MIDWEST REGIONAL HEALTH

MIDWEST REGIONAL HEALTH EHR I-Tech Medical Consortium Overview of the Electronic Patient Record System

Midwest Regional Health BackgroundMidwest Regional Health is one of Wisconsin's largest and most sophisticated hospitals. Located in Pewaukee, this hospital opened in 1953 and has been an integral part of the community ever since. They offer an extensive scope of services complemented by a highly qualified medical staff representing a wide variety of medical and surgical specialties. Where they are proud to provide high-quality health care services to Wisconsin.Midwest Regional Health is frequently recognized by the national associations and local publications for its unsurpassed commitment to providing high-quality healthcare to the Wisconsin community and beyond.

The Midwest Regional Health Selection Committee is recommending an immediate move to an EPM/EHR system based on the need to demonstrate quality, competitive market considerations, a rigorous selection process, and a high expected Return on Investment.

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Product ObjectivesThe goals of the product are as follows:Computerized physician order entry to allow health care personnel to process orders for medication or other medical services directly from the computer.Provide patients with an electronic copy of their health information upon request.Capability to exchange clinical information with other providers of careFull EMR that will include lab orders, results, billing, and full medical history.Privacy and security of data access control by patient and providers Greater patient access to medical history data Increased quality of careImproved efficiency and time management of medical staff

Product RequirementsThe system and all hardware utilizing the system must be encrypted for security reasonsThe system and the data storage facilities must be HIPPA compliantApplication must follow the HITSP and IHEThe EHR system must be accessible 24/7 to all health care personnel User(s) must be able to access records remotelyThe EHR system must accessible by any approved health care personnel in any location within the organizations various locationsePrescribeE-sign Electronic signature for physician / nurseAll patient record information must be backed-up onto data storage tapes every day for emergency backup support, and then be stored at a secure off-site location

Patient Log-in page

Patient Medical History Page

I-Tech Medical Consortium I-Tech Medical Consortium is a nonprofit organization consisting of a wide variety of experienced partners, including research, academic, public, and private healthcare organizations professionals, dedicated to championing the development of a universal patient record system.Its mission is to improve patient care and provide real-time access to complete and accurate patient history through the development of this innovative system.

Project Team membersMyra Sanchez Project ManagerBrett Fry - Technical LeadWillie Greer - Quality Assurance AnalystJames Tillman Risk Management Analyst IICharles Winters Talent Development Research Analyst

Project Objectives

Electronic data has the vast potential to improve the quality of healthcare audit and research. However, increasing access to data through an EHR system also brings new risks to the privacy and security of health records.

Among the proposed projects objectives are:The creation, expansion and linkage of electronic healthcare record (EHR) - successfully implement and deploy a fully functioning EHR system.Training successfully train all necessary personal on the EHR system.Security successfully secure the data both on-site and off-site and ensure all personnel have the appropriate security access to EHR system and/or data.HIPPA compliancy successfully ensure that the EHR system is HIPPA compliant.

Project scheduled milestonesJune 5th, 2012 Project team kick-off meetingJune 7th, 2012 Meeting with client November 26th, 2012 Vendor selection processJanuary 30th, 2013 Live and fully functioning at all clinics July 20th, 2013 Live and fully functioning at hospitalDecember 6th, 2013 Project sign-off meeting with clientDecember 16th, 2013 Team project closure meeting

Project BoundariesObtain list of product and/or service requirements from the clientObtain a subject expert matter Research and selection of vendors Train all affected personnel Implementation of the EHR system throughout business center location, main hospital location and 3 separate clinic locations18 months schedule$16 - $20 million budget

Project AssumptionsApplication vendor of choice will be responsible for patient data records while in full compliance of the HIPPA regulations.Application vendor will create and monitor data backup and have an offsite data storage locationCurrent workstations meet system requirements to run the EHR applicationAll Workstations will have system encryption software.Internet service provider can support the network bandwidth needsFull guarantee from data facility including: useable data, secure off-site location and access to backup information within a maximum of 3 hours from the time of the backup information requestAll staff will be trained in time to utilize the system

Project ConstraintsTimeline constraint Lack of technical resources Data transfer failure Overlooked features missing from application Limited access to subject matter expert Employee resistance to new systemThis type of system has never been implemented so nothing to reference

Communication Matrix

Work breakdown structure

Cerner EHR Selected Vendor By choosing Cerner for this application, they support the application 100%, while providing a secure data infrastructure system which includes a guaranteed network systems that stores all patient data, data backups, and multiple data servers which will minimize any chances of accessing any private patient data.

Cerner EHR Infrastructure Diagram

Vendor Supported EHR BenefitsThe key benefits of this system are: Increased communications throughout the health care system and their providers.Meeting HIPPA requirements by enabling the exchange of discrete clinical information.Meets HITSP and IHE compliance guidelinesIts availability 24/7/365 except for maintenance windowsIts accessibility from a tablet, laptop and stand-along computer without loss of functionalityReduces costs and increases efficiency by automating patient serviceswill provide a Disaster Recovery Plan along with maximum outage timeline before they start subtracting money from the signed contract terms.

Cerner EHR Cost of Operation370 devices that will receive the Cerner EHR application.Cerner Application and support - Based on the current count of 370 beds to support the cost per bed equals $17,200.The expected cost is $6,364,000; this covers the cost of the bed and the annual operating costs.As more clinics are brought online, at this time the estimated cost is $14,500 with an additional annual operating of $2700 per bed.

RACI Chart

Network StructureMidwest Regional Health will provide an internet link between the Office Center, hospital, and clinics will be redundant links that are supported both by AT&T and TW Telecom.

Both the Main Hospital and the Office Center will have a connection to all clinics which also provides a complete redundant link protecting from any major downtime due to an ISP issue.

The primary links between the Main Hospital and the Office Center will be a 10Gig connection from both ISPs and T1 connections to all clinics producing a Mesh Network

To have internet provided in this manner a total cost for a 5 year support plan will cost $198,000 or 45,000 per year.

ISP Network Structure

Workstations and Mobile CartsMidwest Regional will provide all workstations and mobile EHR carts fully encrypted with all staff security credentials installed for all locations.There will be (15) workstations and (10) mobile EHR carts located at all nurses stations supporting each department of the 3 floors for ICU, CICU, 1 Burn department, 1 ER department, and 1 Day Surgery department for the Hospital. At each clinic there will be (3) workstations and (3) mobile EHR.The workstations that will be provided will consist of a Dell 790 or equivalent at a cost of $900 per station and monitor. Each mobile cart will consist of a mobile cart that has a built in security laptop lock and a Dell Latitude laptop at a cost of $1800 per cart.Not including the temporary command center workstations, a total cost of $291,600 will be required to supply the appropriate number of workstations and mobile carts.

EHR Mobile CartMobile EHR Cart and laptop informationEnovate Lite Medical Cart: Lvl1 (Trade Compliant) Mfg. Part: L-S10-01-0|CDW Part: 1921360

Quality Management in Healthcare Any evaluation of services provided and the results achieved as compared with accepted standards. In one form of quality assurance, various attributes of health care, such as cost, place, accessibility, treatment, and benefits, are scored in a two-part process. First, the actual results are compared with standard results; then, any deficiencies noted or identified serve to prompt recommendations for improvement.

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What is Quality management? Quality management is the act of overseeing all activities and tasks needed to maintain a desired level of excellence. This includes creating and implementing quality planning and assurance, as well as quality control to your products or services to achieve a more consistent quality level.

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6 key dimensions of health care qualityHealth care should be Safe unintended patient injuries should be avoided.

Health care should be Effective based on scientific knowledge, service should be provided to all who could benefit. Services should not be provided to people who are not likely to benefit.

Health care should be Patient-centered this means providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

6 key dimensions of health care qualityHealth care should be Timely we should reduce waits and sometimes harmful delays for those who receive care.

Health care should be Efficient we should avoid waste, including waste of equipment, supplies, ideas, and energy.

And lastly, health care should be Equitable this means that health care should not vary in quality because of a patients personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

I-Tech Medical Consortium Quality Policy I-Tech Medical Consortium quality policy is based on the fundamental concept that the control of quality is a team obligation that recognizes that quality is built into every aspect of the project. Our team will provide quality products and services that meet or exceed Midwest Regional Healths (MRHs) requirements, delivered safely, on time, and within budget.

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Quality Management Importance Quality Management is essential to ensure that the project deliverables, whether they are tangible or intangible, are on par with expectations. Maintaining quality is accomplished by reviewing outputs and establishing systems for quality assurance. These deliverables includes:Quality planning, assurance and control, Issue identification, tracking, resolution.

Quality Management StandardsISO 9001:2008 is the standard that provides a set of standardized requirements for a quality management system, regardless of what the user organization does, its size, or whether it is in the private, or public sector.ISO 9004:2009 is the standard which provides a measurement framework for improved quality management, similar to and based upon the measurement framework for process assessment.Six Sigma combines established methods such as statistical process control, design of experiments and failure mode and effects analysis in an overall framework.

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Quality Improvement & Risk Management Functions

RISK MANAGEMENT

Security Risk Analysis

A security risk assessment is required under the HIPAA Security Rule.

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What is Risk Management? Risk management is the identification, assessment, and prioritization of risks (defined in ISO 31000 as the effect of uncertainty on objectives, whether positive or negative) followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events or to maximize the realization of opportunities.

Risk Management MethodologyFor the most part, these methods consist of the following elements, performed, more or less, in the following order.identify, characterize, and assess threatsassess the vulnerability of critical assets to specific threatsdetermine the risk (i.e. the expected likelihood and consequences of specific types of attacks on specific assets)identify ways to reduce those risksprioritize risk reduction measures based on a strategy

Risk Management ProcessAccording to the standard ISO 31000"Risk management Principles and guidelines on implementation, is that the process of risk management consists of several steps which involves:Identification of risk in a selected domain of interestPlanning the remainder of the process.Mapping out the following:the social scope of risk managementthe identity and objectives of stakeholdersthe basis upon which risks will be evaluated, constraints.

Risk Management ProcesscontDefining a framework for the activity and an agenda for identification.Developing an analysis of risks involved in the process.Mitigation or Solution of risks using available technological, human and organizational resources.

RISKsUnauthorized access to patient informationInternet Service Provider Network connectivityData storageData backupSecure patient dataIT infrastructure (servers, network, etc)Secure data center entryBudgetQuality standards not metInadequate skills / training

Risk Register Matrix

The Endand Thank You