Case Studies In Best Practices for Implementing an EHR

Case Studies In Best
Practices for
Implementing an EHR:
Telecare Corporation
California Institute for Mental Health
April 5th, 2012
Tim Wafa, Director of Information Services
1
Agenda
Topic
Time
10 Min.
About Telecare Corporation
EMR / HIS Background
Best Practices & Lessons Learned
Q&A
10 Min.
15 Min.
10 Min.
2
About Telecare - Overview
Headquartered in
Alameda, CA
80+ programs in 7
states
2,300 + employees
Employee and
family owned
Specialize in services
for people with SMI
and co-occurring
disorders
About Telecare (Cont.)
• Who we serve …
Persons with complex mental health needs
– Adults
– Older adults
– Dual diagnosis / co-occurring disorders
• Developmental / intellectual disabilities
• Substance abuse
– More limited basis
• Neurobehavioral disorders*
• Seriously emotionally disturbed adolescents*
• Early intervention services
*inpatient services only
4
About Telecare – Services (Cont.)
5
About Telecare
• Information Services
– 25 FTE’s
• Centralized Staffing Model (No Regional IT Staff)
• Tenured Team w/ Broad Organizational Experience
– 24/7 Helpdesk
– Enterprise Application Deployment Model:
• Hybrid: Thin & Fat Client / In-House & SAS
– Current Department Initiatives
• EMR/BHIS, BI, CRM, HRIS, NDS AD, Exchange
6
Health Information Systems (Overview)
• Currently Relying on Two In-House Solutions as
Primary Health Information Systems (HIS)
– BHS Caminar (1996) – Used in 76 Programs (~1100 users)
– Netsmart Avatar (2006) – Used in 15 Programs (~325 users)
• Plethora of Secondary HIS Solutions, Examples:
– CommonGround (Shared Decision Making Tool)
– Pyxis (Dispensing Medication)
– RxLink (Pharmacy Management)
– Achieve Pathlinks (MDS 3.0 for Skilled Nursing)
7
Customer HIS Initiatives
• State/County BHIS/EHR Initiatives
– Almost all have initiatives
– Moving at different paces
– Rules differ (e.g. data-exchange approaches, system use)
– Evaluating each individually
8
Customer/County BHIS Initiatives
(Overview)
Phase
NETSMART
OTHER
RFP
Planning
2
1
Implementation
1
Operational
4
2
Interoperability
1
1
Unknown
TBD
8
Health Information System Goals
• Strategic Goal: Improve Client Care & Lower Costs
• Tactical Steps:
– Bite Sized Moves: Move All Fee-For-Service Programs
to Avatar PM/CWS for increased back-office benefits.
– Evolving Solutions: Develop & Deploy “Gold-Standard
EMR” for Acute In-Patient Programs.
– Partnership & Shared Learning: Partner with
customers and broader community to drive towards
solutions that add value, improve productivity, and
allow seamless exchange of data. Partner with vendors
on functional gaps and needs.
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Implementations: What HIS To
Deploy? How to Scope?
• Business considerations to help set direction…
– Customer/County Requirements
– Financial/Revenue Benefits
– Operational/Clinical Benefits & Outcomes
– Meaningful Use Incentive $$$’s*
– Scalability & Sustainability of Roll-Out
– Estimated Duration of Roll-Out
* Note: MU is one of many drivers in our roll-out calculus.
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Avatar Implementations
FY
Program Go-Live
Avatar Module(s)
# of PM
# of CWS
FY2008
Solano PHF (Pilot)
PM
1
0
FY2009
Heritage PHF
Oregon ACT
PM
PM
3
0
FY2010
Oregon ACT
Willow Rock PHF
Pierce RSN
Clark RSN
CWS
PM
PM
PM
6
1
FY2011
Short-Doyle Phase II
Deschutes Recovery Center
12th St. RTH
Edgecliff RTH (PM/CWS)
9
4
PM/CWS
PM/CWS
PM/CWS
Gresham Recovery Ctr.
72nd Avenue Recovery Ctr.
Woodburn Recovery Ctr.
3 SNFs (Proposed)
2 PHF’s (Proposed)
PM/CWS
PM/CWS
PM/CWS
PM
EMR
15
9
FY2012
Note: Additionally, County Avatar Being Actively Used In a Narrowly Tailored Way in Several County Programs:
(e.g. San Mateo, Ventura, Sacramento)
9
EMR / Health Information Systems Background
Facilities Using Netsmart Avatar @ Telecare
16
# of Telecare Facilities Using Avatar
15
14
12
FY2007
10
FY2008
9
FY2009
8
FY2010
FY2011
6
6
FY2012
4
3
2
1
0
0
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
13
EMR/HIS Roll-Out Considerations (Overview)
Roll-Out
Options
Meets
Impending
Customer
Requirement
Finance/
Revenue
Benefits
Operational
/ Clinical
Benefits
Meaningful
Use
Incentives
Scalability
of RollOut
Est.
Duration
Option 1
Option 2
Option 3
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Best Practices - #1
EHR Strategic Plan Alignment to Org. Goals
- Lack of alignment can prove problematic during
the trials and tribulations of system
implementation
- Best to receive explicit organizational
commitment and support up front
Definition of Success?
- Define “success” before you start. Narrowly tailored
definition of success is a conservative approach.
- Measurable definition where possible (e.g. KPI’s, Uptime,
Users, Productivity)
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Best Practices - #2
Governance & Stakeholder Involvement
– Project Ownership: IT vs. Business Units
(Temptation that IT own everything)
– Team Composition: Cross-functional team with a
drive toward value add solutions
– Structure: Right-size the governance model to
meet the unique circumstances of your
organization
• Goal: Balance Agility, Transparency & SME Deference
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Best Practices - #3
“Solutioning” on a Viable Foundation
• IT Infrastructure Up to Par?
– Stable/Reliable Network, with Sufficient Capacity?
– # of Computers per FTE? Printers?
– Age of Workstations / Desktop Image Stability?
• Delivering End-to-End Solution Is More Than
Just Software, Examples:
– Physical Ergonomics (chairs, desks, monitors, keyboards)
– Overcoming Space Limitations in Facilities
• Cart on Wheels (COWS), Kiosks, Mobile Computing, etc..
– Business Continuity & Disaster Recovery
17
Best Practice #4
Scalability of Design
– Scope: Big Bang vs. Phase-In
– Architecting for 80% vs 99%
• Unless your business practices are highly consistent,
consider architecting a solution that meets common
functional needs
• Standardize remaining business practices where
possible & release incremental updates thereafter
– Solutioning vs. Implementing
• End-user and customer needs should drive technology,
not vice versa. Listen to your staff.
18
Best Practice #5
Leverage EMR as a Positive Change Agent
• An EMR implementation without
incorporating workflow/process redesign will
only exacerbate existing operational
deficiencies
– Make the investment of time and resources to do
it right
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The End / Q&A
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Contact Information
Tim Wafa, J.D.
Director of Information Systems, Enterprise Solutions
[email protected]
510-337-7950 x 545
510-759-9227
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