hit toolkit understanding the ehr marketplace health information technology toolkit for critical...
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HIT ToolkitUnderstanding the EHR Marketplace
Health Information Technology Toolkit for Critical Access and Small Hospitals
http://www.stratishealth.org/HIT_Toolkit_hospitals
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Presenter• Margret Amatayakul
RHIA, CHPS, CPHIT, CPEHR, FHIMSS
President, Margret\A Consulting, LLCSchaumburg, IL
• Independent consultant, who focuses on achieving value from electronic health records, HIPAA/HITECH, and health information exchange. Developer of tools in Toolkit
• Adjunct faculty College of St. Scholastica, Duluth, MN, masters program in health informatics
• Founder and former executive director Computer-based Patient Record Institute, associate executive director AHIMA, associate professor University of Illinois
• Active participant in standards development, former HIMSS BOD, and co-founder of and faculty for Health IT Certification
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Stratis Health● Stratis Health is a nonprofit organization that leads
collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities
● Stratis Health works toward its mission through initiatives funded by federal and state government contracts, and community and foundation grants, including serving as Minnesota’s Medicare Quality Improvement Organization (QIO)
● Stratis Health operates the Health Information Technology Services Center for health care organizations seeking to use health information technology in support of their clinical transformation
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• What are you buying?
• Vendor state of affairs
• Interoperability
• Requirements analysis
• Going to market with request for proposal
• Key differentiators
• Due diligence
• Contracting
Agenda
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What are you buying?
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Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
EHR Migration Path
Timeline Current Phase I Phase II Phase N
Goals Support ambulatory Patient safety Quality of care
Applications:- Financial/
Administrative- Operational
- Clinical
R-ADT/MPI
Patient Accounting
Payroll/T&A
Laboratory IS
Pharmacy IS
Home Health IS
PM System
Radiology IS
Provider Portal
E-prescribing
EDMS
Order Communication
POC Documentation
BC-MAR
PACS
CPOE
Ambulatory EHR
Technology- Database- Network &
Infrastructure- Interfaces
D.M. Registry
Frame Relay T1
Unit Dose Packager
CDR
WLAN
Tablets
Operations- People- Policy- Process
IT Director 1 FTE Pharmacist
Retail Pharmacy Readiness
Critical Pathways Clinical Guidelines
Results Retrieval
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Reality for Many Small and Rural Communities• Buy from incumbent
– What incumbent offers• Or
– Depend on standalone systems– Utilize expensive interfaces– Wait for the vendor to catch up
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Vendor State of Affairs/CCHIT(Certification Commission for Health Information Technology)
0
50
100
150
200
250
1995 1997 1999 2003 2008A 2008H LTC
# EHRvendorsw/same name as previous year on annual EHR market survey
Total Number of Ambulatory EHR Vendors
CCHITEstimates 24 AcuteCare EHRVendors
CCHITCertified
CCHIT Certified
LTC # Vendors*20052008No CCHITCertification
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
•Source: Provider
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180 pages of functional requirementsfor NH
Interoperability vs. Functionality
Interfaced
Integrated
Connected
9Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
• Health Information & Data
• Results Management• Order
Entry/Management• Decision Support
• Electronic communication & connectivity
• Patient support• Administrative processes• Reporting & population
health management
www.nap.edu/catalog/10781.html
Institute of Medicine EHR Core Functionality
● Describes detailed functionality along a timeline:o 2004-5o 2006-7o 2008-10
● For:o Hospitalso Ambulatoryo Long term careo Care in the community
(personal health records)
10Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
HL7 EHR – System Functional Model(www.hl7.org/ehr)
• Direct Care– Care management– Clinical decision support– Operations management
& communication
• Supportive– Clinical support– Measurement, analysis,
research & reports– Administrative & financial
• Information infrastructure– Security– Health record information &
management– Registry & directory
services– Standard terminologies &
terminology services– Standards-based
interoperability– Business rules
management– Workflow managementInitial focus of CCHIT certification
for ambulatory care (www.cchit.org)
11Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
CCHIT 2007 Hospital Certification
RadiologyLab InpatientPharmacy
CPOEClinicalDocumentation EMAR Results
ManagementReporting
Imaging
BloodBank
Dietary/Nutrition
MedicineDispensing
DevicesRobotics
Smart Infusion Pumps
MonitoringEquipment
“Smart” Peripherals
Departmental Clinical Applications
Core Clinical Applications
IntensiveCare
Perioperative/Surgical
Cardiology OncologyEmergencyMedicine
Labor &Delivery
Specialty Clinical Applications
EHR FoundationR-ADT, Order Communication
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Do Your Own Functional Requirements Analysis
• Work flow and process mapping
• Goal setting• Scenario development• Use case analysis
• Performance-based RFP• Due diligence• Contract• System build• Testing and Training• Benefits realization Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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• Trade publication product lists– Self-reported, but most complete and permits side-by-side review
• Web searches– Likely to reveal most aggressive vendors with no side-by-side screening
capability, but often provides demos• Professional organization trade shows
– Good way to get educated on the “possible” but may include an eclectic mix of established vendors and those only exploring the marketplace
• User groups– Provides “bird’s eye view” of many users outside the context of a selection
process and may yield great objectivity and potential candidates for due diligence• Recommendation lists
– Compiled by professional organizations or other groups for specific purposes• Peer experience
– Interesting but criteria may not match yours; positive experience is good to know, negative experience may be unique and due to poor planning
• Recognition or award programs– Some are more objective than others, but consistency in appearance is helpful
• Product certification– Certification Commission for Healthcare Information Technology – Proprietary vendors of product analysis tools are also resources
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
Triangulate Information from Product Resources to Narrow Field
14Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
Used with permission of Medical Strategic Planning
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*Key Differentiators
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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• Functionality is very important, and vendors under consideration should provide type of functionality you want. For example, don’t look at a vendor that only supplies clinical messaging or document management if you want full EHR functionality
• Other factors are also very important, for example:– What is the vendor’s reputation for help with implementation and
ongoing support?• Does the vendor provide local support? Is there an established local presence
of users to provide community support?
– How long has the vendor been in business? • With a dynamic marketplace, the vendor should have at least survived their
initial few years• But the trade off in acquiring an EHR from a long-established vendor may not
be the latest technology or most comprehensive clinical functionality!
• Check these other characteristics through performance-based demonstrations, site visits, and reference checks; but . . .
Due Diligence
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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Contract Negotiation• Negotiation is an iterative
process of give and take• Do not plan to work out details
after contract is signed. There is no leverage after contract signing
• Get it in writing. What you are told in demos, see on site visits, or are promised by sales staff have no contractual impact.
• Maintain validity of business points
• Keep a list of contract issues and resolutions
• Read and verify the final contract version prior to signing
• Manage to the contract
Price is an offer to sellCost is what you pay to vendorTotal cost of ownership is all costsPayment is transfer of funds.Value is what you get
Schedule Vendor Buyer
Down payment 50% 10%
Software install 25% 10%
# days after software install 25%
Completion of training 20%
Completion of testing 20%
Go live 20%
90 days after go live 20%
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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• What are you planning to acquire next to help you enhance your clinical information systems?
• Are you planning to go to market?– If not originally, how might doing so help you?– If so, how can you avoid “analysis paralysis” in light of so
many vendor offerings?
• If you decide not to go to market, will you do some due diligence before acquiring the next component from your incumbent to assure you have the technology, people, policy, and process in place to support your new acquisition?
Questions to Consider . . .
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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Contact:
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Bloomington, MN 55425
952-854-3306
1-877-787-2847 (toll free)
www.stratishealth.org
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