can’t be
turned into meaningful information.
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WHY SHOULD WE BOTHER GOING THROUGH
THE REQUEST FOR PROPOSALS (RFP)
PROCESS?
• Dog n’ Pony shows do not ensure quality – just good
vendor sales pitches
• RFP response can become part of a contract
• Ensures a more apples-to-apples comparative
• Protects CEO and Board – demonstrates due
diligence
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HOW DO WE DEVELOP THE RFP?
• Requires experience and keen understanding of
environment
• Legal input is recommended
• Evaluate the vendor and reputation in addition to
the product
• Use HRSA as a resource for functional
requirements baseline
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HOW SHOULD WE EVALUATE THE RFP
RESPONSES?
• Create a scoring tool – which of the functional
requirements are “required” vs “optional”?
• Use of a scoring tool – weighting the required items
• Document, document, document – questions and
answer exchange
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THE VENDOR WANTS TO COME DO A DEMOWHAT SHOULD WE DO?
• Allow free form demos first
• Follow up with controlled demos
• Don’t be afraid to make them demo again and
again.
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ONCE WE CHOOSE THE PRODUCT WE WANT,
HOW DO WE NEGOTIATE WITH THE
VENDOR?
• Understand their various licensing models available
• Understand your needs and how they much the
licensing model
• Pay the money as deliverables are met, not all up
front
• It pays to contract with a competent resource to
assist in this process.
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HOW DO WE DEVELOP AN IRONCLAD
CONTRACT TO PROTECT OUR
ORGANIZATION?
• Read the contract thoroughly, understand the
various licensing options
• Use a competent attorney experienced in software
contracts
• Use a competent resource to advocate for your
needs and help with the review process
• Don’t scrimp on expertise here or it will cost you in
the long run
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Section 3
IMPLEMENTATION
“BABY-STEP” VERSUS “BIG-BANG”
Big Bang Pros:
Big Bang Cons:
• A more complete,
comprehensive system is
deployed to providers
• Takes 2+ years to build
• More time available for
configuration and testing
• More functionality at Go-Live
may impact productivity levels
for a longer period of time
• Large staffing infrastructure
needed to support at Day one
• Larger investment required upfront
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• Longer time frame to recoup
investment dollars
“BABY STEP” VERSUS “BIG BANG”
Baby Step Pros:
Baby Step Cons:
• Return on Investment comes
more quickly
• Patience required as all
functionality not available
initially
• Growing champions is easier
• Implementation and support
can be built slowly
• Productivity levels return more
quickly
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QUESTIONS