EBR Labor PainsEBR Labor Pains

Donna CalabreseDonna Calabrese

Director, Office of Vital StatisticsDirector, Office of Vital Statistics

Center for Health & Environmental StatisticsCenter for Health & Environmental Statistics

Division of HealthDivision of Health

Kansas Department of Health & EnvironmentKansas Department of Health & Environment

Why Update our EBR?Why Update our EBR?

In 2000, we began discussing and planning In 2000, we began discussing and planning re-engineering our Vital Statistics system.re-engineering our Vital Statistics system.– Birth registration topped the listBirth registration topped the list

» Using an antiquated DOS based system Using an antiquated DOS based system

» Losing maintenance on outdated partsLosing maintenance on outdated parts

of the systemof the system

Re-engineering Begins Re-engineering Begins

Touched every facet of our electronic system:Touched every facet of our electronic system:– Registration of births, deaths, marriages, divorces, Registration of births, deaths, marriages, divorces,

ITOPsITOPs

– AmendmentsAmendments

– Point of sale accounting systemPoint of sale accounting system

– Certificate issuanceCertificate issuance

– Internal workflow system with queues and audit trailInternal workflow system with queues and audit trail

– Database conversionDatabase conversion

Incorporated certificate revisionIncorporated certificate revision

Pre-Labor PainsPre-Labor Pains

Completed Needs AssessmentCompleted Needs Assessment Appointed Steering CommitteeAppointed Steering Committee Updated existing FileNet Imaging SystemUpdated existing FileNet Imaging System Wrote RFPWrote RFP Contract awarded in mid-2003 to ManTechContract awarded in mid-2003 to ManTech

Contract Tips:Contract Tips: Ownership of MaterialsOwnership of Materials LiabilityLiability DefaultDefault Liquidated DamagesLiquidated Damages PaymentPayment

– Payment for all accepted deliverables not to exceed 50% of total Payment for all accepted deliverables not to exceed 50% of total Project payments and payment for all completed and accepted Project payments and payment for all completed and accepted phases not to exceed 50% or total project payments.phases not to exceed 50% or total project payments.

MaintenanceMaintenance– 24/7 use of web-based system24/7 use of web-based system

Do Your HomeworkDo Your Homework Know what you wantKnow what you want

– Conduct site visits to assess other state systemsConduct site visits to assess other state systems– Review NAPHSIS Use Cases and ArtifactsReview NAPHSIS Use Cases and Artifacts– Meet with key office and IT staffMeet with key office and IT staff

» Review all desired functionalityReview all desired functionality

– Provide every detail possible to the vendorProvide every detail possible to the vendor» Vendors do not know your business like you doVendors do not know your business like you do

Thoroughly read every design and data flow Thoroughly read every design and data flow documentdocument– These documents are used to verify processes and These documents are used to verify processes and

functions throughout the entire projectfunctions throughout the entire project» Avoid change ordersAvoid change orders

CommunicationCommunication Vendor Vendor

– JAD SessionsJAD Sessions– Conference CallsConference Calls– Individual Calls, E-MailIndividual Calls, E-Mail– Provision of hardware/software needs for external partnersProvision of hardware/software needs for external partners– Develop good rapport with agency IT Develop good rapport with agency IT

Hospitals/Birthing CentersHospitals/Birthing Centers– Sessions held re: certificate revisionSessions held re: certificate revision

» Requested feedbackRequested feedback» Provided information on web-based systemProvided information on web-based system

– Letters with hardware/software requirements for new systemLetters with hardware/software requirements for new system» Projected impact of effect on processingProjected impact of effect on processing

– Contact state medical boards, associationsContact state medical boards, associations» Articles in weekly, monthly publicationsArticles in weekly, monthly publications

Heavy Labor BeginsHeavy Labor Begins

Time commitment is criticalTime commitment is critical– Your own staff must be committedYour own staff must be committed

» Key staff with detailed knowledge of processes and Key staff with detailed knowledge of processes and functionsfunctions

A tremendous amount of time must be devoted to the re-A tremendous amount of time must be devoted to the re-engineering project – 60% of total time of key individuals.engineering project – 60% of total time of key individuals.

– Your agency IT must be committedYour agency IT must be committed» Responsive and knowledgeable of project Responsive and knowledgeable of project

– Your vendorYour vendor» Ask about resources committed to the project Ask about resources committed to the project

short and long term staff commitmentshort and long term staff commitment

Training & Pilot TestingTraining & Pilot Testing

Train the trainer sessions conducted by vendorTrain the trainer sessions conducted by vendor Training sessions for pilot hospitals conducted by our Training sessions for pilot hospitals conducted by our

staffstaff– Selected 5 hospitals for pilotSelected 5 hospitals for pilot

» Large, medium, small, city, ruralLarge, medium, small, city, rural» Testing conducted June, July 2004Testing conducted June, July 2004

Required dual entryRequired dual entry

– On-site training for 82 hospitalsOn-site training for 82 hospitals» 1 and a half day sessions1 and a half day sessions

11stst day – structured training; 2 day – structured training; 2ndnd day – practice on mock-up day – practice on mock-up worksheetsworksheets

Hospitals continued pilot testing until Hospitals continued pilot testing until system implementationsystem implementation

Imminent Arrival Imminent Arrival Testing by office staff, IT, and hospitalsTesting by office staff, IT, and hospitals

– IT advanced test system date to ensure birth certificate numbering started IT advanced test system date to ensure birth certificate numbering started correctlycorrectly

– Tested every function possibleTested every function possible Planned for after-hours customer assistancePlanned for after-hours customer assistance

– Registration Chief and Field Rep on call Registration Chief and Field Rep on call – Determined vendor availability after hoursDetermined vendor availability after hours– Determined IT availability after hoursDetermined IT availability after hours

» Installed a third party software that checks server processes on window Installed a third party software that checks server processes on window server (status change)server (status change)

Interruption in serviceInterruption in service CPU usage problem (overload)CPU usage problem (overload) Disc spaceDisc space Memory space (significant spike or none available)Memory space (significant spike or none available)

» Most resolutions done by IT remotelyMost resolutions done by IT remotely On-site as necessary 24/7On-site as necessary 24/7

The Delivery The Delivery

IT’S AN EBR!IT’S AN EBR! – The system went live January 1, 2005The system went live January 1, 2005

» All critical issues with birth registration were addressed firstAll critical issues with birth registration were addressed first

» Second priority was data exports (SSA, NCHS, internal Second priority was data exports (SSA, NCHS, internal partners, state partners)partners, state partners)

» Next, internal functions of amendments, adoptions, foreign Next, internal functions of amendments, adoptions, foreign born and delayed birth filingsborn and delayed birth filings

– Negotiated and compromised with vendor on priorities, Negotiated and compromised with vendor on priorities, deadlines, resources, fixes, and changesdeadlines, resources, fixes, and changes

Work With Your VendorWork With Your Vendor

Develop and maintain a good working Develop and maintain a good working relationshiprelationship

Be firm when necessaryBe firm when necessary Negotiate when appropriateNegotiate when appropriate

– Determine “bottom line” issues internallyDetermine “bottom line” issues internally Document conversations, verbal agreementsDocument conversations, verbal agreements

Lessons LearnedLessons Learned Ensure design/functionality documents are updated Ensure design/functionality documents are updated

throughout the project.throughout the project.– Require documentation of the Require documentation of the completedcompleted system system

Watch carefully the ease and cost of making changes to Watch carefully the ease and cost of making changes to certificate data, formatscertificate data, formats– Subject to legislative changes every yearSubject to legislative changes every year– Certificate revisionCertificate revision– Other program changes (i.e., Newborn Hearing Screening, Other program changes (i.e., Newborn Hearing Screening,

PRAMS, etc.)PRAMS, etc.) Stress importance of your office staff and agency IT Stress importance of your office staff and agency IT

carefully reviewing documentation and progress of the carefully reviewing documentation and progress of the vendor.vendor.– Requires resource commitment Requires resource commitment