Strategies for Selecting an EHR: Beginning with the End in Mind

1. Strategies for Selecting an EHR:Beginning with the End in Mind • Presenter: • Dwayne Edwards Director, WVRHITEC • No other affiliation or financial interests exist between the presenter and any company or product mentioned or presented within

2. Agenda • 1. EHR Benefits • 2. Select the Right Team • 3. Workflow • 4. Setting goals • 5. Five-Star EHR Vendors • 6. Selecting an EHR • - RFP Stage • - Demo/Evaluation Stage • - Negotiate Everything • 7. Implementation • 8. Evaluation • 9. WVRHITEC and its Services

3. How EHRs Benefit Medical Practice BETTER FOR PRACTICES BETTER FOR PATIENTS

4. Resulting in Improved Quality, Safety and Efficiency Better Communication and care coordination Safer Treatment viae-Prescribing More efficient Coding and billing Faster Delivery of information and results

5. EHR Benefits For Providers: For Patients: • Reduced need to fill out the same forms at each office visit • Reliable point-of-care information and reminders notifying providers of important health interventions • Benefits of managing digital medical record data vs. paper • Convenience of e-prescriptions Patient portals for online interaction with providers • Electronic referrals allow for easier access to follow-up care with specialists • Electronic health exchange no matter where you are • Quick access to patient records from inpatient and remote locations for more coordinated, efficient care • Enhanced decision support, clinical alerts, reminders, and medical information • Performance-improving tools, real-time quality reporting • Legible, complete documentation that facilitates accurate coding and billing • Interfaces with labs, registries, other EHRs and HIEs • Safer, more reliable prescribing • Efficiencies, productivity benefits

6. EHRs Yield Financial Benefits Once an electronic health record system has been implemented, a practice may recoup its investment by enhancing revenue and increasing efficiency. It is estimated a practice can achieve a return on their EHR investment within an average of two and a half years. Financial benefits of EHRs include: 1. Revenue enhancement through better and more thorough documentation. 2. Integrated practice management solutions that promote better tracking and management of billing processes. 3. Cost savings through the reduction of storage space and transcription. 4. Participation in Pay-for-Performance or Pay-for-Prevention (P4P) initiatives.

7. Studies Demonstrating Improved Efficiency and Productivity • Increased accuracy in coding, leading to average billable gains of $26 per patient visit • Improved care delivery from clinical decision support capabilities (avg 12-20% improvement) • Increased patient flow, staff productivity and increased revenue

8. EHRs May Enable Better Risk Management • Clinical alerts and reminders enable better risk management • Improved aggregation, analysis, and communication of patient information • Consideration of all aspects of patient’s condition • Support for diagnostic decisions • Relevant information all in one place (lab results, etc.) • Support for therapeutic decisions • Evidence-based decisions at point of care • Prevent adverse events • Built-in safeguards against prescribing treatments that would result in adverse events • Enhanced clinical quality improvement research and monitoring Couch, James B. (2008) “CCHIT Certified Electronic Health Records May Reduce Malpractice Risk”. Physician Insurer

9. Who are the stakeholder leaders? Select the RIGHT TEAM

10. Identify Stakeholders Within the Practice • Management: Board of Directors, Owners, Partners, Administration • Business office: Front Desk, Billing • Clinical Support: Nursing, Lab, Imaging • Practitioners: MD’s, DO’s, NP’s, PA’s, Midwives • PATIENTS Remember this is a Health Improvement Project, NOT an IT project

11. Selecting an EHR is a TEAM Sport! • TEAM CHARACTERISTICS • Members are respected • Authority in their area of expertise • Realistic • Enthusiastic • Members represent all key components of the practice • Leadership includes an engaged physician champion dedicated to the project’s success. TEAM MEMBER COMPOSITION • Administration • Clinical Practitioners • Clinical Support • Practice Management/Business Office • Information Technology (In-house, contractors, vendors)

12. ResistorsKnow the characteristics of resistors and identify them now • Anyone who is reluctant to change • Pessimistic about success or improvement • Vocally Against EHRs • Unintended Saboteurs – Sees things going wrong but doesn’t speak up • Exhibits any behavior that may jeopardize or slow the project Do not dismiss comments by these staff members as they often identify roadblocks in a project

13. EHR Selection is COMPLEX. Get Help! Vendors have limited capability and time for details such as careful work process assessments. Resources: • WV Regional Health Information Technology Extension Center • WV Health Improvement Institute, Community Health Network of WV, West Virginia Medical Institute, and IPA of WV • Medical Groups and Associations • Independent Consultants/Project Managers • Information Technology Project Management expertise

14. Getting Your Practice Prepared Workflow Planning

15. Selection of an EHR begins with knowing what functions are needed to practice effectively and what END is expected • Complete a comprehensive Practice Workflow Assessment • Who does what, when and where. • Are roles/office functions clearly defined? • Gather Verbal and Written Process documents (Patient, Internal, & External) • Identify how Clinical Data is accessed, used, and reported i.e. Vital signs, Prescriptions, Orders, Demographics Workflow Planning

16. Initial Office Contact Appointments Registration Enrollment Verifications/Pre-Authorizations Vitals Clinical Visit Check Out Billing Statements Collect and compile examples of all needed reports Elements of the Practice Workflow Assessment

17. Patient Calls • Messages • Refills • Referrals • Consults • Discharge • Lab Results • Recalls • Immunization/Health Monitoring • Care management • Patient Education Workflow Change - Communications

18. Structured Clinical Data Set – Vitals, Preventive Care and Documentation of care • E-Prescribing – Call-ins, Paper, Reconciliation, Allergies, Refills • Orders Entry and Clinical Decision Support– Lab, Imaging, Internal, External • Performance measurement and reporting Clinical Data Acquisition, Use, Management, and Reporting

19. What are we going to accomplish? Setting The Goals

20. Keeping the END in Mind – FOCUS on what must be accomplished with EHR • Demonstrate quality, efficiency, safety • Reduce health disparities, improve health status • Engage patients and families in health care • Improve customer service and care coordination • Choose the best EHR for your practice • Improving patient-physician relationship • Flexibility/mobility of platform • Achieve Meaningful Use standards; incentives • Mitigate information security/safety concerns • Maintain productivity; reduce workflow disruptions • Getting staff up to speed • Technical/troubleshooting support • Focus on patient care while effectively navigating rapidly changing health care environment.

21. Set specific and measurable goals: • i.e. “Return to pre-implementation productivity levels within 6 months of Go Live; BP checks on 90% of all patients. • Electronic exportation of Immunizations • Increase Enrollment Verifications • Quality Health Improvement Monitoring • Increase Collection • Achieve Incentives • Eliminate Manual Reporting Setting Project Goals

22. Where are you now: • Do you have IT staff? Will you be adding this expertise, or do you plan to outsource/contract? • What equipment do you have, and how old is it? • What IT infrastructure do you have currently? • Network wiring up-to-date? • Secure wireless? • Broadband: DSL, T1, Modem? • Is the service reliable? Redundant back-up? • Do you have a practice management system now? Technology Analysis/Inventory

23. Do you plan to host the software or access it online? • Options: • EHR software that is loaded on your computers/servers? • Web-based EHR system (via an Internet connection) • Do you understand the pros and cons? EHR Options

24. WVRHITEC’s Five-Star VendorsEHR Vendor Recognition Program

25. WVRHITEC Five-Star EHR Vendors Developed to help connect health care providers interested in acquiring an electronic health record system with vendors who have met certain thresholds of clinical functionality and service.  • Meet the ONC’s EHR certification requirement and meaningful use objectives • Attain certain thresholds of clinical functionality and service developed by the WVRHITEC • Will be working closely with the WVRHITEC in order to facilitate the implementation process

26. Five-Star EHR Vendors

27. Where do we start? Selecting an ehr

28. Gather Information about Possible EHR Solutions for the Practice • Create a flexible, short list of venders • Regional Extension Centers’ vendor programs • ONC Certified Products • Medical Associations • Peers • KLAS - http://www.klasresearch.com/ • RFP-RFI (Request for Proposal/Information)

29. Creating a Request for Information (RFI) or Request for Proposal (RFP) can be useful for selecting an EHR • Use internally as a guide for your practice • Use Externally -Informs Vendor of practice unique needs and key functions. • Prioritizes goals and needs • Allows all vendors to respond to the same criteria (Apples to Apples comparisons) • Defines evaluation criteria for necessary features vs. what would be nice. • Allows the vendor to describe the attributes of the software and special hardware/infrastructure requirements necessary to operate software. Using a Request for Proposal/Information

31. This is your SHOW - Take Charge of the Demonstration • Create a Score Card, (use the RFP/RFI as a guide) • If a function or attribute is mentioned, insist on seeing it demonstrated • Make certain to involve the entire TEAM in the demo process • Take time to pre-view system on line or in other practices prior to vendor presentation. • Provide clinical scenarios common to your practice and request to see how these flow in the system. • Set Time Frames – Don’t let the demo drag on • Ignore “it’s in our next release/version” statements - if you cant see it, assume it doesn’t exist • Evaluate the vendor, not just the software. The vendor will become part of your team The Demo

32. See software in action – Visit LIVE sites Give the TEAM time to absorb Don’t ignore “gut” feelings Discuss with the TEAM - Are there strong reactions for or against? Review functionality – Does the software do what you want it to do? Eliminate prospects that do not. Does the software create needed/desired reports? Is the Vendor reputable and stable. (finances, number of local installations) Evaluating the Software

33. A collaborative effort between the Team and Vendor is necessary to create a successful implementation plan and to minimize implementation problems. • Decisions will need to be made regarding: • Incremental phase-in process or all at once implementation. (Pros and Cons) • Demographic/Clinical Data Conversions from other systems. • Chart management and retrieval (to scan or not to scan) • Planned productivity levels during implementation • Communicate with Patients about the process • Training • Train the trainer or independent staff training • On line - Training • Support Services • Who is responsible for set up and maintenance? • PM – Proc/Diag Codes, Billing Formats, Common Insurance • Clinical – RX’s, Frequently Used Pharmacies, Lab Test Codes Implementation Planning

34. What is the software cost? • What is the training cost? • What is the hardware cost? • Are there third party subscription costs (Codes, Clearing House)? • What is the on-going costs? - does this include support? • Productivity loss? • Infrastructure Investment (wireless, printers, network)? Understanding the Cost

35. Consult an attorney • Nothing is sacred - negotiate the price of everything • Payments due at milestones - pay when the system works • Contracts should protect you as much as the vendor and should spell out what you purchase, when it is to be delivered, what you are to pay for, when you pay for it, who owns the data • Is the source code “escrowed” in case the vendor goes out of business • Timelines • Interfaces provided identified • Again, consult an attorney Negotiations/Contract

36. Time for Action Implementation

37. 2. Set Up – Its not plug and play!! • Involve appropriate team members in implementation, set up • Review workflow, data requirements/reports and necessary functional attributes defined in project goals as a reference for setup. • Test drive the system, Fix issues, then TEST again. • Build and test all interfaces (lab, Xray, e-Rx) • Test all reporting. • 1. Training – Don’t short change training time! • Make training mandatory for all staff, including providers • Monitor “resistors” • Ensure training and workflow plans are being followed • Be involved - don’t let the vendor call all the shots • Be flexible - if more training is needed, slow implementation time lines • 3. Go LIVE • Orient patients to new process • Reduce work load • Acknowledge staff work load • Provide encouragement & constructive feedback • Watch for frustration with system or avoidance behavior • Celebrate Success!!!! Three-Step IMPLEMENTATION Process

38. How is it working Evaluation

39. Stay on top of things – frustration, poor workflow integration will erode confidence and progress! Continuously assess integration of system functions into workflow and alignment with Project Plan and Goals Evaluate human performance and adoption factors Evaluate workflow & make corrections. Fix issues ASAP, and start evaluation cycle again Evaluation & Change Management

41. WVRHITEC -- Who Are We? • Team of experienced local Health IT professionals with intimate knowledge of the W.Va. medical community • Clinical and technical expertise • Part of a national network of organizations designated [by U.S. DHHS] to assist providers with modernizing their practices with certified EHRs • Direct, rapid and reliable access to a pipeline of key information on health IT and meaningful EHR use

42. WVRHITEC • Available to provide independent clinical and HIT services to any provider or hospital system • Can provide subsidized services to Priority Primary Care Providers and Critical Access Hospitals • Knowledge of federal EHR incentive program, meaningful use criteria • Working closely with WVHIN on exchange project

43. WVRHITEC Services Available Services On-site assessment and create EHR 101 plan Consultation and assistance with EHR implementation, effective use, upgrading, and ongoing maintenance Assistance in selection of an EHR Guidance and training on achieving “meaningful use” Information about Medicare/Medicaid incentive payments Training on privacy (HIPAA), security, data storage, etc. - Privacy & Security Toolkit Integration of health information technology, including EHRs, into the initial and ongoing training of health professionals Development of health data analysis, extraction and report applications Special EHR loan programs and group purchasing opportunities Support for participation in health information exchanges Dissemination of best practices

44. Resources • Web site: www.wvrhitrec.org • Webinars/training • Workflow changes • Understanding meaningful use • Quality improvement • EHR 101 • Tips on Selecting an EHR • HIPAA and privacy • Privacy and security toolkit • Other: • Low-interest EHR financing • Med mal premium discounts

45. The West Virginia Regional Health Information Technology Extension Center (WVRHITEC) was created as part of a national program by the Office of National Coordinator for Health Information Technology/U.S. DHHS. It has been established as part of the federal stimulus plan and is operating under the West Virginia Health Improvement Institute (http://www.wvhealthimprovement.org . This project is supported by Grant Number 90RC0017/01 from the Office of the National Coordinator, Department of Health and Human Services.

46. dedwards@wvhealthimprovement.org www.wvrhitec.org QUESTIONs?