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Selection & Implementationof a MIS System in Collaboration with 3 Agencies
Stephen Christian-Michaels
Family Services of Western Pa
March 1, 2004
Overview
Selection
Collaboration
Negotiation
Implementation
Selection
Self Assessment
Window shopping
Demonstrations
Estimating Costs
Request for proposals (RFP/RFI)
Work Flow Re-Engineering
Self Assessment:Modules Needed
Billing systemElectronic consumer record (ECR)Human resourcesPayrollAccounting (AP, GL)OutcomesRisk managementInventory of paper charts/contents
Self AssessmentType of Information System
– Off the shelf software
– Build your own
– Legacy systems
– Web enabled legacy systems
– Web based systems
Self Assessment:Types of Billing
Electronic Billing vs. Paper– 837 transmittal capability– HCFA 1500/UB92
Submittal to Web Based SystemsSubmittal to DOS based systemsSubmittal to Excel, Word etc.Other types of BillingMedicaid Eligibility
Self Assessment:Simple VS. Complex
Narrow VS. Broad Range of Programs
Single Location VS. Multiple Locations
Single Payor VS. Many Types of Payors
Office Based VS. Mobile Services
Fee for Service, Capitation, Grants
Similar Staff VS. Many types of Staff
Window Shopping - where
National Conferences – exhibit hallsState Conferences – exhibit hallsOn-Site DemonstrationsWeb castsVisit providers with new systemInvite vendors to demonstrate as local or
state associations
Window Shopping – test drive
Get a feel for how software worksHow easy will it be for staff?Get familiar with new MIS termsLearn different options availableGet initial estimates of costGet initial specifications for hardwareSee as many as you can see
Estimating Cost of Implementation
Replacement VS. Re-engineering
Estimate cost efficiency - reduced staff
Estimate cost of implementation
Estimating Cost of Implementation
Internal IS Staff VS. Consultant– Do Internal IS Staff have new vision/skills– Consultant to guide the process
Costs of Conversion– Preparation of your data at your end– Conversion done by software company
Cost of HardwareCost of Infrastructure–LAN, routers, etc.
Estimating Ongoing Cost of Implementation
Comparison of vendors across:
IS license and maintenance fees
Web Based user fees
Any additional 3rd Party Software costs
IS Staff salaries
IS Consultants
Estimating Start-up Implementation Costs
HardwareInfrastructure upgradeConversion * DevelopmentTraining (external, include travel/hotel) *Internal Training – lost revenueCash Flow (reduced)Consultant * (* often underestimated)
Collect Inputs and Outputs
Inventory ALL databases around the agencyCollect all forms (inputs)Collect all internal reports (outputs)Collect all external reports (outputs)
– Billing/invoices/electronic transmissions– Licensing reports
Combine/eliminate when possibleDevelop list of Forms and ReportsPrioritize Include in contract
Re-Engineering Work Flow
Point of Entry (Intake)Clinical FormsFront Desk/SchedulingPsychiatric ServicesAccounts ReceivableChart of AccountsAccounts PayableHuman Resources
Request for Proposals
Request for Information (RFI)– Broader – allows for flexible negotiation
Request for Proposal (RFP)– Narrow definition of specifications– Required by state regulations for some
RFI/RFP Change
Re-define RFI/RFP as you learn more
Start Comparative Cost Estimate
Revise with each revision of the RFI/RFP responses
TEST Support Services
Are they open when you are open
Keep in mind different time zones
Are they customer oriented
Are they knowledgeable
Call them and see how they respond
Collaboration:Description of Agencies
FSWP– 17 million budget, 425 staff– MH&MR, Foster Care, Community Building
Allegheny East MH/MR– 14 million budget, 300 staff– MH&MR, Psychiatric Inpatient
Turtle Creek Valley MH/MR– 10 million budget, 250 staff– MH/MR, Mentoring Project
Collaboration
AdvantagesCost efficiency (1 build, 3 agencies)Best Practice used by all threeCollaborative moves beyond resistanceCan be pulled up to best of bunch
DisadvantagesTakes more meetings, more timeDifficult to come to quick decisionPulled down-lowest common denominator
Collaboration Projects
Administration– Information Systems implementing– Purchasing considering– Building Maintenance considering
Clinical Services– Crisis Residential Services proposed– Dual Diagnosis Children-MH/MR denied– Combined Crisis Array idea– Common Intake idea
Lessons Learned - Collaboration
Identify strong leadersLeaders need to be from higher up
leadership among peers, failedSet clear deadlinesDemand frequent meetingsFrequent meetings with CEO’sCEO’s present in multiple level meetings
Collaboration – Next Steps
Establish a shared corporation Dec
Hire executive director March
Develop a budget for shared corp. May
Move IS staff to shared corp. June
Negotiation
Don’t accept boiler plate contractDefine deal breakersInclude system test prior to go-liveInclude HIPAA compliance testsHelp line/support service Include help response/emergency repairRequest legal hearings in your stateEscrow deposit for software
Implementation
Coordination
Re-Engineering
Managing Culture Change
Forms
Reports
Alerts & Prompts
Interfaces
Coordination
Hired consultant
Project Manager across 3 agencies
Steering Committee – 6 staff
Work Teams
CEO MIS Committee
Ad Hoc Consultation for each agency
Work Teams
Clinical Forms
Human Resources
Accounts Receivable
Mental Retardation
Quality Assurance– Outcomes
– Risk Management
– Chart Audit
Point of Entry
Front Desk
Accounting
Medical Records
Systems Administrators
Conversion
Authorizations
Managing the Culture Change
Frequent Communication– Rationale for change – re-integration– Email, staff meetings, team leader mtgs.
TrainingCelebrate milestonesIdentify rumors early and squashIdentify early adopters, spread visionTeams - work process re-engineering
Re-Engineering
Clinical Forms – 18 months on paper– Standardized 20 forms across all programs– Eliminated double entry– Consolidated forms– One Individualized Service Plan– 2 pilots on paper– Then revised formats in electronic format– Fine tuned, worked out bugs
Caution – paper to electronic is not 1:1
Re-Engineering
Examine work flowEliminate unnecessary stepsCheck licensing requirementsEliminate “because we always have”Eliminate all double/triple entryReplace re-assessments w/ addendumsInvolve state licensing staff, avoid nibbling
around the ankles START EARLY, Get into great detail
Develop Prompts/Alerts
Prompts and Alerts eliminates reportsIdentify what you want to push at staffRemove un-needed reports from listIdentify What, Whom, When, WherePrioritize list, develop in phasesTrain staff on shift from reports to alertsPhase alerts in slowly
Accounts Receivable
All payors go through AR
Define all Fee for Service rules/payor
Clarify all per diem funded programs
Build capability-bill/not bill for absences
Bring unique programs into the fold
Interfaces
Define required interfacesExamples:
– Electronic Record/AR Accounting – Electronic Record Medicaid Eligibility– Electronic Time Sheet Payroll – Electronic Record Mailing Lists
Build Test
Security/Privileges
Develop HIPAA Privacy security levelsOperationalize “Minimum Necessary”Develop list of staff privileges by groupsDevelop list of staff – required HR fieldsLimit Systems Administrator to 1 personImplement HIPAA Security rulesFirewalls sufficient to protect data
Other Special Features
Voice RecognitionHandwriting Recognition – Tablets/PDAWireless Laptops/Tablets/PDA’sConsumer Electronic SignatureElectronic Time DocumentInternet Insurance Eligibility ChecksRemote Access
Manage Mission Creep
Be clear what is in the contractClarify modification and new ideasDelay new ideas to 2nd phase
Vendor will manage this, but
You must also manage this
Conversion
Start earlyAssess ability to do internallyRevise data fields
(accounts, programs, locations)Re-map data to new structure In Oracle – shift from codes to valuesSet up test files (early)Schedule conversion – multiple transmissionsLeave time to test accuracy of conversion
Plan for Go Live
Inform staff of tasks coming up
Send memo on transition tasks
Send set-up instructions
Send Go Live instructions – first day
Plan for After Go Live
Policies/Procedures - new work process
Use implementation structure - forward
Use developed approval process
Develop new user/privilege/HR form
Develop remote user policy/procedure
Training
Orientation – all staff– Rationale – integrated services– Integrated software (HR, Clinical, AR, GL)
Hands On TrainingSupervisors TrainingRemedial TrainingRefresher Training
Identify Staff, Require It, Enforce It
Time Frames
Selection 6 – 18 monthsImplementation 6 – 24 months
More work re-engineering done 1st – soonerLess complex agencies – soonerLess customization – soonerLess interfaces with other software – soonerHigher sophistication with IS – soonerCross agency buy-in - sooner
Lessons Learned
Start re-engineering planning earlier
Hold work teams accountable
More focus on reports early in process
Start earlier on conversion process
The End
Questions
Stephen Christian-MichaelsFamily Services of Western Pa(412) 820- 2050 ext. [email protected]