Public Health Impact of EHR Eduardo Simoes, MD, MSc, MPH University of Missouri School of Medicine Department of Health Management and Informatics 10/27/2015LPHA

Public Health Impact of EHR

Eduardo Simoes, MD, MSc, MPHUniversity of Missouri

School of MedicineDepartment of Health Management and

Informatics

10/27/2015 LPHA TRAINING SESSION 1

LPHA TRAINING SESSION 2

The Current Landscape

• A fragmented US healthcare sector

• Discordant information systems

• Lower quality care than most industrialized nations, at a higher cost

• Health disparities and inequalities

• Sickness care

• Focus on specialization training

• Weakening of PH infrastructure

Lesko, Sarah, et al. "Communities of solution: the Folsom Report revisited." Annals of Family Medicine 10.3 (2012): 250-260.

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Fig. 1. The core functions and essential services of public health. Reprinted from Public Health Functions Project of the US Department of Health and Human Services (1995, http://www.health.gov/phfunctions/public.htm); permission pending.

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Paper Health Record

1. Speed of Data Input2. No change required.3. Low upfront costs.4. Ease of designing own paper form to fit practice’s workflow.

1. Paper chart records take a lot of space and require expensive chart pulls.2. Difficulty in backing up information makes vulnerable to fire/flood/loss.3. Difficulty in sharing data between offices.4. Legibility of record increases risk of error in care.

EHRs

1. No file room to maintain.2. Patient information available at all your office locations for each patient.3. Ability to backup EHR data in remote location through network to prevent data loss .4. Ability to use helper applications such as CPOE/CDS and Infobuttons to improve quality of care rendered and reduce liability risk.5. Ability to more easily analyze practice’s data to determine best outcomes.6. Interactivity encourages patient disease management.7. Ease of integration with telemedicine applications allowing for close monitoring of chronic disease patients with resulting better outcomes.8. Legible records.

1. Expensive software andcomputer purchases upfront.2. Software maintenance expense.3. Practice dependent upon reliable computer operation

Table of Advantages and Disadvantages of Health Record Methods

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EHR ADVANTAGES FOR PUBLIC HEALTH

• Improve public health reporting and surveillance◦ through syndromic surveillance data submission, immunization registries,

and electronic laboratory reporting, providers can transmit public and population health data to public health officials.

◦ can better monitor, prevent, and manage disease. In New York City, for example, public health officials designed a program that leverages EHRs to deploy public health alerts to clinicians.1

1. Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. “Using electronic health record alerts to provide public health situational awareness to cliniciansWeb Site Disclaimers.” J Am Med Inform Assoc. 2010

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• Better your organization’s ability to prevent disease.◦ With electronic health information about the entire population of

patients you serve, you can look more meaningfully at the needs of patients and offer better health care.

◦ EHRs can remind providers when patients need immunizations, 2 enable providers to send reminders to patients for preventive/follow-up care, and give providers access to clinical protocols.

2. Fiks AG, Grundmeir RW, Biggs LM, Locallo R, Alessandrini EA. "Impact of clinical alerts within an electronic health record on routine childhood immunization in an urban pediatric populationWeb Site Disclaimers" , Pediatrics. 200

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• Expand communication between health care providers and public health officials.

◦ By meaningfully using EHRs, your organization can expand its communication and collaboration with public health officials.

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Health System Performance(System Health)

The Health System Governmental public health Health care Other stakeholders

Measuring Population Health – Role of Information Systems: The Health System Feedback Loop

Environmental Determinants

DiseasesInjuries

Health Outcomes

Individual Determinants

Population HealthPathogenesis (risk factors)Protection, prevention, care

Salutogenesis (resources)Health promotion

Information Systems

Data, Information, Knowledge

CAPTURE MANAGE ANALYZE USE

Policies and Programs

Decisions Interventions Collective action

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1

23

4

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Role of Health Information Technology

Information is the lifeblood of modern medicine [and public health]. Health information technology is its circulatory system.David Blumenthal, MD, MPP, Former ONC Director

Blumenthal, David. "Launching HIteCH." New England Journal of Medicine 362.5 (2010): 382-385.Cox, R. Information Pathology in the Army Tactical Command and Control System. Monograph. School of Advanced Military Studies (DoD). 1991.

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Information is the raw material for decision-making.

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Role of Informatics in Total Population HealthIntegrating data from disparate sources – complex business!

References: (1) Stange, Kurt C. "Refocusing knowledge generation, application, and education: raising our gaze to promote health across boundaries." American Journal of Preventive Medicine 41.4 (2011): S164-S169. (2) Discussions and reflections with Asim Jani (PMR/F Lead).

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Electronic Health Records (EHRs)Health information exchanges

Personal Health Records (PHRs)

Community Health Records (CHRs)Community health needs assessments

Mobile Health (mHealth)TelehealthBody sensors (quantified self)Augmented realityConnected Homes

Primary Care Informatics

Clinical InformaticsClinical Research Informatics

Public Health Informatics

Consumer Informatics

Community InformaticsPersonal Health Informatics

Internet of Things

Genome databases (plant, animal and human)

Bioinformatics/genomicsSurveillance systemsRegistriesOther databases

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What kind of EHR?

• In order to support public health’s traditional focus on preventive health and socio-behavioral factors, EHR data models would need to be expanded to incorporate environmental, psychosocial, and other non-medical

data elements, and workflow would have to be examined to determine the optimal way of

collecting these data.◦ Support LHDs billing for services: Immunization, HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Rita Kukafkaa, Jessica S. Anckera, Connie Chana, John Chelicoa, Sharib Khana, Selasie Mortotia, Karthik Natarajana, Kempton Presleyc, Kayann Stephensa. Redesigning electronic health record systems to support public health. Journal of Biomedical Informatics; Volume 40, Issue 4, August 2007, Pages 398–409

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http://www.sciencedirect.com/science/journal/15320464

http://www.sciencedirect.com/science/journal/15320464/40/4


LHD Billing

• long history of working with public insurance providers (e.g., Medicaid, Medicare, Children’s Health Insurance Program)

• Insurance companies have worked with LHDs through Medicaid, especially Managed Care, but LHDs have little history of being in-network providers in private insurance networks.

• Barriers:◦ high level of staff engagement and commitment. ◦ Health department staffs are already being tasked with more responsibilities as a result of shrinking

budgets. ◦ Not all health departments have switched to electronic health records, which are helpful in

establishing a billing program. ◦ Resources and training are greatly needed to support many health departments across the country. ◦ private insurance companies may not recognize health departments’ clinical services as part of the

medical home (ACA push for “medical home” or using primary care providers◦ with bundled payments for managed care)

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Billing Workforce Capacity-support of Revenue Cycle

• The workforce needed for LHD billing operations depends on the claims volume.

• In smaller LHDs, individuals may perform multiple functions and some of these functions may be performed by clinical staff.

• Key revenue cycle functions and skill sets will be similar across LHDs. Personnel are needed for: 1. Front end scheduling and registration; 2. Billing and collection; 3. Payer electronic claims and electronic funds transfer deposit enrollment; 4. Contracting and credentialing effort; 5. Management to oversee the billing and collections function, and; 6. Information technology support for software implementation, maintenance and

trouble shooting.

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EHR for Public Health Practice:Results of Survey

10/27/2015

Lanis Hicks, PhD.

Missouri Health Information Technology Assistance Center

Department of Health Management and Informatics

October 27, 2015

LPHA TRAINING SESSION

Objectives of Survey

• To determine current use of health information technology among local public health agencies

• To gain a better understanding of the assistance needed to enable local public health agencies to acquire, implement, and use electronic health records and health information exchanges more effectively in coordination of care provided to clients

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Overview of Results

• Responses were received from 100 of 117 agencies (85.5%)

• Although 79% of respondents consider electronic health records (EHRs) to be an important tool, only 24% currently use one

• Only 17.5% of respondents currently use a health information exchange (HIE)

• Most (68.8%) do not plan to use on in the future

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Current Vendors Being Used

• Insight was the product used most, with 4 agencies using it• Practice Fusion followed with 3 users• Cerner and eClinical Works each had 2 users• There were 9 other products used by one agency• Of the 24 agencies with EHRs, there were 15 different

EHRs being used

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Utilizing Health Information Exchanges

• The majority of agencies using HIEs use them for public health reporting (90%) and receiving lab results (71%)

• Less than 20% use HIEs for interoperable care transitions or alerts with other providers

• Less than 20% use HIEs for direct messaging of continuity of care documents

• Missouri Health Connection was the most commonly used HIE

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Barriers to EHR Use

• Funding was the greatest challenge identified◦ Funding for software – 82%◦ Funding for continued maintenance cost of the system – 76%◦ Funding for implementation services – 70%◦ Funding for hardware – 68%

• Other concerned expressed were◦ Inadequate knowledge/training about selection of software – 63%◦ Lack of technical support – 49%◦ Internal staffing challenges to manage implementation – 42%◦ Current workflow and processes – 42%

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Provide Service and Bill for Service

Cholesterol testing

Lab blood draw

Hemoglobin test

Lead testing

Blood pressure checks

Birth/Death Certificates

Flu shots

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51

45

53

10

65

80

67

70

88

88

90

93

96

Provide Bill

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Ways Data are Collected and Sent to Regulatory Agencies

• Manually – 56

• Electronically – 60

• Through software provided by state -- 55

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Payers Billed for Services

• Medicaid – 95%

• Medicare – 69%

• Private Insurers – 56%

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Quality Improvement Initiatives Participation

• Missouri Voluntary Local Public Health Agency Accreditation – 19 agencies

• Mobilizing for Action through Planning and Partnership – 15 agencies

• National Public Performance Standards Program – 7 agencies

• National Voluntary Accreditation for Public Health Departments – 7 agencies

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Agency Staffing

• On average, reporting local public health agency had 16 full-time staff and 4 part-time staff

• The size of full-time staff in the reporting agencies ranged from 0 to 126; the size of part-time staff in the reporting agencies ranged from 0 to 15

• For agencies with less than 5 full-time staff, only 7.1% had an EHR

• For agencies with more than 25 full-time staff, 46.2% had an EHR

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Summary

• There was an 85.5% response rate to the survey• Only 24% of respondents are currently using an EHR• There were 15 different EHR vendors used by agencies• Increasing pressure to improve the health of the population

focuses on coordinating care provided• Role of EHRs increases with care coordination• Ability of local public health agencies to collect, analyze, and

transmit health-related data electronically will be increasingly essential

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Questions or Comments?

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EHR for Public Health Practice:Health Information Exchange (HIE) –

What LPHAs Need to Know

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Angie Bass, Chief Operating Officer

Missouri Health Connection

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Missouri Health Connection (MHC) is the state-designated Health Information Exchange (HIE) Network for Missouri.

MHC connects health care providers so they can share patient records quickly through a secure, electronic network.

MHC enables a patient’s health care team to see data from different clinical providers within one secure network.

MHC bridges the communication gap between separate health systems operating on different standalone EHR systems.

Mission is to provide a statewide health information exchange network that:◦ Improves the quality of medical decision-making and the coordination of care;◦ Provides accountability in safeguarding the privacy and security of medical information;◦ Reduces preventable medical errors and avoid duplication of treatment;◦ Improves the public health;◦ Enhances the affordability and value of health care; and◦ Empowers Missourians to take a more active role in their own health care.

What is Missouri Health Connection?


Why is a Health Information Exchange Network needed?

• Because your primary care physician’s EHR cannot talk to EHR system at the hospital you were born in.

• Because the long-term care facility that your grandfather receives care at doesn’t have an EHR system and only communicates with the hospital with a fax machine.

• Because community health centers refer patients to the community hospitals on a daily basis for acute care, yet their EHR systems are different so they cannot share information about that patient unless they fax or sent the records with the patient.

• Most importantly, because it is the right thing to do.◦ Meeting patient expectations

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Why MHC is important?• MHC fulfills the need for interoperability of EHR systems that patients expect and health care

providers need.

• MHC is the interoperable network that enables connectivity between the silos of health information as they exist today between

◦ large and small◦ rural and urban◦ acute and ambulatory

• MHC’s mission is simple: “No Provider Left Behind”◦ Any provider, regardless of type or size, can participate in Missouri’s state designated health

information exchange network by joining the MHC network. ◦ MHC has service offerings for any provider, small or large, and regardless of EHR maturity. ◦ This strategy helps MHC achieve a critical mass of patients in its network.

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How does it work?

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How does it work?1) Patient comes to the ED for chest pain.

2) Treating Physician logs into the EHR system and selects the “MHC” button to send a query to the MHC network to get a patient history of the Patient.

3) MHC receives the patient query and sends messages to all of the MHC members requesting health information about the Patient.

4) Those MHC members that have clinical information about the Patient send that clinical information back to MHC.

5) MHC aggregates all of the clinical information received on the Patient into a consolidated record.

6) MHC sends the aggregated record of the Patient back to the Physician’s EHR system.

7) Physician sees the longitudinal record of the Patient for clinical decision making to further treat the chest pain.

8) Physician downloads that longitudinal record of the Patient into their EHR system, and it then becomes part of the EHR system’s record for the Patient.

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Health Systems

Independent Hospitals

CAH

FQHC

Clinics

Physician Groups

Behavioral Health

State of Missouri

LTC Facilities

MHC exists to serve all health care providers, so they can better serve their patients.


MHC Membership• Connectivity

◦ MHC is the only statewide HIE network with the majority of acute care provider participation More than 70 hospitals, 350 clinics and community health centers More than 7,000 physicians

◦ MHC will provide interstate connectivity and interoperability with Missouri’s eight border states and Healtheway.

◦ 2015 and after roadmap includes connectivity to ambulatory, specialty and ancillary health care providers.

◦ MHC is the only HIE network that provides connectivity and interoperability with MO HealthNet (Medicaid), offering clinical and claims data for all Medicaid patients.

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Health Information Exchange Use CasesforPublic Health Facilitated by MHC

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MHC CareMail

Secure, electronic email platform for sending and receiving protected health information (PHI) by encrypting all messages and attachments when exchanged between secure mailboxes.

USE CASES

Secure messaging of clinical information with other health care providers with MHC CareMail

◦ Request Lab results◦ Send/Receive Care summary documents◦ Replaces fax workflows between clinical providers

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HIE Use Cases for Public Health Facilitated by MHC CareMail

MHC CareNet & MHC CareView

A secure, electronic, real-time, query-based exchange platform that creates a consolidated patient record that is offered as an integrated or web-based service.

USE CASES

Care Coordination with MHC CareView / MHC CareNet◦ Current diagnosis◦ Current medications◦ Vaccinations◦ Radiology / Lab results◦ Allergies

EHR Light with MHC CareView / MHC CareNet◦ Access to comprehensive and consolidated clinical record for a patient. Improve patient care by providing access to a patient’s full medical record using a platform integrated into a health care provider’s EHR system.

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HIE Use Cases for Public Health Facilitated by MHC


Patient ConsentWRITTEN AUTHORIZATION REQUIRED

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MHC’s Consent Policy – Written Authorization (Opt-in) Required◦ All patients MUST provide a written authorization in order for their data to be shared over the MHC network.

◦MHC provides form, language, training and materials to each Participant on obtaining consent

All MHC Participants will have the ability to obtain a patient written authorization to share their clinical data on the MHC network.

Global consent acknowledgement◦ MHC provides consent management for each Participant

Medicaid patients – authorization included in their MO HealthNet enrollment. ◦ Exclusive to MHC network only

Patient Consent


HIE Interoperability Forecast for Public Health

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Bi-Directional connectivity to DHSS for reporting of immunization and syndromic surveillance data that will enable MHC Participants to access all of the data in Show-Me Vaxx and HESS.

Alerts and Notifications via MHC CareMail to communicate patient encounter updates

Patient Portal to provide patients with access to the comprehensive patient record

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HIE Interoperability Forecast for Public Health


Please contact MHC @WWW.MISSOURIHEALTHCONNECTION.ORG

Phone: 573.777.4550

[email protected]/27/2015


EHR for Public Health Practice:Implementation Success Story

10/27/2015

Mende Kemper, RN, BSN

Jennifer Harris, MPH

Lincoln County Health Department


About Lincoln County HD

• North of St. Charles County

• Located in Troy, MO• Population ~53,000• Rural/Urban• 21 Full-time staff• 7 contractors

Programs and Services:ImmunizationsVital RecordsCD (TB, STD screens, Education)Environmental Health (Food, On-site)Emergency Response PlanningHealth Education ProgramsWIC Dental – Children and AdultsHome Visits by RN/Aide/HomemakerFamily Planning******

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What we did

• Implemented 2 Electronic Health Record Products (as of October 1, 2015)

◦ eClinicalWorksGeneral Clinical Side Live date 11/01/2012

◦ Umbie DentalCareDental Clinic Live date 10/01/2015

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Why do we need a clinical ehr?

• Meaningful Use reporting requirements• Wanted to move away from paper charts, hoped to

streamline clinic processes• Previously using AHLERS

◦ scheduling, insurance/billing, some reporting

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Why do we need a dental ehr?

• Meaningful Use reporting• Lack of consistency in charting

◦ Digital signatures & time stamps◦ Many volunteers/changing contractors

• Clinic growth• Agency shift away from paper

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TimelinesTIME FLIES…

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8/2011 First started talking

about EHR products for Clinical/Dental

11/2012 Clinical EHR live

10/2015 Dental EHR Live

BASIC TIMELINE

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Timeline for Clinical EHR

9/2011Started Looking

at EHRs9/30/2011

Signed up with MOHIT

11/15/2011 Compiled a list of EHR Vendor

wants and needs

12/2011First demo of an

EHR

4/2012 Watched Demos

5/29/2012 Product

selection finalized

10/02/2012 Ordered

Hardware

11/01/2012Went LIVE!

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Timeline for Dental EHR

8/2011 Approached

by Total EHR for possible funding.

10/2011 Signed on with Total

EHR for Attestation

2012 Began

searching for dental

EHRs; none certified

01/2014 Began

searching again for

dental EHRs;

limited selection

3/2015 Started the

search again; more

to chose from but

most were costly

6/2015 Began

demos; 6 through 8/2015

8/27/15 Selected Umbie

DentalCare

9/11/2015 Began

training using Umbie

10/01/2015 Went LIVE!

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process

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First Steps

Form A Selection Committee

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• Clinical EHR◦ 9 staff members

Lots of input – PRO! Lots of input – CON! Ideal is probably 4-6

◦ Variety of perspectives Administrative staff, IT, Billing staff,

Users/clinicians◦ Meetings ad hoc, as information available◦ Purpose:

Solidify PRIORITIES Review PRODUCTS and make decision Develop IMPLEMENTATION plan

committee• Dental EHR

– Previously signed on with Total EHR (2011), found out was not certified. Process on hold indefinitely.

2015: Process begins again, committee formed– 5 staff members

• Fluctuating commitments- challenging– Variety of perspectives

• Primarily 2 Administrative Staff and Dental Manager• Others joined to review products: other Admin Staff,

eCW Committee Chair– Purpose:

• Review PRODUCTS and make decision

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priorities

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Clinical EHR

Priorities

Customizable (forms)

Patient Portal

Interface (MOWINS, WIC, other

EHRs)

Data

Cloud Server Based

Dental

Lab and Prescription Integration

Billing

Tablets/ Mobile UseSchedulingRegistration/

Notifications

Cost

Sliding Scale management

Telephone Orders

Reporting

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Dental EHR

Priorities

Customizable (forms)

Patient Portal

Interface (MOWINS, WIC, eCW,

other EHRs)

Data

Cloud Server Based

Dental

Lab and Prescription Integration

Billing

Tablets/ Mobile UseScheduling

Registration/Notifications

Cost

Sliding Scale management

Telephone Orders Reporting

Contractors/Volunteers

Visual chart/ User interface

Streamlining

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Reviewing Products

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• Clinical EHR◦ Assistance from MOHIT◦ First product reviewed December 2011◦ 4 Demos – webinar format

Sage, eCW, Practice Suite, and e-MD

Each demo took at least an hour

◦ 2 quotes obtained◦ All committee members attended if available◦ Questioning-made sure that same questions were asked each time

PRODUCT REVIEW - clinical

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MOHIT Awesome Resource!

What they helped us do:• Gave us an

implementation specialist

• Step by step process• EHR Vendor List

HTTP://ehrHELP.MISSOURI.EDU

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http://ehrhelp.missouri.edu/


EHR Vendor List EHR Vendor MO Demo Scores MO RFI

ScoresAverage Demos

EHR Usability

EHR Functionality

PMS Usability

PMS Functionality

e-MDs 84% 81% 90% 87% 78% 67%eClinicalWorks 83% 89% 85% 79% 78% 72%Greenway 79% 84% 80% 79% 74% 67%NextGen 70% 52% 63% 87% 79% 68%GE Healthcare Centricity 70% 68% 71% 75% 65% 61%Sage Intergy 68% 68% 72% 68% 65% 64%Amazing Charts 61% 66% 55% NA NA 52%Pulse Systems 61% 59% 72% 60% 52% 63%McKesson Practice Partner 60% 56% 63% 72% 47% 68%Allscripts Professional 59% 53% 61% 74% 47% 65%Cerner PowerChart 57% 53% 58% 70% 46% 69%

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Vendor Product Version ONC-ATCB ID

eClinicalWorks eClinicalWorks 9 8.0.48

CC-1112-955447-1

Demo Scores – Panel: 4 physicians + 4 office managers

Average Score EHR Usability EHR Functionality PMS Usability PMS Functionality

83% 89% 85% 78% 79%

Company Info

Company Type Private

Years in EHR business 11

Installed practices 7000

Practices in Missouri NA

FQHC installations 150

PCMH installations 6+

Datacenter for Missouri NA

Product Info

Integrated EHR & PMS Yes

Remotely hosted option Yes

Locally installed option Yes

Subscription model available Yes

Browser based NoOutsourced billing services offered No

MO HIT AC RFI Scores 72%

National Rankings

2009 AAFP Survey: User Satisfaction Easy & Intuitive

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KLAS Ranking

“I really liked this EHR! It seemed logical, flowed well, and was simplistic

yet powerful. I liked its appearance and its easy customization.…”

Demo Evaluator

“Did like that the system defaults were USPTF based. ; Order set menu is adequate,

but didn’t seem to pull up “smartly” based on diagnosis

made…”Demo Evaluator

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Product review – clinical

• From MOHIT• Rating sheets• Committee members

completed after reviewing each demo

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Product review - dental

• Started with a review of the CHPL

• Reviewed all Complete EHR Dental products (~30)

• Ruled many out early on• Sought information and quotes• Only 2016 certified

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Product review - dental

• Dental EHR– First product reviewed June 2015– 6 demos – webinar format

• At least Dental PM and 1 Admin Staff

• Repeated demos for product

– 7 quotes obtained – much clarification, especially regarding “add-ons”– Questioning:

• Asked same questions prior to each demo

• Tried to ensure similar topics and questions were covered

– No formal rating process– Final meeting to make decision

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implementation

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Things to consider

◦Computer NeedsBandwidth

Will your current system handle what is required to run the EHR?

Current System What are the specific computer requirements to run the EHR? Will you need to upgrade your computer systems? What kind of IT support do you have available?

Cloud based vs in-house storage Is the EHR entirely cloud based? Is it remotely accessible? Is your agency equipped with sufficient server capabilities?10/27/2015


• Clinical EHR◦ Signed contract 5-29-2012

◦ Developed schedule for training & Live dates

◦ In-person training started 10-29-2012 through 11-9-2012

◦ Training time varied per person

◦ Super users

◦ $$$

Implementation

• Dental EHR– Signed contract 8-27-15

– Cancelled 1 week of clinic

– ALL training was remote (webinar), started 9/11/15

– Opened training to contractors and volunteers as they were available

– $$

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The good, the…challengingLESSONS LEARNED AND CLOSING THOUGHTS

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The good

• Quicker turn around time on claims• Billing costs decreased

◦ No postage necessary mailing CMS 1500 forms

• Paperless in many areas• Automatic patient reminders; check-in kiosk• Easier to read records and reproduce for clients• Easier to send records to other providers• Centralized patient records between clinical services• Accessible data • Meets the needs of the changing workforce

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The challenging

• HIPAA• Needs vs. Wants• All the bells and whistles• Changed programming vs. cost• Paperless in many areas• Difficult to dedicate staff time – interns

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Lessons learned

• The grass is always greener…• Be adaptable

◦ Your practice flow may need to adjust

• Training is essential – make it a priority, schedule it and prepare! • Change is hard

◦ Who is your champion?◦ Anticipate resistance

• Do your research - but don’t get stuck in the data• Be aware of potential costs associated with changing systems in the

future10/27/2015


Next steps

• Reviewing eCW◦ Data capture◦ Using our data◦ Cost

• Continue with UmbieDentalcare◦ Ensure MU reporting continues◦ Complete training for all providers

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Things to consider

◦ Integration + Interfacing Are your current vendors able to integrate with the system? If you have multiple clinical settings, do you want platforms to be integrated, interface or be

independent?

◦ Cost Payment structure: monthly vs. flat fees, per user, add-ins, etc. Fees to offset, i.e. Meaningful Use

◦ Data What is the process to integrate the data you have? What will it cost to integrate that data? How can you access that data?

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Questions?

Contact Information:

Mende Kemper, RN, BSNTraining and Compliance OfficerLincoln County Health Department(636) 528-6117 x [email protected]

Jennifer Harris, MPHDirector of ProgramsLincoln County Health Department(636) 528-6117 x [email protected]

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EHR for Public Health Practice:Assessing Your EHR and Implementation Needs

10/27/2015

Lisa Hays, MAOM, CHTS-IM, CHTS-TR

Larry Henderson, BBA, CHPS

Primaris


Agenda

• eHealthcare Goals• EHR Benefits General• EHR Benefits LPHAs• Components of a Successful EHR Implemention• Introduce Tools

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Federal & State eHealthcare Goals

• Accountable Care

• Improved Coordination Of Care Reduce procedures Reduce costs Improve outcomes

• Interoperability Medical clinics, hospitals Social services Behavioral health Public health systems Patient communications

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EHR Benefits - General

• Improved Patient Care

• Increased Patient Participation

• Improved Care Coordination

• Potential Increased Revenue

• Practice Efficiencies And Cost Savings

• Improved Diagnostics And Patient Outcomes

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EHR Benefits For The LPHA

• Improved Communications With multiple specialists and community providers Insure a common game plan

• Improved Patient Safety goals Error reduction Reduction of handwritten orders and manual reports

• Improved Work Processes Referrals Tracking Reporting Care coordination

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EHR Benefits For The LPHA Contd.

• Improved Public Health Outcomes Efficient collection of data in a standardized form Shareable across multiple health care organizations Leveraged for quality improvement

• Improved Public Health Reporting and Surveillance Standardized data Monitor, prevent and manage disease Share health data with public officials More effective data gathering allows for generating public health alerts to clinicians

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Top 10 Essential Components of Successful EHR Implementation

1. Committed leadership

2. Objective evaluation of current state (Tool Provided)

3. Clearly defined objectives and measures

4. Well defined and communicated implementation plan (Tool Provided)

5. Staff involvement throughout

6. Commitment to training

7. Effective EHR evaluation and selection (Tool provided)

8. Commitment to Privacy and Security

9. Realistic expectations and timelines set

10. Continuous measurement against objectives and measures

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Tools Provided This Session

• LPHA EHR Readiness Assessment Tool Assess current state Gather and capture data Assists with gathering requirements

• LPHA EHR Implementation Project Plan Management tool Track project progress Document responsibilities Set milestone targets Real time record of project status

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Thank you!

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EHR for Public Health Practice:EHR Options for LPHAs

10/27/2015

Lisa Hays, MAOM, CHTS-IM, CHTS-TR

Larry Henderson, BBA, CHPS

Primaris


Agenda

• 7 Steps to an EHR selection• EHR System Requirements• Vendor Selection tool

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7 Steps to EHR Selection

1. Gather requirements and build a team

2. Analyze and prioritize practice requirements

3. Create a vendor short list

4. Request vendor proposals

5. Evaluate the vendor shortlist

6. Conduct software demos

7. Make the final decision

• HealthIT.gov10/27/2015


Typical LPHA Business Requirements

• Recruitment/Outreach

• Screening/Eligibility Determination

• Intake

• Assessment

• Close Care

• Client Referral

• Provide Education

• Coordinate Care

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Typical LPHA Business Requirements Contd.

• Patient Registration

• Clinic Visit

• Patient Follow-up

• Process Lab Orders

• Review Lab Results

• Client Referral

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EHR System Requirements

• Stable And Highly Available

• User Friendly Interface

• Ease Of Data Capture

• Transaction Logging

• Reporting Capability

• Privacy/Security Adherence

• System Administration Capabilities

• Reliability/Recovery Features

• Interoperability10/27/2015


Vendor Selection Tool

• LPHA EHR Vendor and Scoring Tool

• Technical questions

• Business Questions

• Transaction Logging

• Reporting Capability

• Privacy/Security Adherence

• System Administration Capabilities

• Reliability/Recovery Features

• Interoperability

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Thank you!

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EHR for Public Health Practice:EHR Implementation – People, Process & Technology

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Michael Levinger

President and CEO

Digital Collaboration Solutions


Goals&

Metrics

EHR SuccessBalanced Performance Model

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Copyright 2015 Digital Collaboration Solutions, LLC


EHR Technology

EHR Functionality◦ Clinical◦ Business management

EHR Technical Infrastructure◦ Architecture Design◦ Network infrastructure◦ Cloud/SaaS◦ Security

Goals&

Metrics

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Electronic Health Record Functionality

Typical Clinical Functions

• Patient information

• Manage “labs and rads”

• Clinical decision support

• Order entry/management

• Patient care management

• Alerts

• Referrals

• E-prescribe

• Patient engagement/portals

• Security and authentication

• Reporting and quality metrics◦ Quality◦ Surveillance◦ Financial

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Software To Manage:

Manage Patient Records & Clinical Activities Operations and Billing



EHR Technology

EHR Functionality◦ Clinical◦ Business management

EHR Technical Infrastructure◦ Architecture Design◦ Network infrastructure◦ Cloud/SaaS◦ Security

Goals&

Metrics

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Technology – The EHR Environment

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ElectronicHealthRecord

Surveillance Systems &

Portals

PatientPortals

Other EHRs

HospitalInformation

Systems

BillingSystems

RadiologyPACS

Lab ResultsLIMS



EHR Technical Infrastructure Requirements

• Users• Access• Network Architecture

Distributed

• Speed ● Availability• Capacity ● Usability• Scalability

Performance

• Backup• Redundancy• Recoverability

Data Management

• Interoperability• HIPPA & Security• Other Compliance Regulations

Security & Access Management

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Goals&

Metrics

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Program must involve users

EHR deployment is a mix of ◦ Clinical◦ Administrative and◦ Technical

Deployment must:◦ Involve all groups◦ Be broad-based within the groups◦ Be well planned◦ Gain support of users

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Goals&

Metrics

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Project Management - Goals

Quality

Scope

ScheduleCost

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Project Management is About Balancing These Project ElementsCopyright 2015 Digital Collaboration Solutions, LLC


EHR Deployment Tasks

• Project planning• Workflow review and redesign• Develop EHR functional requirements• Vendor selection• Design infrastructure – what’s on-site

vs. cloud• Interfaces design & implementation• Procurement

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• Testing & training plan• Implementation

Site assessment Site remediation Hardware installation – less with cloud Software installation – limited with cloud Workflow change Training Data migration Go Live

• Support



EHR Deployment Resources

• People

• Software

• Hardware

• Telecommunication

• Services

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Goals&

Metrics

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Why an Electronic Health Record System?

Value of an EHR

Quality of Care Monetary

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Critical Success Factors

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Success Factors for All Size LPHAs Must include all aspects of an EHR implementation Use good project management – scaled to your size Plan for ongoing EHR management & support Learn from your peers Don’t re-invent but re-use Pool resources where possible

Small• Cover all the issues• But do it informally• Keep the EHR solution simple

• SaaS/Cloud• Straightforward system• Focus on helping team

Medium• Balance formality and informality• Plan for change in size• Keep EHR solution as simple as

possible• SaaS/Cloud• More functionality• But don’t let it overwhelm

benefits

Large• Requires formal project

management• Investment upfront is essential• EHR Solution

• Can be more complex• Primarily SaaS/Cloud• Watch budget!



Case Study - Appalachian District Health Dept.

• Public Health Agency responsible for three counties in northwestern North Carolina

• Population of approx. 78,000

• 974 square miles of mountainous terrain

• Approximately 120 employees in three offices

• Services in four areas:◦ Patient care◦ Environmental health◦ Health promotion◦ WIC/Nutrition

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Source: http://www.apphealth.com/about-us/ Copyright 2015 Digital Collaboration Solutions, LLC


Case Study Public Health Dept.

Challenge

• Frustration with an antiquated, paper-based system requiring practice personnel to re-key patient data multiple times across multiple screens, as well as a cumbersome & slow billing system

• Range of comfort with computer systems across staff

Solution

• Implemented an integrated EHR, practice management and billing solution

Process

• Chose product after conferring with local office of rural health and a community care consulting physician with EHR experience

• Phased roll out – Practice management county by county followed by billing

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Source: http://patagoniahealth.com/customers/case-studies/case-study-1/ Copyright 2015 Digital Collaboration Solutions, LLC


Case Study Public Health Dept. - Benefits

Monetary

Billing to third party insurance cos. faster and more efficient

Faster turnaround time

to receive reimbursement

Improved Workflow

Data does not have to be re-keyed

Easier patient scheduling

Meaningful Use Data

Provides access to Meaningful Use data

To improve quality care issues like:• Preventative health• Chronic care• Immunizations

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Source: http://patagoniahealth.com/customers/case-studies/case-study-1/ Copyright 2015 Digital Collaboration Solutions, LLC


Case Study - Jeremy L. Bradley, MD, FAAFP HIMSS 2012 Davies Ambulatory Award

• Family Practice clinic located in Owensboro, Kentucky

• Population of approx. 50,000

• Practice directly serves 18%

• Owensboro is a federally-designated primary care physician shortage location.

• Designated Patient Centered Medical Home

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Source: http://www.himss.org/ResourceLibrary/ContentTabsDetail.aspx?ItemNumber=26918 Copyright 2015 Digital Collaboration Solutions, LLC


Case Study Family Clinic

Challenge

• Paper-based records in rural clinic

Solution

• Implemented an integrated EHR, practice management and billing solution

Process

• Chose product after a “careful research process”

• Deployed EHR and moved to a “virtually paper-free” office in less than six months

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Source: http://patagoniahealth.com/customers/case-studies/case-study-1/Copyright 2015 Digital Collaboration Solutions, LLC


Case Study Family Clinic - Benefits

Monetary

Investment $47K

One Year Return: $130K

One Year ROI 278%

Clinical Value

Improved monitoring of quality care metrics

Improved patient safety across multiple measurements

100% patient immunization screening

Increased patient satisfaction measured by survey

PCMH recognition

Population Health

Integral to PCMH care in rural area

Applied to Bridges to Excellence Care Recognition

Program

Used EHR to track 13+ qualifying care metrics

Marked improvement in measures

And Improvement in achieving PCMH philosophy

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Source: http://www.himss.org/ResourceLibrary/ContentTabsDetail.aspx?ItemNumber=26918Copyright 2015 Digital Collaboration Solutions, LLC


SummarySuccessful EHR Deployment Requires Balanced Performance

Goals&

Metrics

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Documents

Public Health Impact of EHR Eduardo Simoes, MD, MSc, MPH University of Missouri School of Medicine Department of Health Management and Informatics 10/27/2015LPHA