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Mountain Wellness Hospital EHR Solution

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by

Anita Figueroa

on 18 December 2013

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Transcript of Mountain Wellness Hospital EHR Solution

Described the project objective.
Explained the business problem.
Showed the value of EHR Solution.
Reviewed our Project Strategy and Logistics -to implement an EHR system.
Conducted System Alternative Assessments -to describe the vendor of choice.
Is the project worth it?

ROI Rate of return for amount invested for lifetime
NPV Net Present Value
Payback Analysis (Payback Period)

Meaningful Use What is it?
Hospitals not Meaningful Users of EHR of certified EHR will be subject to payment adjustments by 2015 for Medicare

Requirements: Must meet sets of objectives in 6 months in advance of this date.

Center for Medicare & Medicaid Services: CMS.ORG
EHR Mandate for
Meaningful Use
Mount Wellness Hospital EHR Solution
Vendor Selection
Project Value
Vendor of Choice
Process & Cost Inefficiencies
Paper management and delivery methods to exchange medical information is costly

Process workflow needs Improvement.


Disparate Systems
Physical Records
Incompatible digital records
Redundant Systems
Fragmented medical records
in different systems
Business Problem
Better Coordination of Care
No more fragmented records.

EHR provides solutions to support safer health care from accurate and complete information.

Providers will know more about patient before patient contact -records available “whenever and wherever it is needed.
Safe Guards

EHR has safe guard to flag dangerous drug interactions.
Set of standards:
Defined by Center for Medicare & Medicaid Services (CMS) Incentive Programs governing use of Electronic Healthcare Records –allowing eligible providers & hospital to earn incentives (money) by meeting specific criteria.

Background Legislation/Regulation
: Health Information Technology for Economic and Clinical Health (HITECH) Act provides authority to government agencies.
Two regulations apply to meaningful use standards for certified EHR
.
Incentive Program for Electronic Health Records -governed by CMS
Standards and Certification Criteria for Electronic Health Records -governed by Office of National Coordinators.

Hospitals:
Must complete 18 of 23 objectives -13 core and any of the 5 from the list of 10 must be met

Goal:
Meaningful use is to promote the spread of electronic health records to improve health care in the United States

Center for Medicare & Medicaid Services: CMS.GOV
Feasibility Assessment
Summary
Mount Wellness Hospital
Executive Summary
Study conducted by Menachemi and Collum describes the beneficial outcomes in 3 classifications:
Clinical
to improving the quality of care provided to patients and reducing medical errors.
Organizational
financial and operational benefits.
Societal
to include the improved ability to conduct research, improved population health, and reduced costs.

National Center for Biotechnology Information:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692323/
Valued EHR Outcomes
Cost Savings:
Reduce Operating expense by 3% ($2012 operating cost $150 million) saving $13.5 million over period of 3 years

Rewards:
Medicare and Medicaid formula for rewards factor $2 million base amounts in its formula -capped at $6 million.
A national survey of doctors who are ready for meaningful use offers important evidence:

79% of providers report that with an EHR, their practice functions more efficiently.

68% of providers see their EHR as an asset with recruiting physicians.
Important Evidence
from EHR Solution
Cost Savings & Rewards
Objective
Implement Electronic Health Record System April 30, 2014

EHR Project Logistics
High Level Overview
Start Date: Dec 15, 2013
End Date: August 30, 2014

Revised Dates
Start Date: Nov 11, 2013
End Date: April 30, 2014

Duration reduced from 10 to 5 months
Deadline Date for Compliance: January 1, 2015

Estimated Implementation Costs $2.5 million

Including software licensing and hardware costs
Center for Medicare & Medicaid Services: CMS.GOV
U.S. Department of Health and Human Services (HHS),Office of the National Coordinator for Health Information Technology: HealthIt.gov
U.S. Department of Health and Human Services (HHS),Office of the National Coordinator for Health Information Technology: HealthIt.gov
U.S. Department of Health and Human Services (HHS),Office of the National Coordinator for Health Information Technology:
http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings
Milestones
MS 1: Select Vendor by 11/1/13
MS 2: Project Initiation by 11/11/13
MS 3: Business Requirements Gathering sign off 1/6/13
MS 4: Design & Development 2/3/14
MS 5: UAT 3/5/14
MS 6: Training 2/3/14
MS 7: Production/ EHR Deployment 4/30/14


Agile Methodology

Agile
Advantages & Disadvantages
Agile Advantages
Early delivery of work
Continuous delivery of software
Easily incorporate user feedback
Close working relationships with large multi team
Higher Degree of User Satisfaction
Agile Disadvantages
High degree of resource allocation required
Difficult methodology for matrix organizations
Challenge of envisioning the entire system as a whole
Very little documentation
Requires experienced resources
Communication Plan

Project Initiation Phase
Business Requirements Gathering Session

Weekly Reports
Project Plan
Project Status Reports
Financial Reports
Risk/Issue Log, Change Control Log

As Needed
Milestone Completion Forms
Change Requests


Scope Requirements
Business Cases:
Use Case 1 Patient Check In
Use Case 2 Office Visit
Use Case 3 Office Discharge
Use Case 4 E - Prescription
Use Case 5 Extract, transform, and load

Commence a strategic planning on November 1, 2013 to develop a 5 month endeavor to implement a certified Electronic Health Care System (EHR) -shifting towards improved business workflows by April 30, 2014
Objective
Migrate medical to target Electronic Health Care Record System inclusive of
the following:
patient demographics and progress notes
medications and vital signs
past medical history and immunizations
laboratory data and radiology report
Intergrate with our existing radiology, pathology, and laboratory systems.
Scope
Project Strategy
Advantages
Forefront of needed change to support Health Reform (HITECH Act) for newer Health Technology (EHR)
Recognized both locally and nationally as a hospital that provides highest-quality health care services by its provider to their patients
Improve patient workflow process.
Reduce operating expenses by 3% -savings of $13.5 over 3 yrs.
Increase revenue opportunities from incentives programs
Mount Wellness Hospital

Large based Critical Access Hospital in Chicago full service since 1950
Earned $350 million revenue in 2012
Medicaid Patient Volume in excess of 10% -criterion minimum for incentive payment
Integrated physician clinic
Nursing home provider care
Intensive Care Unit (ICU)
Surgical Units
JAC Consulting, LLC.

About Us
Founded in 1992
Headquarters based in Downers Grove, IL
750 Employees World wide
250 local, 500 remote consultants
Specialize in IT Healthcare Solutions
Electronic Healthcare Record (EHR) Implementation
Development
Go live on April 30, 2014
Release support by Implementation Coordinator and Release Team:
Help Desk call for release route to Release Team.
Chain of command
Escalation process
Set shifts for 24/7 support for 7 days after implementation.
Close out meeting
Archive all project documents
End procurement arrangements to pay cost due -final phase.
Iteration
Repeat the process for subsequent iteration until project completion.
Agile Methodology
Team: Anita Figueroa, Chris Marchwick
Jamila Parham
• Identify what needs to be done (project chart definition of the objectives)?
• How it will be done (revealing activities and its sequence)?
• Who will do it (referring to resource and responsibilities)?
• How long it will take to complete it (identifying durations and schedule)?
• How much it will cost (showing total project cost)?
Gido and Clements (2012)
Planning
Project Manager
Subject Matter Experts
Business Representatives
Extract Transform Load Lead Developers
Data Quality Analysts
Database Administrators
Software Engineers -Lead Developers
Network Architectures


Functional Requirements
: Reporting, algorithms used, data access, conversion aggregation and summary information, and listing layouts of all reporting outputs.

Data Requirements
. Identifies the required and important data elements.

Data cleansing
according to business rules and standards.

Performance Requirements
like computer processing time.
• Security Requirements
according to PHI & HIPAA.

Availability Requirements.
Define the availability terms including percentages of time data will be available (e.g., weekdays, available 24/7 hours, at rate of 97% availability).

Infrastructure setup: Hardware, software, DBMS, and network changes.
Construct physical design per business requirements.
-Extract Requirements, it details the requirement for the extraction to list all data elements showing the source file it reside in.
-Transformation Requirements, it identifies all data elements transformation requirement and defines business rules to apply if needed.
Test to verify outcomes: Unit, Quality Assurance, Beta, Acceptance test.
Modeling

Documents important entities -internal (people or system) or external (people or systems).
Shows process and flow of data
Identifies important data stores for inputs/outputs
Omits details logic in the process.
Office Visit
Collaboration with business users to ensure the models for the project reflects:
Proper business relationships.
Captures system design for all important uses cases.
Confirmed to be complete and accurate.
Project Blue Prints
Problem: Project schedule changed 10 to 5 months.
Executives approve change to the new implementation date of April 30,2014
No scope changes
Budget increase approved.
Resource leveling implemented -setting other projects to lessor priority; affording SME to work an increase percentage of time on EHR project.
Resource smoothing pushes other tasks where there is float (available time) as long as it is not on critical path.
Hired new resources
Healthcare Information and Management Systems Society. (2013). Electronic health records. Retrieved from Himss website: http://www.himss.org/ASP/topics_ehr.asp
Resource Optimization
Revised Target Dates
System Alternative Candidates
Scalability
High Availability
User Training Considerations
Infrastructure Needs
Selection Criteria
System Characteristics
Addresses all Business Requirements
Mature design ensures scalability and system resiliency.
Comprehensive training curriculum.
SOA service oriented architecture to support connectivity from legacy to new system -support existing system and integrating with newer technology.
Feasibility
EHR System cost: $2.4million
Pay back period: 2.4 Years
Return on Investment 18 %
Net Present Value: $2.9 million


Projects may face potential impacts of adverse events on the accomplishment of the project objectives.
7 inherent risks associated with Information Systems include technological risk, human risk, usability risk, project team risk, project risk, organizational risk, and strategic and political risk
Address risks proactively will increase the chances of accomplishing the project objective.
Don't get caught off guard.
Be prepared and defined risk response plan to either mitigate, accept, or avoid unacceptable risks.
Monitor: reassess risks to determine if it it remains relevant or diminished or new risks are discovered.


Gido, J., & Clements, J. P. (2012). Successful project management (Fifth ed.). Mason, OH: South-Western Cencage Learning
Rapid Deployment Hybrid
Business owners actively participate
User focused and flexible to Changes
Pilot / Soft Go Live Friendly
Rapid Deployment
Rapid Application Protocol for Implementation and Deployment
Results. Align. Pilot. Insure. Deploy
EHR Implementation Cost Summary
Software $593,000
Hardware $ 86,000
Personnel $1,794,600
Total $2,473,600
Full transcript