Practice Fusion EHR implementation at a residential care facility

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.

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

Proposed Project Duration: One Year

Quality, confidentiality, and security will be feature-rich, cost-effective and to include the core competencies as follows:

(1) Application User Interface;

(2) Interoperability & Integration based on Standard Messaging

Included in the EHR system will be graphical user interfaces and web-based applications.

The EHR system implantation will include provisions for the secure storage of data ensuring that data does not become compromised or published inadvertently. Data integrity will be a provision of the system ensuring that only necessary data is collected and provided. The system provisions include data integrity ensuring that only authorized users are able to access the data and providing for proper dissemination of the data across the organization.

II. Specifics on Additional Personnel Needed for Implementation and Maintenance of System

Additional personnel needed for implementation of the system includes an IT Operations Manager and Team. The EHR Practice Fusion system is fully designed for interoperability with other systems in the health care setting.

Part Four

I. Implementation Plan Inclusive of Stages for Technical Infrastructure

Stages of the implementation plan include the discussion and communication stage followed by the planning and development stage, assessment of needs and support, training and installation, testing and monitoring followed by roll-out of the plan in July 2013.

II. Training of Personnel

Personnel will be trained by Panotech technicians on use of the system.

III. Roll-out Timing

Because of the nature of the Practice Fusion system, the system will be rolled out with assistance from Panotech technicians. Roll-out is to occur 1 July 2013.

IV. Trouble-shooting Support

The deliverables for the EHR system implementation are system requirements from management, clinical and operational staffs including the development, testing and certification of those requirements as well s the installation and ongoing maintenance of the system. The requirements will be collected and summarized through use of application development tools, information and proposals will be collected from vendors and automated through use of electronic bid management through the purchasing division. Project management tools can be used to assess the system's implementation. Training will be provided through computer-based training tools. EHR system deliverables include the following:

(1) health record system integration;

(2) interoperability;

(3) graphical presentation via web-based applications;

(4) online reporting and querying audits in a secure and restricted environment.

The IT Management team will be responsible for developing and maintaining a security monitoring and security breach response team. The management team will be responsible for the development and maintenance of standard quality check reports in compliance with the security policies and procedures as well as being responsible for requesting that the vendor make provision of tools for testing the system making sure the right information is collected in the right locations at the right time. A quality assurance team is responsible for periodic testing of the system, which includes testing for accuracy in the system's processes, application and output. After implementation of the EHR system there should be quality checks performed on the following schedule:

30 day check

60 day check

90 day check

These measures for accuracy should be enacted and should includes questionnaires for end users, which are used in the quantitative rate the system. A forum for suggestions and for sharing knowledge should be provided which will enable feedback. There should be logging of improvements that are suggested, errors that are unexpected and user experiences that are satisfactory.

. It is crucial to follow-up with end-users and to ensure their needs and suggestions are listened to and a resolution is provided to the end-user. This helps to ensure cooperation for future endeavors and respect for the implementation and operational teams.

V. Expected Outcomes

The following future benefits map shows the expected outcomes of the EHR system.

Figure 6 -- Expected Outcomes

Current Current Improvement Future Outcomes

Pain Points Challenges Opportunity

Too much time No sense of urgency automation of manual Project implemented quicker

In maintenance for change support tasks work

Customer satisfaction is low.

There are various stages required in realization of future benefits and that includes working through the present difficulties and current obstacles as well as accessing opportunities for improvement all of which will result in the realization of future benefit of the EHR system.

Costs of Practice Fusion System Development, Implementation, and Roll-Out

The initial cost for the Practice Fusion applications costs $100.00 per month per physician. The additional support and training features are not stated on the Panotech website but can be estimated at 200.00 per month. The addition of employees will cost the organization 1600.00 per month for two IT employees to be hired.

Conclusion

This document has related the choice of the Practice Fusion electronic health record (EHR) along with the various planning and design needs as well as the process for training, communication, assessment, monitoring, service and maintenance, and the final roll-out of the system in one year's time. The Practice Fusion EHR will serve to integrate all the processes of the residential care facility and to streamline the operations of the facility. The system can be used for charting, ordering or tests, prescribing medications, location of patients, and keeping of health records across all departments of the residential care facility. The system is relatively simple to install and use and training will be provided by Panotech, the vendor for Practice Fusion.