Executive Summary - EHR LOGISTICS, INC - Home



E H R LOGISTICSDescribe your co: EHR Logistics Inc is an electronic health vendor that provides a system that will reduce the amount of time healthcare providers and clinical staffs are spending recording patient information. The use of the EHR will allow immediate access to health records to help provide the best quality of care.Describe company contracted to help: ABC Pediatrics is a group 3 physicians and 2 physician assistants. The group has three sites/locations within Arizona. They are a family medicine group that is currently using 100% paper for documentation and communication. Describe project: The project will be a gradual transition into a web-based electronic health records system. The web-based system is a remotely hosted system with a secure server and HIPAA compliant. This type of system will reduce the amount of hardware/equipment upgrades needed because most computing is done on remote server. The use of EHR will lower cost, immediate access to records, automate and streamline workflow, and improve quality of care. The scope of the project will be fairly large because the company is transitioning from complete paper documentation.Describe people involved: These members are important because the EHR would be part of their daily job duties/tasks. They know the current issues and needs of the group to specify what should be included in the EHR system. The members would be included in the planning/implementation of EHR because they work closely with physicians, patients, and medical records. MEMBERS INVOLVED: Project Manager:keep the project moving /monitor project to ensure all timelines are metdelegate tasks to members of the implementation teammaintain list of issues that need to be resolvedcommunicate updates to the group/practicePhysician Champion:liaison between physicians within the group and implementation teampoint of reference regarding how things are done clinicallykeep physicians up-to-date on progress of HEREHR Builder:build and customize EHR application (templates, drop-down boxes, auto populate)communicate often with EHR vendorApplication Trainer:assist with training staffassist with building tasksRegistration User:provide input for registration processBilling User:1. provide input for billing processMedical Records User:provide input for medical records processTechnical Support:maintenance of EHR server(s) usedrunning back-ups and upgrading system when/if neededassist vendor with maintaining and developing software/interfaces(5) Benefits realization: StaceyBenefit StatementHow EHR can helpBefore & After MetricSave time for staff filing/searching for patient chart/records.The chart will be accessible immediately for patient visit. The chart can be viewed in real time from all practice locations.This saves time for locating/retrieving charts. The charts will not have to be carried to the different sites if the patient goes to different locations for office visits. Access to records between sites will be available immediately upon implementation.Save time on writing and faxing prescriptions with the use of E-prescribing.E-prescribing will allow the staff to submit prescriptions online.The staff currently submits hand-written or faxed prescriptions. The prescriptions will go directly to the pharmacy and reduce the time staff spends calling/faxing. This will be available within 2 months of implementation.Reduce the amount of shelves/space needed for filing charts.The office will not have wasted shelves/space. This space can be utilized for additional patient rooms, waiting area, etc.This will reduce the need to purge charges to make space and/or add additional space for charts. The 10 shelves will be removed from the office immediately after finalizing/reviewing scanned documents.Save time on entering patient information for each visit.The patient information is auto-populated for all appointments. The scheduler/receptionist just needs to verify with patient if there have been any changes (i.e. address, insurance, etc)The staff will be able to save time and reduce errors if information is not entered for each visit, only updates when needed. There will not be a need to enter all new information for established patients. The use of this auto-populated information will be accessible immediately after implementation.Reduce the turn-around-time for medical record requests.Easily access records to be faxed/mailed upon receipt of request for medical records.The records request can be completed within 24 hrs instead of the current 7 business days. Within the following 2 months of implementation the CD ROM and USB will be available.(6) FEASIBILITY STUDY - StaceyExecutive SummaryThe use of an Electronic Health Records (HER) system will help improve the quality of care, assist with organization within practice, and improve integration between providers. The EHR will assist with the practices multiple site locations by making medical information readily accessible by providers. The implementation of an EHR will provide both immediate and long term benefits for the practice.BackgroundThe EHR system selected should be certified by the Certification Commission for Healthcare Information Technology. The need of the EHR system for this practice is to save time, save cost, and quality improvements. The practice should have the capability of immediate access of medical records for a routine office visit and/or emergency visit. There should be a 24/7 Support or Help Desk Representative available. Along with the implementation of the EHR system it should include routine upgrades in the maintenance service fees. System OverviewThe EHR system needs to be in compliance with Health Level 7 (HL7). This will make it easily accessible by other provider groups and/or facilities. The use of EHR will allow multiple providers the ability to view patient’s current/past medical history, registration information, medications, and labs/test results. The benefits of the system would include improved claims/billing process, reduce cost in transcription, additional office space, and eliminate lost/missing charts. Technological FeasibilityThe EHR system should be developed to specifications needed within the practice. The practice will need to train staff and providers to use the system. The vendor can provide a survey to current staff members for daily job duties/activities to make the software specific. The practice would also need backup plans in the event of system outage/downtime. There can also be “workarounds” included in order for the system to perform tasks that are not part of the initial application. In the event that there are questions by users they software can include areas regarding:frequently asked questions (FAQ)term/quick referenceupdates recently made to the system. Organizational FeasibilityDuring the implementation and testing of the new EHR system there will be the need for new and/or re-trained IT Dept Representatives. There needs to be access to Help Desk Services 24/7 or at least during the hours of operations for employees. There will be a learning curve of employees during this time. By employees having access to assistance with hardware/software issues is important in the practice’s productivity. During this process there may be the need for temporary staff to assist with scanning all paper records into the system initially. In some cases employees may also be required to cross-train for more than one department within the practice. Financial FeasibilityEHR systems can be very expensive due to growing technology. The practice has to consider the best EHR for their size and type of practice. The installation of new EHR system can initially cost the practice in revenue and production. There is going to be expenses for operating and maintain the new software. The time/money spent for training and future training will also affect the company. It’s important to determine that this system is the best for the practice and not cause any financial struggle. The cost for purchase/installation, ongoing training, maintenance, and support services should be considered. ScheduleSome of the steps in scheduling include:Plan for conversion from paper records to EHRFeedback from staff, physicians, IT DeptStaff morale (how to handle resistance from employees regarding change, job security, and fear of not performing up to standard)Establish goals/expectations Establish predetermined timeline to measure implementationFindings and RecommendationsThe results/findings include:There needs to be a business and financial plan which include risks/benefits of new EHR. Ensure that all of the practice needs are met before making a final decision on software/vendors(s).The group/practice upper level managers should communicate with staff regarding the reason/vision for the new system and discuss how it will better the company.(7) Process Assessment: Patricia St.Pierre Process TypeFunctionDescriptionThis is a manual processScheduling and Appointment RemindersAppointments are by patient’s calling in and front desk entering appointmentFront Desk checks appointments and call reminders 24 hours before appointment.This is a manual processRegistrationFront desk checks insurance via calling companies starting the day before the appointmentThis is a manual processChart preparationStaff pulls the charts the day before and checks insurance informationThis is a manual processPatient arrivalInformation is rechecked by front desk with patient then chart is given to M.A.This is a manual processInitial examM.A. enters findings and notes by hand into recordThis is a manual processPhysician’s examPhysician enters all findings and notes by hand into recordThis is a manual processIf there is lab work called forThe physician gives the record to the M.A. who carries it to the lab and gives it to the tech with the lab order. Lab tech hand writes his results and places it into record. Tests that are sent out will be places in record after receiving them back for outside lab and noted by the tech then reviewed by physicianThis is a manual processMedication ordersHand written and given to patientThis is a manual processCheck outPatient goes to front desk and makes payment and if they need another appointment it can be made at this point.This is a manual processBilling and CodingDone in house and mailed out.Reimbursements are entered by hand into computerThis is a manual processOutside record retrieval such as x-rays from hospital or inpatient recordsThey are couriered after verifying approvalThis is a manual processRecord storage after useStaff replaces file into file storageNoneConnectivity to record from remote location Hospital etc.This is a manual Medication adverse effectsChecked on-line(8) NEEDS ASSESSMENT: Patricia St.PierreTechniques UsedSurvey of Staff and PhysiciansStudy of other comparable officesInventory of present materials and connectivityAdministrative decision making safety issuesResourceDiscoveriesPrioritySurveyMedical record completely computerizedAccess to records from remote locationsAbility to retrieve medical records and test results via computer from remote locationse-prescriptions and instant medication reaction tagsDirect connectivity to insurance providers for billing purposesComputerized insurance verification programComputerized appointment reminder calls.1StudyStudy of comparable offices:Both receiving comparable business flowBoth receiving comparable income flowBoth implementing E H R that facilities ABC’s requestsReport considerable saving in capital time and a more complete and precise medical record2InventoryThe connectivity and technical components that are previously installed can be used with a new E H R system. They will be a need to allocate more components to double the existing ones. This can be done within ABC’s budget.2Administrative DecisionThe safety of the medical record is a priority.With the new system the record will be more precise, clearer and more accessible.The office will flow smoother and create a better environment for both patients and staff.1(9) System Infrastructure Assessment – VanitaSystem Infrastructure AssessmentAdding Memory to support more computersComponentCurrent SystemPlanned SystemRationale/ExplanationDatabase Server(Windows based with LAN interface and hardwire cabling) Two redundant database servers Dell Inspiron dual core Use current servers with expanded memoryExpand current system to quad core.Current database system is capable of handling the traffic for the planned system, but requires more memory to hold all the patient records. The addition will also allow for more spending in other areas of the project, as we will have two more work stations added to the group.Application ServerWindows basedWindows basedWe will be keeping the Windows based server because it fits our needs. You’re staff is well acquainted with the way it works and are accomplished in getting the best results with Windows. Changing will create disorganization and lead to inadequate service. Web ServerW.W.W.W.W.W.W.S.A. is too costly for nowStaff Workstations1 COW/1desktopKeep the C.O.W. and desktops but add two laptopsWe are adding laptops so that we will have mobility for the staff while they are doing their work. The nurse can note directly to the EHR. The C.O.W.s are unreliable and cumbersome. By adding the laptops we can leave the C.O.W. plunged in in the lab for use there. The addition will allow everyone a workstation.Physician WorkstationsDesktop(office)Keep office desktop but also use an added laptop & 5 iPhones for 3 physicians and 2 physician assistantsHaving laptops in the examining room will allow the physicians to note directly into the EHR.Peripheral Devices2 printers 3 miceThe devices will stay the same with 2 wireless mice added.Adding the mice gives the laptop user a choice. Some find navigating a laptop easier and more efficient with a mouse.Software Application(s)Medisoft is leased/ Java/HTMLMedisoft is leased/ Java/HTMLelectronic claims submissions & remittance postings, Productivity software, word processors, accounting database management, scheduling, email, collection letters Specialty software, encoders, Educational & Reference software, anatomy atlases, external articles, dictionaryThese are functional for our needs. Leasing comes with a maintenance option which makes it less of a burden. NetworkLAN LANThis fits our needs. It is local and there is no need to change.(10) SURVEYS (2): StaceyWorkflow AnalysisCurrent ProcessWho performs each step?What steps are taken for process?What is the purpose of the process?What systems/tools used to perform process?EfficiencyWhat works well for current process?What are challenges/difficulties with current process?ImpactWhat impact do the challenges/difficulties cause for the practice?Who is affected by the challenges/difficulties?Suggestions for improvementIndicate changes that could improve current process.How could new technology improve process?Desired OutcomeWhat are some benefits of updating/changing process?E H R Logistics Inc Practice/Location: ABC PediatricsYour Job Title ________________________ Date ___________Have you had prior experience outside of your facility with any electronic health records or computerized provider order entry systems? No____ Yes ____ If yes, about how many years of experience _______ Years working in healthcare Would you rate your computer knowledge as below average; average; above average; advanced?_____________ Please indicate the extent to which you agree with the following regarding the EHR.Please check only one (1) response per item. Strongly Disagree Moderately Disagree Moderately Agree Strongly Agree StronglyModeratelyModeratelyStronglyAgreeAgreeDisagreeDisagreeThe electronic health record is consistently available.The electronic health record is subject to frequent system problems.The electronic health record is user-friendly.Sufficient support is available to use the electronic health record.The electronic health record features enable me to perform my work wellPatient care data being recorded is accurate and validPatients have concerns about the electronic health record security or confidentialityPatient care services are provided in a timely mannerThe electronic health record supports effective communication between most team members about patient careThe electronic health record contributes to the safety of patients(11) Flowchart diagram Systems Comparison: Patricia St.PierreHospitalsRecords New SystemOld System New SystemInsurance ProvidersBilling and CodingFront DeskPhysicians Back OfficeWWWHospitalsExisting SystemRecordsPharmacyBilling and CodingInsurance ProvidersPharmacyWWWFront Desk Systems ComparisonPhysicians back officeI-phoneRecommendation: Logistics can provide an E H R with the connectivity and versatility that ABC Pediatrics is looking for.This will improve performance, increase capital flow, and create a safe working environment. This can be done within the timeframe and expense that ABC Pediatrics has contracted at. (12) Cost benefit analysis – CarrieCOST BENEFIT ANALYSIS$MYear 1Year 2Year 3Year 4Year 5TotalCostHardware1.250.250.250.000.001.75Software1.000.000.250.000.001.25Network Fees0.150.150.150.150.200.80Installation and Training0.500.100.000.000.000.60Maintenance0.000.000.500.500.751.75Support2.502.001.501.001.008.00MiscContingency Costs0.100.000.000.000.000.10 Total5.502.502.651.651.9514.25BenefitsCharge Capture0.100.250.551.251.753.90Decision Support0.100.150.250.500.751.75Financial Management0.250.250.250.250.251.25Reduce O.T.0.100.150.200.250.751.45Cost Avoidance i.e. decr malpractice d/t improved quality & pt safety0.050.150.200.250.250.90Decr storage costs0.000.200.500.500.751.95Med Record Operations0.501.002.003.005.0011.50Referral Management0.150.200.500.500.501.85 Total1.252.354.456.5010.0024.55Net Impact-4.25-0.151.804.858.0510.30(13) Training with rationale – JackieTrain all super users and managers of each department-Let users become comfortable with use of the EHR Logistics system.Hands on training within test environment for all super users-The super user and trainees will build test patients, test diagnosis and test lab/result to train in a somewhat real patient chart.Load one department at a time for feasibly training in a live environment -Rather than opening all of the departments we will manage one department at a time. Go live after monitor of a single department being successful Go live will mean all departments will perform job duties/tasks electronically in the EHR Logistics system.(14) Security Plans – StaceyA security plan is needed to maximize the financial and productivity of the EHR System. The plan will accommodate the structure and needs of ABC Pediatrics. The use of an EHR allows easy access to a patient’s medical history which includes problem list, medications, lab results, and billing. A proper security will help to safeguard protected health information. The best practices used to assist in building a security plan:Protect hardware, third-party software, and EHR from security breaches with firewalls and anti-virus software.Provide secure electronic communications with suppliers, patients, and pharmacies.Enable mobility through secure access to confidential documents from inside/outside practice.A risk analysis will be conducted to help determine where security could be vulnerable both inside and outside of ABC Pediatrics by comparing current security measures to what is required to safeguard patient information. This will assist with questions regarding virus protection, evaluate firewalls, and secure e-communication. The security plan will consist of five components: administrative, physical, technical safeguards, policies and procedures; and organizational standards. Administrative safeguards would evaluate risk and enact policies/procedures to manage risks. This would include policies, established by an internal security official, to manage the development, implementation, and maintenance of security measures to protect PHI. Technical safeguards are used to monitor network and EHR capabilities in the most secure ways. This assists with monitoring use/access to information that a current/past employee is not authorized to view. The information should only be accessible based on need for job duties/tasks. In the event of technical support from source outside the office there should be a virtual private network used to access ABC Pediatrics system. Physical safeguards within the office are workstations, electronic information, and environmental hazards. This includes such measures as locking workstation when unattended, control access to areas with network servers, and secure documents in event of fire/inclement weather. The security official should include policies that states how often to back up the system to recover information so that it does not interrupt the work flow. It is important that a plan is in place for downtime in the event the systems and networks go down from time to time. (15) Project Plan –PatriciaProject Plan For ABC Pediatric ClinicTaskTask NameOwner of TaskStart Duration End 1E H R set up hardwareIT and electricians and E H R Logistics8/1/1248/5/122apply softwareE H R Logistics and clinic IT8/3/1228/5/123Test for systems connectivityE H R Logistics and clinic IT8/5/1228/7/124Train front desk staff trainingE H R Logistics and clinic IT8/6/1258/11/125Train billing staff training E H R Logistics and clinic IT8/7/1278/14/126Management trainingE H R Logistics and clinic IT8/2/12148/16/127Run Check for accuracy of systemE H R Logistics and clinic IT8/18/1218/19/128Run two week report of activityE H R Logistics and management8/18/1218/19/129Analyze data for functionalityE H R Logistics and management8/18/1238/21/1210Revise if neededE H R Logistics and management8/19/1248/23/12Project goal is to have ABC Pediatric Clinic running on their new system within one month.EHR Logistics will meet with the facilities management and IT departments on 7/23/2012.The purpose is train these departments on systems implementation and their rolls in it.After systems go live EHR Logistics Help Desk will be available 24/7 via phone or on-line to troubleshoot any problems that may arise.(16) Gantt Chart - Patricia? GANTT CHART??(17) Project progress form – CarriePROJECT PROGRESSTASKSTART DATECOMMENTSEND DATEBenefit Realization Study8/1/2011?8/15/2011Feasibility Study8/30/2011?9/15/2011Process Assessment9/16/2011Delay with clinic owners10/16/2011Needs Assessment10/30/2011Review Delay due to schedules11/28/2011System Infrastructure assessment12/1/2011Review with I.T.12/30/2011Cost Benefit Analysis1/5/2012Schedule with owners mtg2/15/2012Training Plan3/1/2012?3/30/2012Final Approval Process4/15/2012?5/30/2012Training Implementation schedule6/10/2012Review PTO schedules6/30/2012EHR set up hardware8/1/2012?8/5/2012Apply software8/3/2012?8/5/2012Test for systems connectivity8/5/2012?8/7/2012Front desk staff training8/6/2012?8/11/2012Billing staff training8/7/2012?8/14/2012Management training8/2/2012?8/16/2012Run check for accuracy of system8/18/2012?8/19/2012Run two week report of activity8/18/2012?8/19/2012Analyze data for functionality8/18/2012?8/21/2012Review progress8/22/2012?8/22/2012(18) Backup Plans – Stacey The backup will be completed by IT Dept member due to the use of a Windows based EHR system. The patient data will be saved in-house as well as backup-tapes stored off-site and protected in the event of malicious attacks, fire, natural disaster, and/or server theft. The group will have policies and procedures, employee training, and IT assistance to prevent unauthorized access to system data. The backup will be scheduled/completed daily every 4 hours via tape/hard drive). This will help to ensure that records are saved and available. The group will have policies and procedures, employee training, and IT assistance to prevent unauthorized access to system data. Members that are part of the backup plan should know their roles/duties in the event that there is an issue and the set time frame to complete tasks to have system functional. A backup plan is a very important part of the operation of a group/practice; loss of all data/patient records can greatly affect business. The plan will also include a backup for the system (i.e. CD, data entry template) itself. The backup data/system will be accessible to authorized persons and allow the group to process/work as normal (in remote location if needed due to natural disaster) until the system has been fully restored. Contingency PlanPurposeTo establish procedures that provides continued care for patients in the event of nonfunctional or improper function of EHR system during work hours.PolicyThe Contingency Plan is developed to reduce any negative effects/results due to system outage or improper function.Backup PlanThe assigned IT Department Manager/Lead will communicate with Office Manager, Physicians, and Lead Clinical Staff regarding length of expected downtime.Scheduled downtime for maintenance/updates will be communicated in advance with managers who will then notify departments regarding date/time.Unscheduled downtime occurring due to software/hardware issues will be communicated between assigned IT Department Manager/Lead and Office Managers/Physicians. The Lead Clinical Staff will notify and provide staff with estimated downtime and implementation of plan/procedures.ProceduresDowntime over 1 hour:The practice staff will complete job tasks/duties in the manner before EHR system was implemented.Registration/Payments completed on paper documents and later entered in system.Encounter forms completed manually and later entered in system.Lab/Test orders completed on paper request documents and results called/delivered.Restoration:All future visits completed in EHR system and current or in progress visits completed in EHR system.Staff to enter tasks/procedures (i.e. office visit, prescriptions, labs, scheduled appointments) performed during outage in EHR System.***Website Development (Weebly)– Vanita/Patricia*** ................
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