How to Best Select an EHR and The new HITECH Stimulus Act What you need to know

Session Goals Introduce you to an Electronic Health Record Review the HITECH Stimulus Act and discuss timing Walk you through a proven process and teach you how to avoid the pitfalls of others who have gone before you.

Why do many EHR implementations fail or are under utilized?

Why many EHR implementations fail or are under utilized The Practice is NOT prepared for change (Lack of planning. Unclear vision, goals and approach). Lack of resources dedicated to the project (Staff, time, money, end-user involvement, project management and IT support) Unrealistic expectations for what can be accomplished and how quickly it can occur. Not aligned with vendor incentives.

The Electronic Health Record What is an Electronic Health Record (EHR)? Streamlines the practice workflow through the electronic storage and retrieval of patient information. What are the benefits to my practice? Increased quality of patient care through accessibility of information Bridges the Gap Improved patient experience by increasing practice efficiency

Today s EHR Patient Visit Check-In/Reception New Patient Kiosk Check-in

Today s EHR Patient Visit Check-In/Reception New Patient Kiosk Check-in Examination Supports all documentation habits including Voice Recognition Health Maintenance Alerts Medical device integration e-prescriptions

Today s EHR Patient Visit Check-In/Reception New Patient Kiosk Check-in Examination Supports all documentation habits including Voice Recognition Health Maintenance Alerts Medical device integration E-Prescribing Check-Out/Billing E&M Coding Charge Passing Follow-up

How to Quantify Benefits Increase Revenue & Reduce Expenses Patient Access (+1-2 pt visits/day) Billing Accuracy (Coding and Claims Submission) Transcription / Printing Paper Trail Reductions (missing charts, fax puddles, claims re-billing) Staffing (Chart Pulling, Referrals, Billing)

EHR Pay-4-Performance Initiatives Medicare Program FIRST YEAR FILE 2011 2012 2013 2014 2015 2016 TOTAL 2011 $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 2012 $0 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000 2013 $0 $0 $15,000 $12,000 $8,000 $4,000 $39,000 2014 $0 $0 $0 $12,000 $8,000 $4,000 $24,000 2015 or later $0 $0 $0 $0 $0 $0 $0 CMS payments for professional services will be reduced (1-3%) beginning in 2015 for all providers who are not meaningful EHR users.

EHR Pay-4-Performance Initiatives Medicaid Program 2011 2012 2013 2014 2015 TOTAL $25,000 $10,000 $10,000 $10,000 $10,000 $65,000 CMS penalties in 2015 do not apply Eligibility: Non hospital-based providers that have at least 30% of the professional s patient volume coming from Medicaid patients Pediatrician who has at least 20% of the patient volume coming from Medicaid patients* Providers predominantly in a FQHC or rural health clinic and have at least 30% of the professional s patient volume coming from Medicaid patients

What you need to know for HITECH Stimulus Act Medicare and Medicaid Program Options. Payments begin in 2011 for practices that can prove meaningful use with a certified EHR, penalties begin in 2015 (1-3%) Certified vendors have not been identified. www.cchit.org Meaningful Use has yet to be completely determined but will include: Use of e-prescribing Demonstrate Information Exchange and Report Quality clinical measures. *Certification Commission for Health Information Technology (CCHIT)

Objectives What s the Best Approach for Selecting an EHR? What Selection Criteria Should You Use?

EHR Formula for Success Know the Total Cost/Savings Understand Your Time Commitment Before You Invest

Common Approach Talk to Peers Loop Effect 1 2 Demo s Timeline: 1-2 years

Common Approach Pitfalls Vendor pricing is not competitive Practice time is not used efficiently No clear timeline to keep the process on track No structured mechanism to compare vendors and products

Recommended Approach: RFP Benefits Competitive Pricing from Vendors Physician/Admin. Time is Managed More Effectively Clearly Defined Set of Requirements Clear Process to Compare Vendors

Selection Process Timeline Step 1: Practice Profile Learn Requirements Prepare Practice Profile Identify Vendors (3) Step 2: Vendor Introduction Initial Product Demonstrations (3) Request/Receive RFP, Pricing Proposal Step 3: Vendor Evaluation Review Vendor Data (RFP, References, Comparison Matrix) Reduce Vendors to 2 Step 4: Preferred Vendor Detailed Demonstrations (2) - Hands-on Testing Identify Preferred Vendor Step 5: Reference Verification Site Visit Step 6: Vendor Validation Final Demonstration Vendor Confirmation Timeline (weeks) 1-3 Practice Profile 2-6 6-8 Vendor Vendor Introduction Evaluation Step 7: Final Selection Contract Negotiations 8-10 Preferred Vendor August September October 10-12 Reference Verification 12-14 Vendor Validation 14-15 Final Selection November

RFP Document: Sample Questions Vendor Background Is your company profitable? If yes, for how long? Attach a copy of your most recent financial statement. Functional Requirements Health Maintenance Alerts, EDI Support, Reporting, Formulary, Drug Interaction Alerts, Messaging, Secure Email, etc. Technical Requirements What are the staff responsibilities for system maintenance and upgrades? Expect on-going IT requirements to increase. Implementation Plan Please provide a sample project plan and timeline delineating practice and vendor responsibilities. Support What is the average response time for problems reported? Pricing Please provide comprehensive pricing proposal including hardware, software, services, and third party products.

Objectives What s the Best Approach for Selecting an EHR? What Selection Criteria Should You Use?

Selection Criteria: TCO 5 Year TCO = Direct Costs + Indirect Costs + Risk Factors Direct Costs -software licensing, annual support, training, hardware equipment Indirect Costs - IT support, lost billable physician time, new staff training, integration costs Risk Factors company stability (company goes out of business, product is no longer supported)

TCO Selection Criteria #1: Company Stability What to focus on? Profitability Red Flag: Vendor does not provide financial statements (non-disclosures) Organizational Structure Leadership Certification Commission for Healthcare Information Technology - CCHIT.org)

TCO Selection Criteria #1: Company Stability Risks Factor: Is the Vendor Profitable? Indicator: Annual Burn Rate is Greater than Annual Sales Burn Rate Estimation Tool: (staff # end of year + # staff beg, of year) X $100,000 2 $100,000 = Avg. FTE Cost in tech company (FTE = salary X 1.25)

TCO Selection Criteria #2: Integrated Solution Evaluate the following integrated solutions: Practice Management Electronic Health Record New Patient Portal There are indirect costs with non-integrated solutions. The EHR Vendor should provide a complete, integrated solution (enabling the highest ROI over a five-year period)

Integration Advantages: Single Source Solution Dashboard Snapshot of Financial/Clinical Performance Available to Physician at Anytime EHR Patient Demographics, Scheduling, Refill Requests, Lab Results and Messaging sent seamlessly. Patient Services Patient can make payments, view billing, see lab results, and request refills, schedule appts. online. Data seamlessly shared between PM and EHR system. Billing Process Seamless: Super-bill step eliminated. Encounter data goes straight to E&M and data scrubbing before processed. Any changes in PM are automatically updated in EHR.

Objectives What s the Best Approach for Selecting an EHR? Utilizing a Request for Proposal (RFP) What Selection Criteria Should You Use? Developing Criteria based upon Total Cost of Ownership (TCO): Company Stability Integrated Solutions

Maxwell IT Endorsed by the California Medical Association to help select and adopt EHR solutions We provide: EHR Budgeting and Contract Review Services EHR Optimization and Project Management to meet Meaningful Use stimulus requirements. Hardware and Network Managed Services www.ehrbestpractice.com Scott Heaton (360)903-7719