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Selecting the best HIT product
Rural Health Group, Inc.
About us
Rural Northeastern North Carolina
Founded in 1974 Medical: Seven sites
– Electronic medical record: EClinicalWorks
Dental: Two sites– Electronic dental record: Daisy
Integrated behavioral health Onsite pharmacy
Why did OHIT invite me? School of Hard Knocks!!
– One-site CHC (25,000 visits)•1997: MDX to HealthPro
– Regional Network (>1 million visits)•2000: HealthPro to Epic
– Multi-site CHC (80,000 visits)•2005-2008: Misys to EClinicalWorks
I have made the mistakes, learned from them and made new mistakes.– Not an expert, just a guy who has
been beaten up enough by the IT gods to know a little
1997: Single site CHC
Small committee of finance, executive director, medical director, nurse manager and IT coordinator (me)
No RFP– No formal process
Vendor driven– Promises made – believed the
salesman– Never test drove the system before
buying
2000: Regional Network Formal RFP process – sent to a list of
vendors meeting the RFP qualifications– Practice management first priority with EMR
as a future.• Integrated EMR/PM not required
RFPs evaluated based upon “objective” criteria
Only three vendors chosen for on-site– Onsite demonstrations attended by clinical
and operation staff– Formal scoring process
Site visit to vendor to evaluate financial performance & stability of vendor
Site visit to clients using IT solution
2005-2008: Multi-site CHC RFP developed by 3 clinicians, 2
billing mgrs, 1 RN and 1 IT mgr.– Integrated EMR/PM solution
requirement– FQHC experience
•Quality measures, UDS reporting, etc. RFP sent CCHIT-certified vendors
– RFPs evaluated by EMR task force Four vendors invited to on-site
– All providers and staff attended; each product scored by staff.
Top two vendors: client site visits to evaluate functionality, support
Why Invest in HIT
Ask PATIENTS, board, providers and staff:- Are we providing quality health care that is making a positive impact on our patients? How do we know?
Reality:- Without an integrated, well-designed health information solution we don’t know if we are providing high quality, effective care.
- Information is power; it should not be locked in a disorganized, incomplete paper chart.
Purpose of HIT
To improve the quality of patient care & health outcomes through patient-centered care.- Better quality begins with the
accessibility of accurate patient information when and where it’s needed.
- Better quality means providing evidence-based medicine at the point of care so providers can choose the best treatment plan for the patient.
The Truth: We do NOT know if we provide
evidence-based care Brutally honest workflow analysis will
absolutely reveal:– Impossible to provide quality health
care without a health information system to track, organize and present the information in an useable format.•Health care is all about information but we under invest in health information technology.
Efforts to Implement Health Information Technology in Six Countries, 2003
U.S. Australia Canada Germany Norway U.K.
Initial year of national IT effort
2006 2000 1997 1993 1997 2002
Expected year of complete implementation
2016 Undefined 50% by 2009
2006 2007 2014
Estimate of total investment (as of 2005)*
$125M $97.9M $1.0B $1.8B $52M $11.5B
Total investment per capita (as of 2005)**
$0.43 $4.93 $31.85 $21.20 $11.43 $192.79
*In U.S. dollars. Exchange rates as of September 2005: $1 U.S. = $1.31 AUS; $1.19 CAN; $0.80 EURO; $6.21 NOR; $0.54 U.K.** In U.S. dollars. Per capita is based on 2003 population numbers from the Organization for Economic Cooperation and Development (OECD).Source: Adapted from G. F. Anderson et al, "Health Care Spending and Use of Information Technology in OECD Countries," Health Affairs, May/June 2006 25(3):819–31.
RFP Process: Or “Oops should have done that first”
STEP ONE: Most Important Part
EMR is only a tool, not a panacea.– Standardizing work flows and practices
MUST occur before EMR implementation.•Analyze all the systems in the current environment through flow diagramming (include time!!).
Workflow analysis will reveal:– Time spent looking for:
•Charts•Lab results•Hospital reports•Consultant reports•Referrals
– Overtime as a result of inefficient workflows (i.e. faxing Rx, phone calls)
– Missed opportunities to provide EBM
…RFP Process
Get the process right, outcomes will follow
Provider and staff EMR readiness survey– Develop pre-training program
•General Computer skillsRHG filled out its IT department (3.0 FTE) & hired 1.0 FTE clinical informatics specialist
…RFP Process
STEP TWO:The Team & Project
EMR/PM is NOT an IT project– Clinical and Operations Project
EMR/PM Task Force– EMR/PM Project Manager with:
•Clinical Leader•Operations Leader• IT Leader•Senior-level Leader
…RFP Process
Project management is ESSENTIAL– Use tools like MS Project to
plan/track Regular EMR/PM task force meetings Communication plan with all staff
about project progress and next steps Be real and visionary
– What you need and what you would like.
…RFP Process
STEP THREE:WRITING THE RFP
Beg, borrow and steal examples from other FQHCs and primary care practices– Rural Health Group: E-mail me at
[email protected] with “EMR RFP” in subject line.•We created our own & “borrowed”
liberally from: OCHIN, BPHC, CHCF– http://www.acgroup.org/surveys.html– http://www.chcf.org/topics/chronicdisease/
index.cfm?itemID=133495
…RFP Process
Develop RFP – (Team of clinicians, nurses, operations, IT, finance)– Integrated solution EMR/PM– FQHC experience
•How many, how long, which are using integrated solution
– FQHC quality and UDS functionality– Training– Support
…RFP Process
Customize the RFP to fit your needs– Know your processes & systems– Make sure the RFP captures what you
need currently to operate– Use the real and vision steps from Step 2.
•Write, modify and evaluate to make sure you are not missing anything essential
– Get it in writing– MOST IMPORTANT:
•Prioritize the MUST HAVES in each section
…RFP Process
STEP FOUR:Evaluate RFP
Send RFP to CCHIT-certified vendors Evaluate the RFPs
– Use the MUST-HAVES list as your evaluation tool:Show it, prove it and test itDo NOT trust the vendor
…RFP Process
Onsite demos for top 3-5 vendors– Providers and staff get chance to view &
evaluate each vendor using MUST-HAVES tool.
Narrow down to top two vendors & VISIT FQHC clients using solution– MUST-HAVES: make sure that the client
can show that your MUST-HAVES are functional; test drive it!!!
…RFP Process
STEP FIVE:Decision
Purchase Decision:– Use RFP, onsite vendor evaluations, client
site visit evaluations & MUST-HAVES list– Training, clinical decision support,
flexibility, support, company rep, price, etc.•Each organization determines weight
…RFP Process
Contract:– Training plan, implementation
plan, support, & customizations.– GET IT IN WRITING – do not
accept promises– Plan the divorce before the
wedding
…RFP Process
Lessons Learned Training plan
- Do NOT short-change training• At least one week of Super User Training
with the following representation REQUIRED:
Doctor, nurse, front desk, billing, IT, senior management
• One week of onsite training at EACH clinic with 40% patient schedule
Communication with staff Interfaces
- Lab: generally not live at GO-LIVE EMR/PM is a relationship:
- One bad experience – pressure sales: NO!
