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 (Contd)

• 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
7
(No Transcript)
8
RMCs 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 (Contd)

• 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 (Contd)

• Shrewd negotiations
• Outcome
• Awardee Dairyland, now Healthland
• Award factors
• Most favored functionality
• Best overall value
• Highly responsive
• Committed to schedule

14
Vendor Selection (Contd)

• 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 (Contd)

• 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 RMCs
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 (contd)
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
TRACK 4-TARGETED INTERVENTIONS
Key Accomplishments
ALTERNATIVE FUNDS FOUND
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
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 (Contd)

• 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
• HPs,
• 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 (Contd)

• 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_at_adph.state.al.us
• Michael Tipsword
• Director Strategic Development,
• Randolph Medical Center
• Ph. 334-863-4111, Ext 4102
• mtipsword_at_randolphmc.org

48
Questions????