County Director. Chief Information Officer. County Director

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1 County Name: Kern Enclosure 3 Exhibit 1 Face Sheet For Technological Needs Project Proposal Project Name: eprescribing - Project 3 This Technological Needs Project Proposal is consistent with and supportive of the vision, values, mission, goals, objectives, and proposed actions of the Mental Health Services Act (MHSA) Capital Facilities and Technological Needs Component Proposal. We are planning to, or have a strategy to modernize and transform clinical and administrative systems to improve quality of care, operational efficiency, and cost effectiveness. Our Roadmap for moving toward an Integrated Information Systems Infrastructure, as described in our Technological Needs Assessment, has been completed. This Project Proposal also supports the Roadmap. We recognize the need for increasing client and family empowerment by providing tools for secure client and family access to health information within a wide variety of public and private settings. The Proposal addresses these goals. This proposed Project has been developed with contributions from stakeholders, the public and our contract service providers, in accordance with California Code of Regulations (CCR), Title 9, Sections 3300, 3310 and 3315(b). The draft proposal was circulated for 30 days to stakeholders for review and comment. All input has been considered, with adjustments made as appropriate. Mental Health Services Act funds proposed in this Project are compliant with CCR Section 3410, non-supplant. All documents in the attached Proposal are true and correct. County Director Name: Phone: Name: Phone: James A. Waterman, PhD (661) M. Daniel Walters (661) Signature: Date: Chief Information Officer Signature: Date: Name: Phone: County Director Signature: Date: Page 1 of 1 Enclosure 3, Exhibit 1 - Face Sheet

2 Enclosure 3 Exhibit 3 Technological Needs County Name: Kern Date: Apr 15, 2009 Project Name: eprescribing - Project 3 Check at Least One Box from Each Group that Describes this MHSA Technological Needs Project New System. Extend the Number of Users of an Existing System. Extend the Functionality of an Existing System. Supports Goal of Modernization / Transformation. Support Goal of Client and Family Empowerment. Indicate the Type of MHSA Technological Needs Project > Electronic Health Record (EHR) System Projects (Check All that Apply) Infrastructure, Security, Privacy. Practice Management. Clinical Data Management. Computerized Provider Order Entry. Full Electronic Health Record (EHR) with Interoperability Components (Example: Standard Data Exchanges with Other Counties, Contract Providers, Labs, Pharmacies). > Client and Family Empowerment Projects Client/Family Access to Computing Resources Projects. Personal Health Record (PHR) System Projects Online Information Resource Projects (Expansion / Leveraging Information-SharingServices) > 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 Projects / Decision Support. Imaging / Paper Conversion Projects. Other. Page 1 of 9

3 Indicate the Technological Needs Project Implementation Approach Custom Application Name of Consultant or Vendor (if applicable): Commercial Off-The -Shelf (COTS) System Name of Vendor: Anasazi Software, Inc. Product Installation Name of Consultant or Vendor (if applicable): Software Installation Name of Vendor: Page 2 of 9

4 Project Description and Evaluation Criteria (Detailed Instructions) Small County? Complete Each Section Listed Below. Yes No Small counties (under 200,000 in population) have the Option of submitting a Reduced Project Proposal; however, they must describe how these criteria will be addressed during the implementation of the Project. A completed Technological Needs Assessment is required in addition to the Technological Needs Project Proposal. Technological Needs Project Proposals that are for planning or preparation of technology are not required to include hardware, software, interagency, training, or security considerations. These items are indicated with an *. Project Management Overview (Medium-to-High Risk Projects) Counties must provide a Project Management Overview based on the risk of the proposed Project. The Project must be assessed for Risk Level using the worksheet in Appendix A. For Projects with Medium to High Risk, the County shall provide information in the following Project management areas. Independent Project Oversight Integration Management Scope Management Time Management Cost Management Quality Management Human Resource Management (Consultants, Vendors, In-House Staff) Communications Management Procurement Management Page 3 of 9

5 For Low-Risk Projects, as determined by the Worksheet in Appendix A, the above Project Management Reporting is Not Required. Instead, the County shall provide a Project Management Overview that describes the steps from concept to completion in sufficient detail to assure the DMH Technological Needs Project evaluators that the proposed solution can be successfully accomplished. For some Technological Needs Projects, the overview may be developed in conjunction with the vendor and may be provided after vendor selection. The Anasazi Doctor's HomePage provides full support for eprescribing including: recording all medications prescribed by other providers, recording over the counter drugs, homeopathic, and herbal remedies, electronic transfer of the prescription to the pharmacy of choice for the consumer, interactive drug warnings for drug, food and allergy adverse interactions, dosage warnings, and a number of other sophisticated features to speed the prescribing process and reduce the possibility of medications errors. This application is a foundation for recording and maintaining the medication information being contemplated for interoperability standards. Implementation Steps are as follows: 1. Negotiate appropriate contract amendments with Vendor 2. Initial installation of Doctor's HomePage module in Kern's system 3. Performance of a workflow analysis led by Kern's Project Manager and Anasazi's Project Manager. Medical staff (including support staff) will participate in this step. 4. Identification and documentation of configuration parameters required within the module 5. Development of training agenda and support materials 6. Testing of system including final configuration changes 7. Training of Medical (and support) staff on use of the new functionality Project Cost Technological Needs Projects will be reviewed in terms of their cost justification. The appropriate use of resources and the sustainability of the system on an ongoing basis should be highlighted. Costs should be forecasted on a Quarterly basis for the life of the Project. Costs on a Yearly and Total basis will also be required for input on Exhibit 3 - Budget Summary. 08/09 09/10 10/11 Future Total Personnel $0 $50,000 $15,000 $15,000 $80,000 Hardware $0 Software $0 $47,300 $4,200 $11,825 $63,325 3rd Party $0 $8,235 $8,235 Recurring $0 $12,852 $17,136 $17,136 $47,124 Total $0 $118,387 $36,336 $43,961 $198,684 Nature of the Project Extent to which the Project is Critical to the Accomplishment of the County, MHSA, and DMH Goals and Objectives. This project is necessary to fulfill County, MHSA, DMH and Federal requirements regarding the Order Entry phase of a certified Electronic Health Record (EHR). The technology used by the vendor for this module of their system will be the model for future development of their system. Moreover, the medication related data elements defined for eprescribing will form the core of information required for EHR Interoperability. In addition to all of the regulatory and EHR certification aspects of this project, it also satisfies the number one goal identified by the Department's Technology Needs Assessment - client safety. There is no question that this technology will radically transform the way our Medical Staff perform their day-to-day tasks. The critical avoidance of medication related errors will be an immeasurable benefit to the clients. Degree of Centralization or Decentralization Required for this Activity. By definition the EHR system is centralized. This is essential both from a technological perspective, but also due to the requirement for critical client information to be available in real-time to all service providers (within the limitations of Privacy and Security procedures, of course). However, Anasazi is utilizing two additional vendors for this project: the first provides Page 4 of 9

6 access to a national medication data base providing alerts, warnings, dosage, interaction and educational information and the second (SureScript) provides connectivity to the National Pharmacy network. Data Communication Requirements associated with the Activity. In order to access the above external services, the system requires secure and encrypted Internet services. These services are already in place in Kern County. Characteristics of the Data to be Collected and Processed (i.e., source, volume, volatility, distribution, and security or confidentiality). The data managed by the software related to this project includes any and all medication related information. There are multiple sources for this data, including the aforementioned National Medication Data Base, medications prescribed by the Department's physician's, medications prescribed by other Physician's and over-the-counter medications as reported by the clients. Obviously, this data requires the most stringent security and confidentiality protocols available. The proposed system meets or exceeds all required security requirements. Degree to which the Technology can be Integrated with Other Parts of a System in achieving the Integrated Information Systems Infrastructure. Because this functionality is developed and provided by the County's EHR software vendor, it will be completely integrated with all other aspects of the EHR. Page 5 of 9

7 Hardware Considerations * (As Applicable) Compatibility with Existing Hardware, Including Telecommunications Equipment. This Software Module is totally compatible with all other modules of the EHR and utilizes the same hardware as existing modules. As stated above, secure and encrypted connections to the internet are also required and are currently available. Physical Space Requirements Necessary for Proper Operation of the Equipment. N/A Hardware Maintenance. N/A Existing Capacity, Immediate Required Capacity and Future Capacity. N/A Backup Processing Capability. Like all of the EHR system, data associated with the Doctor's HomePage will be backed up on a daily basis utilizing existing backup procedures and equipment. Software Considerations * (As Applicable) Compatibility of Computer Languages with Existing and Planned Activities. Since this software module is provided by the same vendor as the primary EHR application (and is a component piece of that application), all languages, data base structures, etc. are completely compatible throughout. Maintenance of the Proposed Software (e.g., vendor-supplied). On-going software maintenance is provided by the primary software vendor (Anasazi). Availability of Complete Documentation of Software Capabilities. Anasazi will provide complete documentation of this software module as related to implementation and configuration of the product. Because the software functionality is driven by configuration parameters, each implementation is unique. Therefore, end-user documentation will be prepared by the County. Availability of Necessary Security Features as defined in DMH Standards noted in Appendix B. Anasazi Software's EHR product currently meets all of the applicable requirements associated with the HIPAA security rules. The vendor is working continuously to meet the forthcoming CCHIT standards for Behavioral Health systems due to be published within the next two years. Recognizing that the security criteria outlined in the CCHIT Ambulatory Security documentation will likely be transferred directly to the Behavioral Health criteria, the vendor is currently working to identify and meet any of those requirements not currently in place and to have the requirements in place for DMH by May 1, Ability of the Software to meet Current Technology Standards or be Modified to meet them in the future. As a nation-wide vendor of Behavioral Health Systems, Anasazi is committed to meeting all applicable standards as they become defined. The vendor is taking a proactive role by participating in many of the national organizations currently formulating these standards. By participating at this level in the process of developing the standards, they are positioning themselves to include the changes necessary to meet the standards at the earliest possible time. Page 6 of 9

8 Interagency Considerations* (As Applicable) Describe the County's interfaces with contract service providers and State and Local Agencies. Consideration must be given to compatibility of communications and sharing of data. The information Kern County's Organizational Service Providers currently have full on-line access to the EHR. The licenses being purchased for the Doctor's HomePage include providing access to the Medical staff of those providers. Training and Implementation * (As Applicable) Describe the current status of workflow and the proposed process for assessment, implementation and The proposed process for training and implementation is described in the paragraph on Project Management Overview on page 4 of this document. Security Strategy * (As Applicable) Describe the County's policies and procedures related to Privacy and Security for the Project as they may differ from general Privacy and Security processes. Protecting Data Security and Privacy. This project will require no changes from current policies and procedures. Operational Recovery Planning. This project will require no changes from current policies and procedures. Business Continuity Planning. This project will require no changes from current policies and procedures. Emergency Response Planning. This project will require no changes from current policies and procedures. Health Information Portability and Accountability Act (HIPAA) Compliance. This project will require no changes from current policies and procedures. State and Federal Laws and Regulations. This project will require no changes from current policies and procedures. Page 7 of 9

9 Project Sponsor(s) Commitments [Small Counties May Elect to not Complete this Section] Sponsor(s) Name(s) and Title(s) Identify the Project Sponsor Name and Title. If multiple Sponsors, identify each separately. Dr. Tai Yoo, M.D. James A. Waterman, PhD Joint Chairman of Psychiatry Program Director, UCLA - Kern Psychiatry Residency Program Clinical Professor and Vice Chairman, Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLA Director Commitment Describe each Sponsor's commitment to the success of the Project, identifying resource and management commitment. Dr. Yoo is more aware then anyone of the value of electronic prescribing. He is constantly involved in insuring that correct medications are prescribed and totally vigilant regarding drug/drug and drug/allergy interactions. Dr. Yoo has been promoting the use of technology by his medical staff since he joined Kern County. As Joint Chair of Psychiatry for both the Mental Health Department and the County hospital, his support of this project is critical. He is fully aware of the importance of Senior Management being the champion of new technology. With his leadership, the medical staff will embrace the use of this functionality. Dr. Waterman also recognizes the importance of leadership when implementing new technology. New technology creates changes and many staff can be resistant to change. Dr. Waterman realizes that if he embraces and promotes these changes, those resistant staff will follow his lead. Both in his dealings with the Department s Management Team and in his dealings with line-level staff, Dr. Waterman has displayed his continued commitment to new technology. Page 8 of 9

10 Approvals/Contacts Please include separate signoff sheet with the Names, Titles, Phone, , Signatures, and Dates for: Individual(s) responsible for preparation of this Exhibit, such as the Project Lead or Project Sponsor(s). Signatures Prepared By Name: M. Daniel Walters Title: Technology Services Manager Signature: Date: Phone: (661) Address: Name: James Waterman, PhD Title: Interim Director Signature: Date: Phone: (661) Address: Page 9 of 9

11 Category Estimated Cost of Project Project Manager Experience Like Projects Completed in a "key Hardware Software *Commercial Off-The-Shelf Software New Install Update/Upgrade Infrastructure Custom Development- Application Service Provider COTS* Installation Architecture Factor Rating Score Over $5 million 6 Over $3 million 4 Over $500,000 2 Under $500,00 1 None 3 staff" role One 2 1 Two or More 1 Team Experience Like Projects Completed by at least 75% key staff 1 Elements of Project Type Number of Users Appendix A - Project Risk Assessment None 3 One 2 Two or More 1 Local Desktop/Server 1 Distributed/Enterprise Server 3 Local Desktop/Server 1 Distributed/Enterprise Server 2 Local Network/Cabling 1 Distributed Network 2 Data Center/Network Operations 3 Center 5 "Off-the-Shelf" 1 Modified COTS 3 Over 1,000 5 Over Over 20 2 Under 20 1 Browser/thin client based 1 Two-Tier (client/server) 2 Multi-Tier (client & web, database, 3 application, ect. Servers) Total Score: Total Score Project Risk Rating High Medium 8-15 Low Project: 3 - e-prescribing Appendix A - Project Risk Assessment March 5, 2008

12 County Name: Kern Enclosure 3 Exhibit 4 Budget Summary For Technological Needs Project Proposal Project Name: eprescribing - Project 3 (1) (List Dollars in Thousands) (2) (3) (4) (5) (6) Category 08/09 09/10 10/11 Future Years Total One-time Costs ( ) Personnel Estimated Annual Ongoing Costs* Total Staff (Salaries and Benefits) Hardware From Exhibit 2 Total Hardware Software From Exhibit 2 Total Software Contract Services (list services to be provided) Implementation Services 6 6 Travel 2 2 Total Contract Services 8 8 Administrative Overhead Other Expenses (Describe) Total Costs (A) Total Offsetting Revenues (B) ** MHSA Funding Requirements (A-B) * Annual Costs are the ongoing costs required to maintain the technology infrastructure after the one-time implementation. ** For Projects providing services to Multiple-Program Clients (e.g., Mental Health and Alcohol and Drug Program clients), Attach a Description of Estimated Benefits and Project Costs allocated to Each Program. Project Proposal, Enclosure 3, Exhibit 4 - Budget Summary Page 1 of 2 10/29/2008

13 Notes: Project Proposal, Enclosure 3, Exhibit 4 - Budget Summary Page 2 of 2 10/29/2008

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