Data management systems overview and applications

Practice Fusion

Strategic Planning Document:

A Plan for Conversion, Integration, and Implementation of Electronic Health Records (EHR) in a Residential Care Facility

Description of Institute

The objective of this study is to examine the implementation of a new information technology data-management plan at a residential care facility for individuals with mental illness/mental retardation. This facility also provides day treatment and respite care. This will include a two-person practice for a Nurse Practitioner and a Psychiatrist. The institute at focus in this study is a residential care facility for individuals with mental illness and mental retardation.

The mission of the residential care facility is to provide day treatment and respite care in addition to care for mentally ill and mentally retarded individuals in the best possible setting with the most effective treatment available.

Business Model

The term 'assisted living" is defined by the Assisted Living Facilities Association of America as any group residential program "that is not licensed as a nursing home and that provides personal care and support services to people who need help with daily living activities as a result of physical or cognitive disability." (Institute of Medicine [IOM], 2003) Placing residents in an environment that is more home-like has been demonstrated to "foster a greater degree of self-sufficiency among residents, lower costs, and a higher sense of self-esteem." (Institute of Medicine [IOM], 2003) Assisted living facilities while not offering the full freedom associated with independent living are still not as restrictive as is the nursing home environment. Residential living facilities serve to bridge the gap between independent living and nursing home care. The residential care facility is designed to promote "individualized attention and opportunities to address residents' individual needs and personal desires." (Institute of Medicine [IOM], 2003) The business model is such that addresses the physical, emotional, and spiritual welfare of the residents. The team will make provision of assistance with medications, dressing, grooming, bathing, and dining and all other activities associated with daily living. The program will provide a level of care that ensures the best quality of life through anticipation of and exceeding the needs of residents.

IV. Governance Structure -- Organizational Chart with All Stakeholders

The following figure illustrates the governance structure of the residential care facility.

Figure 1 -- Governance Structure

V. Change Transformation Framework

Implementation of the EHR system will be based upon the 'Change Transformation Framework' shown in the illustration labeled Figure 2.

Figure 2 -- Change Transformation Framework

Change Transformation

Assessment of Transformation Planning Transformation Implementation

Target Analysis Plan for Stakeholder engagement Activities to motivate stakeholders and Readiness Analysis Plans for Sponsor Engagement sponsors

Needs assessment of: Plan for Development/Implementation

Individual adoption

Education/Developmental

Institutional Adoption

Communication

Transformational Communications

Planning for Communication Implementation of Communication Adoption of Communication

Learning Development for Transformation

Education and Developmental Planning Implementation of Training Deployment of Development

As shown in the above figure transformation to EHR system use involves several phases including:

(1) Transformation assessment

(2) Transformation planning;

(3) Transformation implementation

(4) Transformation communications; and (5) Transformation learning development.

VI. Project for Implementation

Practice Fusions HER (Electronic Health Record) was developed from the real workflows of physician's practices. The free, web-based EHR system is a fully-feature system that enables the physician and/or the facility to effectively manage the practice. The system can be utilized for appointment-scheduling, completion of a medical chart, sending of prescriptions with the e-prescribing feature and even billing for services. The EHR is reported as being easy to use enabling the physician and/or facility to sign up for the service and to immediately begin charting.

VI. Overall IT Plan and Planning Time Horizons and Organizational Budgeting

The typical implementation of the Practice Fusion EHR is approximately 1 year's time. While the Practice Fusion EHR upfront cost is relatively low, training of employees and the addition of certain employees will represent some expenses to the organization's budget.

VII. Sponsorship Team and Implementation Team

The objective of the plan is to facilitate the desired outcome for the residential care facility including an increase in integration and interoperability amongst multiple facilities, to make provision of multiple methods for information presentation, facilitation of identification and location of patients and to introduce the standardization of accessibility protocols, to provide support for data integrity and confidentiality and to make provision for systems operation and maintenance in the determination of system and data accuracy.

The stakeholders that are responsible for making contribution to the implementation of EHR at the residential care facility will be inclusive of customers, various levels of management, outside experts and business and IT leaders. The customers, or the EHRs end users include health care consumers and clinicians will make provision of the necessary inputs in regards to policies, procedures, requirements, and usability of the system. The management team will have the responsibility for roll-out of the system and to ensure that staff members are sufficiently bought in and able to contribute to the system implementation. The industry consultants and vendors will make provision of the needed outside perspective for the organization and will provide the necessary tools for EHR implementation.

VIII. Strategy for Capturing Current Workflow

The identified strategy for capturing the current workflow includes those stated as follows:

(1) Identification of stakeholders;

(2) Conduct a structured team interview;

(3) Observe the process;

(4) obtain copies of paper forms and tag them to a step;

(5) Get copies of the policies and procedures in place;

(6) Obtain a copy of the management and control reports;

(7) Present findings to the stakeholders.

The following illustration identifies key stakeholders, key EMR capabilities, and the systems that support and interact with EMR.

Figure 3

IT infrastructure, telephony and internet access are reported as "just some of the resources in which companies invest large amounts of money but only use by 10% to 45%. his low utilization rate of resources, coupled with the unperceived duplication of these, significantly increases operating costs (OPEX), which imposes a heavy burden on businesses." (Panotech, 2012) Panotech protect will protect the organization's IT system through its unique infrastructure design and development for the residential care facility that will be "cost-effective, scalable, and manageable." (Panotech, 2012) Panotech provides IT management and maintenance services as well as disaster recovery services.

Part Two

I. Process for Request for Proposal for System Chosen and Reason for Selection

The process chosen for request for proposal for the chosen system and the reason for selection involves a comparison of the vendors who offer EHR/EMR systems. The facility is currently using an electronic patient care charting system, a physician ordering system, and a pharmacy ordering system. The following objectives are recommended:

(1) Creation of a mission statement for implementation of full EHR

(2) Project management team development and implementation.

(3) Key stakeholder involvement from each user group to inform IT.

(4) Make certain executive management and ongoing support for the project exists;

(5) Selection of vendor;

(6) Written benchmarks to measure success and in testing effectiveness.

Necessary as well is demonstrating to early adopters how success has been realized through the use of EHR. Also important is the integration of a wish list in the discussions on functionality and introduction of new product releases. Partial implementation of EHR has occurred at the residential facility and there is an expectation for resistance in the creation, adoption, and implantation of the full EHR system. It will be of key importance that current employees are surveyed concerning their feelings in regards to implementation of a full EHR system in the residential care facility. The survey has been constructed and includes the following stated questions:

In an effort to prepare the residential care facility for implementation of the electronic health care records and an interoperable system of electronic health records, the team has prepared a readiness assessment to identify questions that need to be answered as strategies are developed for appropriate implementation appropriate. The assessment tool is used for the purpose of gathering data that the implementation will use throughout the implementation process to ensure the successful roll out of the EHR.

Readiness Assessment

Question

What is the most positive aspect of the system in your opinion?

Question

How do you perceive the system will affect your work/responsibilities?

Question

What are your primary concerns about the new system in terms of your use of the system?

Question

Please state two methods that can be used to reduce your concerns about use of the system?

IV. Business Case for Implementation of the New System and Strategy for Choice of Vendor

The strategy used for the choice of vendor for the EHR system involves a comparison of vendors that provide such systems. There was an extensive list of vendors compared with the top chosen being those listed as follows which make provision of electronic health record solutions for the health care industry which have been screed for the their system's capacity for interfacing with other systems and solutions:

(1) Vendor: Netsmart Technologies

Website Address: www.ntst.com

Solution: Avatar, Social Services Data Management

Overview: This system makes offerings of a full range of health solutions and a comprehensive practice management system. Avatar PM, case management, Avatar CWS, and industry leading EHR management solutions. Benefits of this system including the reduction of budgets and staffing and automation of clinical processes, compliance with emerging electronic health record (EHR) requirements; flexible, next-generation financial, clinical and management systems including electronic medical billing; Interest in applications to support caseworkers in mobile, disconnected settings; Desire for data analysis, reporting and benchmarking.

(2) Vendor: Defran Systems

Website Address: www.defran.com

Solution: Evolv-CS

Overview: EVOLV-CS is a completely integrated Electronic Health/Medical Record (EHR/EMR) and AR/AP sub-ledger system. Included are case and clinical management tools that are of an advanced nature as well as reporting and billing features and supports. Included in benefits are automation of administrative tasks, revenue increases, cash flow improvement, and data entry and paperwork reduction.

Core Features of the System:

Referral Processing & Intake

Client Information & Record Management

Assessments & Treatment Planning

Service Delivery & Productivity Aids

Quality Improvement & Outcomes Management

Resource Family & Facility Management

Comprehensive & Integrated AR / AP Management

Extensive Reporting Solutions

Front Desk Scheduling and Resource Management

(3) Vendor: REHAB-EMR

Website Address: www.rehab-emr.com

Solution: REHAB-EMR

Overview: This is patient-centered software that specializes in paperless charting and documentation for physical and occupational therapists in outpatient rehabilitation clinics, skilled nursing homes, sub-acute rehab centers, and hospitals. Benefits of the system include enhanced Productivity, Reduced Overhead Costs, Improved Patient Care, Clinical Documentation At Point-of-Care, Intuitive System Workflow, Automated Coding and Compliance, More Effective Management, Customizable Functionality, Lower Cost of Ownership, Enhanced Analytics

Features: An innovative therapy documentation system designed for physical and occupational therapists and their administrators, web-based system designed to use internet/intranet technology. Access to the system is through a standard Web browser and supports a wide array of hardware platforms, including wireless Tablet PC's and Laptops, Linux, SQL-based

(4) Vendor: SourceMedical

Website Address: http://sourcemed.net/

Solution: TherapySource

Overview: TherapySource is a therapy practice management software solution, delivering comprehensive functionality and is used by the majority of all large PT chains in the U.S. TherapySource is a scalable solution for small clinics and built to streamline and automate clinical and financial processes, including EMR, scheduling, registration, clinical documentation, billing, revenue cycle management and more. TherapySource physical therapy software is ideal for clinics looking for software that can grow with them. Benefits include the system being built to handle multiple sites across the enterprise, TherapySource is the practice management solution for large chain clinics in America. Whether you own 2 or 2000 clinics, TherapySource is the most scalable, comprehensive practice management system in the industry. TherapySource has a built in EMR featuring a unique knowledge base designed by top rehab professionals in the industry. TherapySource is the best business partner for managing scheduling, registration, clinical documentation, billing, revenue cycle management... And much more.

Major Features: Reporting and Clinical Documentation; Scheduling and Clinical Documentation; Coding, Billing & Collections

(5) Vendor: Optimus EMR, Inc.

Website Address: www.optimusemr.com

Solution: Opitmus EMR, C.N.A. Kiosk or PDA Point of Care Module

Overview: The Icon-based CAN Charting Module is engineered with total software automation. Primary features include:

The Optimus C.N.A. icon-based charting module allows C.N.A.s to document or observe all of the following:

ADLS, Mood and Behaviors;

Continence (Bowel and Bladder);

Vitals,

Intake and Output,

Meals;

Care Plan Driven C.N.A. Task Lists;

Resident Messages entered by Facility Nursing Management;

Clinical Alerts generated by the OEMR Alerts; Dashboard;

esident Complaints;

Restraints;

Restorative Nursing Assistants and Restorative Therapy documentation; and Therapists minutes.

The following chart lists the various systems compared along with the system's architecture, language, payment methodology and website address.

Figure 4 - Systems Compared

Company Name

Software Name

Architecture

Language

Payment Methodology

Website

Altos Solutions, Inc.

OncoEMR, oncology-specific EMR

Web-based or Client-hosted

Annual Subscription for MDs & Extenders, all others free http://www.altossolutions.com/

BetterHealth Global (USA), Inc.

BETTERHEALTH record

Client-Server and web based

Delphi

Monthly per Provider or One time plus annual maintenance http://www.bhgusa.com/

DoctorsPartner

DoctorsPartner

Client-Server (web based)

ASP

Monthly per Provider

http://www.emr-electronicmedicalrecords.com/

Intuitive Medical Software

UroChart EMR

SAAS and Client-Server

C#

SAAS - Monthly per Provider

Client-Server - One time with annual maintenance http://www.intuitivemedical.com/

MedbaseInc

Medbase

LAN server or web-based your choice

MS Visual Fox c++ Adobe

No monthly fees one time http://www.medbaseinc.com.com/

MDoffice

MDoffice

LAN & web based

Delphi SQL Server

licensed or subscription http://www.mdoffice.com/

Medical Voice Products, Inc.

MPS

LAN

.Net

One time plus annual maintenance http://www.medicalvoiceproducts.com/

Medicat

Medicat

Client-Server

Visual Basic

One time plus annual maintenance http://www.medicat.com / meridianEMR

meridianEMR

"Blended" SAAS and Client-Server

Java

One time plus annual maintenance http://www.meridianemr.com/

NexTech Practice

NexEMR

Client-Server

Native C++, Transact-SQL

One time plus annual maintenance and technical support http://www.nextech.com/

Patient Now

Medical Records Suite

Client-Server

C##

24 months http://www.patientnow.com/

PracticeFusion

Practice Fusion EMR

SAAS

C# .NET & Adobe Flex

Free (ad supported) or $100 per provider per month (no ads)

http://www.practicefusion.com/

Sevocity

Sevocity EHR

SAAS

Java

Monthly per Provider

http://www.sevocity.com/

Company Name

Software Name

Architecture

Language

Payment Methodology

Website

SSIMED

SSIMED EMRge

Client Server/Hosted

.Net

One time plus support http://www.ssimed.com/

STI Computer Services

ChartMaker Medical Suite

Client Server

C++ and C# .Net

One time plus annual maintenance http://www.sticomputer.com/

TECNEX Systems LLC

TECNEX POMS

Client-Server

C#

One time plus annual maintenance http://www.clinicbusinesspartner.com/

Webahn, Inc.

Capzule

Web-based / iPhone

Java

Monthly (starting at $50)

http://www.capzule.com/

WebDMEMR

WebDMEMR

Web Based

ASP.NET

Monthly per visit, user and disk space http://www.webdmemr.com/

The system chosen is that of the Practice Fusion EMR system which includes the iPad EHR, Web-based EHR, EHR Drawing, Patient Portal, e-Prescribing, Lab Integration, EHR Interoperability and Medical Charting. The reasons for this choice include the integration of the system and its ability to operate with other already in use systems and the low cost for implementation of this IT solution.

III. Timeline for Planning Process

The timeline for the planning process includes the following segments:

Development -- 6 months

Implementation -- 3 months

Roll-out and assessing -- 3 months

V. Chart of Key Stakeholders and Pros and Cons

Types of change that are encountered in the implantation of the EHR system include the following types of changes and their accompany characteristics:

(1) Operational: changes in the methods of the ongoing operations of the conduction of business and automation in specific areas;

(2) strategic changes in the business direction;

(3) Cultural changes in the basic philosophy of the organization and the conduction of business;

(4) Political changes due to changes in staffing.

There are various personalities that emerge during organizational change that must be dealt with including the following personalities:

(1) The Initiator -- this personality perceives the challenge or opportunity and conceptualizes the change that needs to be made in response to these challenges or opportunities;

(2) The Approver -- this personality is a power figure in the organization that supports the change, which has been proposed;

(3) The Leader -- this personality is a visible and enthusiastic supporter of change who works in rallying support for the change in who provides maintenance for that support.

(4) The Facilitator -- this personality assists in making the organizational change process smooth and is generally involved from the beginning of the change.

(5) The Developer -- this personality takes responsibility for the technical aspects of the organizational change.

(6) The Installer -- this personality holds responsibility for change implementation including the needed training and support activities;

(7) The Doer -- this personality has to perform their work in the changed environment;

(8) The Obstructionist -- this person guards the status quo and is against the change;

(9) The Customer -- does not view that they will be impacted immediately by the change and observes the change with interest; and (10) The Ignorer -- views the change as having no personal impact and is indifferent to the change.

The following tables lists the stakeholders and members of the project.

Figure 4 -- Stakeholders and Project Members

Group

Job Title

Major Project Roles & Responsibilities

Executive

CEO / President

Participate in developing Mission Statement

Support Project

Identify & Help to Resolve Obstacles to Implementation

Executive

Nurse Executive

Participate in developing Mission Statement

Support Project

Identify & Help to Resolve Obstacles to Implementation

Identify Budget & Restraints

Approve Project Plan

Certify Vendor Selection

Certify Vendor Solution

Support Go-Live

IT

Manager

Facilitate Project Plan

Serve as liaison between stakeholder groups

Participate in vendor selection

Primary contact with vendor

IT

IT Operations Manager

Perform acceptance testing

IT

Operations

Provide requirements for operations

Perform operational testing (e.g. server loads, etc.)

Departmental Groups

Project Manager

Work with IT Project Manager for departmental deliverables

Departmental Groups

Business Analyst / Informatician

Define business processes & requirements

Participate in acceptance testing

Participate in training plan development & execution

Participate in vendor selection

Departmental Groups

Advanced User / IT Leaders

Contribute business processes & requirements

Participate in training plan development & execution

Departmental Groups

Physicians

Approve project plan schedule

Participate in training plan development

Departmental Groups

Nurses

Participate in training

Part Three

I. Infrastructure Roadmap for Project and Budget

Funds for the EHR system implementation are divided between ongoing and upfront costs. The majority of the costs of implementation will be in the area of personnel costs. The implementation of the electronic health record (EHR) system makes requirement of budgeting for the following:

Upfront Purchase and Licenses & Maintenance or Subscription Fees for Web-Based Solutions

Implementation Costs including Personnel Training & Overheard including lost time for training

Implementation Costs: includes gathering of requirements and acceptance testing.

Implementation Costs: including redundant costs that ensure a working and tested process is in place with simultaneous assessment testing, raining and roll-out.

The budget must account as well for the subscription plan needs, which include the internet connection fees for the web-based solution.

Recommendations include the development of a comprehensive policy with standardized procedures that make provision of patient confidentiality and data security. The policy must incorporate the HIPAA framework and provisions for the following:

(1) Provision to patient of a list of what is known about them and who knows this information;

(2) Provision to patients of the reasons and purpose for the collection, storage and utilization of the information;

(3) Provision of assurance to patients that the data is being collected only for the reasons and purposes stated;

(4) Provision to patients of the ability to consent as to the collection, use, application and dissemination of their information as well as destruction of the information;

(5) Provision to patient of the capacity to control access to their information;

(6) Provision to patient of the ability to request copies of their information and the capacity to change, correct, modify or update their information;

(7) Provision to patient of assurances that their information is stored in a private and secure manner;

(8) Provision to patient of assurances that their information can only be viewed by those with the rights and permissions to view their information;

(9) Provision to patients of a method of auditing the accountability of the policies and procedures; and (10) Provision to patients with recovery plan should their information somehow be compromised.

The collection, storage, access, modification and reporting procedures on the personal health data of patients should be inclusive of general information security measures and permissions, including encrypted data and secure passwords.

The necessary steps to assess resistance to change in the organization are listed in the following illustration labeled Figure 5 in this study.

Figure 5 -- Identification of Types of Resistance

Practice Fusion, which is a fully integrated solution will make provision of interoperability between each electronic health record system for the various residential care facility departments.

EHR system department and the integration of each will follow a simultaneous project plan and will operate under the same milestone schedule.

Proposed Project Start Date: July 1, 2012

Proposed Project End Date: July 1, 2013