NTW 429 Final Project

1. NTW 429 Final Project Gerben Kleijn

2. Table of Contents

3. ENTegrity • An Ear, Nose, and Throat medical practice located in Scottsdale, Arizona. • Employs three medical doctors, a physican’s assistant, a doctor of audiology, and several people for office staff. • Looking to switch to electronic medical records (EMR).

4. Current Situation • Seven years of paper medical records • Approx. 18,000 records per year, for a total of approx. 126,000 paper records. • Fax is used for exchange of records between facilities • For instance, between ENTegrity and the OR • Doctor’s spoken notes are sent to transcribers, transcribed, and then sent back

5. Business Problem • ENTegrity is looking to switch to Electronic Medical Records (EMR) • What software to use? • What changes need to be made? • How to ensure a smooth transition? • How to be HIPAA compliant?

6. System Requirements • ENTegrity’s office manager outlined the following requirements for the system: • All medical records need to be electronic and accessible throughout the practice by those who need them • Records need to be easily but securely exchangeable between ENTegrity and external facilities (business associates – HIPAA)

7. System Requirements cont. • Doctors’ spoken notes need to be transcribed automatically • Eliminate the need for third-party transcribers • Needs to be HIPAA compliant • ENTegrity website needs to be tied into the system so patients can access / print out their required paperwork

8. System Requirements cont. • System should keep track of trends • For instance, what insurance companies pay for a certain procedure over time • Needs to not exceed the budget • $120,000 - $160,000 • Needs to be secure • Firewalls / security solutions to protect personally identifiable information (PII) • Needs to be implemented by the end of 2014

9. Breakdown of Requirements • The stated requirements cover multiple aspects of ‘the system’ • ‘The system’ in this case refers to ENTegrity’s entire IT infrastructure, including software • There is not one single software package that meets all these requirements • Multiple different software and hardware solutions would need to be implemented

10. Breakdown of Requirements cont.

11. Redefinition of the Business Problem • At the basic level, ENTegrity’s ‘problem’ is to stay compliant with government mandates and HIPAA • This can be accomplished without implementation of: • Transcribing software • Website integration • Trend analysis • First things first • Focus on staying compliant • Implement additional software solutions later

12. Staying Compliant • The Health Information Technology for Economic and Clinical Health (HITECH) Act assesses penalties to clinics that have not adopted an EMR system by 2015. • Under the HITECH Act, healthcare providers must demonstrate ‘meaningful use’ of their EMR system • Meaningful use is demonstrated by meeting certain objectives for three stages over five years

13. Staying Compliant cont. • Demonstrating meaningful use of EMR:

14. Staying Compliant cont. • If a company meets the criteria for demonstrating meaningful use: • Can qualify for $44,000 ‘or more’ in economic stimulus incentive payment for adopting and implementing a certified EMR system. • If not: • Medical reimbursements will be reduced by 1% in 2015 and an additional 1% every subsequent year • The average American Academy of Family Physicians (AAFP) user is reimbursed 20% by medicare

15. Staying Compliant cont. • HIPAA: • Privacy Rule • Requires appropriate safeguards to protect the privacy of personal health information • Security Rule • Requires appropriate administrative, physical, and technical safeguards to ensure confidentiality, integrity, and security of protected health information • Breach Notification Rule • Requires HIPAA covered entities to provide notification following a breach of unsecured protected health information • Unsecured PHI means it is rendered unusable, unreadable, or indecipherable to unauthorized individuals through (1) encryption or (2) appropriate destruction of the media on which it was stored.

16. EMR Software Considerations • There are hundreds of EMR systems available, targeted at every type and size of practice. • The following questions and considerations will help ENTegrity make the right choice • Narrow the list down to vendors who’s software matches ENTegrity’s business and size • Visit offices similar to ENTegrity and see their EMR system in action

17. EMR Software Considerations cont. 2. Try out the software • Most vendors allow you to log in to a sample account or will send you a sample CD. Make sure these trials are used by the same people that will eventually use the EMR software 3. Look for HIPAA compliance as part of the evaluation • Most EMR software will meet HIPAA requirements, but you should still make the vendor provide details on how it does so

18. EMR Software Considerations cont. 4. Look at the software features to make sure it has what you need / want • Can the system handle multiple staff members accessing the data at the same time? • Are labs, x-rays, and other types of information (incl. from external sources) easy to manage and access? • Can it be accessed remotely? • Does it have built-in reporting?

19. EMR Software Considerations cont. 5. How will data be entered into the medical records? • Keyboard and mouse? • Touch screen? • Handwriting recognition? This will determine if you need to purchase desktops, laptops, or tablet PCs for each doctor or exam room

20. EMR Software Considerations cont. 6. Portability of data • How easy is it to change to another solution or vendor? • The patient data is always yours, regardless if you’re using ASP or client-server (see next slide) • Vendor needs to be able to provide you with usable information if you switch

21. EMR Software Considerations cont. 7. ASP versus client-server • ASP = Application Service Provider • With an ASP solution, the software and data reside on the vendor’s servers, and staff members access it through specialized client-software • The advantage is that the software and data is managed and maintained by specialized professionals • They typically have multiple layers of security, uninterruptible power supplies, fail-over, etc. • A lot of the HIPAA security rule requirements might not have to be implemented locally with an ASP solution • The disadvantage is that the software or data can’t be accessed without an Internet connection

22. EMR Software Considerations cont. 7. ASP versus client-server • Client-server means to run the software in-house and save data on local servers. • This gives more control, but it also requires maintaining and configuring security and storage hardware, as well as keeping regular backups. • ENTegrity might need to purchase and maintain a lot more security hardware / software to be compliant with HIPAA’s security rule if it decided to go with a client-server product

23. EMR Software Considerations cont. • 7. ASP versus client-server • For a relatively small practice with no specialized IT team on staff such as ENTegrity, ASP is the recommended way to go • No need to purchase and maintain expensive security equipment • Cost is spread out monthly, rather than a lump-sum up front • Internet interruptions are rare • As long as the network is configured correctly beforehand

24. EMR and MPM • Many offices that switch to EMR also implement medical practice management (MPM) software • Tracks patient demographics, visits, and diagnoses • Collects, transmits, and tracks billing information and insurance payments • Manages appointment scheduling • Etc. • It is advisable to first implement one system, get used to it, and then to implement another • Don’t implement multiple new systems at a time

25. Pricing • Client-server • Software ranges from $2,000 to $15,000 per user • Medium sized practice could easily spend $50,000 on hardware and software to install an EMR system • Determine what you really need • Don’t pay extra for options that you don’t need or will rarely use

26. Pricing • ASP • Usually includes setup fees of less than $1,000 and monthly fees ranging from $50 to $300 or more • Some ASP’s charge for actual usage • $0.50 per updated chart, $0.80 for a new record, etc.

27. Steps to Take • Determine what software features you need • Get input from everyone who will use the software for this • Determine if you wish to implement an ASP or client-server solution • ASP typically recommended for small to medium sized practices without an IT staff • Visit other, similar practices to see their EMR solutions

28. Steps to take • Meet with your business associates and get their input • For instance, the OR from which you need to receive patient data or reports. • Chances are they already have a system set up for this, for their business associates that already use EMR. How is this done? • Build a test plan • Create a script that walks through the most common office tasks. Use this when evaluating the trial software so you can compare them better

29. Steps to Take • Contact vendors for information / trial versions / demonstrations • Test out multiple EMR solutions thoroughly • Have them tested by the people that will use the software • Meet with the office staff and discuss the results • Finally, purchase the software

30. Post-Purchase • Don’t expect to switch systems from one day to the next • Issues will occur with any new system • People are used to the old system • Make sure that the paper charts are still available and the old system can still be used when needed • As people start getting used to EMR and less issues occur, gradually fade out the old system • A complete switch to EMR can take years

31. Post-Purchase cont. • Scanning of the paper charts • With 126,000 paper charts, this can seem like a daunting or even impossible task • Remember; HIPAA requires keeping medical records for 7 years. It does not require that these all be electronic • Not every single chart needs to be scanned. The trick is distinguishing between what does and what doesn’t need to be electronic

32. Post-Purchase cont. • Different conversion methods to consider: • Scanning everything up front • With 126,000 charts, this would be an enormously time-consuming and costly task. • Hiring an outside firm to scan everything • There are companies that will come on-site and scan in everything for you • It will still require ENTegrity staff to help / oversee the process • It will be a significant up-front investment • Scanning charts for patients as they come in • By scanning only charts for patients that come in that day (or the next), and limiting the conversion to only the last 3 or 4 visits, the work is spread out over several months or even years and only relevant (recent) information is included

33. Conclusion • Switching to EMR by the end of 2014 and staying compliant with HIPAA and the HITECH ACT should be manageable • Assess readiness of ENTegrity and software needs • Meet with vendors and test different products • Make a purchase decision by the end of 2013 • Implement EMR gradually over 2014 • Display ‘meaningful use’ by the end of 2014

34. Conclusion cont. • From the research done, a budget of $120,000 - $160,000 seems very manageable - high, even • Ways to keep cost of this project down • Opt for ASP over client-server implementation • Drastically reduces up-front investment and spreads the cost of the project out over time • Scan medical records for patients as they come in • Eliminates up-front cost of scanning everything at once, either through hiring a third party or investing employee man-hours for this task

35. Final note on HIPAA compliance • There is no single product or solution that guarantees HIPAA compliance • Products or services can’t be HIPAA compliant. Only institutions can be HIPAA compliant, through comprehensive processes • Keep that in mind when looking at EMR products / services • Ask how a product or service will helpENTegrity to be HIPAA compliant

36. Vendor Options • There are many different vendors to choose from • Three options that seemed well-suited to ENTegrity: • HealthFusion’sMediTouch • http://www.healthfusion.com/ • Great reviews • Easy to use • Relatively low cost • Designed to work well in combination with iPads

37. Vendor Options cont. • Waiting Room Solutions • http://www.waitingroomsolutions.com/ • One of the first web-based EMR solutions • designed to enable doctors to run their whole Practice Enterprise; not just electronic health records (EHR), on one platform. • Company CEO is a practicing physician, so software design is very intuitive.

38. Vendor Options cont. • Medios • http://www.ioshealthsystems.com/electronic-health-records/ • Scalable solution that can be fit for many different practice sizes • Can be integrated with Medios PM (Practice Management) • Has an integrated ‘meaningful use’ dashboard that can be used to keep track of a medical practice’s compliance with ONC Standards • Other vendor options: http://www.softwareadvice.com/medical/web-based-emr-software-comparison/

39. Recommended Sources • EMR Buyer’s Guide. Contains a lot of good information on preparing to implement EMR • http://www.buyerzone.com/healthcare/electronic-medical-records/buyers_guide_electronic-medical-records.pdf • About HIPAA. Contains myths and facts about HIPAA compliance and EMR • http://abouthipaa.com/wp-content/uploads/The-Truth-HIPAA-HITECH-and-Data-Backup-NOV12-FINAL.pdf • Tips on converting paper charts to electronic medical records • http://www.kevinmd.com/blog/2010/09/converting-paper-charts-electronic-medical-records.html • Guidance on Risk Analysis Requirements under the HIPAA Security Rule • http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pdf • How to implement EMR: Is your practice ready? • http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-1-assess-your-practice-readiness • Web-based EMR software comparison • http://www.softwareadvice.com/medical/web-based-emr-software-comparison/

40. DISCLAIMER • The author of this presentation is NOT an expert on HIPAA • Although a lot of research has been done to ensure the accuracy of the information in this presentation, independent research and fact-checking is encouraged before making any purchase or implementation decisions