Implementing a Successful Health Information Technology (HIT) Program Through HRSA

Presenter:

Harold “Brownie” Brown –

Alabama Office of Rural Health

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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 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

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Project Background (Cont’d)

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

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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 2003-2005U.S., Alabama, Alabama Rural Action Commission Districts, and Special Regions In Alabama

289.8

364.1

273.9

300.9

339.9

247.8

264.2

266.9

290.5

230.1

285.4

330.0

366.0

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.

United States

Alabama

Alabama Rural Action Commission Districts

North Alabama

West Alabama

Central Alabama

East Alabama

South CentralAlabama

Tombigbee

Wiregrass

SouthwestAlabama

Black BeltAction Comm.

Special Regions

AppalachianRegion

Delta Region

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Heart Diseases Mortality Rates U.S. Alabama, and the East Alabama Action Commission Counties, 2003-2005

322.3

352.4

389.3

363.3

294.5

432.3

305.4

394.6

285.4

230.1

366.0

362.1

385.5

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.

Coosa Co.

Etowah Co.

Randolph Co.

Talladega Co.

Tallapoosa Co.

East AlabamaAction Comm.

Calhoun Co.

Cherokee Co.

Chambers Co.

Clay Co.

Cleburne Co.

Alabama

United States

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RMC’s Investment

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The Grant

The Grant Award 16th awardee Piecemeal awards $1.2M vs. $1.6 Delayed start Project phases

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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

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The Grant & Subgrant (Cont’d)

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

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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

Heavy clinical emphasis Robust discussions

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Vendor Selection (Cont’d)

Shrewd negotiations Outcome

Awardee: Dairyland, now Healthland Award factors:

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.

Wiring Tertiary interface (New Age Systems)

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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

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Program Management (Cont’d)

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

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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

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 RMCTRACK 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 EntitiesTRACK 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 ReportingTRACK 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 InterventionTRACK 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

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

Enterprise Scheduling Physician Practice Mangement Patient Care Guidelines Clinical Information

Order Entry Laboratory Transcription Radiology Therapies Dietary Patient Care Instructions Clinical Scanning

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Phase Three 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 AccomplishmentsKey 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 AccomplishmentsKey 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 AccomplishmentsKey Accomplishments

Vendor Selected

Hardware Installed

Software Installed

Build Out Scheduled

Alternative Funds Secured

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TRACK 4-TARGETED INTERVENTIONS

Key AccomplishmentsKey Accomplishments

ALTERNATIVE FUNDS FOUND

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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

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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

HIS Workup Evaluation of system for trackable outcomes

Scihealth Communication between EAMC and RMC

Healthland Main software vendor

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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.

Special Vendor – New Age System

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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: 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

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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 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 BrownProject Manager, AL Office of Rural HealthPh. 334-206-5430Email: hbrown@adph.state.al.us

Michael TipswordDirector Strategic Development, Randolph Medical CenterPh. 334-863-4111, Ext 4102mtipsword@randolphmc.org

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Questions????