MACH needs an EMR system that integrates internal and external lab info, physical order entry, provider documentation, x-ray results, and billing/finance info across its 3 practices and 24 staff members. The EMR must comply with HIPAA, ARRA, and CCHIT requirements. MACH's mission is to be the premier healthcare provider in the area through efficient, effective, and innovative quality care. An EMR implementation will help achieve this through improved processes, access to incentives, and an improved brand. MACH will buy a vendor-based EMR package for quicker implementation over building its own system, which is not its core competency.
1. Presented by
Casey Ryan | Manav Gupta | Michael Budiman | Muhammad Ali Usmani
Sajith Kaimal | Temidayo Adebayo
2. Overview MACH
Medical Associates of Chestnut Hill
MACH needs a system that 3 practices | 24 staff members
integrates and supports the
following –
Standard med practice software
1. Internal / External lab info
integration No IT units | lean organization
2. Physical Order entry
3. Health care provider Requires EMR implementation
documentation
4. X-ray and procedure results
5. Billing and finance info
3. Compliance MACH
HIPPA
Mach needs to make sure the
EMR system comply with the
requirement of one if not all of
the following health agencies
ARRA EMR CCHIT
ELINCS
5. EMR Framework MACH
MACH Mission | Strategy |
Business Value
1
EMR
Recommendation
6. EMR Framework MACH
MACH Mission | Strategy |
Business Value
1 Mission: Being the premier provider of physicians and
healthcare services EMR area by emphasizing
in the
Efficient , Effective and Innovative Quality care for our
Recommendation
patients
Strategy: Focus on process improvement with
enabling technology to achieve increased efficiency.
Business Value: Access to hospitals, Improve
healthcare , Access to AARP Incentives, Improve Brand
7. EMR Framework MACH
MACH Needs Assessment
MACH Mission | Strategy |
( Business Context | Users,
Business Value
Business Process | Compliance)
1 2
EMR
Recommendation
3 4
Vendor Research
Selection Criteria | (Build vs Buy | SWOT | POCs |
Scale | Weightings questionnaires | demos | client
references)
8. Build Vs. Buy MACH
In-house Vendor-based
Better ability to customize the Typically low setup cost,
product as per business needs economies of scale
Ability to retain direct control Proven reliability &
& privacy of internal functions performance benchmarks
Less time to implement
o Not core competency of Statutory / Legal
MACH requirements taken care of
o High cost in establishing in-
house facility and longer ramp- o Challenges in communication
up time of precise requirements
o MACH needs to hire qualified o Dependency on vendor for
staff support and maintenance
9. Which EMR should MACH use ?
Recommendation
MACH can go for buying Vendor-based package as it would
provide quicker Time-to-Market & a cost-effective solution
Building software is not MACH’s core competence & its on the
hook to be on EMR in 6 months!
Traditional EMR Cloud-based EMR
Virtualization, Remote
You can scale only to the computing over network
limits of your hardware Easy Scalability
Better disaster recovery
Security concerns Pricing based on usage
Easy inter-operability
10. McKesson Specialty Health
1. Healthcare services company ->
pharmaceutical solutions | medical
supplies | technologies
2. Operates in two business segments
1. Distribution Solutions (97% of total Sales)
2. Technology Solutions
3. Total Revenues 112B (March 2011)
4. Number of Employees: 36,000
5. Strengths-> Market Leadership |
Broad Solution Portfolio | Industry
Recognition
11. McKesson Lytec MD & RelayHealth
1. Lytec MD combines the practice
management features of Lytec
2011 with electronic health record
(EHR)
1. Bright Note One Touch
Technology
2. RelayHealth connectivity services
connects healthcare providers to
payors, pharmacies, patients and
other providers
12. eClinicalWorks
“eClinicalWorks is the only EHR in the marketplace that
meets our requirements for full interoperability, 1. Privately-held, leader in
advanced security and private cloud hosting,”
ambulatory clinical solutions
Dr. John Halamka
CIO of Beth Israel Deaconess Medical Center and
Harvard Medical School 2. Its solutions extend the use of
electronic health records beyond
practice walls with the latest
technologies and create
community-wide records
3. Established customer base of
more than 55,000 providers &
250,000 plus medical professionals
across all 50 states
13. eClinicalWorks
On-demand
SaaS | Premises Industry Standards
client / server
3-tier technology using
HTTPs & XML
HL7
Continuity of Care Record
(CCR)
Continuity of Care
Document (CCD)
Enterprise Business Healthcare Information
Optimizer (eBO) to Technology Standards
provide more Panel (HITSP)
dynamic reporting
16. EMR impact –Organizational structure
Impact Management
Current workflow disruption during transition • Schedule training sessions during less busy
season
• Hire temporary staffs for parallel
• Clarify project milestones and phases
Potential resistance from physicians and admin • Rally supports from the more vocal and/or
staffs during training and learning curve tech-savvy physicians
period • Provide big picture of short-term and long-
term EMR benefits
• Provide financial incentives for overtime
related to training and learning curve
Administrative staffs reduction • Provide job referrals for impacted staffs
• Shift role of impacted staff to another area
In-house IT support staff addition • Assess in-house versus 3rd party consultant
cost-benefit
17. EMR impact – Process and Output
Impact Measurement Management
Historical data conversion from • Number of patient charts • Hire temporary admin staffs
paper-based to digital for data input and data
format integrity check
Physicians spend more time on • Physicians’ daily schedule
patients than on
administrative tasks
Patients data are more readily • Number of days needed to
available to physicians get information into patient
chart
• Record and compare
Quicker information flow to • Time needed to complete
measurement units (in
pharmacies and other prescription
hours/days) before and after
medical institutions • Time needed to process
EMR implementation
referrals
Quicker information flow to • Time needed to complete
patients prescription
• Time needed to notify
patients of drug recalls
18. Impact Example (Org Structure)
Source: MedicaLogic. Ambulatory EMR: Establishing a business Case [White paper]
19. EMR impact –Cost and Revenue
Impact Measurement Management
Quicker cloud-base • “Meaningful Use” standards • Synchronize implementation
implementation = higher set by Centers for Medicare timeline with CMS
chance of MACH to qualify and Medicaid Services (CMS) “Meaningful Use” checklist
for HITECH Act funding
Reduction of overhead costs • Time spent on chart-pulls, • Calculate salary cost based
transcription and other on hours spent on admin
administrative task tasks
Increase of per-visit patient • Number of patients visit per • Track number of patients
charges doctor visit per doctor before and
after EMR
Faster and more accurate billing • Number of days between • Track number of days and
patient visit and invoicing cases before and after EMR
• Number of cases of billing
disputes
Cost of implementing EMR • Profit and Loss statement • Formulate and monitor
might put MACH in net loss short-term and long term
position in the short term financial forecast and budget
20. Impact Example (Cost and Revenue)
Source: MedicaLogic. Ambulatory EMR: Establishing a business Case [White paper]
23. Implementing EMR
Phase One
(2 months)
Designate Project
Organize Internal Manager &
ERM Committee Physician Champion
Training Set Clear Goal for
“Going Live” Date
Implementation
Budget
24. Implementing EMR
Phase Two
(3 months)
Possible Tasks for after Complete Software
“Going Live” configuration &
Integration
Conduct
post go
reviews GO LIVE !
25. Recommendation
• Finalize requirement / workflow automation /
Month 1 initial launch goals
• Vendor Engagement / Contract Approval
• Hardware / Software Review & Acquisition
Month 2 • Steering committee creation
• Project plan creation and assignment of
internal and vendor resources and project
Month 3 manager
• Finalizing implementation Budget
• Finalize Integration plan for initial
Month 4 launch with other systems ( practice and
hospitals)
• Finalize migration /archiving of
Month 5 existing paper records
• Hire supporting staff ( temp or permanent)
26. Recommendation
• Initiate Configuration of software template /
Month 1 data import
• Initiate h/w acquisition and set up
• Initiate Data migration / archiving
Month 2 • Initiate Training
• Initiate Systems Integration
Month 3
Month 4
Month 5
27. Recommendation
• Complete the Configuration
Month 1 • Complete the Integration
• Complete Training
Month 2
Month 3
Month 4
Month 5
28. Recommendation
• Go Live !
Month 1 • Monitor systems use
• Conduct post go live reviews
• Identify process improvement opportunities
Month 2 • Ensure EMR adheres to "meaningful use "
Month 3
Month 4
Month 5
29. Recommendation
• Utilize reports / metrics
Month 1 • Provide follow up action plan for ongoing
• Support service needs
Month 2
Month 3
Month 4
Month 5
32. Bibliography
Centers for Medicare and Medicaid MedicaLogic. Ambulatory EMR:
Services; Medicare and Medicaid Establishing a business Case [White
Programs, Electronic Health Record paper]. Retrieved from
Incentive Program Final Rule. http://www.blackbookrankings.com/pdf/
Released July 13, 2010. Accessed Establishing-a-Business-Case-for-
October 10, 2010, at Ambulatory-EMR.pdf
http://edocket.access.gpo.gov/2010 http://www.blackbookrankings.com/pdf/
/pdf/2010-17210.pdf Issues-in-EMR-Implementations.pdf
google.com Meaningful use Deconstructed -
Wikipedia.com http://mahit.wikkii.com/wiki/Meaningful
eClinicalWorks.com _Use_Deconstructed
mckesson.com
33. Implementation: Phase One - Develop Project Plan
Objective 1: Designate an Internal Project Manager & Physician Champion
1. Set clear goal for “going live” date
2. Provide vision of long /short term goals
3. Help to reduce potential disruption of workflow
4. Possible resistance from staff to new systems
Objective 2: Implementation Budget
1. Assess the amount of work and available time
2. Evaluate cost of in-house IT support staff
3. Review current personnel , redundant staff
4. Costs will be high early in implementation
5. Increase of per-visit patient charges after implementation
6. Formulate 5-7 year forecast and budget
7. Budget for Training
Objective 3: Training
1. Vendors will train all staff
2. No use of “train the trainer” program
3. Provide financial incentives for overtime related to training and learning curve
4. Schedule training during slow season
5. Acclimated and familiar to new devices before in exam room
34. Implementation: PhaseTwo-Organize internal EMRcommittee
Objective 1: Strategy for transition from paper documents
1. Compliance with federal/state requirements on destruction of medical records
2. Scanning and shredding paper documents to save on storage costs
Objective 2: Additional IT support staff
1. Assist in maintenance and daily IT operations
Objective 3: Hardware Decisions
1. Check for slow, outdated equipment
2. Upgrade from “low memory” devices
3. Eventual template customization
4. Transcriptions will be replaced with template-based documentation
Objective 4: Tasks after “Going Live”
1. Connect multiple lab interfaces
2. Designating patient portals
3. Gradually customize system
4. Monitor progress to see if adjustments may help
36. Meaningful Use
Below are the Meaningful Use requirements
This rule implements the provisions of the
1. Use CPOE
American Recovery and Reinvestment Act
2. Implement Drug-Drug and Drug-Allergy Checking
of 2009 (ARRA) (Pub. L. 111–5) ARRA set 3. Use e-Prescribing
aside more than $19 billion in funding for 4. Record Demographics
medical services providers that make 5. Maintain a Problem List
"meaningful use" of "certified" EMR 6. Maintain a Medication List
systems 7. Maintain a Medication Allergy List
8. Record Vital Signs
9. Record Smoking Status
10. Implement Clinical Decision Support
11. Report Quality Measures
12. Provide Patients with Electronic Copies of Health
Information
13. Provide Patients with Clinical Summaries
14. Capability to Exchange Clinical Information
Electronically
15. Protect Electronic Health Information
37. Cloud is Secure Enough for
the Pentagon.
Security in the cloud Why Not for You?
Drawing on the findings from multiple
benchmark studies on best practices in • Resource relocation: Relocate resources and
content security and security software data for filtering, traffic controlling,
as a service, analysis shows that users of verification, encryption and other security
cloud-based web security had measures. This ability provides more resilience
substantially better results than users of against security threats.
on-premise web security
implementations in the critical areas of • Multifactor authentication: Multi-factor
security and compliance. Compared to authentication systems combine something
companies using on premise web you know (password), with something you
security solutions, users of cloud-based have (hard token), and/or something you are
web security solutions had 58% fewer (biometric).
malware incidents over the last 12
months, 93% fewer audit deficiencies, Physical security: Reputable cloud computing
45% less security-related downtime, vendors often host their systems in facilities
and 45% fewer incidents of data loss that have much stronger physical security
or data exposure. controls with meaningful certifications that
many small-to-midsize companies cannot
provide on their own.
MACH is a group of 24 internal medicine physicians and associated professionals including nurse practitioners, physician assistants, and supporting nurses.MACH physicians see patients at Newton Wellesley Hospital, Mass Eye and Ear, and the Faulkner Hospital.MACH is required to implement patient electronic medical records (EMR) by one of their hospital partners or lose its privileges at the hospital.MACH as no IT units and they ran a lean organization making it difficult to change.Mach needs a system that integrates and supports the following to make them more competitive:· Internal and external Labs information integration· Physician order entry· Health care provider documentation· Lab, x-ray and procedure results· Medication management· Billing and finance informationEMR will increase the number of Patients physician see per hour
The EMR system must comply with minimum regulatory requirement - Mach needs to make sure the EMR system comply with the requirement of one if not all of the following health agencies:· Health insurance portability and accountability act of 1996 (HIPAA)· American Recovery and Reinvestment Act of 2009 (ARRA)· Certification Commission for Healthcare IT (CCHIT)· EHR-Lab Interoperability and Connectivity Standards (ELINCS)