EHR Implementation in SBHCs: Lessons Learned from Louisiana Public Health Institute (LPHI) December 18, 2012

Transcription

1 EHR Implementation in SBHCs: Lessons Learned from Louisiana Public Health Institute (LPHI) December 18, 2012

2 Objectives 1. Identify at least five key components of an EHR selection and implementation. 2. Identify at least two common barriers to a successful EHR implementation in School-Based Health Centers (SBHCs) and how to overcome them. 3. Identify at least two strategies for risk mitigation from firsthand lessons from the field panelists who have been on the front lines.

3 The Benefits of Having EHRs in School- Based Health Centers (SBHCs) SBHCs provide an assortment of health services to students and the community, and EHRs can improve the quality of these services as well as make health care more convenient for both providers and patients. Track and share information about clinic visits, prescriptions, allergies and referrals, etc. However, choosing, implementing and effectively using the right EHR system for each SBHC can be challenging.

4 Today s Presenters Gaurav Nagrath - CIO, Louisiana Public Health Institute Jody West - SBHC Administrator for St. Martin Parish SBHCs (former), now Mental Health Coordinator for Lafayette Parish Schools Haley Sulser - Health IT Project Manager, Louisiana Public Health Institute Kelly Berendt - Health IT Analyst, Louisiana Public Health Institute

5 EHR Implementation in SBHCs: Tips from the Field Tuesday, December 18 th, 2012

6 Speakers Gaurav Nagrath, CIO, Louisiana Public Health Institute Jody West, SBHC Administrator for St. Martin Parish SBHCs (former), now Mental Health Coordinator for Lafayette Parish Schools Haley Sulser, Health IT Project Manager, Louisiana Public Health Institute Kelly Berendt, Health IT Analyst, Louisiana Public Health Institute

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8 What is Health IT? Making health information available, electronically and more readily to those who need it (providers, payers and patients). Electronic Health Records Health Information Exchange Digital Lab Instruments & Systems Patient Portal And much, much more!

9 What are the goals behind Health IT? HIT Provides the framework to provide the organized management of health information. Improved Access to Info. Increased Quality Improved Patient Outcomes

10 History of LPHI Health IT Programs in SBHCs School Health Connection Robert Wood Johnson Foundation Goals: Comprehensive analysis of SBHC workflows, infrastructure and staff readiness. Procurement and Implementation of a common EHR for metro New Orleans SBHCs. Procurement of and installation of IT Infrastructure and hardware requirements. Implement quality improvement initiatives. W.K. Kellogg Foundation Goals: Aid in the recovery and sustainability of school health programs post-katrina. Capital Investments to increase physical infrastructure Goals: Expand SBHC Impact and Quality. Increase enrollment and utilization at SBHCs. Maximize billing at SBHCs through use of the EHR. SBHCs to receive certification from NCQA for Patient-Centered Medical Home. GE Foundation Goals: Develop and implement sustainability strategy and plans for Orleans SBHCs. Expand SBHC Impact and Utilization. Increase sustainability through proactive scheduling of well visits, and accepting patients from other schools. SBHCs to receive certification from NCQA for Patient- Centered Medical Home. Increase quality and coordination of care through HIE initiatives, such as GNOHIE.

11 History of LPHI Health IT Programs in SBHCs Regional Extension Center, LHIT Resource Center REC Est Expansion of SBHC partnerships throughout the state of Louisiana. Goals: Provide TA for eligible providers towards achieving Meaningful Use. Assist with vendor selection and contracting. Assist with workflow improvement and provide on-site support.

12 Implementation of EHR in SBHCs: The LPHI TA Model 1. Needs Assessment a) Workflow Analysis b) Facility Profile 2. Vendor Selection a) Research and Demonstrations b) Contract Review and Negotiation

13 Implementation of EHR in SBHCs: The LPHI TA Model 3. Implementation of EHR a) Workplan Development b) Training c) Go Live Support d) Post-Go Live Support

14 Implementation of EHR in SBHCs: The LPHI TA Model 4. Optimization of EHR a) Education and Coaching b) Progress Monitoring c) Interface Development d) Meaningful Use Attestation e) Advanced User Training

15 Common Barriers in Implementing EHR for SBHCs Funding to adequately support the implementation and optimization of EHR Lack of Experience with EHR Vendor Bias Appropriateness and adaptability of an EHR to SBHC requirements and workflow Turnover among staff of the SBHC

16 Barriers in Implementing EHR for SBHCs Funding to adequately support the implementation and optimization of EHR. Strategy to Overcome: CMS Meaningful Use Incentive Program $63,750 over 6 years $21,250 upon registration

17 Federal Investment in Health IT ARRA Stimulus Bill HITECH Act $19 Billion invested Meaningful Use $63,750 /eligible provider

18 What is Meaningful Use? Meaningful Use (MU) is an incentive program with a set of standards created under CMS to help physicians implement EHR and to help ensure they are using them meaningfully. What is meaningful? Improving safety, quality, and efficiency Reducing errors and health disparities Engaging patients in their care Improving care coordination Improving population health Ensuring privacy and security of PHI

19 MU Timeline MU Program: Medicaid Total Incentive: Up to $63,750 Total Years: 6 First Year's Payment: $21,500 Patient Volume must be 30% Subsequent Years: $8,500/year

20 Meaningful Use in St. Martin SBHCs St. Martin Parish 3 Eligible Providers Signed up with the help of REC Medicaid eligibility numbers obtained with help from the billing company.

21 Barriers in Implementing EHR for SBHCs Lack of Experience with EHR Vendor Bias Strategy to Overcome: Vendor-Neutral and experienced support team during the Selection and Implementation phase. Example: Regional Extension Center

22 How to find your REC: 62 RECs currently exist Main purpose: help primary care providers adopt and use electronic health records

23 REC Program for St. Martin SBHCs St. Martin Parish SBHCs timeline: May 2011 Register with REC April 2012 Go-Live October 2011 Vendor Selection June 2012 Stage 1 MU Attestation

24 Barriers in Implementing EHR for SBHCs Appropriateness and adaptability of an EHR to SBHC requirements and workflow. Strategy to Overcome: Conduct robust research and a thorough procurement process. Identify and reach out to references from an SBHC or similar pediatric setting.

25 Topics for Vendor Evaluation Certification Hardware Requirements Specialty References Software Requirements Practice Management Hosted vs. ASP Model Scheduling Billing/Revenue Mgmt. Reporting License breakdown Buy vs. lease Part-time providers Interfaces Labs Immunization Registry Other Up-front costs Workflow Requirements Usability

26 Vendor Selection Process Needs Assessment This is often overlooked, but important to do pre-research. Vendor Research (At Least 5) Review as many systems as time allows for, and look into references, locally or otherwise, that have a similar use case. Vendor Demonstrations This is one of the most important steps, and should always be at no cost. Vendor Contracting (At least 2) Review the contract with the vendor, and get any changes or assurances in writing on a revised proposal. Vendor Selection

27 Vendor Selection in St. Martin SBHCs 1. Research conducted by administrators and REC 2. Vendor Demonstrations 1 Full day 3 Vendors Diversified staff to evaluate 1 NP, 1 RN, 1 Front Office, 1 LCSW, 1 Administrator REC staff present to support, developed evaluation tool 3. Decision was made based off of evaluation tool and general usability of the system 4. Multiple rounds of contract review.

28 Barriers in Implementing EHR for SBHCs Turnover among staff of the SBHC. Strategy to Overcome: Have in place a variety of training materials provided by the vendor, or developed by staff. Identify Superusers utilize advanced EHR training to achieve a train the trainer model.

29 Training in the St. Martin SBHCs Online Training Courses Allows for flexibility for each staff member Independent, more role-centric Superuser Method 1 Superuser for each location (3 SBHCs = 3 Superusers)

30 Common Training Resources Provided by the vendor: Webinars (pre-recorded and live) Manuals Online chat Support phone line On-site trainer ($$$$)

31 Common Training Resources Developed by staff or partners Cheat sheets Recorded trainings Process Mapping Step-by-step guides (By role or task)

32 Resources Independent Organizations, such as REC, LPHI. Industry Organizations, such as HIMSS. Industry Rankings, such as KLAS* CMS Website EHR Incentive Programs Meaningful Use List of Certified EHR Vendors Peer Recommendations What are others in your community using? Do they like it? Can the vendor connect you with other users/clients to ask questions?

33 Q & A

34 Closing Reminders This presentation is being recorded and will be archived on the NASBHC website later this week. For more information and resources, please visit the HIT section of the NASBHC website at: To request support and technical assistance related to HIT and EHR systems for your SBHC, please send us an at: