Participant Site Readiness Questionnaire

Transcription

1 Participant Site Readiness Questionnaire Appendix A - Readiness Questionnaire_0.doc 1

2 Table of Contents Purpose of Document...3 Site Integration Activities...3 Facility Overview Please provide the following Participant information:...4 Contact Information...4 Technical Information...5 System Details...5 Appendix A - Readiness Questionnaire_0.doc 2

3 Purpose of Document The information requested in this document will enable the NHHIO-Orion team to develop a customized onboarding strategy for the Participant to connect to the NH Statewide HIE. Upon completion and validation of the requested information, the Participant will be considered ready to join NHHIO. This document should be returned to the NHHIO Project Manager prior to the participant kick-off call. Site Integration Activities Integrating with or interfacing to the NH Statewide HIE through the LAND Appliance will consist of the following activities outlined below. Each facility will need to schedule time and resources needed to participate in the effort. For the most part, the resources required will be individuals from the IT department that can develop a process to direct messages to/from the LAND Appliance, providing production quality test data, testing the interfaces, and, eventually, moving the interfaces into Production. The Test Data to be provided by the facility needs to be a representative sample of the data that will be provided during Production including the appropriate format and styling. Participant Roles Integration Resource(s) Integration Resource(s) Integration Resource(s) Integration Resource(s), Integration Resource(s), Clinical Expert(s), Registration Expert(s) Help Desk 1 st Level ( if your facility has a Help Desk) Expected Tasks Develop process to transport messages from EHR system(s) to/from LAND Appliance Provide Sample Test Messages for Validation between participants, Provider list, Create Outbound Interfaces to the HIE Message Specification Complete Integration Testing Support Acceptance Testing Raise Support Request with NHHIO Appendix A - Readiness Questionnaire_0.doc 3

4 Facility Overview Please provide the following Participant information: Description: e.g. The facility was started in 1892 and serves the greater Riverside area. The services we provide are xxx,yyy,zzz. We have three locations throughout Riverside and one satellite location in XXXX. Total number of affiliated providers affiliated with Facility: Brief Overview of the Facility Current referral & information trading partners: e.g. Our facility would like to replace current paper faxing of discharge summaries to XYZ nursing home Facility Physical Mailing Address [Facility Name] [Telephone] [Mailing Address] [City] [State] [Zip] Issues that may impact scheduling, e.g.- Major system upgrades that impact resource availability Upgrades to systems communicating with LAND Appliance Participant infrastructure requirements for installing LAND Appliance, approvals, participant documentation required Issues that May Impact Scheduling Appendix A - Readiness Questionnaire_0.doc 4

5 Contact Information The following contact information is requested for various project participants involved in connecting the Participant to NHHIO. This information will be useful for determining who needs to be contacted for questions as the project moves forward. Project Manager [Name] [ ] [Telephone] Description: Date Interface/Technology Specialist [Name] [ ] [Telephone] Description: Date Network Administrator/Other IT [Name] [ ] [Telephone] Description: Date Appendix A - Readiness Questionnaire_0.doc 5

6 Technical Information Technical Support: In order to understand how the NHHIO technical support will fit into the Participant organization s internal support structure, please describe the current technical support infrastructure, availability, and the nature of the services provided. Description: e.g. Help Desk Services provide support to all physicians and staff and are available 24/7. They provide technical desktop support, in addition to application specific report. Current Technical Support Infrastructure System Details Please provide us with information pertaining to the system(s) that will be communicating with LAND Appliance (i.e. your local EHR systems, integration engine,. If your facility s clinical messages are not routed through a single integration engine, then please feel free to add additional fields for all systems that will connect directly to the LAND Appliance. EHR Vendor: EHR Product Name : EHR Current Version: accessed through, including any thirdparty access tools (such as Citrix or EHR System EHR Operating Environment Appendix A - Readiness Questionnaire_0.doc 6

7 LAB System LAB Vendor: LAB Product Name : LAB Current Version: accessed through, including any thirdparty access tools (such as Citrix or LAB Operating Environment Radiology Vendor: Radiology Product Name: Radiology Current Version: Radiology System Radiology Operating Environment accessed through, including any thirdparty access tools (such as Citrix or Transcription System Vendor: Transcription System Product Name: Transcription System Current Version: Transcription System Transcription System Operating Environment accessed through, including any third- Appendix A - Readiness Questionnaire_0.doc 7

8 party access tools (such as Citrix or HIS Vendor: HIS Product Name: HIS Current Version: accessed through, including any thirdparty access tools (such as Citrix or HIS System HIS Operating Environment Integration Engine Vendor: Integration Engine Product Name: Integration Engine Current Version: Integration Engine Interface Connections Please list which applications interface with your integration engine (as much information as possible is helpful e.g., Vendor, Product, Version, Message Type,. Feel free to add additional rows. Providing an interface diagram would also be helpful. Vendor: Product: Version: Interface Message Type: Appendix A - Readiness Questionnaire_0.doc 8

9 List any applications that do NOT have interfaces with your integration engine (please add additional rows, as necessary). Vendor: Product: Version: Interface Capabilities Please provide any additional information about your organizations existing interface capability that you think might be relevant: Comments: Data Hosting Location (Remote/Local): Additional Notes: Security Requirements Please provide any special security related considerations, processes or procedures that your organization may have. Please provide any security scanning requirements that must be adhered to prior to the NHHIO LAND Appliance being installed within your organizations data center. Appendix A - Readiness Questionnaire_0.doc 9