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www.openminds.com n 15 Lincoln Square, Gettysburg, Pennsylvania 17325 n 717-334-1329 n [email protected]
How To Find The Right Electronic Health Record: The OPEN MINDS Seminar On Best Practices In EHR
Selection & Contracting
T h e 2 0 1 8 O P E N M I N D S T e c h n o l o g y & I n f o r m a t i c s I n s t i t u t eO c t o b e r 2 2 , 2 0 1 8 | 1 : 0 0 p m – 4 : 0 0 p m
J o s e p h P . N a u g h t o n - T r a v e r s , E d M , S e n i o r A s s o c i a t e , O P E N M I N D S
W a y t t D e l a n e y , C o n s u l t a n t , O P E N M I N D S
© 2018 OPEN MINDS
AgendaI. Steps For Vetting EHR Vendors, Their Products, & Services
Phase 1 – Organizational Assessments & EHR Vendor Research
Phase 2 – Preliminary EHR Vendor Selection
Phase 3 – Vetting Finalists & Making A Final Selection
Phase 4 – Contract Negotiation & Implementation Preparation
II. EHR Costs & Budgeting
III. Key Elements Of An EHR Implementation
IV. Best Practices: Workflow Mapping & Project Management
V. Questions & Discussion
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The Big Picture On Behavioral Health EHR Implementations
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The Good
• There is consensus among behavioral health providers that implementation of an electronic health record (EHR) system brings value when things go right
• The majority of providers report implementing an EHR in 6-12 months
The Bad
• Challenges include lack of involvement from executive leadership, staff engagement, poor planning and project management, and failure to identify and fully implement the key components of the EHR system
The Ugly
• 12% reporting implementations of two years or longer!
© 2018 OPEN MINDS
Key Findings
1• 85% of the providers surveyed have purchased an EHR
2• 73% of providers with an EHR define their EHR as fully implemented, with most
having implemented their system in 6-12 months
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• 25% of those with incomplete implementation attribute the delay due to internal causes, and 34% report that it was a combination of delays from the vendor and their own organization
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• When implementation was not fully complete, the clinical, scheduling, and billingmodules were the major functionalities reported as being fully implemented with the reporting module just over halfway complete
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Group #1: The Imperfect
EHR
Group #2: EHR
Disasters
Should We Change EHR Systems & Vendors?
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Group #1: The Imperfect EHR
EHR mostly implemented by your organization, but there are problems:
• Key features such as billing, scheduling, mobile use, and clinical forms are not fully functional
and easy-to-use
• Management reporting and analytics not sufficient
• Poor vendor support
• Staff not delighted with the system
• Not getting key benefits expected from the EHR
Likely next steps:
• Evaluate EHR system and vendor alternatives as well as evaluate if you can improve your
current implementation
• OPEN MINDS estimates that 75% of providers will switch systems after this process, with
roughly 25% choosing to stay with the current vendor
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Group #2: EHR Disasters
These are the (not-so-rare) situations where the EHR implementation has failed
altogether or the system has been implemented with very minimal functionality.
Likely next steps:
• Evaluate EHR system and vendor alternatives as well as evaluate very frankly where your
agency may have failed in the selection and implementation of the current EHR
• OPEN MINDS estimates that 100% of providers will switch systems after this process!
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I. Steps For Vetting EHR Vendors, Their Products, & Services
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Key Vendor Evaluation Areas
Functionality
Customer Support & Service
Implementation Expertise
Company Stability
Cost
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Key Phases In EHR Vendor Selection & Contracting
Phase 1• Organizational Assessment & EHR Vendor Research
Phase 2• Preliminary EHR Vendor Selection
Phase 3• Vetting Finalists & Making Final Selection
Phase 4• Contract Negotiation & Implementation Preparation
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Phase 1:
Organizational Assessment & EHR Vendor Research
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Organizational EHR Readiness Assessment
Review organizational strategic plan and role of
technology & EHR in achieving key strategic
and operational objectives
Assess staff readiness for an EHR
Assess IT infrastructure readiness
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Phase
1
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Preliminary EHR Vendor Research
One of the keys to successfully selecting a software application is knowing what functionality your business needs, or, from what software it would benefit
• Trade shows where vendors exhibit
• Request marketing and promotional materials from vendors
• Issuing a Request For Information (RFI) to gather basic information about functionality and services
Get an overview of what products and services are available
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Phase
1
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Advantage Of Researching
The goal in this step is not to evaluate
the vendors, but rather to gain a better
understanding of how technology could
benefit your organization, so that you
are able to detail the functional
specifications based on both current
operations and needs, as well as what
“could be.”
Phase
1
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Determine If You Have Any Vendor ‘Knock-Out’ Factors
For this preliminary screening of
vendors, we recommend using
“knock-out” factors that are driven
by your organization’s business
needs and management and
purchasing choices.
Phase
1
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Commonly Used Knock-Out Factors
Whether the vendor has or requires a hosting or
application service provider (ASP) option or software as a
service (SaaS) option
Vendor experience with local market or specific service
types
The vendor’s software technology platform and
database
Lack of mission critical functionality
Whether the vendor offers wireless or disconnected database technologies
Phase
1
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Phase 2:
Preliminary EHR Vendor Selection
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Develop & Release A Competitive Request For Proposal (RFP)
Develop a detailed listing of your organization’s
functional needs
• Incorporate any knock-out factors
Exact functional specifications vary
from organization to organization
• Common areas of functionality to review to determine which specifications are most important for meeting your needs
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Phase
2
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Sample RFP Sections
Vendor Overview
Technical Information & Infrastructure
Requirements
Training, Implementation Support, Data
Conversion, & Software Upgrades
Customer Support Approach
Data Conversion, Customization &
Software Upgrade Processes
EHR Capability & Implementation
Experience
Software Functionality
Report Writing
Scanning, Document Management, &
Record Release Capabilities
Mobile Solutions
Data Import/Export & Software Interface
Capabilities
Experience In Local Market
Compliance Plans
Integration With Primary Care
Customer Reference Contact Information
Cost
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Phase
2
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Vendor Overview
This Section Provides A Basic Understanding Of The Vendor’s Business
Company Customers Services
Key Qualifications
Offered To Meet Your
Technology Needs
Phase
2
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Technical Information & Infrastructure Requirements
This Section Should Contain Detailed Questions From The Technology Staff About Needs For:
Hardware Software NetworkTelecommunications Set-up Needed Or
Recommended
Software Platform/Database
(Any Near-Term Plans For
Upgrading?)
Recommended Staffing To
Support The Application
Once Implemented
Phase
2
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Training, Implementation, Support, Data Conversion, & Software Upgrades
• Training
• Implementation
• Support
• Data Conversion
• Software Upgrades
In This Section, Describe Your Organization’s Typical Approaches To:
• Number of full-time equivalent (FTE) staff members you have in each of these operational areas
• Information on typical implementation services• Include key tasks, timelines, and staff members involved both from your organization and the purchaser
• Help desk operations• Include information on 24/7 availability, how calls are prioritized, response times, whether the caller has routine access to
live staff, and all other information of interest to a customer
• Experience in converting data from other EHR systems
• Information about user groups
• Information about how customers are involved in the software enhancement decision process
• Frequency of upgrades
Include The Following Detailed Information In This Section:
Phase
2
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Configurable Form & Field Capability
• How is the creation of electronic health record forms supported?
• What if other electronic data forms are needed?
• How can end-users (rather than the vendor) customize the electronic health record?
In This Section, Ask The Vendor To Detail:
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Phase
2
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Report Writing Functionality
• Report writing capability of its technology solutions
• A listing and description of standard reports
• Export capabilities
• Compatibility with other applications
• Ease of use, etc.
In This Section, Ask The Vendor To Describe:
Phase
2
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Desired Reporting Functionality
A report-writer that is comprehensive and easy to use, allowing reporting on all data elements in the system
Ability to write custom reports and write and use
stored procedures
Data-warehouse and data mining capabilities
A data dictionary and supporting documentation
An extensive library of reports, with commonly used queries and sorts, which can
be easily customized as needed by the customer
Ability to save and name report templates
Ability to run reports in batches
Ability to run reports or report batches at scheduled
times
Ability to create management information
dashboards
Ability to create graphs or charts
Phase
2
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Additional Business Intelligence Tools
• Additional business intelligence tools for reporting executive and management metrics
• Partner(s) that provide these tools
• Functionality in detail
In This Section, Ask The Vendor To Detail:
Phase
2
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Scanning, Document Management & Record Release Capabilities
• Supports for scanning and managing documents that are created by other parties so that they can be included in a case or medical record
• Supports for releasing parts or all of the case or electronic records to other partiesBoth in paper and secure electronic formats
In This Section, Ask The Vendor To Describe:
Phase
2
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Software Interface & Data Exchange Capabilities
• Expertise in interfacing with common general ledger and human resource applications
• Helping provider organizations share data with other providers and stakeholders
In This Section, Ask The Vendor To Describe:
Phase
2
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Experience In Local Market
• Experience in the local market
• Support for your state’s versions of electronic billing forms
• Interfacing with state systems
In This Section, Ask The Vendor About:
Phase
2
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Overall Software Development Plans & TechnicalDirection
• Plans for continued software and business development
• Technical directions the vendor is taking with its products and servicesInclude both short-and long-term roadmaps about product
enhancements or other initiatives
In This Section, Ask The Vendor To Describe:
Phase
2
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Mobile Solutions
Ability to securely connect its software to smartphones, tablets, or other mobile devices.
What functionality is available?
Phase
2
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Disconnected Database Functionality
Does software application have the functionality to support disconnected use of the system in instances where internet or wireless is unavailable or unreliable?
• If so, detail what functionality is available with the disconnected solution.
Phase
2
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Consumer/Family/Other Care Provider Portals
What “portal” capabilities its software has for outside parties to securely
access the system?
Detail what functionality is available with the various portals.
Phase
2
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Meaningful Use Certification & Compliance Plans
What is the software’s current status with regards to Meaningful Use as
prescribed by the Centers for Medicare & Medicaid Services
(CMS)?
What plans are in place for supporting requirements under
Stage 2 and Stage 3?
Phase
2
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Experience With Integration With Primary Care
Describe experience with aiding behavioral health providers with integrating with primary care providers through data exchange.
Phase
2
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Cost
• Clearly distinguish between one-time and on-going costs
• Be complete enough (along with the information from the Technical Requirements section) for you to develop a five-year budget for the proposed solution
Detail The Cost For Its Software Technology Solution
Provide The Number Of Users To Vendor (Named As Well As Simultaneous) So Vendor Can Respond With Cost Information
Phase
2
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Software Functionality
Ask The Vendor Whether Its Product Supports The Detailed List Of Functional Specifications
• Vendors can indicate Yes/No to the functional specifications list and make comments
Included An Appendix As Part Of The RFP
Phase
2
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Customer Reference Contact Information
Ask For List Of At Least 25 Customer Contacts
(Needed to evaluate vendor on customer service)
Ask Vendor To Highlight Customers Similar To Your Organization Or Will Reflect
Satisfaction With The Vendor
Phase
2
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Additional Information
Include an optional section where vendors have an opportunity to share any other information they feel would be helpful to you in the selection process
Phase
2
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Appendices
I. Customer Market Information
II. Pricing Template (Excel Spreadsheet)
III. Functional Specification Checklist
IV. Customer Reference Information Form
Give the vendors 30 days to respond to the RFP.
Phase
2
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Phase
2
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Phase
2
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Phase
2
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Conduct Preliminary Vendor Screening From RFP Responses
Receive all responses from software vendors
Score vendors on how well they meet your
functional needs
Develop preliminary 5-year budget for each
vendor
• Include any required technology infrastructure upgrades and changes in staffing so that you can begin to compare cost
Phase
2
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Functional Specifications Scoring Example
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Vendor A Vendor B Vendor C
Functional
Specification Weight 1=Yes/0=No Weight 1=Yes/0=No Weight 1=Yes/0=No Weight
A. Core Electronic Health Record Functionality
A1.Referral Call tracking & Disposition Data 1 1 1 1 1 1 1
A2.Admission, Transfers, & Discharge Information 1 1 1 1 1 1 1
A3.Standard & Program Specific Consumer Demographic Data 1 1 1 1 1 1 1
A4.Consumer Photo 1 1 1 1 1 1 1
A5.Family & Relationship Tracking 1 1 1 1 1 1 1
A6.Waitlist Tracking 1 1 1 1 1 1 1
A7.Discharge Planning & Referral Tracking1 1 1 1 1 1 1
A8.DSM & ICD Diagnoses 1 1 1 1 1 1 1
A9.Master Individual Service Plans 1 1 1 1 1 1 1
A10.Program-Specific Service Plans 1 1 1 1 1 1 1
A11.Care Provider Tracking 1 1 1 1 1 1 1
A12.Consumer Electronic Signature 1 1 1 1 1 1 1
A13.Staff Electronic Medical Record Signature Standard Compliance 1 1 1 1 1 1 1
A14.Support For Multiple Signature Requirements & Progress Note Roll-Up 1 1 1 1 1 1 1
A15.Configureable Progress, Telephone, & Shift Notes 1 1 1 1 1 1 1
A16.Group Notes 1 1 1 1 1 1 1
A17.Aftercare Monitoring 1 1 1 1 1 1 1
A18.Supervisor Monitoring Tools 1 1 1 1 1 1 1
A19. Internal Referral Process Support 1 1 1 1 1 1 1
Total Score 19 19 19 19
Percentage Score 100% 100% 100% 100%
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Functional Specifications Scoring Example 2
B. Psychiatry, Nursing, & Primary Care Functionality
B1. Medical Conditions, Vital Signs, & Metrics 1 1 1 1 1 1 1
B2. Medication Monitoring 1 1 1 1 1 1 1
B3. Medication Administration Records (eMAR) 1 1 1 1 1 1 1
B4. Electronic Prescription Transmission 1 1 1 1 1 1 1
B5. Preferred Prescription & Orders Sets 1 1 1 1 1 1 1
B6. Links To Medication Information & Drug Interaction & Contraindications 1 1 1 1 1 1 1
B7. Formulary Support 1 1 1 1 1 1 1
B8. Laboratory Interface 1 1 1 1 1 1 1
B9. Laboratory Order Sets 1 1 1 1 1 1 1
B10. Laboratory Result & Medical Condition Alerts 1 1 1 1 1 1 1
B11. Injection Site Monitoring 1 0 1 1 1 1
B12. Pharmacy Inventory For Individual Consumers 1 0 0 1 1 0 0
B13. Pharmacy Inventory For Medication Samples 1 0 0 1 1 0 0
B14. Support For Tracking HEDIS Measures 1 1 1 1 1 1 1
Total Score 14 11 14 12
Percentage Score 100% 79% 100% 86%
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Vendor A Vendor B Vendor C
Weight 1=Yes/0=No Weight 1=Yes/0=No Weight 1=Yes/0=No Weight
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Functional Specifications Scoring Example 3
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VENDOR OVERALL
A. Core Electronic
Health Record
Functionality
B. Psychiatry,
Nursing, &
Primary Care
Functionality
C. Additional Bed
& Slot-Based
Program
Functionality
D. Additional Case
Management, Care
Coordination,
Service
Coordination &
Crisis, & ACT
Team
Functionality
E. Additional
Outpatient
Functionality
F. Additional
Behavioral Health
Home
Functionality
G. Substance Use
& Dependence
Functionality
H. Employment
Services
Functionality
I. Family &
Children's
Functionality
J.Child Day Care
Services
Functionality
K.Compliance,
Quality
Assurance, &
Medical Record
Department
Functionality
L.Billing &
Accounts
Receivable (A/R)
Functionality
M.Other System
Functionality
Vendor A 92% 100% 79% 100% 100% 100% 75% 100% 60% 90% 100% 100% 92% 90%
Vendor B 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Vendor C 91% 100% 86% 100% 100% 89% 100% 50% 80% 90% 83% 100% 85% 90%
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Screening From RFP Responses
Determine if any of the knock-out factors apply
Select vendors to move to software demonstration phase
• Average is inviting 6-10 vendors for half-day software demonstrations
Phase
2
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Conduct Software Demonstrations & Select Finalists
Develop Likert scoring tool for your staff to use during the software demonstrations
Scoring should be based on core areas of functionality
from RFP
Narrow vendors to 2-3 finalists, based upon both
functionality and user-friendliness
•In most instances, organizations come to a very quick consensus about finalists at this point in the process
Phase
2
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Phase 3:
Vetting Finalists & Making Final Selections
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A Structured Approach To Final EHR Demonstrations
• One- or two-day software demonstrations by your 2-3 vendor
finalists
• Structured topics for the demonstrations with your staff subject
area experts attending and scoring the vendors
Phase
3
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Phase
3
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Web-Based Technical Reviews
• Determine system configurability
• Reporting flexibility
• Any other technical factors deemed important by your team
Have your technical staff do a web-based “technical review” of the two finalists
Phase
3
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Additional Vetting Of Vendor Finalists
Reference Checks
Current Customer Site
Visits
CEO & Management
Team Interviews
Financial Due Diligence
Phase
3
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Phase 4:
Contract Negotiation & Implementation Preparation
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Contracting
Select the best system available to meet your
needs
Finalize contract and begin implementation
• Some purchasers do this with the 2 finalists
Have the contract reviewed by your attorney
before changes and requests are presented to
the vendor
Phase
4
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Key Contract Areas To Review
I. Contract Term & Termination Clauses
II. Ensuring That All Agreed Upon Functional Specifications Are Included
III. Warranties & Limitations
IV. Support & Implementation Details
V. Software Escrow
VI. Costs & Cost Increases
VII. Payment Terms & Timelines
Phase
4
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Contract Negotiation Tips
Present all major and minor contract change requests along with any pricing changes in a single memo
Determine ‘must-have’ versus ‘desired’ changes
• If both parties have clear, fair, and reasonable requests, the negotiation usually goes very quickly
Keep in mind that you are building a long-term relationship
Phase
4
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II. EHR Costs & Budgeting
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The CEO Perspective On Technology
“We are stuck with technology when
what we really want is just stuff that
works.” - Douglas Adams
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ROI In Technology
Simple ROI% = net benefit / total cost
• Advantages:
o Simple - easy to calculate
o Easy to understand
o Buyers use it frequently
• Disadvantages:
o No consideration for the timing of the cash flows
o No consideration of the time value of money
o Not sensitive to the magnitude of the project
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Simple ROI Analysis:
Benefit $750,000
Cost $150,000
ROI Percent 500%
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Major ROI Analysis Components
Technology system costs
Quantifiable financial savings and benefits of technology
Intangible and unquantifiable financial benefits of new systems to organization and
stakeholders
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System Costs
Hardware costs:
• Capital investments in workstations, printers, networks, etc.
Software licenses or user fees
Installation costs
Staff training costs
Software maintenance, system upgrades, and customization
Hardware maintenance, repair, and service
On-going user support and troubleshooting
Data migration costs
Additional IT staff
Consulting services
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Quantifiable Financial Savings & Benefits Of System (EHR Example)
Meaningful use incentive dollars
Reduced data entry time (elimination of duplicate data entry)
Record transcription time and records access costs
Increased professional productivity and net billing (due to reductions in record search
and manual recording time)
Reduced admin and professional staff time correcting chart deficiencies
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Quantifiable Financial Savings & Benefits Of System (EHR Example)
Improved collections rate (due to improved documentation)
Decreased payment lag time
Reduced compliance cost and improved risk management (due to better and faster
information)
Reduced accreditation costs
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Typical Timeframe For ROI Cost Analysis
Most organizations calculate ROI for technology purchases in two ways:
• Return on Investment (ROI) over five-year period
• Actual ROI payback period (i.e. how many years does it take for the financial benefits to equal
the costs)
o If done over one year, this is knows as the annual or annualized rate of return.
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Mostly Likely Areas For Significant Financial Return
Increased billable staff productivity
Increased fee-for-service billing and collection
Reduced payment retraction due to problems with medical records
Reduced staff numbers due to automation
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Sample Initial Pricing Information for EHR Purchases
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Request For Proposal
Software Vendor Pricing
Return To Summary Tab
Section #1: One-time costs
Year One Year Two Year Three Year Four Year Five Total
Software License $ 55,000 $ - $ - $ - $ - $ 55,000
Training $ 16,000 $ - $ - $ - $ - $ 16,000
Implementation $ - $ - $ - $ - $ - $ -
Data Conversion $ 14,000 $ - $ - $ - $ - $ 14,000
Other: FormBuilder $ 55,000 $ - $ - $ - $ - $ 55,000
Other: State Reporting $ 13,000 $ - $ - $ - $ - $ 13,000
Other: BI Module $ 70,000 $ - $ - $ - $ - $ 70,000
Other: Inpatient $ 70,000 $ - $ - $ - $ - $ 70,000
Other: Direct Messaging $ 2,000 $ - $ - $ - $ - $ 2,000
Other: Secure Hosting $ 3,000 $ - $ - $ - $ - $ 3,000
Section #1 TOTAL $ 298,000 $ - $ - $ - $ - $ 298,000
Section #2: On-going costs
Year One Year Two Year Three Year Four Year Five Total
Maintenance $ - $ - $ - $ - $ - $ -
Other: Monthly Users (Assume 6 Month
Implementation) $ 80,000 $150,000 $150,000 $150,000 $150,000 $ 680,000
Other: Monthly Training Domain $ 5,000 $ 6,700 $ 6,700 $ 6,700 $ 6,700 $ 31,800
Other: Monthly Billing Module $ 1,000 $ 25,000 $ 25,000 $ 25,000 $ 25,000 $ 101,000
Other: Monthly Mobile Module $ 5,000 $ 9,600 $ 9,600 $ 9,600 $ 9,600 $ 43,400
Other: Monthly Inpatient $ 6,000 $ 8,100 $ 8,100 $ 8,100 $ 8,100 $ 38,400
Other: Monthly Housing $ 30,000 $ 30,000 $ 30,000 $ 30,000 $ 30,000 $ 150,000
Other: Annual FormBuilder $ - $ 10,000 $ 10,000 $ 10,000 $ 10,000 $ 40,000
Other: Annual eLabs $ - $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 12,000
Other: Annual eRx $ - $ 4,000 $ 4,000 $ 4,000 $ 4,000 $ 16,000
Section #2 TOTAL $ 127,000 $ 246,400 $ 246,400 $ 246,400 $ 246,400 $ 1,112,600
TOTAL (Sections 1 & 2) $425,000 $246,400 $246,400 $246,400 $246,400 $ 1,410,600
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III. Key Elements Of An EHR Implementation
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Four Groups Of EHR Implementation Tasks
• These are the typical elements of an EHR implementation that require time and focus, but are not complicated in and of themselves.Routine Elements
• These are the trickier areas of the implementation require much more attention and can be stumbling blocks if not managed carefully.
Complex Elements
• These are all the final tasks and steps before going-live with the new EHR.System “Freeze” & Final Preparation
• These are the often forgotten tasks of continuing to implement other and evolving features of the EHR application to leverage the technology for all possible benefits.
Expanding & Leveraging the EHR Implementation
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EHR Implementation
Routine Elements
1. Vendor training and implementation
2. Hardware
3. Data conversion
4. Mobile system use
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1. Vendor Training & Implementation Days
This includes all of the training and support from your vendor partner—these items are
often included in the vendor’s standard project management template
The number of training and implementation support days and the vendor’s approach
vary significantly from vendor to vendor
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2. Hardware & Infrastructure Changes
This is for all tasks related to making sure that our hardware and infrastructure is
configured correctly and works for implementing the new system; it also includes
making all required hardware and software purchases
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2. Hardware & Infrastructure Changes Checklist
File servers and related infrastructure
Connectivity and internet access
Wireless cards or mobile hotspots
Laptops and other portable devices
Signature pads
High-speed scanners
Portable printers
Kiosks
Other?
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3. Data Conversion
This is for all tasks related to planning and executing a data conversion of data from the
old software package to the new one
Key decisions:
• What data elements to convert from the old system to the new one
• Which consumers to include in the data conversion
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4. Mobile System Use Planning
This is for testing and planning the use of the EHR in community- or home-based
settings
Vendors may offer connected and/or disconnected mobile EHR solutions, each of
which should be tested thoroughly, using all related equipment (such as signature pads,
portable printers and scanners, etc.)
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EHR Implementation
Complex Elements5. Workflows
6. Clinical content
7. System set-up
8. Billing testing
9. Reports
10. Interfaces
11. Meaningful use
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5. Workflow Process Mapping
This is for all tasks related to doing the workflow reviews and documentation (typically
with VISEO software), identifying opportunities for improvement, and modifying them to
represent how things will work in the new system
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6. Clinical Form Content Decisions
This includes all tasks that revolve around reviewing clinical forms that will be part of
the EHR, the technical design and review, and system set-up
Vendors typically have form libraries and/or allow customers to share forms
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Key Elements For Clinical Form Development
For each new form:
Initial form review and approval of content
Technical form design or modification
Form review and feedback for changes
Final form sign-off, completion, and hanging in the system
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7. System Table & Structure Set-Up
This is for all system set-up tasks, it is usually very comprehensive and ultimately
affects how the overall system and reporting works
• Cost center, programs, locations
• Service codes and payers
• Other key system table files
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8. Billing Set-Up & Testing
This is for all tasks to set up billing in the new system
as well as for thorough testing to ensure it works
correctly
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Billing Set-Up & Testing Tasks
Develop a task for all set-up items for the billing system
Develop a full testing plan to confirm that the system creates a correct bill for all
services and all payers
Conduct the testing plan
Correct any errors and re-test necessary items
Do an electronic billing test for all payers that accept electronic claims (set these up as
separate tasks)
If possible, do an electronic remittance test; in order to do this, you may need to
duplicate a REAL billing run from the old system in the new system so that you can
load the electronic remittance for testing in the new system
Develop detailed instructions for billing and accounts receivable staff on using the new
system, including a schedule of daily, weekly, and monthly activities
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9. Report Needs Assessment & Development
This is for all tasks for report development for the programs being implemented
Key tasks for each new report or report modification:
• Initial report specifications for the programmer
• Report development
• Review, feedback, and revisions
• Queries, sorts, defaults defined
• Reports hung in system
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State Reporting & Other Required Or Compliance Reporting
Most often, this is monthly reporting of consumer demographic, service delivery, and
outcome data
In some instances the data is cumulative (such as, fiscal year-to-date data which can
complicate data conversion and go-live planning)
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10. Software Interface Needs Assessment & Development
This is for all tasks related to identifying all interfaces that need to be built for the new
software application as well as the detailed plans for developing and testing the
interfaces
For each interface, create four tasks –
• Planning the interface
• Developing the interface
• Testing the interface
• Planning implementing of the use of the interface
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Typical Interfaces Or Data Exchanges
GL/Accounting software applications
Payroll applications
HR applications
CRM applications
Laboratories and pharmacies
State, county, or other systems
Other payers
Other providers
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11. Meaningful Use Registration & Implementation
This is for all tasks related to
implementing meaningful use
requirements as well as obtaining
meaningful use federal dollars under the
incentive program
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EHR Implementation
System Freeze & Final Preparation
12. Final workflow testing
13. Training materials and execution
14. Final go-live preparation
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12. Final Workflow Testing
Once the entire system has been set-up, it must be “frozen” so that the final workflow
testing can be completed
You can’t finalize the workflows and develop training materials until the entire system is
set- up!
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13. End User Training Material Development & Plan
This is for all tasks related to developing best-practice training materials and executing
the training plan for end users prior to go-live for each program
Key tasks include:
• Define training groups, anticipated number of attendees for each groups, and list of key things
to train each group
• Develop model for handling all training logistics
• Develop training material development plan
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14. Go-Live Planning
This is for all remaining tasks related to preparing for the final Go-Live
Typically, they include:
• Final data conversion and possible duplicate new client entry for a short period of time
• Identifying all post-data conversion data entry that needs to occur and developing a plan for
execution (e.g. caseloads, appointments, updated diagnoses, medication information, etc.)
• Planning the roll-out of treatment plan data entry into the new EHR
• On-site staff support for Go-Live date
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EHR Implementation
Expanding & Leveraging The EHR Implementation
15. Implementing more features
16. Leveraging data through business intelligence tools
17. Additional clinical and analytic use
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On-Going
Implementing more features
Leveraging data through business intelligence
Additional clinical and analytic use
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EHR Implementation
Routine Elements
• Vendor training and implementation
• Hardware
• Data conversion
Complex Elements
• Workflows
• Clinical content
• System set-up
• Billing testing
• Reports
• Interfaces
• Meaningful use
• Mobile system use planning
System Freeze & Final Preparation
• Final workflow testing
• Training materials and execution
• Final go-live preparation
Expanding & Leveraging the EHR Implementation
• Implementing more features
• Leveraging data through business intelligence
• Additional clinical and analytic use
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IV. Best Practices: Workflow Mapping & Project Management
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Workflow Mapping Best Practices
Standardize Formulize Optimize
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Making The Workflows Standard
Before starting to map services, ensure
that all workflows have standard
• Shapes
• Colors
• Language
• Orientation/Layout
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Standardizing the workflow look
and layout can improve
understanding of the service flow
as well as reduce the chance of
confusion for someone who is
unfamiliar with the service itself
Standardize
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Standard Workflow Shape & Layout Example
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NOTES
Standardize
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Develop A Standard Form Tracking Tool
Create a standard
tracking tool with the
goal of identifying
which forms are utilized
within which service
processes
Ensure that a master
tool will be available for
teams to update as
they begin to create the
workflows
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Standardize
Form # Form Name Description Workflow 1 Workflow 2 Total
1Referral
Form
Tracking form
completed by upon
receiving referral
X 1
2Consent
Form
Informs clients of
overview of services
and consent for Tx
X X 2
3
Self-
Screening
Form
Assortment of
measures completed
by client at intake
X 1
4Progress
Note
Notes completed
during routine careX X 2
Example
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Formulating The Service Flow
Mapping a service line requires staff to be present that have a deep understanding of
• What the actual service process looks like from admission to discharge/transfer
• Which specific forms are utilized in the service
• When there are deviations from the “usual” service flow
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Formulize
It is recommended that staff who are familiar with how
the service is delivered on a daily basis be present and
provide input during the workflow mapping process
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Mediating The Workflow Mapping Discussion
Ensure that the discussion stays on a linear path – from service start to service finish
Ask probing questions to reveal deviations from the standard service flow
Don’t get bogged down by improvement discussions prematurely
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The Opportunity To Move From Actual To Ideal
Review the current workflow opportunities to
improve service delivery, such as:
• Identifying areas to utilize new technologies and
future EHR system capabilities
• Clipping obsolete or redundant steps
• Revising inefficient processes
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Optimize
Mapping how the service is actually
delivered initially can provide an
opportunity for staff to critically evaluate
how the process can better support their
work and the individuals your
organization serves
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Form Tracking & Optimization
The form tracking tool provides opportunity to quickly view the total number of forms
utilized across the organization, a particular service, and how often a particular form is
used across services.
Leverage form tracking tool data to:
• Remove duplicate forms from the service delivery process
• Identify forms that are outdated or barely used
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Optimize
Reviewing the form tracking tool provides an opportunity for staff to
brainstorm where current form data collection can be improved and
transferred from paper to electronic collection
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Sample Clinical Workflow Mapping & Optimization
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Building A Project Plan With Your Vendor & Your Team
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Creating A Vision For Your EHR Implementation
A sense of urgency and the right implementation team are necessary for implementing
the major changes that software implementations represent, but they are not sufficient
Successful transformation requires a sensible vision with clear objectives
• A clear and compelling statement of where all of this change is leading
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The Right Implementation Team . . .
Is not just comprised of IT staff
Is comprised of operational staff from all department areas effected
Includes management & non-management positions
Is not expected to do another full-time job while they are also implementing the new
software application
Includes a full-time project manager
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The Implementation Team Is The “Guiding Coalition” For Change
Senior management MUST be active supporters of the project!
The “change coalition” must be powerful – in terms of title, expertise, reputation,
relationships, and leadership capacity
Oftentimes, more complex implementations have groups or tiers of teams (steering
committee, implementation team, program area teams, etc.)
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Implementation Planning
Software vendors have extensive experience in planning and helping to manage
software implementations
What is their standard approach and how might it be modified to meet your agency’s
objectives?
Ask if they have customers like your organization who have recently implemented their
system
Contact those customers to find out what their approach was, what timelines they used,
and what suggestions they may have
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Big Bang Versus Incremental EHR Implementations
Big Bang – Implementing use of the EHR for all services and programs as of a single
date of service
Incremental – Rolling out the use of the EHR by site or program over a period of time
What are the advantages and disadvantages of each of these?
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A Best Practice Project Plan Includes . . .
1. Timeline and tasks for all the elements of the EHR implementation
2. Clearly assigned responsibilities for the various tasks
3. Balances an aggressive implementation with enough “breathing room” to address
problems
4. Re-tooling work processes and staff job descriptions as needed
5. A clear plan for communicating progress and changes to the entire organization
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Project Management Software
You’ll need to use project management software to organize tasks, timelines, and
assignments, and to communicate with team members
Commonly used project management software:
• Microsoft Project
• BaseCamp (www.basecamphq.com)
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Managing Towards Success, Averting Typical Obstacles
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Common EHR Implementation Problems
1. Wrong team and insufficient resources
2. Poor system set-up
3. Insufficient billing testing
4. Poor clinical form decision-making process
5. Poorly designed forms and workflows
6. Lack of sufficient leadership guidance
7. Hardware and other tech problems
8. Poor end-user training and support
9. Not enough testing after system freeze
10. ???
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Questions & Discussion
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