Integrating the EMR into SBHC Settings: Local and National Perspectives

Objectives for today…

 The Participant will be able to to Electronic Health (

Medical

system within a SBHCs

evaluate

opportunities and challenges for SBHCs to convert ) Record (EHR) and determine the basic requirements for an EHR  The Participant will the infrastructure needed by SBHCs and sponsoring organizations to respond to the need to convert to EHR.

identify

resources, training and  The Participant will be able to

assess

education and health care policies and finance mechanisms that support the conversion to EMR systems, including community, state, and regional networks.

What is happening now?

 The national health IT agenda is moving forward and there will be widespread adoption of EHRs with in the next decade.

 SBHCs are asking for information, networking opportunities and support around data collection and the EHR.

“

Electronic health records and other information technology tools have the potential to speed advances in medicine and help doctors make more rapid and informed decisions about medical care for their patients. Health information technology is expected to fill major gaps in medical knowledge and help doctors learn on a real-time basis what works and what doesn’t for their patients.”

Health Affairs Briefing: Health Information Technology and Rapid Learning, Friday, January 26, 2007

Current State of Technology

 Management Information System/Clinical Fusion  Electronic Health (Medical) Records

Clinical Fusion (MIS Software developed for SBHCs by Dr. David Kaplan) • • • • We are not certain how many SBHCs are currently using Clinical Fusion or what other software programs they are using. We are aware that in some states the Health Department has required the use of Clinical Fusion in order to facilitate reporting and evaluation.

There have been no major changes in Clinical Fusion for some time.

Clinical Fusion does not support billing

Data Collected by SBHCs (Census 2001, N=959)

120 Process Impact

ER Use 15%

100

School Attendance 36%

80

Contraceptive Use 18%

60

Health Behaviors 36%

40

Pregnancy Rates 34%

20

STI Rates 25%

0

What SBHCs do With Their Data (Census 2001, n=956)

90 80 70 60 50 40 30 20 10 0 Report to School Parents Funders Media Policy Makers Publish in Professional Journal Other

Do you Collect These Data Elements? (Census 2004-05)

Electronic Data Collected (n=1252)

Communication with Parents Student Sent back to Class DSM IV Codes Length of Visit Referrals Lab Tests CPT Codes Grade ICD Codes Enrollment/Registration Insurance Status Race/Ethnicity Provider Type DOB Gender 0 20 40 60 80 100

Accountability: Types of Data Collected by States (State Policy Survey, 2006)

number of visits SBHC users staffing enrollment diagnosis Budgets Billing/collections Cost per user Cost per visit 0 10 20 30 40 50 60 70 80 90 100

States that Fund SBHCs (n=20)

SBHCs that Bill and Collect

2004-05 Census of SBHCs

70 60 50 40 30 20 10 0 Medicaid SCHIP Bill Private Collect Self Pay

Electronic Health (Medical) Records

    Currently, sponsoring organizations of SBHCs are moving forward with new MIS and EHR systems The sponsoring organization may not have considered the SBHCs thus resulting in MIS and/or EHR systems that do not meet either the reporting or billing needs SBHCs have shared their belief that they will be left out of any information technology improvements occurring in the sponsoring agency or will be the last to receive the technology Constraints are financial, technical and legal

Challenges

      Data collection – Practice Management – Billing – Collection and Reporting Confidentiality Staffing Change in the clinic culture Cost – Software – Additional costs: – Hardware – Remodeling – IT support – Training Maintenance

“The number of hours both needed administratively and pulling staff out of clinics to prepare for the EMR, so there is a loss in productivity”

Opportunities

 Improved Quality of Care  Never having lost charts  Improved communication between health care sites and increased opportunity of cross coverage  Ability to close the gap between the medical literature and the medical field

Minimum Data Elements for SBHCs

          DOB Gender Race/Ethnicity ( needs to be compatible with how education data is reported) Provider type CPT codes ICD 9 codes Insurance status at visit Referrals (internal or external) Sponsors registration information (may include some of the other elements such as DOB) Student disposition (sent back to class, home, ER, other))

Minimum Data Elements for SBHCs

     Communication with parent (elementary and middle school) Primary language spoken in the home Risk Factors

(list needs to be generated for those not already ICD or CPT Codes)

Enrolled Student – Only children in our schools are eligible – Students from other schools – Out of school youth – Faculty/School Personnel – Family of student users (siblings/parents)/infants of students – Other people from the community – Other (describe):____________ If SBHC is PCP or not and if communication occurred

Concluding Recommendations:

    There is a definite need for Clinical Fusion however billing capabilities need to be developed NASBHC needs to publish an overview of the current state of SBHCs and HIT (issues/opportunities) NASBHC needs support sharing information & experiences of SBHCs with the selections of and development of HIT related products i.e. LA, ME, NM. MI State Health Departments are central to discussion on this topic.

“we need to support clinics in continuing to collect data that documents their work”

Changing the Face of SBHC: Integrating EMR into SBHC settings a local and national perspective

A primer on Methodology and Vendor Selection

Gaurav Nagrath, MBA Director, Division of Information Services Louisiana Public Health Institute [email protected]

504.301.9810

Outline

1.

2.

3.

4.

5.

LPHI & a vision for strategic health information focus The National Health IT Agenda Methodology: Coordinated Health Information Systems Vendor selection life-cycle Stakeholder Analysis & Management Purchasing Lifecycle Overview The Users Requirements Value For Money The Request for Proposal (RFP) The Evaluation Plan Contract Management Q&A/Discussion

The Louisiana Public Health Institute

LPHI’s mission is to promote and improve the health and quality of life in Louisiana through public-private partnering at the community, parish and state levels.

 Public health programming    Broker of traditional and non-traditional partnerships Fiscal agent Technical assistance (including health information services)  Research and evaluation

LPHI builds capacity among communities, providers, and decision-makers.

LPHI and Health Information Services

Vision

-

Develop the capacity to provide innovative solutions, guidance and TA to health policy-makers, healthcare organizations, and Louisiana communities based in current and emerging Public Health/Bio-Medical Informatics best practices.

Goal

-

Design, Plan & Enable Health Information Services and supporting platforms to positively impact population level health outcomes in Louisiana

National Health Information Technology Agenda

1.

2.

3.

4.

Widespread adoption of interoperable Electronic Health Records within a decade Medical Information follows the consumer Clinicians have complete, computerized patient information Quality initiatives measure performance and drive quality based competition 5.

Public Health & bio-surveillance are seamlessly integrated into care Source: Office of National Coordinator for Health IT (ONCHIT)

Methodology: Coordinated Health Information Systems

(the how) Health Information Services strategies involve taking our partners through the entire systems development life cycle and include following services:        Information technology strategic planning Business process analysis Selection and assessment of EHR product compliant with national standards Workflow redesign Change management System implementation Ongoing Health IT support & training

LPHI Information Services Vendor selection life-cycle

1.

2.

3.

4.

5.

6.

7.

Stakeholder Analysis & Management Purchasing Lifecycle Overview The Users Requirements Value For Money The Request for Proposal (RFP) The Evaluation Plan Contract Management

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5/30/2008

SBHC Stakeholder Analysis

Stakeholders

Identify:

1.

Direct or indirect relationship 2.

3.

Leadership structure Draft Stakeholder matrix, level, influence +/_ etc

Prioritize:

1.

Understand level of involvement

Incentives/Risk Existing relationships?

SBHC Stakeholder Management 1.

2.

3.

4.

5.

Stakeholder profile Engagement strategy – Key Issues Communication/Action plan – Unified Message Support/Project Role Follow ‐ up

Purchasing Cycle

Identify Need

Vendor Rating

•

Evaluation

Manage Contract Award Contract Post Proposal Negotiation Receive Proposal

•

Open Proposal

•

Evaluate Proposal

Invite Proposals Financial Approval

•

Option Appraisal

•

Business Case

Develop

•

Specification

•

Contract Strategy

•

Evaluation Criteria

Identify Suitable Suppliers

•

Source the Market

•

Appraise Vendors

Compose Request for Proposal

Specification

•

Terms and Conditions

•

Pricing Schedule 27

5/30/2008

The Users Requirements

1.

2.

3.

Is the primary purpose of selection process Should be expressed in terms of outputs, not solutions Must be tested for business fit with existing and strategic business model

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5/30/2008

Value For Money

The optimum combination of whole life cost and quality to meet the customer's requirements.

Some elements to take into consideration include:

1.

2.

3.

4.

5.

status of vendors involved – undertake the necessary due diligence for oversight equipment offered – does it adhere to best industry standards, latest technology not always best solution immediate cost of acquisition delivery method – options to look at include outsourcing delivery, building in-house team operating costs – be aware of any hidden costs over lifetime of product/service, e.g. Product support

29

5/30/2008

Request For Proposal (RFP)

RFP Could Include – 4.

5.

6.

1.

2.

3.

Project Overview Software Billing Capability Software ability to Interface with existing/legacy systems Software Reporting Attributes Company Customer Service & Infrastructure -> SLA Software capability in areas of Clinical Care Protocols, Behavioral Health, Patient Management

Vendor evaluation

1.

2.

3.

4.

5.

Create an RFP Have a demo scripted to give each vendor (easier comparison) Video tape demos (review later) Visit sites that currently use product Ask for trial software for hands-on comparison 6.

7.

Interview vendor leadership/support team Negotiate contract (enhancement requirements/payment terms) 1.

Some Cost considerations

Data conversion 2.

3.

Interfaces Upgrade costs

Contract Management Objectives

1.

2.

3.

4.

5.

6.

7.

ensuring the contract requirements are met within timescales and budget maintaining a positive relationship between parties to the contract measuring and assessing performance (ours and the contractor’s) against the contract requirements providing constructive feedback to the contractor and/or your own staff involved in the contract being proactive about problem solving resolving contract disputes should they arise contracts should include agreement about how customer/vendor relationship is to be managed e.g.

a.

decision points - could be linked to payment b.

c.

quality reviews 5/30/2008

Plant your EMR & Plant your EMR & Nurture its growth

Simply selecting an EMR for your organization is not enough to make it’s implementation successful. Much like a tree, before you plant the seed you must prepare the ground. After the seed is planted you must make sure that the roots are strong and the tree continues to grow. Simply, placing the seed in the ground and walking away will not successfully produce a thriving tree.

Tips on How to Plant & Grow your EMR…



The Facts

What is an EMR Types of Electronic Records Why should I plant my EMR tree 

The Right One

Knowing what is out there Organization needs Staff needs Functionality 

The Game Plan

Preparation Planning Training

Changing the Face of SBHC: Integrating EMR into SBHC settings a local and national perspective

Contact Information

Gaurav Nagrath, MBA Director, Division of Information Services [email protected] Summer Creasy Interactive E-Solutions LLC [email protected]

Tiffany Clarke, MPA NASBHC [email protected]

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