Selecting the Right Vendors for Your Health IT Projects

1. Selecting the Right Vendors for Your Health IT Projects April 17, 2012

2. Listen only mode • This webinar will be recorded and available on NACCHO’s 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

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

4. 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

5. Selecting the Right Vendors for your Health IT Projects Lincoln-Lancaster County Health Department Lincoln, NE April 17, 2012

6. 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?

7. 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

8. Where does this fit in our Strategic Plan?

9. 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

10. 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?

11. 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

12. 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

13. 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

14. Put a Team together This is going to be a major investment of time and money—Involve 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

15. 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

16. 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?

17. 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

18. 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

19. 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 don’t receive proposals that meet your needs—don’t be afraid to try again. Take what you learn and revise your RFP / criteria / vendor search • Our implementation came after our third effort

20. 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-up—it is never apples to apples

22. 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

23. 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.

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

25. 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 aren’t 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

26. 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 completed—incentive to complete • This can take up to several months to finalize through all the approvals • Don’t try to skip this—if for any reason, the project goes bad—you need the support from legal and purchasing • This can be a major investment—take the time to get it right—you will likely have to live with it for the next twenty years

27. 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)

28. Selecting the Right Vendors for your Health IT Projects April 17, 2012 Tracy Lockard Business Process Director Cabarrus Health Alliance

29. 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

30. Collaborative Requirements Development Methodology

31. 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

32. 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

33. 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

34. 12/2010 Go-Live with Practice Management Modules PM/EMR Implementation Timeline 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 Define Modifications to Lab Module 10/2011 11/2011

35. 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

36. 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

37. 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

38. Resource Planning

39. Resource Planning

40. Lessons Learned in Adopting EHR • Lots of process change • Focus on cross-department processes • Billing – Can’t test until live • Productivity/Revenue decrease • Never done! EHR is an integral part of your operations efficiency and effectiveness

41. Reference Materials • PM/EMR Evaluation Project Web site – www.cabarrushealth.org/commonground

42. Questions • Please type your questions in the box

43. 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/informatics/resources/spring-2012-webinars_ephi.cfm • Vendor Portal

44. Contact Information • Vanessa Holley, MPH • Program Analyst, ePublic Health • vholley@naccho.org • (202) 507-4239