2011/12 ANNUAL UPDATE EXHIBIT F6. TECHNOLOGICAL NEEDS NEW and EXISTING PROJECT DESCRIPTION

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1 County: County of Santa Clara TECHNOLOGICAL NEEDS NEW and EXISTING PROJECT DESCRIPTION Project Name: Electronic Health Record Project Number: (EHR) Select One: New Existing Completed Project (PIER) TECHNOLOGICAL NEEDS NEW PROJECT Check at least one box from each group that describes this MHSA Technological Needs project category: New system Increases the number of users of an existing system Extends the functionality of an existing system Supports goal of modernization/transformation Supports goal of client and family empowerment Indicate the type (and subtype if applicable) of MHSA Technological Needs Project and provide the Vendor/Consultant information: ELECTRONIC HEALTH RECORD (EHR) SYSTEM PROJECTS (Check All That Apply) Needs Assessment and Vendor Selection Needs Assessment Vendor Selection Process Infrastructure, Security, and Privacy Practice Management Electronic Registration Electronic Scheduling Billing Interface with State Billing Interface with Contract Providers Clinical Data Management Assessment and Treatment Plan Document Imaging Clinical Notes Module Computerized Provider Order Entry Lab Lab External Pharmacy Pharmacy External Interoperability Components Messaging Data transfer between different systems with different data standards. Record Exchange Data transfer between two systems that share a common structural design. Full Electronic Health Record (EHR) with Interoperability Components (Example: Standard data exchanges with other counties, contract providers, labs or pharmacies) CLIENT AND FAMILY EMPOWERMENT PROJECTS Client/Family Access to Computing Resources Personal Health Record (PHR) System Online Information Resource (Expansion / Leveraging Information Sharing Page 1 of 7 Name _ Name _

2 Services) OTHER TECHNOLOGICAL NEEDS PROJECTS THAT SUPPORT MHSA OPERATIONS Telemedicine and Other Rural / Underserved Service Access Methods Pilot Projects to Monitor New Programs and Service Outcome Improvement Data Warehousing /Decision Support Imaging/Paper Conversion TECHNOLOGICAL NEEDS NEW PROJECT DESCRIPTION 1. Provide an Executive Summary of your Project: This project, as described in the approved TN EHR plan, will: Reduce paper medical charts and provide an electronic mechanism to securely share critical client treatment data with all providers in the network; Improve coordination of care between providers of services through integration of data; Provide opportunities to reduce costs by streamlining and automation of clinic operations; Produce better treatment outcomes because of better coordination of care and integrated treatment protocols. 2. Describe how your Technological Needs Projects will meet MHSA s goal of the Integrated Information Systems Infrastructure (IISI): 3. A Project Management Overview is required. Do you certify that you have completed or will complete each of the following plans? Yes or No a. Independent Project Oversight (not applicable to this project) b. Integration Management c. Scope Management d. Time Management e. Cost Management f. Quality Management g. Human Resource Management h. Communication Management i. Procurement Management j. Risk Assessment k. Change Control Plan l. Needs Assessment 4. Complete a proposed implementation timeline with the following major EHR categories (Example below): NOTE: Your implementation plan may not be in this order. 5. Will funding be used for Data Collection Reporting (DCR)? Yes or No 6. EHR and PHR Standards and Requirements: If the project includes an EHR or PHR, please follow the standards found in Appendix B of Enclosure 3 located at: 7. Project: Proposed Start Date: Proposed End Date: Page 2 of 7

3 TECHNOLOGICAL NEEDS EXISTING PROJECT Please provide the following information when requesting additional funds for existing projects only: 1. Provide a justification how this request is a continuation of a previously approved project and not a new project. This project originally called for the selection and implementation of a new EHR. After further analysis, the project Sponsor Committee determined that in order to integrate mental health client information with outpatient care received through Santa Clara Valley Health and Hospital System, it would be prudent to use the same EHR as that used by the system s ambulatory care providers. At the time the decision was made, over half of the County adult mental health clients were being seen in county ambulatory clinics also called Federally Qualified Health Centers (FQHCs) and a pilot program for children and youth was underway to move children and youth to FQHCs. When the information system transition is completed in 2013, it is anticipated that the integrated model of mental health clients seen in FQHCs will account for over half of the universe of county and contractor clients. The information system that will accommodate this integrated practice consists of a clinical component, NextGen including its base system and behavioral health template; a registration component, Invision; a scheduling component, EWS; and a billing component to be determined. This means that while a new system will not be purchased and implemented, similar work will be required consisting of 1) workflow analysis, 2) purchase of licenses for clinical and scheduling system users, 3) analysis and customization of the NextGen behavioral health template, 4) building of interfaces between the registration, clinical and billing components, 5) training on all components, 6) uploading information from the current information system, Unicare, into NextGen, and 7) testing of all components before we go live. Simultaneous to the transition of the County EHR, the County committed to disengaging its contractors from its information system (Unicare) and required that each have its own capability along with the ability to transfer information in a secure and HIPAA compliant mode for billing and reporting purposes. The County also committed to partially assist contractors with the transition. 2. Why was the initial funding insufficient? Check all boxes that apply and provide a brief explanation. a. Project manager performance h. Change in Vendor/Contract services cost b. Project staffing i. Change in cost of materials (hardware, software, etc.) c. Requirements not completely defined j. Personnel cost increase d. Change in scope k. Delay in RFP process e. Difficulties in customizing COTS l. Insufficient management support f. Delay in project start date m. Training issues g. Completion date has lapsed n. Other Explanation: The revised approach described above will take approximately the same time as bringing up a new system, with an estimated completion by the end of However, the phasing and cost will differ slightly. The original EHR budget of $13.6 million included $2 million to support contractors in their development of EHR capability. After extensive research into the actual cost of contractor transition, the County estimated that $2 million would fund only 10 percent of contractors costs. In an effort to assure a smooth transition, and in the absence of capital facilities projects other than those recognized in Exhibit F5 of this Plan Update which total $800,000 of the $2.682 million available for capital facilities projects, the County proposes to apply the remaining $1.882 million of capital funds to its TN contractor strategy. 3. Which sections, if any, of your original project are being changed or updated? Check all boxes that apply and provide a brief explanation. a. Project organization j. Project phasing b. Project management resources k. Change management plan c. Support resources l. Risk management plan d. Development and maintenance resources m. Contract services costs e. Quality assurance testing resources n. Hardware costs f. Project plan dates (schedule) o. Software costs g. Project scope p. Personnel costs h. Project roles and responsibilities q. Other costs i. Project monitoring and oversight r. Training provisions Explanation: The change in project scope is described in #1 (above). Deliberations to determine the appropriate course of action were completed in early Following the decision to proceed with an integrated system based on products that are currently in Page 3 of 7

4 use, the County will not need to go to an RFP process. Once contract amendments with existing vendors are finalized, work can begin on customizations, interfaces and training. We expect the bulk of this work to take place in FY12-13 for an 18 month implementation. Consequently we are requesting that the $5.498 million that has not yet been received be transferred to the County for use in FY12 and FY13. This is the difference between the $ full allocation and $8.103 previously transferred to the county. PROJECT BUDGET Electronic Health Record Initiative Dollars are listed in thousands A. EXPENDITURES Type of Expenditure FY 11/12 FY 12/13 FY 13/14 Total 1. Personnel 2, , Hardware Software Contract Services , Indirect Administrative Cost ,036 Total Proposed Expenditures 5,948 B. REVENUES 1. New Revenues a. Medi-Cal (FFP only) b. State General Funds c. Other Revenues 450 Total Revenues 450 C. TOTAL FUNDING REQUESTED 5,498 Page 4 of 7

5 D. BUDGET NARRATIVE 1. Provide a detailed budget narrative explaining the proposed project expenditures for each line item. Personnel costs include interface support analyst, data base administrator, systems administrator Contract Service to be provided include subject matter experts, workflow analysis professionals, programmers for mental health customizations and interfaces, and trainers Hardware costs include network and interface equipment Software costs include licensing costs and participation in the cost of system-wide upgrades Other expenses include training materials, system documentation, and miscellaneous expenses not categorized elsewhere Costs listed on this summary are for SCVHHS MHD portion of the project only. Other agencies will be asked to contribute a proportional share of the project. These costs will be developed as the projects are defined and planned. Page 5 of 7

6 TECHNOLOGICAL NEEDS POST IMPLEMENTATION EVALUATION REPORT (PIER) Basic Information Actual Start Date: / / Check if different than planned start date in original project proposal Actual Completion Date: / / Check if different than planned completion date in original project proposal What was the final Project Schedule Status? Project was completed on time Project was completed early Project was completed late What was the final Project Budget Status? Project was completed within approved budget Project was completed over budget Final Cost: MHSA funds - $ Non-MHSA funds - $ Project was completed under budget Final Cost: MHSA funds - $ Non-MHSA funds - $ Objectives Achieved Describe the achieved objectives of the project. Also describe the User and Management Acceptance of the Completed Project. Lessons Learned Please select the categories which best describe your lessons learned: a. Scope (planning, defining, verifying, and controlling) h. Cost (estimating, budgeting, and control) b. Documentation (requirements and use cases) i. Human Resources (team acquisition, development, c. Development (design, coding, and data) management, and turnover) d. Quality (assurance, control, metrics, and testing) j. Communications (info distribution and reporting) e. Implementation (installation and deployment) k. Procurement (purchase, acquisitions, and contracting) f. Risk (identification, response, and control) l. Training (system education) g. Time (sequencing, estimating, and scheduling) m. User acceptance (sponsorship and buy-off) Describe lessons learned, best practices used for the Project, any notable occurrences or factors that contributed to the Project s success or problems, or other information which could be helpful during future Project efforts. Describe problems that were encountered and how they were overcome. Corrective Actions This section will have to be included when the Project is deemed to be a Limited Success or Failure, or when there are Significant Differences between Project Expectations and Project Results. If this condition applies, summarize alternatives for improving the outcome. Next Steps Describe if the Project has any future phases or enhancements; or if it be in maintenance phase. Page 6 of 7

7 CERTIFICATION STATEMENT This Technological Needs project is consistent with and supportive of the vision, values, mission, goals, objectives and proposed actions of the MHSA Capital Facilities and Technological Needs Component Proposal and is consistent with the County Major Milestones Timeline for moving towards an Integrated Information Systems Infrastructure, as described in the County Technological Needs Description. I certify that all County, State, and Federal guidelines for ensuring the privacy and security of client data will be met. All documents in the Funding Request and/or Post Implementation Evaluation Report (PIER) are true and correct. Chief Information Officer (Print) Signature Date HIPAA Privacy/Security Officer (Print) Signature Date Page 7 of 7