Implementing a Successful Health Information Technology (HIT) Program Through HRSA

1. Implementing a Successful Health Information Technology (HIT) Program Through HRSA Presenter: Harold “Brownie” Brown – Alabama Office of Rural Health

2. Overview • Project Background • The Grant & Subgrant • Vendor Selection • Program Management • System Development & Implementation • Operational Components • Issues and Lessons Learned

3. Project Background • HRSA Announcement • FLEX HIT Application • Tight Timing • $24M, with 15 awardees • 18 month performance period • Limited to FLEX states • Required network with CAH & tertiary hospital • Focus on CVD and Diabetes Prevention

4. Project Background (Cont’d) • Subgrantee Selection Process • CAHs solicited • Selected Randolph Medical Center • Heavily invested in high tech scanner • Located in high CVD mortality area • Poised to act • Application developed by team • SORH • RMC

5. CHC Locations • Map where 3 CAHs located Red Bay Hospital Randolph Medical Center Washington County Hospital

6. Health Indicators

8. RMC’s Investment

9. The Grant • The Grant Award • 16th awardee • Piecemeal awards • $1.2M vs. $1.6 • Delayed start • Project phases

10. Why was our HIT application successful? • Teamwork: SORH, RMC & Others • Unique combination of talent • Project designed in severable pieces • Huge financial commitment by RMC • Self-evaluation by ‘Murder Board’ • Proposal conveyed great health need

11. The Grant & Subgrant (Cont’d) • The Subgrant Award • Based on project phases • EHR for RMC • Data link • Quality data & tracking • Feb 2009 completion date • Payment tied to milestones & holdback • Progress reviews

12. Vendor Selection • RMC attended vendor expo • Consultant employed • RFI to determine vendor interest • RFP to solicit proposals • Vendor demos required • Hospital selection team • Heavy clinical emphasis • Robust discussions

13. Vendor Selection (Cont’d) • Shrewd negotiations • Outcome • Awardee: Dairyland, now Healthland • Award factors: • Most favored functionality • Best overall value • Highly responsive • Committed to schedule

14. Vendor Selection (Cont’d) • Second Award • To Sci-Health • For Phase 3: Quality Data & Interface • Real time interface vs. data warehouse • Based on price & functionality • Other Awards • For miscellaneous requirements; e.g. • Wiring • Tertiary interface (New Age Systems)

15. Program Management • Developed Project Review Team • SORH program mgr • Medical school tech reps • AL Quality Assurance Foundation (AQAF) • AL Primary Healthcare Association • AL Dept of Public Health (Legal, Financial, Technical, Cardiovascular & Others) • Periodic reviews

16. Program Management (Cont’d) • HRSA Reviews • Monthly reports and teleconferences • Site visits • Contractor evaluation (Alterum) • Quarterly calls • Site visits • In-depth interviews • SORH Project Manager Reviews • Monitor payments vs. progress • Site visits

17. The View From RMC • The Work Plan • Vendors & roles • Phases & milestones • Project tracking charts • Key accomplishments • Descriptions • Pictures • System Structure & Functions • Issues & Lessons Learned

18. Other Financing • FCC Broadband Project • Small Rural Provider Quality Program • Network Development • USDA Equipment Loan • Small Hospital Improvement Program (SHIP) • FLEX

19. TRACKS TRACK 1-EHR System Selection and Implementation at RMC: All the steps required to bring RMC’s current H.I.T. up to state of the art standards. This TRACK is required so that RMC is capable of electronically sharing data among the project organizations. TRACK 2-Point of Care Data Links Across All Entities: All the steps required to electronically link the project organizations clinical data systems. This TRACK is a departure from the original grant application which called for a shared data repository. Given the reduction in grant funds and the complexity of building and maintaining a shared data warehouse it was determined that a more elegant solution would be to simply provide links to the source systems and make these links available at each participating organization. These links are aimed at providing physicians in the ER and clinics with up to date data to improve point of care decisions.

20. TRACKS (cont’d) TRACK 3-Performance Reporting: All the steps required to identify data elements necessary to monitor progress towards improving cardiovascular disease. The concept is that each month, each organization will download discrete data files pertaining to select patients. These data files will be loaded into a rudimentary data base for sorting, trending and analysis. It is during this TRACK that the data elements are defined, the download protocols are established and the database to house the information is built. This TRACK does not require automated data interfaces. It does not require real time feeds. As a result the technical scope is greatly reduced and well as the cost. TRACK 4-Targeted Intervention: All the steps required to implement direct patient intervention to improve patient disease care compliance.

21. Choose Vendor • Randolph Medical Center went through and exhaustive list of vendors. We found the one that best suited our needs was Dairyland Healthcare Solutions. They have recently gone through a name change to Healthland.

22. Phase One • General Ledger • Accounts Payable • Payroll • Human Resources/Personnel • Materials Management • Health Information Management • Release of Information • Quality Assurance/Utilization Review • Electronic Remittance Advice • Eligibility Verification • Forms Express • Scanning • Pharmacy

23. Phase Two • Enterprise Scheduling • Physician Practice Mangement • Patient Care Guidelines • Clinical Information • Order Entry • Laboratory • Transcription • Radiology • Therapies • Dietary • Patient Care Instructions • Clinical Scanning

24. Phase Three • Clinical Documentation • Online Medication Administration Record • Bar Coded Medication Administration • Physician Access • Physician Practice Documentation • Surgery Management

25. DHS Application Data Flow

26. TRACK 1-RMC EHR Key Accomplishments EHR Vendor Selected System Infrastructure Installed Hardware Delivered Training Room Build-Out Underway Financial System Conversion Begun Pharmacy Conversion Begun

27. TRACK 2-POINT OF CARE LINKS Key Accomplishments Regulatory Issues Addressed Medical Staff Issues Addressed Patient Consent Issues Addressed Vendor Contracted Work Begun

28. TRACK 3-PERFORMANCE REPORTING Key Accomplishments Alternative Funds Secured Vendor Selected Hardware Installed Software Installed Build Out Scheduled

29. TRACK4-TARGETED INTERVENTIONS Key Accomplishments ALTERNATIVE FUNDS FOUND

38. Other Vendors Used • Valiant Technologies IT consulting resource • The Analytical Resources Group Data Tracking Resource • Dixie Heating and A/C AC for new Server room • CDW Misc wiring, connectors, cords • Staples Computer monitors • Office Depot Chairs & desks training room • Columbus Fire and Safety Fire suppression - server room

39. Other Vendors Used (Cont’d) • Pro-advantage Network switches • Telecom, Inc. CAT 5 wiring • Innovative Workflow Tech S/W & H/W for interface with EAMC • HIS Workup Evaluation of system for trackable outcomes • Scihealth Communication between EAMC and RMC • Healthland Main software vendor

40. Special Vendor – New Age System Built a system that allows us to view patient information from our tertiary hospital. Designed to allow doctors to view patients that live in local zip codes. If the patient presents and says they were recently at the tertiary we can quickly see everything that happened to them at that location.

41. Randolph & EAMC Patient presents to Randolph ED Randolph ED doc authenticates into EAMC Clinician Access Certifies has patient authorization; searches for patient in CA. If exact match in CA, AND patient lives in a Randolph County zip code, then patient clinical data menu displays.

42. Clinician Access Lab results Radiology reports Transcribed documents: H&P’s, consults, operative reports, discharge summaries Cardiology reports Medications Orders

43. Security Authorized access: Role based (i.e. “Randolph role”): Exact match search: name, dob, sex Limit access to only patients living in Randolph zip codes Access to clinical data only (not demographic) Certify that patient or legal rep authorization has been obtained. Complete audit trail of Randolph access

44. Reports Audit trail, logs for each access: Date/time of access User Patient Data types Utilization statistics report: # patients accessed # users accessing the system # hits by data type

45. Issues & Lessons Learned Pharmacy Conversion Financial challenge Schedule Get key staff involved from day one Stay focused on what works for your facility specifically Keep a positive outlook at the top and display it to all below Reinforce a positive attitude every day

46. Issues & Lesson Learned (Cont’d) • Choose partners based on dependability • Look for recurring costs when you buy the software; i.e., fees every year you use the software • Identify hardware need and order it early • Anything done by contract (running wires, building infrastructure, etc.) will probably take longer than planned • Make sure your key players are on board and supportive

47. Contacts • Harold Brown Project Manager, AL Office of Rural Health Ph. 334-206-5430 Email: hbrown@adph.state.al.us • Michael Tipsword Director Strategic Development, Randolph Medical Center Ph. 334-863-4111, Ext 4102 mtipsword@randolphmc.org

48. Questions????