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Electronic Medical Record Business Plan

MEDINF 404, Winter 2010, Team 1

Monroe Memorial Hospital

Background

Monroe Memorial Hospital (MMH) is a 300 bed community hospital in a relatively affluent and technically savvy community which provides the usual range of medical inpatient and outpatient services in the Chicago suburbs. MMH also has an affiliated outpatient facility for acute care and treatment.

Plan Outline

Guiding Principles Project Objectives Steering Committee Roles and Responsibilities Project Implementation Committee Roles and Responsibilities Communication Responsibilities & Tasks Architecture Inventory Input Device Analysis Project Budget & ROI

Request for Proposal (RFI)

Overall Recommendations of Project Next Steps & Implementation Activities

Guiding Principles

Engage Stakeholders Plan for Interoperability Requirements Patient Centered Focus Manage for Accountability Systems Coding & Classification Integration Design analysis Functions Workflow analysis Business process analysis Strategic alignment User requirement specifications HIPAA, Joint Commission, OIG

Measures Develop performance metrics Evaluate performance

Approach

Project Objectives

Implement and improve MMHs health information system towards a comprehensive electronic medical record accessible at any point of clinical decision-making
Improve clinical quality and process efficiency through an effective implementation of Computerized Physician Order Entry and Clinical Decision Support Leverage technology to advance strategic health care goals and support priority clinical areas of emphasis Move from standalone, independent systems to a more integrated suite of related business, financial, and clinical systems

Steering Committee Members

Chief Executive Officer (CEO)

Chief Medical Officer (CMO) Chief Nursing Officer (CNO)

Chief Financial Officer (CFO)

Chief Information Office (CIO)

Project Implementation Members

Project Leader/Manager System Champions Medical Directors Nursing Directors IT Director Finance Director Operations Directors Key individuals from Clinical and Administrative Departments

CMO CNO CFO COO CIO Vendor representatives Project manager System trainer IT Systems Administrator

Project Organization

Major Milestones

Project Charter
Budget Development Implementation Plan Workflow Assessment/Reengineering Data Conversion User Acceptance Testing Training

Deployment of System
Implementation Assessment

Systems Inventory

Currently have disparate:

ER Lab Pharmacy Radiology Cardiology

Input Device Analysis

Desktop PC Requires space for monitor and keyboard User position Patient position Tablet PC Slates and convertibles Issues Weight Heat Space Navigational precision

Some space issues can be overcome by: Computers on wheels (COWs) Suspended/flat panel monitors Special trays for keyboards

Mobility Affords continuous log-on More like pen and paper Requires wireless network or docking stations life issue High cost Not all electronic medical records (EMRs) are designed to work optimally on a tablet

Infection control Liquid-proof keyboards available Do not wrap in plastic wrap

Require log-on/log-off Always available Network connection Power

Lower cost Laptop/Notebook PCs Laptop/Notebook PCs may substitute for desktop PCs, especially when some degree of mobility is desired, or when affixed to carts (COWs). When used as a desktop, they take on the characteristics of desktops. Laptop/Notebook PCs also come with tablets (called convertibles). When used as a tablet, they take on the characteristics of a tablet. In general, laptops/notebooks are more expensive than desktops and somewhat more expensive than a slate-type tablet.

Timeline Overview
Tasks Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012

Create Training Budget Implementation Communications System customization and testing Work flow Assessment

Workflow redesign
Creation of workflow reference tools per Department

Create Disaster Recovery Protocols Update policy and procedure manuals Distribute P&P manuals and collect old Create Training Schedules Design Training Format

Develop Assessment tool

Staff assessment for computer competence Pre training for computer competence Super user training Staff training Staff System testing Create Go Live Plan Go live

Training Format
Identify Current Skill Level
Employee Questionnaires on computer skill level
Catergorize Staff based on Skill Computer Literacy skill Level

Level Playing Field

Identify Skill level needed by staff in particular field Provide train to bring all staff members to same lbasic level of functioning based on job requirements

Design training plans for the new EMR software

Identtify workflows for each department Create Flow sheets for the new workflows Train Superusers in new work flows Create contact sheets with superuser information Train all staff on new work flows Assess basic competency in new workflows

Training Assessment

Training Timing

Documentation Design

Redesign Workflows

Design Training Modules

Design Competency testing for each module

Initial Budget

The initial budget for this project is $3,065,000 with a 5-year investment of $18,000,000

Software and licensing = $1,000,000 Hardware = $1,000,000 Implementation= $1,000,000 Training= $65,000

Return on Quality of Care

Staff Efficiency and Productivity

Patient Safety Patient Outcomes and Satisfaction

Category

Item Criteria 1 Company History 2 3 Research & Development References

Questions Requiring Vendor Responses How long in business, products offered, strength of website and product offering Number of resources devoted to R&D; recent successful rollouts of R&D activities Strength of positive referrals; why terminated clients left the vendor Company Details Scoring Ranking Total Overall strength of vendor's financial metrics; profitability ratios; leverage, liquity and turnover ratios

Scoring Ranking 1.00 1.00 2.00 4.00 1.00

Company Details

4 Vendor Financials

Financial Analysis

5 Hardware Requirements 6

Operating System Vendor Hardware

Vendor Financials Scoring Ranking Total Strenght of operating system the vendor runs on; ability to run on other operating systems Is purchase of vendor hardware required?

1.00 2.00 1.00

EMR Modular

Is the vendor EMR modular? How many modules come with the basic version?
Hardware Requirements Scoring Ranking Total Can EMR support: Dictation to handheld, using Voice Recognition , Software such as Dragon Naturally Speaking, or dictaphone for later transcription; tablet PCs; CCRs; incoming scans and faxes and technology to support such fuctions

2.00
5.00 1.00

Support of Input Devices

Handheld Devices

Handle real-time and sync; new patient information entered into handheld and ability to sync with EMR; handle billing functions? Does EMR have scheduling module? If not, does it internface with the commonly available products and at what cost? Can system integrate with lab HL7 or other standard, and at what cost Can reports and or images be imported directly and real time from radiology Does the system have integrated billing, or an interface to billing software

2.00

Input Devices

10

Scheduling Module

1.00

11 12 13

Lab Integration Reports Billing

1.00 1.00 1.00

14 HIPAA 15 Audit Trails Security Issues

HIPAA Privacy and Security Compliant Audit trail of all activity and report unauthorized attempts at access Industry standard electronic signatures & al revisions to a record are electronically signed time-stamped and original entry viewable. Inactivity Time-out functions Security Issues Scoring Ranking Total Supports multi-specialty, or is easily customizable by user for specialty. Support simultaneous users of same patient record with appropriate alert Tracks patient in office from check-in to check out; logging of phone messages in chart; generate patient super bills End-User Interface Scoring Ranking Total List conforms to standard vocbulary MEDCIN/SNOMED Does system maintain active & inactive problem list; software will automatically check problem list against NCD and insurance requirements? Vendor updates CPT and ICD9 codes when carriers make changes, and the cost of this is known upfront; intelligent real-time ICD and CPT code assignment at end of encounter; suggest alternative ICD9 codees and or CPT based on historical data from insurance plan

2.00 1.00 1.00

16 Electronic Signatures

17 Time-Out 18 Specialty Interface 19 Simulateous users interface End-User Interface 20 Patient Logs

1.00 5.00 3.00 3.00 2.00

21 Vocabulary 22 Problem List

8.00 2.00 2.00

23 Codes

2.00

Clinical Objectives

24 Templates

Support automated and easily customizable disease standard H&P templates; can reuse last visit template for subsequent encounter

2.00

25 Patient/Physician Encounter

Can nursing notes be automatically entered into physician encounter note; standard customizable patient handouts; user add messages to other users in chart; user view entire chart from remote location; transcribed notes be entered in chart; create a to-do list in chart and progress notes support pick-lists?

2.00

26 Patient Labs & Tests Health Maintenance

Clinical Objectives Scoring Ranking Total Track outstanding tests and flag abnormal labs, and have an inbox to place unsigned notes oustanding tests Does the system have the ability to search entire patient database by diagnosis, by medication or other attribute?

10.00 4.00

27 Database Search

4.00

28 Medication List

Long term; active and inactive; Dced & reason; per episode meds; allergy checking Real-time formulary check of insurance plan; frequent updates to formluary at reasonable predetermined fee; can physician customize a frequently used list of medications by disease condition which takes into account formulary?

2.00 2.00

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Medications

29 Formulary Check

30 Rx History 31 Rx Fills 32 Audit & Track 33 Custom Orders

Recording reason for discontinued medication and displaying medication history and last refills How long does it take to write a prescription? Can system audit prescribing patterns? Can system track prescription renewals? Can system print custom admission orders based on disease and patient medications? Medications Scoring Ranking Total What is the cost of the base system? Describe the typical implementation fees for a company of our size What is the cost of annual support services, including maintenance Identify the costs associated with your hosting services Identify any other costs associated with your proposal All pricing information should reflect a multi-year cost. Fees: License, Installation, Maintenance Scoring Ranking Total Overview of process that will be used to implement the system What resources will be provided for implementation

2.00 2.00 2.00 2.00 12.00 2.00 2.00 2.00 2.00 2.00 2.00 12.00 5.00 3.00 3.00 2.00 13.00 3.00 3.00 1.00 2.00 3.00

34 License Fees 35 Implementation Services 36 Software Support Services Fees: License, Installation, 37 Hosting Servicees Maintenance 38 Other Costs 39 Pricing Structure

40 Implementation Support 41 Resources

Implementation Support 42 Communication & Manage communication and training during the implementation; use of project manager Training 43 Integration of How is legacy data integrated into the system? Ability of your products to integrate with legacy system? Legacy Systems Implementation Support Scoring Ranking Total 44 Technical Support Technical support options and hours of operation; describe the documented support process; online support? 45 Product Documentation 46 Feedback Standard service level agreement and product documentation provided? Ensure feedback from group? User group conference

Training and Ongoing Support

Product Upgrades How are product updates handled? 47 Training Procedures Describe the training procedures for your software. Please identify classes offered, class locations and any other relevant information

48 System Reports Reports

Training and Ongoing Support Scoring Ranking Total Can the system generate reports such as incomplete charts, unsigned notes, labs not back after predetermined period, patient missing predetermined follow-up visits, missing level of visit, or visit generating denials?

12.00 3.00

Summary

This business plan attempts to summarize all of the pre-work the Steering Committee conducted in order to prepare for the EMR assessment and deployment.
While we believe we have considered all necessary items of an EMR deployment, such as the project objectives, roles and responsibilities, current and required inventory, training and educational requirements, budget and ROI, return on quality of care, and MMH feedback, along with all the necessary requirements outlined in the RFI, we are open to suggestion and refinement.