Electronic Health Record Vetting Process: Case Study of CRIHB Member Tribal Health Programs

1. Electronic Health Record Vetting Process: Case Study of CRIHB Member Tribal Health Programs Rosario Arreola Pro, MPH Health Systems Development Director California Rural Indian Health Board June 28, 2010

2. California Rural Indian Health Board (CRIHB) • Founded in 1969 • Sacramento-based Tribal Organization • 11 member Tribal Health Programs; 22 Tribes • Services throughout CA • Program Development • Legislation and Advocacy • Organization Development • Financial Resources Management • Training and Technical Assistance • Networking and Consensus-Building CRIHB Background Services Include:

3. EHR Selection Committee Charge • To find a new system that improves the quality of data collected, is easier to use, provides more security, integrates the functions of the system, provides flexibility in meeting individual program needs, and expedites reporting for administrative requirements. • The benefits of an improved system are improved quality of care for patients, a more user friendly system for providers, and the ability to meet future information system needs.

4. EHR Vetting • CRIHB began studying EHR adoption back in 2000 • Began as part of Health Care Quality Improvement efforts targeted at Tribal Health Programs • 6 Tribal Health Programs actively engaged in selection process • Hired an outside consultant to assist w/efforts

5. People Involved in EHR Selection Process • Tribal Health • Clinic Executive Directors • Medical Providers • IT Managers • Board of Directors • CRIHB EHR Team • Chief Medical Officer • Research Department • Executive Director • IT Staff • Health Systems Development Director • Integrated Care Coordinator-RN (QI)

6. Stages of EHR Evaluation • Phase 1- Determining Software Requirements • Phase 2- Prioritization of Requirements • Phase 3- Analysis of Requirements

7. What Key Factors Influenced EHR Selection? Functional Areas Operational Requirements

8. 16 Key Functional Areas • Patient Registration • Financial Eligibility • Scheduling • Clinical Information/ Electronic Medical Record • Referrals and Authorizations Tracking • Lab Interface • Encounter Processing • Billing and Claims Processing • Immunization and Perinatal Tracking • Case Management and Health Ed. Modules • Public Health • Pharmacy • Dental • Reports and Data Access • User Interface • Security and Privacy

9. Operational Requirements • <$10,000/ year • $10,000-$20,000/ year • $20,000+ • Local • CRIHB • 3rd Party (ASP) Cost preference Location Preference

10. Tools Used • Questionnaires • Surveys • Cross-referencing with required reports such as NPIRS, GPRA, OSHPD, etc. w/fields in selected EHR • Tables comparing all EHRs and their functionality in relation to what you currently have and to one another

11. Other Resources Used • Independent Consultant • Published articles ranking of EHR’s by medical providers • Demonstrations by EHR vendors • Demonstrations by other EHR users (Alaska Native health centers) • Input from medical providers, clinic support staff, IT staff • QI Tools from the Institute for Healthcare Improvement • EHR Reference from similar clinics

12. One process for selecting an EHR system • Request for Proposal for bids from vendors • Use the Primary Requirements from your clinic • Use the Secondary requirements to refine how well the application meets the needs of the users. • Vendors should demonstrate their products based how patients are processed and the clinic’s workflow • Select an application • Perform a pilot test with one clinic that is excited and can foresee the long-term benefits

13. Other Considerations: EHR Equipment Selection • Computers • Memory capability • Portability • Provider preference (laptop vs. stationary vs. cart) • Ergonomic Equipment • Visiting other clinics with EHR • Trying out equipment seen at other clinics • Vendors offering free trial

14. Post-EHR Implementation: Selection of Complimentary EHR Components • Necessity to improve reporting capabilities • Mandatory reporting • Limited resources for further customization • Personnel • Consultant • Time • Need to continue improving business processes • Dental • Pharmacy • Population Health Management • Changes in reporting requirements • i.e. Meaningful Use

15. Lessons Learned • Take into account personnel resources needed to install and maintain EHR • IT support • EHR Training beyond what vendor offers • Clinic Champion • Change Management • Decreased in revenue during EHR implementation • Workflow redesign

16. Lessons Learned • Vendors will overpromise and under deliver • Don’t pay for modules or add-ons that are not currently being used elsewhere • Negotiate • Discounts for purchasing licenses and software • Combine purchase of Electronic Practice Management and Electronic Medical Record (Buy 1, get the other 50% off) • Discounts for quarterly billing of Maintenance Fees (2-3% discount)

17. Lessons Learned • Group purchasing allows clinics to swap licenses due to changes in staffing • extra licenses at one clinic can be “given” to another clinic that will use them • Figure out a centralized billing process that will minimize confusion and effort

18. Where Are the 11 CRIHB Member Tribal Health Programs Today in their EHR Adoption? • 4 have completed NextGen EHR Implementation • 2 Currently transitioning to NextGen EHR • 3 Use RPMS (Legacy IHS practice management system) • 2 Transitioning to from RPMS to RPMS EHR

19. Contact Info: Rosario Arreola Pro, MPH Health Systems Development Director California Rural Indian Health Board (916)929-9761 ext. 1300 rosario.arreolapro@crihb.net