MENTAL HEALTH & DADS CONTRACTOR EHR PLANNING MEETING

Transcription

1 MENTAL HEALTH & DADS CONTRACTOR EHR PLANNING MEETING May 25, 2011

2 AGENDA Welcome & Introductions Breakout Sessions MH & DADS Funding Methodology Funding Application Bring MH and DADS back together Next Steps Concurrent EHR Planning Sessions 2

3 DADS AND MENTAL HEALTH BREAKOUT SESSINS 3

4 FUNDING & FUNDING PROCESS County & Contractor Methodology Committee Purpose: Develop and implement a methodology and criteria to be used in allocating available funds to Mental Health Short Doyle contract agencies for their transition to an electronic health record (EHR) system. 4

5 COMMITTEE PRINCIPLES Funding should be reviewed in relation to meeting minimum requirements for all agencies. All current Short Doyle Mental Health Contractors will be considered for some MHSA Technological Needs funding based on need. 5

6 COMMITTEE MEMBERS Bruce Copley Deputy Director MHD / County Sponsor Liaison Sheila Yuter County MHD / Committee Co Chair Erin O Brien AMCHA / Committee Co Chair Jorge Wong AACI / AMHCA Member Rachel Clausen EMQ Families First / AMHCA Member Michael Hutchinson County DADS / QI Clinical Standards Terry Boyle Unity Care / Non AMCHA At large Member Bruce Fielding Children s Health Council / At large Member Alyce Cobb County MHD Contract Monitor Lauren Gavin County MHD Contract Monitor Sue Clements County EHR Project Manager Tony Perez County Procurement Department Martha Paine County General Fund Finance Director Christine Trong Pathway Society / DADS Gina Trepagnier Hope Services / Small Agency Representative 6

7 FUNDING METHODOLGY SCCo will have up to $4M to award to contractors Amounts are not to exceed and will be considered planning estimates, not fixed amounts Planning estimates will be based on Meeting EHR minimum requirements Agency s need specifically related to meeting EHR minimum requirements by December 31,

8 FUNDING METHODOLOGY General approach Smaller agencies may be awarded more than larger ones, but no award will be more than 20% of an agency s annual SCCo Mental Health budget A blended formula was used to determine planning estimates consisting of an even distribution of one half of the available funds, plus a percent of the remaining half, the percent being inversely proportional to the size of the agency Again, no agency s planning estimate may exceed 20% of total agency MH budget 8

9 APPLICATION PROCESS Applications will be accepted between June 1 and December 30, 2011 The application for funding contains three parts: General information Statement of readiness Budget 9

10 READINESS New or existing system? ASP (contract for external service) or Self Host (own and maintain yourself)? Complete minimum requirements checklist Provide implementation plan and timeline Provide signed (or to be signed) contract % of your budget that is used for SCCo MH

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12 REVIEW AND AWARD Applications will be reviewed by MH and IT staff Individual meetings to discuss proposal Expect up to 8 weeks to process and develop contract

13 MINIMUM REQUIREMENTS The minimum requirements for an EHR and electronic data exchange that must be met to receive County funds. County will further define the data that will be necessary to meet these requirements; including data format and method for which the County will receive the secure HIPAA compliant files 13

14 MINIMUM REQUIREMENTS For each requirement, indicate if it is: Existing: Already installed and/or in use In Progress: Is in the process of being installed and/or used Planned: Is being planned for in the future. Implementation Date: For requirements that are in progress or planned, please indicate the estimated date for completion. 14

15 MINIMUM REQUIREMENTS The minimum requirements for an EHR and electronic data exchange that must be met to receive County funds. County will further define the data that will be necessary to meet these requirements; including data format and method for which the County will receive the secure HIPAA compliant files 15

16 MINIMUM REQUIREMENTS For each requirement, indicate if it is: Existing: Already installed and/or in use In Progress: Is in the process of being installed and/or used Planned: Is being planned for in the future. Implementation Date: For requirements that are in progress or planned, please indicate the estimated date for completion. 16

17 MINIMUM REQUIREMENTS # Requirement 1 Certified EHR 2 Security & Privacy 3 Client ID 4 Claim Information 5 Reporting Data (CSI/CALOMS/Other) 6 Additional Demographics 7 Problem List 8 Outcome Measures (e.g. MORS) 9 Transition Care / Referrals 17

18 MINIMUM REQUIREMENTS # Requirements 10 Electronic Audit Capability 11 Progress Notes 12 Treatment Plans 13 e Signature 14 CPOE (Computer Physician Order Entry) 15 e Prescribing 16 Maintain Active Medication List 17 Vital Signs 18 Maintain Active Allergy List 19 Consents 18

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20 EHR PLANNING SESSION #1 Information for those that are in the early stages of planning. This session will cover Where do you begin? Technical Considerations Vendor Demo and Evaluations Vendor Comparison Costs 20

21 EHR PLANNING SESSION #2 Information for those that are in the early stages of planning. This session will cover: Culture Change Common Risks Project Sponsorship Project and Work Teams Training Productivity Vendor Performance And more 21

22 EHR Planning Session #1 Early Planning 22

23 EHR Planning Session #1 Information for those that are in the early stages of planning. This session will cover Where do you begin? Technical Considerations Vendor Demo and Evaluations Vendor Comparison Costs 23

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25 Where do you begin? What s Needed to Get Started? Start talking about the EHR as a positive change Prepare staff for changes Pull Your Team Together Pick a driver (Agree on the driver) Include varying disciplines Set up ongoing meetings Create realistic timelines 25

26 Readiness Assessment Go through the assessment as a team Take note where the team does not agree Recognize areas of need and follow up Refer back regularly Track change 26

27 Workflow and Needs Track how a client moves through the system Receiving Referral Treatment Billing/Payment Discharge You want to recognize where the system fails and succeeds This will help you identify where an EHR may provide improved efficiency, accuracy and better client care You want a tool that works for you. You don t want to work for the tool 27

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29 Internal Capabilities What shape is your IT Department in? Do you have an IT Department? Who will own the EHR system internally? Program or Support? Do you currently have some sort of an EHR system? What is the reputation of the existing system? 29

30 Technology Assessment Do you feel the need for speed? Cable, T1, Ethernet ready? Who is in charge? Do you have someone identified to be primary interface? Spread the love Test and Validate with several sets of eyes 30

31 Technology Assessment Does Staff know what a computer is? Training capabilities Does Staff have the time? Redesign workflow Implement the system Validate results Repeat 31

32 Budget Considerations Comprehensive Cost Estimate Cost of System or Licensing Fees 3 rd Party Products and Services Annual Support Implementation Services Cost Hardware Internal Staff Project Manager Systems Analyst Database Administrator / Trainer 32

33 Budget Considerations Comprehensive Cost Estimate (continued) External Consultants Lost Productivity Before, During and After Initial Implementation Custom Programming Fees Scalability Adding users in the future Security 33

34 Buy v. Rent Buy Internally Hosted on Your Server Higher Upfront Costs Nominal Recurring Costs Rent ASP (Application Service Provider) SaS (Software as a Service) Remotely Hosted via Internet Low Upfront Costs Continuous Recurring Costs 34

35 Buy v. Rent Buy Not Internet Reliant Quicker Response / Access Time Capital Expenditure v. Operating Costs Data control Rent Access from any place with Internet access Nominal worries about backups, updates, etc. Upgrades usually built into monthly charge Less maintenance / IT dependant 35

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37 Vendor Comparison Begin process immediately: Map existing processes Outline changes to improve workflow Identify problem areas include staffing Do above in parallel while evaluating vendors don t wait! Utilize a collaborative process Include clinical and business management and staff Don t under change Business needs Most systems support clinic needs well and tack on the business end Most systems written for counties how do they insurance claiming, handle private pay, group billing, etc.? 37

38 Enterprise Software System Costs Extended Software & Hardware Costs Database, billing and clinical workstation, electronic signature, point of service and batch scanning software $ 72,000 Seat licenses (billing and clinical) $ 79,000 Server, scanning and other hardware $ 27,000 Electronic signature pads $ 8,000 Customized software development (group Tx) $ 30,000 Sub Total $ 216,000 38

39 Enterprise Software System Costs Implementation Extended Costs Project Management $ 97,000 Software Installation $ 4,000 File Build $ 14,000 Training $ 59,000 Go Live Support $ 17,000 Document Management Setup $ 13,000 Forms Development $ 6,000 Infoscribe (electronic prescription) $ 3,000 Sub Total $ 213,000 39

40 Enterprise Software System Costs Internal Direct Costs Extended Costs Project Leader $ 100,000 Database, file build and clerical support $ 88,000 Sub Total $ 188,000 Estimate of lost revenues while training rank and file $ 215,000 Sub Total $ 215,000 Total Estimated Initial Costs $ 832,000 40

41 Enterprise Software System Costs Maintenance Extended Costs Annual maintenance contract $ 37,000 Annual internal maintenance cost $ 88,000 Total Annual On Going Costs $ 125,000 41

42 Pay As You Go (ASP) Arrangement Pay set annual amount based on system total cost Includes all license fees, installation, and ongoing maintenance costs For the equivalent system detailed above, the annual total is $110K, Therefore, over 6 years, the total cost is roughly the same ignoring the time cost of money The annual obligation continues indefinitely 42

43 Vendor Negotiations Approach as entering into a long term partnership not vendor/customer One sided deals don t work Decide early on what elements are most important to the vendor, and which you can push them for concessions Always have the unseen party who makes decisions for your agency Make it clear that you will be an active participant in vendors user group 43

44 Contract Negotiation Considerations Ensure that Vendor warranty covers all product, including third party components Any Customizations are covered by same warranty, and do not add to maintenance charge after completion Negotiate a 2 3 year price freeze for other products not purchased Include the right to interview the vendor s proposed project manager & eliminate travel time charge Negotiate the delay of onset of maintenance portion after go live Completely define levels of help desk, and priority response times any hours available Include a provision requiring support of prior release(s) of product 44

45 Contract Negotiation Considerations No charge for subsequent updates and improvements, including enhancements developed in response to usergroups Yearly, vendor will provide a list of all known product problems, bugs, etc. Set a limit for any increases to the annual maintenance contract cost Set the hourly installation and consultation cost for a period to avoid cost increases Require that all software source code be placed in an escrow account to mitigate problems from any business failure of vendor Include the right to use software in the event of bankruptcy of vendor 45

46 Contract Negotiation Considerations Ensure Compliance with Federal, State and Local Requirements: Licensed Programs will comply with the provisions set forth in the California State Department of Mental Health Letter No as it pertains to electronic signatures. Vendor further warrants that the Licensed Products meet the current and will continue to meet the future compliance standards set by the State of California and/or the applicable County and Federal regulatory requirements for electronic signature and electronic health record, such that Licensee will be in compliance with MediCal/Medicare recordkeeping and billing requirements. 46

47 After The Contract Is Signed Interview vendor s proposed project team Set quick deadline for vendor s timeline/project management plan presentation Deliver any specifications for customization Appoint a project manager who has responsibility and authority to get the implementation done Appoint a cross agency group to get the job done Set sub workgroups up from clinical, intake, business office areas meet frequently Be honest with yourselves 47