Integrating the EMR into SBHC Settings: Local and National Perspectives

1. Integrating the EMR into SBHC Settings: Local and National Perspectives

2. Objectives for today… • The Participant will be able to evaluate opportunities and challenges for SBHCs to convert to Electronic Health (Medical) Record (EHR) and determine the basic requirements for an EHR system within a SBHCs • The Participant will identify resources, training and the infrastructure needed by SBHCs and sponsoring organizations to respond to the need to convert to EHR. • The Participant will be able to assess education and health care policies and finance mechanisms that support the conversion to EMR systems, including community, state, and regional networks.

3. What is happening now? • The national health IT agenda is moving forward and there will be widespread adoption of EHRs with in the next decade. • SBHCs are asking for information, networking opportunities and support around data collection and the EHR.

4. “Electronic health records and other information technology tools have the potential to speed advances in medicine and help doctors make more rapid and informed decisions about medical care for their patients. Health information technology is expected to fill major gaps in medical knowledge and help doctors learn on a real-time basis what works and what doesn’t for their patients.” Health Affairs Briefing: Health Information Technology and Rapid Learning, Friday, January 26, 2007

5. Management Information System/Clinical Fusion Electronic Health (Medical) Records Current State of Technology

6. Clinical Fusion (MIS Software developed for SBHCsby Dr. David Kaplan) • We are not certain how many SBHCs are currently using Clinical Fusion or what other software programs they are using. • We are aware that in some states the Health Department has required the use of Clinical Fusion in order to facilitate reporting and evaluation. • There have been no major changes in Clinical Fusion for some time. • Clinical Fusion does not support billing

7. Data Collected by SBHCs (Census 2001, N=959) Process Impact 120 100 80 Financial Info/Cost analysis 60 40 Data on Diagnoses Enrollment 20 Visit 0

8. What SBHCs do With Their Data (Census 2001, n=956) 90 80 70 60 50 40 30 20 10 0 Report to Parents Funders Media Policy Publish in Other School Makers Professional Journal

9. Do you Collect These Data Elements? (Census 2004-05)

10. Accountability: Types of Data Collected by States (State Policy Survey, 2006) States that Fund SBHCs (n=20)

11. SBHCs that Bill and Collect2004-05 Census of SBHCs Census 2004-05

12. Electronic Health (Medical) Records • Currently, sponsoring organizations of SBHCs are moving forward with new MIS and EHR systems • The sponsoring organization may not have considered the SBHCs thus resulting in MIS and/or EHR systems that do not meet either the reporting or billing needs • SBHCs have shared their belief that they will be left out of any information technology improvements occurring in the sponsoring agency or will be the last to receive the technology • Constraints are financial, technical and legal

13. Challenges • Data collection • Practice Management • Billing • Collection and Reporting • Confidentiality • Staffing • Change in the clinic culture • Cost • Software • Additional costs: • Hardware • Remodeling • IT support • Training • Maintenance “The number of hours both needed administratively and pulling staff out of clinics to prepare for the EMR, so there is a loss in productivity”

14. Opportunities • Improved Quality of Care • Never having lost charts • Improved communication between health care sites and increased opportunity of cross coverage • Ability to close the gap between the medical literature and the medical field

15. Minimum Data Elements for SBHCs • DOB • Gender • Race/Ethnicity ( needs to be compatible with how education data is reported) • Provider type • CPT codes • ICD 9 codes • Insurance status at visit • Referrals (internal or external) • Sponsors registration information (may include some of the other elements such as DOB) • Student disposition (sent back to class, home, ER, other))

16. Minimum Data Elements for SBHCs • Communication with parent (elementary and middle school) • Primary language spoken in the home • Risk Factors (list needs to be generated for those not already ICD or CPT Codes) • Enrolled Student • Only children in our schools are eligible • Students from other schools • Out of school youth • Faculty/School Personnel • Family of student users (siblings/parents)/infants of students • Other people from the community • Other (describe):____________ • If SBHC is PCP or not and if communication occurred

17. Concluding Recommendations: • There is a definite need for Clinical Fusion however billing capabilities need to be developed • NASBHC needs to publish an overview of the current state of SBHCs and HIT (issues/opportunities) • NASBHC needs support sharing information & experiences of SBHCs with the selections of and development of HIT related products i.e. LA, ME, NM. MI • State Health Departments are central to discussion on this topic. “we need to support clinics in continuing to collect data that documents their work”

18. Changing the Face of SBHC: Integrating EMR into SBHC settings a local and national perspectiveA primer on Methodology and Vendor Selection Gaurav Nagrath, MBA Director, Division of Information Services Louisiana Public Health Institute gnagrath@lphi.org 504.301.9810

19. Outline • LPHI & a vision for strategic health information focus • The National Health IT Agenda • Methodology: Coordinated Health Information Systems • Vendor selection life-cycle Stakeholder Analysis & Management Purchasing Lifecycle Overview The Users Requirements Value For Money The Request for Proposal (RFP) The Evaluation Plan Contract Management • Q&A/Discussion

20. The Louisiana Public Health Institute LPHI’s mission is to promote and improve the health and quality of life in Louisiana through public-private partnering at the community, parish and state levels. • Public health programming • Broker of traditional and non-traditional partnerships • Fiscal agent • Technical assistance (including health information services) • Research and evaluation LPHI builds capacity among communities, providers, and decision-makers.

21. LPHI and Health Information Services Vision - Develop the capacity to provide innovative solutions, guidance and TA to health policy-makers, healthcare organizations, and Louisiana communities based in current and emerging Public Health/Bio-Medical Informatics best practices. Goal - Design, Plan & Enable Health Information Services and supporting platforms to positively impact population level health outcomes in Louisiana

22. National Health Information Technology Agenda • Widespread adoption of interoperable Electronic Health Records within a decade • Medical Information follows the consumer • Clinicians have complete, computerized patient information • Quality initiatives measure performance and drive quality-based competition • Public Health & bio-surveillance are seamlessly integrated into care Source: Office of National Coordinator for Health IT (ONCHIT)

23. Methodology: Coordinated Health Information Systems (the how) Health Information Services strategies involve taking our partners through the entire systems development life cycle and include following services: • Information technology strategic planning • Business process analysis • Selection and assessment of EHR product compliant with national standards • Workflow redesign • Change management • System implementation • Ongoing Health IT support & training

24. LPHI Information Services Vendor selection life-cycle • Stakeholder Analysis & Management • Purchasing Lifecycle Overview • The Users Requirements • Value For Money • The Request for Proposal (RFP) • The Evaluation Plan • Contract Management

25. SBHC Stakeholder  Analysis Stakeholders Identify: • Direct  or  indirect relationship • Leadership  structure • Draft  Stakeholder  matrix,  level,  influence  +/_etc Prioritize: • Understand  level  of  involvement Incentives/Risk Existing  relationships?

26. SBHC  Stakeholder  Management • Stakeholder  profile • Engagement  strategy – Key  Issues • Communication/Action plan – Unified  Message • Support/Project  Role • Follow‐up

27. Purchasing Cycle Identify Need • Vendor Rating • Evaluation • Financial Approval • Option Appraisal • Business Case Manage Contract • Develop • Specification • Contract Strategy • Evaluation Criteria Award Contract • Identify Suitable Suppliers • Source the Market • Appraise Vendors Post Proposal Negotiation • Receive Proposal • Open Proposal • Evaluate Proposal • Compose Request for Proposal • Specification • Terms and Conditions • Pricing Schedule Invite Proposals

28. Is the primary purpose of selection process Should be expressed in terms of outputs, not solutions Must be tested for business fit with existing and strategic business model The Users Requirements

29. status of vendors involved – undertake the necessary due diligence for oversight equipment offered – does it adhere to best industry standards, latest technology not always best solution immediate cost of acquisition delivery method – options to look at include outsourcing delivery, building in-house team operating costs – be aware of any hidden costs over lifetime of product/service, e.g. Product support Value For Money The optimum combination of whole life cost and quality to meet the customer's requirements. Some elements to take into consideration include:

30. Request For Proposal (RFP) RFP Could Include – • Project Overview • Software Billing Capability • Software ability to Interface with existing/legacy systems • Software Reporting Attributes • Company Customer Service & Infrastructure -> SLA • Software capability in areas of Clinical Care Protocols, Behavioral Health, Patient Management

31. Vendor evaluation • Create an RFP • Have a demo scripted to give each vendor (easier comparison) • Video tape demos (review later) • Visit sites that currently use product • Ask for trial software for hands-on comparison • Interview vendor leadership/support team • Negotiate contract (enhancement requirements/payment terms)  Some Cost considerations • Data conversion • Interfaces • Upgrade costs

33. ensuring the contract requirements are met within timescales and budget maintaining a positive relationship between parties to the contract measuring and assessing performance (ours and the contractor’s) against the contract requirements providing constructive feedback to the contractor and/or your own staff involved in the contract being proactive about problem solving resolving contract disputes should they arise contracts should include agreement about how customer/vendor relationship is to be managed e.g. decision points - could be linked to payment quality reviews changes to requirements, associated costs Contract Management Objectives

34. Plant your EMR & Nurture its growth Plant your EMR & Nurture its growth Simply selecting an EMR for your organization is not enough to make it’s implementation successful. Much like a tree, before you plant the seed you must prepare the ground. After the seed is planted you must make sure that the roots are strong and the tree continues to grow. Simply, placing the seed in the ground and walking away will not successfully produce a thriving tree.

35. Tips on How to Plant & Grow your EMR… • The Facts What is an EMR Types of Electronic Records Why should I plant my EMR tree • The Right One Knowing what is out there Organization needs Staff needs Functionality • The Game Plan Preparation Planning Training

36. Changing the Face of SBHC: Integrating EMR into SBHC settings a local and national perspective

37. Contact Information Gaurav Nagrath, MBA Director, Division of Information Services gnagrath@lphi.org Summer Creasy Interactive E-Solutions LLC summer@iesolutions.us Tiffany Clarke, MPA NASBHC tclarke@nasbhc.org