IADDA Annual Conference Consortium Approaches to Adopting and Purchasing EHR Systems A Vision so for Substance Use Disorder Treatment e t Providers Presented by: y Patrick Gauthier September 2011
Problem Statement Providers face difficult and time-consuming steps in the selection and implementation of health IT and software Access to highly-skilled hl IT guidance and support is expensive Providers are challenged by multiple payer systems, enforcing disparate code-sets and applying different business rules with varying rates of success Payer systems are rapidly changing, complicating ability to plan for and deploy new technologies
Drivers Affordable Care Act ACA (Reform) ACO and CCO ICD-10, HIPAA 5010, Meaningful Use Certification ARRA - HITECH incentives
Two Approaches Loose-knit group purchasing wherein the contracts are provider/vendor specific though timed to coincide for implementation purposes Technology Services Organization (TSO)
TSO Provider owned and operated organization developed to provide enhanced access to IT infrastructure and capabilities for the benefit of its members. Includes formal organizational structure (often non-profit status), mission, governance, management, staff, budget, policies, procedures, infrastructure and services
TSO Value & Benefits Centralizes functions and creates efficiencies Increases funding opportunities Enhances revenue management Provides a centralized, reliable source of expertise and dedicated IT support Enhances purchasing power and allied representation Promotes industry standard operating procedures and Best Practices Facilitates standard measures and reporting for performance-based contracting purposes Improves capacity to respond to change Increases user satisfaction among clinic staff and providers Economies of scale
Mission & Goals (Sample) Mission To provide TSO members a foundation to continuously improve upon their business practices, administrative Goals efficiency, quality of care, and clinical outcomes through enhanced deployment and utilization of information technology Enhance revenue through improved operational efficiencies Capitalize on economies of scale and technical expertise Achieve greater reliability and stability in data management and information exchange Assist providers in improving care and outcomes for their patients and communities served by TSO member clinics
TSO Model Hosting Services Server Administration Operations Connectivity Disaster Recovery Hardware and Operating Systems Upgrades Electronic Data Interchange (EDI) & Health Info Exchange (HIE) Services Data Integration Mgmt Data Warehousing RHIO Participation Transaction Processing Business Intelligence SaaS Services Software Patches, Upgrades and Maintenance User Support Training Implementation Reporting Consulting Services Strategic Planning Process Improvement Help-Desk Email Office Automation Project Mgmt
TSO Model Non- Members Members Hosting Services Server Administration Operations Connectivity Disaster Recovery Hardware and Operating Systems Upgrades SaaS Services Software Patches, Upgrades and Maintenance User Support Training Implementation Reporting Trading Partners and Payers Electronic Data Interchange (EDI) & Health Info Exchange (HIE) Services Data Integration Mgmt Data Warehousing RHIO Participation Transaction Processing Business Intelligence Consulting Services Strategic Planning Process Improvement Help-Desk Email Office Automation Project Mgmt
Hosting Services Key benefits to this approach include member access to a professional-grade data center environment and Disaster Recovery services, as well expertise in system capacity planning and 24/7 data center operations. Sample Services: Server Administration Administration for hosted servers including configuration and performance tuning Computer Operations Operations support including backups and maintenance Network Connection for Hosting Installation and maintenance of required network communications lines and equipment Disaster Recovery Planning, testing and execution of DR services Hardware/OS Upgrades Management of operating system patches and upgrades, as well as server refresh
SaaS Services Key benefits include hosting benefits (same as previous slide), expert applications support, system configuration management, help desk management and software upgrade support. Sample Services: Software Maintenance Application configuration, DBMS management, management of software patches and major software upgrades for hosted TSOstandard applications. Shared benefit from ICD-10 upgrade, for example User Support Problem resolution and vendor liaison support for hosted TSO- standard applications Application Training End user training for hosted TSO-standard applications Implementation Support Project management associated with the installation and implementation of hosted TSO-standard applications Report Development Analysis, design and development of application based reports for hosted TSO-standard applications
EDI/HIE Services Key benefits include access to a central technology and support organization to implement and manage health information exchange activities. Sample Services: Data Integration Management Planning, management, implementation and ongoing monitoring of interfaces and data integration tools including interface engines and ETL tools Data Warehousing Development of data warehouse/repositories and associated interfaces/extracts RHIO Administration Coordination and planning with data sharing partners Transaction Processing On-going operations, management, monitoring, maintenance and problem resolution for EDI/HIE transactions Business Intelligence Analysis, design and development of reports, portals and BI tools
Consulting Services Key benefits include access to more cost-effective IT professionals on an as-needed basis to enhance members existing IT resources Sample Services: Planning Strategic planning, needs assessment and product evaluation Operations Improvement Business reengineering and operations improvement associated with TSO-standard applications Help Desk Support Receipt, triaging, logging, dispatch and tracking of service requests E-Mail Support Administration i ti and maintenance of email accounts Office Automation Support Administration and end user support for hosted office automation applications (e.g., word processing, spread sheets and publication software) Project Management Planning and oversight of IT related projects (e.g., product selection and implementation)
Examples Community Health Access Network (CHAN) 5 CHCs in New Hampshire Technical and application support services for e-mail, Internet access and 3 software applications: EMR, PMS, Finance Health Choice Network (HCN) Florida-based, 54 CHCs and other providers in 10 states Strategic Planning, application hosting, network administration and various other IT services. Council of Community Clinics (CCC) 17 CHCs in San Diego and Imperial Counties Project management, application hosting, network administration i ti and various other IT services Oregon Community Health Information Network (OCHIN) State of Oregon, 13 CHCs in Oregon/California, CareOregon, and HRSA ASP support for EPIC EMR and other IT services Community Health Center Association of NY State (CHCANYS) 50 CHCs throughout New York State Funding advocacy, best practice collaboration, vendor coordination, and IT leadership and direction of New York Health Choice Network (NY HCN)
Financial Considerations TSOs offer economies of scale and value add services, but are unlikely to reduce current state stand alone IT costs Smaller organizations will experience higher level of service and access to advanced d technology at an increased cost Larger organizations will experience higher level of service with little change in overall cost Grant funding has been available from various sources at various times for projects of this kind HITECH Incentives for Eligible Providers Existing resources (hardware, software, IT staff) can remain in-place or be leveraged into TSO Balance Need vs. Cost => Value
Financial Models For-Profit / Not-for-Profit Subscription/Membership Monthly Dues Access Fee Transaction Fee Joint Venture Ownership/Shared Cost of Doing Business
Critical Success Factors Assess and address needs, capabilities, readiness and commitment of members (define membership rules) Develop fundraising and multi-year financial plans to ensure adequate startup funds and sustainability of various models Develop a business plan documenting TSO mission, goals, services, staffing and financing Develop policies to ensure confidentiality, security and privacy of hosted data - develop disaster recovery and business continuity plans Focus efforts on high-value services don t branch out too soon Proof of Concept leverage others success and implement incrementally
Next Steps Assess interest level (communication and education) Decide to pursue the TSO opportunity Assess needs, capabilities and commitment t Develop strategic vision and objectives Prepare high-level business model
Thank You. Questions? Patrick Gauthier Director pgauthier@ahpnet.com