I. Ultia/OmniChart. o o. o o. II. OmniDoc Electronic Progress Notes system. III. Document Imaging System scanning and storage of paper documents

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1 Health Chice Netwrk was ne f the first netwrks t be funded as part f the federal Bureau f Primary Health Care s effrts t supprt cmmunity health centers taking cllabrative effrts beynd crdinatin t standardizatin and true integratin, and is ne f nly a handful f netwrks f cmmunity health centers in the natin t have achieved such a high level f integratin. Health Chice Netwrk perates an integrated management infrmatin system (MIS), which it launched in 1997 and cntinues t develp and imprve. Health Chice Netwrk (the Netwrk) and its member cmmunity health centers are linked by an integrated management infrmatin system (MIS) with centralized hardware, sftware and staff. Grup purchasing, licensing and installatin f sftware fr the MIS system are handled centrally. Staff at the Netwrk and all Centers use cmmn, autmated fiscal and patient accunting systems as well as cmmn ffice system sftware. Health Chice Netwrk s patient accunts sftware system, Medical Manager, allws the Netwrk t enter, prvide and track infrmatin cvering the entire patient care spectrum including: patients demgraphic and insurance infrmatin, clinical tracking fr tests and immunizatins, appintment scheduling and n-shw tracking, electrnic billing and payment psting, standard and custm reprting, case management tracking fr special prgrams, quality care guidelines based n patient s age, sex and key health factrs, patient educatin ntices, centralized referrals t facilities and specialists, nline lab requisitin entry and electrnic lab results, and autmated appintment reminders t patients. The first phase f the pilt was t rll ut the mdules that each f the cmmunity health centers had cmmitted t. Three f the CHCs had agreed t pilt the EMR with ne r tw prviders. The descriptin f the mdules and Centers that cmmitted, are as fllws: I. Ultia/OmniChart Rx Writer recrding and electrnic transmissin f prescriptins t any pharmacy Clinical Task Manager means f capturing tasks that require prvider and/r staff fllw up as it relates t patient care (lab results, prgress ntes, prescriptin requests, transcriptins, messages, etc.) Transcriptin Manager allws transcriptinists t transcribe prviders dictated ntes and stres ntes within the patients electrnic chart E-Encunter electrnic methd f selecting visit s prcedure and diagnsis cde(s) View Patient Chart area where all clinical and financial recrds are stred and viewed. II. OmniDc Electrnic Prgress Ntes system. III. Dcument Imaging System scanning and strage f paper dcuments Cmmunity Health Centers Phase 1 Pilt Allcatin - Cmmunity Health f Suth Dade Mdules: ALL Number f Prviders: 2 prviders frm 2 sites Ecnmic Opprtunity Family Health Centers Mdules: Ultia/OmniChart, Dcument Imaging Page 1 f 8

2 Number f Prviders: 1 Family Practice, 1 Pediatrics Family Health Centers f Suth West Flrida Mdules: ALL Number f Prviders: 2 Family Practice Date Event Outcme/ Lessns Learned Pilt sites identified Methd f rlling ut the pilt was 1 t 2 prviders per center. Prviders aren t necessarily in the same physical lcatin nr representing the same specialty Cmputer experience levels varied Prviders vlunteered t be n the pilt and thers were recmmended and had agreed t participate Each site had agreed t different mdules, nt all sites had agreed t d all f EMR mdules Mstly a prvider initiative Must identify Champins thrughut the rganizatins that are cmmitted t a successful implementatin. Rather than identifying specific prviders, wuld have been interesting wuld we had identified an entire clinical unit r site t fllw the same prcedures. Because f the variatin in pilting, had t run dual (electrnic and paper) system t accmmdate the nn-emr prviders. EMR prviders were still tasked with the paper prcesses. 11/01 Medical Manager Cntract Upn signing, shuld have been prvided with a thrugh prject plan utlining the tasks, timeline, resurce and hardware requirements t ensure prper representatin t bard members and prviders. 01/02 Netwrk Level EMR Prject Manager Hired Extensive prject management experience fr large practice, practice management systems N experience with Medical Manager systems N EMR implementatin experience New t the netwrk Immediately began requesting prject plan, dcumentatin and hardware/sftware frm Medical Manager Definite learning curve in understanding Medical Manager s methdlgy f implementatins, system functinality, netwrk structure and prject resurces. Very challenging in understanding and identifying cre prject team members frm vendr and center side. Page 2 f 8

3 02/02 Infrmatin Gathering Cnference call scheduled between team members n Medical Manager and netwrk sides. The imaging team members were nt included n the initial calls. Review f implementatin questinnaire cmpleted by the netwrk fr each center. Questinnaire was intended t prvide Medical Manager with an utline f hw t structure the implementatin and training. Nt very useful. Nr seemed t have been used r fllwed up n after cmpletin. Hardware and Netwrk evaluatin shuld be primary fcus nce starting up. Later realized that systems were slw and disrupted mmentum during training and implementatin. Was very abstract n bth sides. Medical Manager was nt familiar with the structure f the varius centers and the netwrk was nt at all familiar with the prducts being discussed. On Site Kick ff meeting shuld have taken place with all prject team members as well as key center department heads. Overview f all mdules shuld have been dne t assist with the data gathering and understanding f wrkflw impact. As well as a cmplete prject plan with a list f tasks each side is respnsible fr. Began requesting sites t visit. Tk mnths (4) t identify a cmparable site. Prject Manager scheduled a phne call with site cntact t determine if wrth visiting. Resulted in nt visiting site because was nt cmparable t what we were ding r lking t implement. Result is there isn t a CHC wh is yet implementing the EMR mdules we have cmmitted t. 02/02 Ultia and Imaging Hardware Medical Manager n site t begin surveying clinical sites fr hardware needs. Specifically placement f wireless access pints fr hand held wireless devices. Began receiving hardware fr the Imaging Prject Wrking with Medical Manager n trying t schedule trainings with key prject members Fcus fr the mnth was t get hardware installed, cnfigured and begin laying ut system setup training dates fr the varius mdules. Training was very delayed due t lack f dedicated training/implementatin resurces n Page 3 f 8

4 Frming f Implementatin Teams acrss Pilt Sites Multidisciplinary team representing the different clinical areas which will be affected by the implementatin. Included upper level management and clinical staff Medical Manager s side. Slight delay with Imaging System due t hard drive issues and shipping delays frm third parties. Began frming the implementatin teams frm each site. 3/01 Medical Manager Base System Upgrade Dcument Imaging System Setup Training Began the MIS training with the Imaging System. Had HIM Managers invlved with sme f the setup training t familiarize them with the setup requirements and decisins needed. Medical Manager s gal at the end f the training was t have a fully implemented system with medical recrds being scanned. Hwever, pst meetings needed t be held t get buy in frm prviders n the setup f the electrnic chart. Prject Timeline N acceptable prject plan had yet been prvided. Vendr relies mstly n a training plan nt taking int accunt client tasks and risks. Netwrk prject manager prvided vendr with a high level prject plan, but again did nt fully incrprate vendr tasks. Prject Plan reflected a live date f May 3 rd n Imaging fr ne pilt site and May 6 th live with Ultia/OmniChart with ne pilt prvider. Prir t lading EMR sftware, vendr ntified us f the need t upgrade ur base system t Began with imaging system set up training t get the ball rlling. Experienced delays receiving the needed hardware and training fr the main cmpnents f EMR. Was difficult t cnduct grup meetings withut the prper training r system t be able t demnstrate t the staff and prviders. Held first wrkgrup with each tw f the pilt sites t begin discussins n set up fr the Imaging Prject. Very challenging fr the Prject Manager due t numerus "nnimaging" type EMR questins. 04/01 Ultia Hardware Rll ut Received hardware fr wireless devices. Vendr n site t assist with the installatin. Ultia and OmniChart System Setup and Prvider Training Initial week lng training was scheduled immediately after hardware install, but vendr resurce needed t pstpne. Affected prject timeline by tw weeks. Hwever a May 3 rd and May 6 th Live dates fr Ultia and Imaging were still anticipated. 05/01 Medical Manager System Dwn Beginning n May 2 nd, users acrss all centers we re either receiving errrs r being kicked ut f the system. This cntinued int the fllwing week affecting ur Live Date with During this time, prviders level f frustratin grew and their cnfidence in an EMR with Medical Manager had diminished. Page 4 f 8

5 EMR. Users had access t base systems by May 8 th, hwever the EMR prject was n hld due t the unknwn reasn fr the system crash. Numerus calls tk place between MM and HCN, trying t identify and islate the cause f the prblems. Fr several weeks fllwing the first dwn time, Medical Manager wrked alngside Natinal Prducts Grup and R&D n trying t identify and prevent any further dwn time. EMR was still n hld until further ntice. 06/01 Ultia Rx Writer Live Date EMR was given the kay t start up again. A phase in apprach was taken t ensure n further issues with system stability. First pilt prvider was t begin with the electrnic prescriptin mdule n June 4 th. Day after Live, we began experiencing issues with issuing prescriptins. Medical Manager was wrking with the third party. The issue identified was related t the prvider s DEA. 06/13 Patient s began calling prvider cmplaining that prescriptins were never received at the pharmacies. Issue was reprted t Medical Manager. After several days and many phne calls, there appeared that the third party intermediary was experiencing phne line issues. This remained an issue fr almst 3 weeks. Ultia prject was put n hld again. OmniDc Training/Overview Due t dwn time n Ultia Rx Writer, scheduled t have Medical Manager begin the first training n the electrnic prgress ntes, OmniDc. Visited bth pilt sites wh agreed t rll ut this mdule (CHI/Dris Isn and EOFHC). Medical Manager was asked t send a representative t attend the Medical Directr s Clinical Cmmittee Meeting t address the issues and the crrective actins being taken t reduce/eliminate any future system disruptins. Regardless f the effrts t crrect the issues, centers were nw seeking ther EMR vendrs. Again, instability f the system became very cncerning, especially when thinking abut rlling ut all EMR mdules and ding away with paper. DEA number issue was reslved, but Medical Manager wasn t certain n what caused the issue r hw it was crrected. Due t Rx Writer issues, was difficult t get prvider buy in n rlling ut ther mdules. Despite the issues encuntered. Cntinued t wrk with secnd pilt site n setup fr their imaging prject. OmniDc Training- was a gd first step t becming familiar with the prduct. Additinal ne n ne training wuld be required t cntinue t mve frward n this mdule. Need t have a system which prviders feel cnfident in (cnnectivity and speed) as well as prvider cmmitment t wrk thrugh the issues. Otherwise, trainings are endless. Page 5 f 8

6 07/01 Restart f Ultia/Rx Writer 07/08 Prxymed line issues had been reslved and gave the kay t first pilt prvider t begin using nce again fr electrnic prescriptins. N issues encuntered thrughut the mnth. Due t stability in prescriptin writer, was able t rll ut this mdule t three ther pilt prviders. We nw had 2 f the 3 initial pilt sites Live with the Rx Writer. 07/20 perfrmed an upgrade t the Ultia sftware, delivering added additinal functinality desired by the initial pilt prvider. Imaging System Live at ne Pilt Site (EOFHC) 07/22 First pilt site decided t scan cmplete charts fr the tw pilt prvider s future appintments. Hwever, paper charts will still be prvided. Rx Writer Had a gd mnth with neither dwn time nr system issues. Felt cmfrtable t rll ut the Ultia prduct t three additinal prviders. Imaging Prject Had a successful live with ne site n their imaging prject. Did nt hire additinal resurce t scan but have ne dedicated FTE respnsible fr the catalging and scanning f medical recrd dcuments. Chse t fully scan the medical recrds fr the pilt prvider s future appintments. Prviders were trained n hw t view the images n line. Hwever, accessibility f viewing terminals are limited therefre is nt relied n as intended. Secnd site cntinuing t wrk thrugh what they will be scanning int the system. 08/01 New Vendr Prject Manager Assigned In respnse t ur cncerns ver the lack f prject management frm a vendr stand pint. Medical Manager assigned a new Prject Manager wh will assist HCN with the cmpletin f the pilt prject. Pilt Site Number Fur, FHCSWF (Family Health Centers f SW Flrida) Kick Off As a result f a mre stable system, we felt cmfrtable with prceeding with anther Pilt Site. The new Medical Manager Prject Manager develped a prject plan specific fr this site. The Live date fr this site t becme fully paperless was set fr Octber 1 st, FHCSWF n hld due t netwrk perfrmance issues. Center is wrking n increasing their lines t a T1 cnnectin. After cmpletin, this will ensure a mre stable envirnment t cntinue with training and rll ut. Spent time with furth site t cnduct a thrugh Wrflw Assessment t then mdify with the ncming EMR mdules. We had nt dne this fr the first tw Centers since EMR was thrught f as a "Prvider" and "Medical Recrds" prject. Realized that the Mdules being turned n affect all areas and staff. Wrk Flw Assessment fr FHCSWF Page 6 f 8

7 09/02 Dem t FHCSWF EMR Cmmittee Members Tk the pprtunity while lines were being upgraded t redem all the mdules and the revised wrkflw t the FHCSWF cmmittee members. This wuld allw the pprtunity fr prviders and staff t share their cncerns and be aware f the upcming changes. FHCSWF was in the middle f decentralizing their Medical Recrds department and wanted t see hw EMR may address/crrect their current issues with availability f recrds. FHCSWF decided t prceed with the decentralizatin f Medical Recrds and Pilt the EMR at nly ne site, due t the timing f implementatin. Meeting Outcmes: Rllut all EMR Mdules at ne site Rllut Electrnic Sign-Off f Lab results t all prviders acrss the rganizatin Evaluate whether r nt scanning f medical recrds will address the issues with availability f medical recrds 10/02 FHCSWF Prgress T1 line in n Octber 30 th. Prir t lines being upgraded, decided t train the ne prvider n electrnically signing ff n lab results and issuing prescriptins. Retraining f E-Prgress Ntes fr Start up Prvider MM was asked t be n site again t cntinue with the training effrts n the OmniDc (electrnic prgress nte). The mdules requirements f building templates became very cumbersme and the ne prvider trained, grew frustrated with mdule. A nice intrductin t a prtin f EMR. Prvider cnsistently utilizing bth mdules trained n and very receptive t incrprating EMR int his practice. OmniDc Retraining was a great benefit. MM had trained the prvider n dcumenting thrugh Frms. The Frms were much mre user friendly and fund that the number f patient s dcumented n a daily basis, dubled. Submitted a request t have Frms delivered with the sftware in additin t the Lists already prvided. Frms were the user interface which prviders were sld n during the sales prcess. Hwever, the frms had t be created by the client and has resulted in a very time cnsuming task. Medical Manager is currently in the prcess f establishing a library f frms that will be delivered with future releases. Page 7 f 8

8 11/02 Site Visit at a Nn-CHC EMR Site Summary f Wh s ding what Imaging 3 Sites Live n Scanning Medical Recrds Rx Writer 5 Prviders Live n Issuing Prescriptins Electrically Had the pprtunity t finally visit an EMR site wh has implemented all mdules we were interested in. Fund that the site visit, althugh delayed, was f great benefit especially since we had becme very familiar with the mdules and their functinality and limitatins. Never t late t visit an EMR site. On-Line Lab Results Sign-Off 5 Prviders electrnically signing ff n their labs 11/02 Prvider Cmpliance and Use Evaluating the use f the EMR mdules acrss the pilt sites. The tp issues encuntered: Staffing Issues Same expectatin in prductivity while learning new systems Line Perfrmance Issues and Incnsistency Finding prviders are grwing mre and mre frustrated and becming a little less tlerant with system issues. Prductivity expectatins remain high regardless f new tasks being impsed n prviders and staff alike. EMR is taking a lesser pririty while demands n wrk remain high. Things t lk at if using mnitrs, be sure the vide card is sufficient t display scanned images. Page 8 f 8

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