Transcript Implementing a Successful Health Information

Implementing a Successful
Health Information
Technology (HIT)
Program Through HRSA
Presenter:
Harold “Brownie” Brown –
Alabama Office of Rural Health
Overview
 Project Background
 The Grant & Subgrant
 Vendor Selection
 Program Management
 System Development & Implementation
 Operational Components
 Issues and Lessons Learned
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Project Background
 HRSA Announcement
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FLEX HIT Application
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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
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Project Background (Cont’d)
 Subgrantee Selection Process
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CAHs solicited
Selected Randolph Medical Center
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Heavily invested in high tech scanner
Located in high CVD mortality area
Poised to act
Application developed by team
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SORH
RMC
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CHC Locations
 Map where 3 CAHs located
Red Bay Hospital
Randolph Medical
Center
Washington County
Hospital
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Health Indicators
Heart Diseases Mortality Rates for 2003-2005
U.S., Alabama, Alabama Rural Action Commission Districts, and Special Regions In Alabama
230.1
United States
285.4
Alabama
Alabama Rural Action Commission Districts
290.5
North Alabama
266.9
West Alabama
Central Alabama
264.2
East Alabama
366.0
South Central
Alabama
247.8
339.9
Tombigbee
Wiregrass
300.9
Southwest
Alabama
Black Belt
Action Comm.
273.9
364.1
Special Regions
Appalachian
Region
289.8
Delta Region
330.0
0
50
100
150
200
250
300
350
400
Rate
Notes: Data provided by the Center for Health Statistics, Alabama Department of Public Health and the National Center for Health Statistics, Centers for Disease
Control and Prevention. U.S. rate is for 2004. Rates are per 100,000 population.
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Heart Diseases Mortality Rates
U.S. Alabama, and the East Alabama Action Commission Counties, 2003-2005
230.1
United States
285.4
Alabama
East Alabama
Action Comm.
366.0
385.5
Calhoun Co.
394.6
Chambers Co.
305.4
Cherokee Co.
Clay Co.
432.3
Cleburne Co.
294.5
363.3
Coosa Co.
389.3
Etowah Co.
352.4
Randolph Co.
Talladega Co.
322.3
Tallapoosa Co.
362.1
0
50
100
150
200
250
300
350
400
450
Rate
Notes: Data provided by the Center for Health Statistics, Alabama Department of Public Health and the National Center for Health Statistics, Centers for Disease
Control and Prevention. U.S. rate is for 2004. Rates are per 100,000 population.
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RMC’s Investment
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The Grant
 The Grant Award
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16th awardee
Piecemeal awards
$1.2M vs. $1.6
Delayed start
Project phases
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Why was our HIT application
successful?
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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
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The Grant & Subgrant (Cont’d)
 The Subgrant Award
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Based on project phases
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EHR for RMC
Data link
Quality data & tracking
Feb 2009 completion date
Payment tied to milestones & holdback
Progress reviews
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Vendor Selection
 RMC attended vendor expo
 Consultant employed
 RFI to determine vendor interest
 RFP to solicit proposals
 Vendor demos required
 Hospital selection team
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Heavy clinical emphasis
Robust discussions
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Vendor Selection (Cont’d)
 Shrewd negotiations
 Outcome
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Awardee: Dairyland, now Healthland
Award factors:
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Most favored functionality
Best overall value
Highly responsive
Committed to schedule
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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.
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Wiring
Tertiary interface (New Age Systems)
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Program Management
 Developed Project Review Team
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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
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Program Management (Cont’d)
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HRSA Reviews
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Monthly reports and teleconferences
Site visits
Contractor evaluation (Alterum)
 Quarterly calls
 Site visits
 In-depth interviews
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SORH Project Manager Reviews
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Monitor payments vs. progress
Site visits
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The View From RMC
 The Work Plan
 Vendors & roles
 Phases & milestones
 Project tracking charts
 Key accomplishments
 Descriptions
 Pictures
 System Structure & Functions
 Issues & Lessons Learned
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Other Financing
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FCC Broadband Project
Small Rural Provider Quality Program
Network Development
USDA Equipment Loan
Small Hospital Improvement Program (SHIP)
FLEX
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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.
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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.
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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.
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Phase One
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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
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Phase Two
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Enterprise Scheduling
Physician Practice Mangement
Patient Care Guidelines
Clinical Information
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Order Entry
Laboratory
Transcription
Radiology
Therapies
Dietary
Patient Care Instructions
Clinical Scanning
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Phase Three
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Clinical Documentation
Online Medication Administration Record
Bar Coded Medication Administration
Physician Access
Physician Practice Documentation
Surgery Management
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DHS Application Data Flow
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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
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TRACK 2-POINT OF CARE
LINKS
Key Accomplishments
Regulatory Issues Addressed
Medical Staff Issues Addressed
Patient Consent Issues Addressed
Vendor Contracted
Work Begun
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TRACK 3-PERFORMANCE
REPORTING
Key Accomplishments
Alternative Funds Secured
Vendor Selected
Hardware Installed
Software Installed
Build Out Scheduled
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TRACK 4-TARGETED
INTERVENTIONS
Key Accomplishments
ALTERNATIVE FUNDS FOUND
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Other Vendors Used
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Valiant Technologies
IT consulting resource
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The Analytical Resources Group
Data Tracking Resource
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Dixie Heating and A/C
AC for new Server room
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CDW
Misc wiring, connectors, cords
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Staples
Computer monitors
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Office Depot
Chairs & desks training room
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Columbus Fire and Safety
Fire suppression - server room
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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
Evaluation of system for
trackable outcomes
Communication between
EAMC and RMC
Main software vendor
 HIS Workup
 Scihealth
 Healthland
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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.
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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.
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Clinician Access
 Lab results
 Radiology reports
 Transcribed documents:
 H&P’s,
 consults,
 operative reports,
 discharge summaries
 Cardiology reports
 Medications
 Orders
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Security
 Authorized access:
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Role based (i.e. “Randolph role”):
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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
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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
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Issues & Lessons Learned
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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
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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
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Contacts
 Harold Brown
Project Manager, AL Office of Rural Health
Ph. 334-206-5430
Email: [email protected]
 Michael Tipsword
Director Strategic Development,
Randolph Medical Center
Ph. 334-863-4111, Ext 4102
[email protected]
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Questions????
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