EHR Implementation Plan Presentation

Community Health Connections

Electronic Health Records (EHR)

Implementation

Individual Role

David Montanez Project Manager

Luis Perez Clinical Analyst

Keri Vogtmann Project Manager

Sarah Leake Clinical Analyst

Lynda Flower Clinical Analyst

Elizabeth Wellner PMS & Billing Analyst

Warren Goldberg Risk, Regulation & Stakeholder Analysis

Carmen Matthews Training Specialist

DeEtte Trubey Project Manager

Mona Naoum Project Coordinator

Ann Winclair Graphics Designer

Panel 1 – Introduction

Implementación del Sistéma de Records Médico ElectrónicoImplementing EHR

Beneficios en la implementación del EHR Los costos administrativos generales pueden

reducirse, Los errores de datos puede reducirse, y Los resultados adversos pueden ser más

rápidamente identificados

CHC Story

Founded 30 years Federally Qualified Health Center

3 Clinics Providing Adult Medicine, Women’s Health, Mental Health

& Pediatric services Mobile clinic for school programs

Laboratory (LAB), Pharmacy (PHM) & Radiology (RAD) at the 3 clinics

$1.6 million grant to implement & EHR & meet MU

EHR Benefits

Decreased charting/prescribing errors Improved work-flow

Immediate access to Radiology Lab results Patient charts

More satisfying work conditions for our employees

Freeing up space now used to store charts

Central Clinic Layout

West/East Clinic Layout

Scope & Deliverables

Develop Plan to install EHR System Must meet meaningful use Capable of information exchange with National Health

Information Network (NHIN) Use OpenVista

Realistic plan ready for review on 3/25/2010 Final Deliverables

Detailed Implementation Plan with narrative & supporting documents

Presentation of Implementation Plan for the Review Committee

Critical Success Factors

Full C-suite support Clinical champion - Chief Medical Officer will lead

the Implementation project EHR is a clinical project Organization is stable with quality improvement in

place We will achieve a positive return on investment in

an EHR

Assumptions & Constraints

Implementation project to begin March 30, 2010, clinic-by-clinic, using Plan Do Study Act (PDSA) process, & completed by February 2011

CHC is compliant with Federal & State regulations, including meaningful use

CONNECT Gateway will be used for patient access, Uniform Data System (UDS) reporting & updating the County Immunization Registry

Existing use of the Patient Electronic Care System (PECS) registry will migrate to the EHR

CHC has at least 30% patient volume enrolled in the Medicaid program

A train the trainer approach will be used to minimize vendor-related expenses

Individual Role

Keri Vogtmann Project Manager Process

Kal Shenoy Project Manager Hardware

David Montanez Project Manager Software

Ann Winclair Graphics Designer

Project Management Office

Process Team

Individual Role

Jean Frazier Clinical Analyst

Regina Pizarro Practice Management System (PMS) & Billing Analyst

Carmen Valladolid Meaningful Use Analyst

Elizabeth Wellner Practice Management System (PMS) & Billing Analyst

Linda Flower Clinical Analyst

Eric Smith User Acceptance Testing (UAT) Analyst

Hardware Team

Individual Role

Kal Shenoy Project Manager

Chris Vu System Engineer

Michael Tegardine Network Engineer

Josie Aguinaldo Security Administrator

Ben de Rosales Jr. Software Engineer

Thomas Hoffman Service Desk Manager

Victor Cecena Desktop Manager

Software Team

Individual Role

Sheldon Penner Software/Database Engineer

Ras Desimone Software/Database Engineer

Laurelle Palmer Software/Database Engineer

Nga Anamosa Engineer Senior Analyst

Jacqueline A. Harris Process Analyst

Stakeholders

Management Board, Steering committee, Chief Medical Officer

Implementation team PM, Application & clinical specialist, process analysts & Consultants

IT Team Integration Architect, DB, Networking, System Admin, Application

Development Functional Departments

Clinical Team, Billing, Training, Medical records, quality, Pharmacy, Radiology & Libratory departments

External Patients, insurance companies, community volunteers, media,

Medsphere, government agencies; HHS, NHIN…..

Communication Plan

Purpose Vision What could happen Communication Methods

Communication Plan - Accountability

Type of Communication Responsible Stakeholder Communication Method

Community Clinic Marketing & Information Meaningful Use Compliance & PromotionPatient Care Improvement

Public Relations EmailWebsiteNewsletterPublic Service AnnouncementsGovernment Agencies

Communicating Key Project StatusAssuring Support for ProjectCompliance & RegulationsPress ReleasesIncentive & Recognition Programs

C Suite/Senior Management EmailAll-hands MeetingGovernment Agency Conferences

Project Status & ScheduleMaintain Organization Chart & ResponsibilitiesProject Milestones (Go/No Go)Issues & Resolutions

Project Manager EmailMeetingsProject Website

Implementation Advocate Healthcare Rules, PoliciesClinical Information

Clinicians EmailMeetingsVerbal communication

ComplianceRegulatory Level

Name Legal & Regulatory Requirements Description

Federal HIPAA Health Insurance Portability & Accountability Act of 1996 Privacy Rule & Security Rule

Federal PSQIA Patient Safety & Quality Improvement Act of 2005 Patient Safety Rule

Federal ARRA American Recovery & Reinvestment Act of 2009 Meaningful Use Reimbursement

Federal HITECH Health Information Technology for Economic & Clinical Health Act

Initial Set of Standards & Certification Criteria Interim Final RuleHHS Authority & Breach Notification Interim Final RuleCertification Programs – Notice of Proposed Rule (NPRM)State Health Information Exchange Cooperative Agreement ProgramHealth Information Technology Extension Program

Federal CFR Code of Federal Regulations Title 42 – Public Health Federal Office for Human Research Protections (OHRP) Compliance Oversight

State CCR California Code of Regulations Title 16, Title 17, & Title 22State CHSC California Health & Safety Code Access Laws on Health & Safety Regulations for

Health Facilities & Medical Services

National JC Joint Commission of 2004 Documentation & Medical Record Requirements

Federal FRCP Federal Rules of Civil Procedure Federal Rules of Admissibility & Electronic Discovery Civil Rule - 2006

State COAL California Office on Administration Law Additional Discovery Rules for Legal Records, both Paper & Electronic

Regulations CMS - Security/HIPAA

Strong organization culture of security: Documented processes to protect ePHI

Confidentiality, availability, integrity Training

All individuals are personally responsible with severe penalties

Roll-out, new hire training, refresher training Real-life case discussions in monthly department

meetings Top management priority

Talked about often Known organizational auditing

Security Standards

Administrative Security Officer ultimate responsibility Risk Analysis required Roles & privileges process including termination Business relationships

Physical Facility controls Media access Workstation access

Technical Audits Access control Transmission, firewall, virus security Remote access

Risk Analysis

Methodology

Full analysis in Implementation Plan

Higher Risk Areas Poor adoption rates Process improvements required Inappropriately used ePHI data Disaster recovery plans

Threat Prob Impact Plan Adequacy

1 Low Med > Plan 1

2 Med High > Plan 2

Current System State

Future System State

Medsphere OpenVista

EHR Software: OpenVista Leverage billions of dollars of VA software development Open source fosters software enhancements Close relationship with government officials for

meaningful use Local company resources Medshpere management understands “open source“

Track Record Hundreds of reference sites including ambulatory sites Proven & quick Stage 6 implementations

Implementation Schedule

Panel 2 - Workflow

Individual Role

Jean Frazier Clinical Analyst

Elizabeth Wellner PMS & Billing Analyst

Regina Pazarro PMS & Billing Analyst

Process Workflow

PatientRegistration

& Scheduling

PatientCare

&Health

Records

Billing&

Payment

Clinical Decision Support Tools

ORDER SET

• Improve patient safety

• Improve quality of care

• Identify drug-drug interactions

• Identify drug allergies

• Increase patient compliance

• Improve patient self-care

• Meet Meaningful Use

Clinical Decision Support Tools

Templates & Flowsheets

• Record & communicate care

• Create uniformity

• Ability to abstract data for research

Templates

• ADULT• Diabetes• Hypertension

• WOMEN• Initial History & Physical Exam• Trimester Assessments

• PEDIATRICS• Preventive Health• Upper Respiratory Infection

• ADULT• Asthma• Obesity

• WOMEN• Prenatal: blood pressure,

fetal heart tones, etc.• Preventive Care

• PEDIATRICS• Age-Specific: body

measurements, immunizations, developmental milestones

Flowsheets

• Increased patient satisfaction

• Timely access to current:• Medications• Lab results• Patient education

materials

• Email correspondence with physician

• Appointment requests

• Prescription refill requests

Patient Portal

• Modify post-EHR workflow as needed after go-live

• EHR clinical team• Learn the application• Assess what the system

lacks for our needs• Create gap analysis

Next Steps

• QUALITY ASSURANCE TEAM Metrics to track best practice protocols & business practices

• Practice protocols• Meeting hemoglobin A1C goals for

diabetics• Peak flows for asthmatics• Blood pressure control for hypertensive

patients

• Business practices• Patient wait times• Percentage of physician CPOE utilization

• Meet Meaningful Use criteria

Next Steps

CONTINUE RAND HEALTH’S

PATIENT SATISFACTION

QUESTIONNAIRE

18 questions completed after visit

• Paper option• New online kiosk option

Next Steps

Financial Process/Workflow

Front & Back Office Workflow Coordination Interoperability / Coding & Billing Integration Documentation Payer-specific Requirements

Processes E&M Calculator at point of care Data flow from system to system

PMS is utilized. - PSR schedules an appoint. - Demographics & Insurance info input into PMS

PSR performs tasks in PMS:- Convert master ID to a patient Medical record #.- Updates, Collects Deposit/Co-Pay & payer information. Posts in PMS- Scans ID & insurance card.

Patient is processed as per Adult patient Work-flow sheet.

Billing Workflow& Medical Records/Abstracting

Workflow - with EHRPractice Management System (PMS) in Place

• EOB scrutinized & if necessary chart is electronically pulled, notes sent

electronically. Bill resubmitted or adjustedBill reconciled A/R adjusted.

Completes & confirms all provider orders then

Flags orders as completed in EHR

Bill paid?

Patient checks in with PSR to verify Insurance or self-pay.If Self pay referred to social workers, etc. for Financial assistance.

Using CPOE : - Orders & procedures are entered for auto processing into PMS - E&M calculator suggests OV level

Chart reviewed foraccuracy of codes &

Documentation.

Toward end of Patient encounter.

Review & approvesAbstracted &

Scanned itemsSigns off paper chart

Chart sent to Medical Records

Code for billing & diagnosis from the PIS, RIS & Pharmacy auto migrates to

- Bill generated & checked for accuracy - Electronically submitted to insurance or patient

- List of Patients for next day is generated.

s Add Pt name to “To be scanned”

Worklog

MR abstractor locatesRecord, scans, &

abstracts for NEXT DAY Patients.

- Patient records verified complete/approved. - Chart sent to long term storage.

Abstracted Chart sent to PSR at

Clinic.

• PSR Logs into PMS to review daily schedule.

• EHR automatically populated with schedule information.

Data Migration Strategy

The Challenge Pre-populate the EHR

with useful data day 1

145,000 annualpatient visits

Over 30+ years to be scanned & abstracted

Data Migration Strategy

Solution for Existing Electronic Data Mirth Connect integration engine to develop channels

between old & new databases Automate on-going data transfers: Updates, additions &

deletions Solution for Paper Records

Pre-Rollout: Migrate records of patients most likely to be seen soon

Post-Rollout: Migrate records on a “go-forward” basis – patient who make appointments or appear at the clinic

Data Migration Table

TYPE SOURCE METHOD TIMEFRAMEDemographics PMS Bulk HL7 Interface CurrentAppointments PMS Bulk HL7 Interface FutureAllergies Face Sheet Abstract ActiveMedications Face Sheet Bulk HL7 Interface / Abstract CurrentProblems Face sheet, PMS Bulk HL7 Interface

AbstractActive

Medical, surgical, family & social History

Chart Abstract Current

Measurements Chart Abstract Last 3 visitsLab resultsOutside Lab Lab, Chart Bulk HL7 Interface Last yearInside Lab Chart Bulk HL7 Interface Last yearProcedures PMS, chart Bulk HL7 Interface

AbstractLast year

Therapies Chart Abstract Last yearHistory & Physical Chart Scan LastVaccinations Immunization Registry, Chart Bulk HL7 Interface

AbstractLast given (includes all categories) Lifetime for children.

Progress notes Chart Scan Last 3 visitsPreventive & Health Screening

Chart, Lab Abstract all.Scan any abnormalities

5 years

Referrals Chart Abstract Active, allGoals Chart Abstract Last yearAdvance Directive Chart Abstract/scan CurrentPatient Education Chart Abstract Last yearFlow sheets Chart Scan Last yearConsultation/correspondence Chart Scan Last year / Active

Panel 3 - Hardware Operation Environment

Individual Role

Kal Shenoy Project Manager

Chris Vu Hardware Engineer

Michael Tegardine Network Engineer

Josie Aguinaldo Security Administrator

Ben de Rosales Jr. Software Engineer

Victor Cecena Desktop Manager

Implementation Strategy

Current environment Network, Servers/Storage Applications, operations

Upgrade plans Upgraded technical architecture Fiber Ring network Thin client deployments

Technical Architecture

Fiber Ring Topology

Current T-1 connectivity Legacy copper connectivity at 1.544 MPS

Fiber Ring Topology Providers: AT&T & Cox communications Why Cox

Supporting Health Care providers Discussion of data/fact gathering with Sharp IT, & Family Health IT

Fiber connectivity redundancy Dual connectivity from each router to Fiber ring

Access & Security-High Level Patient/PHR-Web Portal IT support & Physician VPN & RSA/Token security

Server Hardware - Location & Features

Location Store in special server rooms, Central & East clinic (backup) Server Rooms Features

Secure entrance Temperature controlled Redundant Power w/ Spike & Surge protection Monitoring – cameras, sensors Qualified staffs

Server Hardware Features Intel Xeon processor – multiple processor RAID with hot swappable HD Redundant connections – multiple Ethernet / fiber ports Tape backup system

Server Software - Operating &Application

Windows server 2008/R2 Standard, business,data center

Features of server Operating Systems Robust – even during hardware failure Multiple security features including firewalls &

intrusion detection Remote administration Extensive audit trail

Special features of application servers & database Cache Clustering Virtualization (VMware) for development, demo,

training, & QA Terminal services

Failover Clustering

Key Benefits Protects against data loss

& service interruptions Automates failover to reduced

downtime, lower complexity of disaster recovery plan

Reduces administrative overhead by automatically synchronize application & cluster changes, easier tokeep consistent than unclustered servers

Updating server without service interruption

Multi-site Clustering

Key Benefits Protects against loss of an entire

datacenter such as power outage, fire, hurricanes, floods, earthquakes, terrorisms

Automates failover to reduced downtime, lower complexity of disaster recovery plan

Reduces administrative overheadby automatically synchronize application & cluster changes, easier to keep consistent than unclustered servers

Updating server without service interruption

Terminal Services Benefits

Windows Server 2008/R2 Terminal Services gateway enables the creation of a scalable SSL-based remote

access solution Terminal Services Session Broker enable the creation of simple & effective Load-

balancing a terminal server farm

Software Installation

Environments Non-production

Development Quality Assurance (QA)/Test User Acceptance Testing (UAT) Demonstration Training

Production

Infrastructure - Security & Privacy

Password policy enhancements SSL Configuration Client Side certificates Audit Control Data Integrity HIPAA Compliant VPN Access – Two Factor Authentication

(RSA Token)

Remote Access

Provider can access EMR using VPNover the Internet

Workstation & Peripherals

Thin Client Stations Work Stations Laptops Monitors Carts Printers All-in-Ones Peripherals

Computer Operations

Service Support Service Desk

Incident Management Client Surveys

Service Delivery Service Level Management

Service Level Agreements Production Review Board

Panel 4 - Software Aspects

Individual Role

Ras Desimone Software/Database Engineer

Jacqueline A. Harris Process Analyst

Kal Shenoy Project Manager (Hardware)

Current System State

Future System State

Current Data Flow State

Future Data Flow State

OpenVista

Install OpenVista & InterSystems Cache Convert & migrate sample patient

data from PMS to OpenVista Support clinical team in system configuration

tasks Test activated features of OpenVista

& interface connections Test Health Information Exchange (HIE)

connections...

InterSystems Cache

OpenVista Database Selection

InterSystems Cache Proprietary software Extension of MUMPS Graphical User Interface

(GUI) interface Window, UNIX, Linux,

Mac OS X, & Open VMS server

High performance object database

Web gateways access to web browser interface

Rapid integration & development platform

GT.M Open Source MUMPS language MUMPS database Linux & Unix

operating system

OpenVista Database

Advantages/Features Benefits

24 x 7 support Provides high comfort level to high-risk businesses such as medical clinics

High performance - runs SQL 5x faster Uses multi-dimensional DB technology

Scalability Enterprise Cache Protocol increases app performance

VA uses it along with many other clinics & hospitals

Stable product, continuously supported & upgraded

On-line documentation & e-learning access Reduced cost to upgrade developer skills

Multidimensional storage, journaling mgt., lock mgt.

Tracks physical, logical DB updates; reduces conflicts between transactions trying to access same data

Tools to work with it exist Supports Java, EJB, VB, .Net, etc.

InterSystems Cache

Interoperability - Mirth & NHIN CONNECT

Add OpenVista outbound & inbound channels Admit, Discharge, Transfer, Scheduling, Financial Transaction

Create new inbound & outbound channels for Order Messages (ORM) & Order Results (ORU)

Create new outbound channel to National Health Information Network (NHIN) CONNECT Gateway

Create inbound & outbound Continuity of Care Record (CCR) & Continuity of Care Document (CCD)

Install Cache Java Database Driver for the Mirth database reader

Configure NHIN gateway connector in Mirth Test & deploy changes

Software Development

Implement Rapid Prototyping Fits well into PDSA philosophy

Application Lifecycle Management Microsoft Team Foundation Server 2010

OpenVista Patient Portal

Configuration Management

Framework Identification Control Reporting Audit

Benefits of Configuration Management Legal Obligations – Meaningful Use, HIPAA

Process & approach Software Configuration Management Team Foundation Server 2010 Configuration Management Database Definitive Media Library

Configuration Management

Manage changes to all Configuration Items in Production

Server & network components, Software programs, Signed contract documents, etc.

Downtime Procedures

GOAL CHC clinics remain operational during planned or

unplanned events Plan is created/approved by internal committee

METHOD Use approved paper methods to maintain workflow

during downtime All paper records must be “back-chartered” into

the electronic record in a timely fashion BOTTOM LINE

Ensure downtime episode does not pose a threat to patient safety & integrity of clinical practice

Panel 5 - UAT, Training & Go Live

Individual Role

Eric Smith UAT Analyst

User Acceptance Testing (UAT)

Failure to conduct UAT will result in finding more problems after release.

UAT should confirm whether the software supports the existing business process, not whether or not the software works.

UAT will compare user expectation to actual results very early in the implementation.

User requirements that evolve during UAT will be part of the post-EHR implementation.

Key: Super-Users acceptance will influence community acceptance of the EHR.

Steps for UAT Run Test Cases Mock-go Live Super-Users sign-off , Go-No Date(readiness for go-live)

Training

Purpose (Why) Who, What, Where, How Effectiveness Afterwards – What’s Next

Training V1

Training V2

Project Monitoring & Control

Data to be collected & reviewed during the implementation Meaningful Use Financial Return on Investment Quality Measures Compliance Patient Satisfaction Surveys

Post Implementation Review Outstanding Issues Maintenance & Support

Panel 6 - Financial Impact

Individual Role

Carmen Valladolid Meaningful Use Analyst

Meaningful Use

Maximum Incentive Payment Amount for Medicaid Professionals

Cap on Net Average Allowable Costs, per the HITECH Act

85% Allowed for Eligible Professionals

Maximum Cumulative Incentive Over 6 - Year Period

$25,000 in Year 1 for most professionals$21,250

$10,000 in Years 2-6 for most professionals$8,500 $63,750

$16,667 in Year 1 for pediatricians with a minimum 20% patient volume, but less than 30% patient volume, Medicaid patients

$14,167

$6,667 in Years 2-6 for most professionals pediatricians with a minimum 20% patient volume, but less than 30% patient volume, Medicaid patients

$5,667 $42,500

Meaningful Use

Payment Scenarios for Medicaid EPs Who Begin Adoption in the First Year

Calendar Year Medicaid EPs who Begin Adoption in:

2011 2012 2013 2014 2015 2016

2011 $21,250

2012 $8,500 $21,250

2013 $8,500 $8,500 $21,250

2014 $8,500 $8,500 $8,500 $21,250

2015 $8,500 $8,500 $8,500 $8,500 $21,250

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

2017 $8,500 $8,500 $8,500 $8,500 $8,500

2018 $8,500 $8,500 $8,500 $8,500

2019 $8,500 $8,500 $8,500

2020 $8,500 $8,500

2021 $8,500

Total$63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Unpacking the “Meaningful Use” Requirements

Major Components of Meaningful Use Proposed Rule & Recommendations

Adoption Year Improve Quality, Safety & Efficiency

Engage Patients & Families

Improve Care Coordination

Improve Population & Public Health

Ensure Privacy & Security for PHI

Stage 1 (2011) Achieve 80% CPOE

75% electronic submission of eRx

Implement 5 clinical decision support rules

Report quality measures to CMS/State

Digitally Record Key patient data

Provide Patients with electronic copy & access to health information within mandated time

Provide clinical summaries for each office visit

Exchange key clinical information among authorized care providers

Perform medication reconciliation for 80% of all relevant encounters, transitions

Submit data to immunization registries

Provide electronic syndrome surveillance data

Exchange key clinical information among authorized care providers

Perform medication reconciliations for 80% of relevant care encounters, transitions

Stage 2 (2013) Use CPOE for all orders

Manage chronic conditions using patient lists & decision support

Provide clinical decision support at the point or care (e.g. alerts, reminders)

Ensure patient access to PHR populated with real time health data

Produce & share electronic summary care record

Reconcile medications between settings

Receive health alerts from public health agencies

Submit anonymized electronic syndrome surveillance data

Ensure compliance with HIPAA privacy regulations

Conduct or review a security risk analysis & implement security updates

Stage 3 (2015) Establish medical device interoperability

Develop multimedia support

Implement clinical decision support for national high priority conditions

Provide self-management tools

Enable electronic reporting on care experience

Access comprehensive patient data from all available sources

Use epidemiologic data

Share automated, real-time surveillance data

Provide on-request accounting of treatment, payment & operations disclosure to patients

Meaningful Use Stage 1

Health Outcomes Policy Priority Objectives MetricsCollaborative Teams Throughout Meaningful Use Stages

Improve quality, safety efficiency & reduce health disparities.

(Objectives 1-16)

CPOE; Drug-drug Interaction; Active problem list; e-RX; Active medication/allergy list; Demographics/vital signs & smoking status, incorporate lab test results into EHR, Generate lists of patients by specific conditions, Report ambulatory quality measures; Patient Reminders; 5 clinical decision support rules; Check insurance eligibility & submit claims electronically.

Recording of structured data, Attestation, Generation of Reports, Electronic submission/transmittal, patient reminders

Required percentage measures:50%, 75%, 80%

Physician & Nursing Staff, Medical Records Staff, Application Support Analyst, QU/MU Specialist

Engage patients & families

(Objectives 17-19)

Provide patient with copy of electronic health information & clinical summaries within federally mandated time limit

Access provided via patient portal or printed copy. Perform test of systems capability.

Required percentage measures: 10% & 80%

Mandated timeframes: 48 hrs., 96 hrs.

Physician & Nursing Staff, Medical Records Staff.

Improve care coordination

(Objectives 20-22)

Electronically exchange key clinical information among providers of care & patient authorized entities.

Medication reconciliation.

Medication reconciliation, clinical information exchange performed.

Perform test of systems capability.

Required percentage measure 80%.

Physician & Nursing Staff, Medical Records Staff.

Improve population & public health

(Objectives 23-24)

Submit electronic to immunization registries; Provide & transmit electronic surveillance data to public health agencies.

Submit & transmit electronically to registries.

Physician & Nursing Staff, QA/MU specialist.

Ensure adequate privacy & security protection for PHI

(Objective 25)

Conduct & Review security risk analysis; Implement security updates as necessary; Ensure full compliance with HIPAA Privacy & Security Rules

Conduct or review security risk analysis & implement security updates as necessary.

IT Support/Security Officer

Progress to Meeting Criteria

Procurement Plan

Initial Understanding: HW, SW team needs Defined process Potential suppliers Budget for investment

Vendor Evaluation Scorecard

Criteria & weights Technology, quality, responsiveness, delivery, business, environment

RFQs Delivery without negatively impacting go-live

Tracking Spending & Performance

Expenditure

Excellence

Major Expenditures

Hardware Capital Expense = $330K Servers WAN SAN Fiber ring Thin clients High speed copiers

Software Capital Expense (1st year) = $ 73K Elite licensing (80 to 115 users increase over 6 years)

Timing

Go-LiveOct 2010

TrainingNov-Dec 2010

Savings from ImplementationMar 2011

MU paymentsMay 2011

Increased demandDuring Year 2012

Benefits

MU Medicaid incentives ($3.5M) One time incentive 2011-2016

Transcription savings ($29K/mo) Increased number of visits:

Labor efficiencies ($38K/mo) Word of mouth

Riddance of flow charts, superbills, H&Ps, etc.& other administrative costs ($5-10K/mo)

Reduction of labor costs ($18K/mo) Reduction of storage expenses

Cost Drivers

Anticipate loss of productivity during training& initial deployment period

Hardware $330K Software

$73K first year $444K over 6 years

Staffing $4M over 6 years

Staffing Assumptions

Temporary 2 Trainers 2 Hardware Engineer Contractors 1 Contractor – OpenVista 4 Abstractors Backfill – MDs, RNPs, Nurses

Permanent 1 Process Analyst 2 Technologists 1 Meaningful Use Specialist

Providers Overtime Costs PSRs during training

Cost Breakdown

Thousands

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

Staffing

Software

Hardware

Cost & Benefits

Benefits

NPV Analysis

MU 100% MU80%

MU 60%

8% $8.9M $8.7M $8.5M $8.2M

10% $7.8M $7.6M $7.4M $7.2M

12% $6.9M $6.7M $6.6M $6.4M

14% $6.1M $6.0M $5.8M $5.7M

16% $5.4M $5.3M $5.2M $5.1M

IRR 5.8% 5.5% 5.1% 4.7%

Cumulative Cash Flows

Millions

Cum. CF

What It’s All About

Additional Questions

Thank You

UCSD Extensions HIT Spring 2010 Class

Name/URL E-Mail

Josie Aguinaldo josie.aguinaldo@gmail.com

Nga Anamosa anamosa.nga170@gmail.com

Victor Cecena vcomptech@yahoo.com

Ras Desimone rassamy@gmail.com

Lynda Flower lflower96@gmail.com

Jean Frazier allaboutbirth@gmail.com

Warren Goldberg warrengoldberg1@gmail.com

Jackie Harris jacaharris@gmail.com

Thomas B. Hoffman hoffmantb@gmail.com

Sarah Leake sarah_leake@yahoo.com

Carmen Matthews vjudo@hotmail.com

David Montanez davidmontanez@san.rr.com

Mona Naoum monanaoum@aol.com

Laurelle Palmer laurelle_palmer@yahoo.com

UCSD Extensions HIT Spring 2010 Class

Name/URL E-Mail

Sheldon Penner sheldon@sheldonpenner.com

Luis Perez ne14emr@gmail.com

Regina Pizarro gpizo@yahoo.com

Ben de Rosales, Jr. ben.de.rosales.jr@gmail.com

Joel Salgado Jr. joelsalgado@gmail.com

Kallya Shenoy kgshenoy@pacbell.net

Eric Smith

Michael Tegardine mategar1@pacbell.net

DeEtte Trubey dtrubey@cox.net

Carmen Valladolid valladolid.carmen@gmail.com

Keri Vogtmann kubomann5@roadrunner.com

Thuan (Christopher) Vu thuandv@sbcglobal.net

Elizabeth Wellner ursa1major@hotmail.com

Ann Winclair awinclair@hotmail.com

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